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Nearly three years after California freelance interpreters and translators won an exemption from gig worker bill AB 5, court interpreters find themselves embroiled in yet another battle over well-intended bills with potentially dramatic consequences.

Two proposed bills are intended to solve California courts’ challenges in retaining qualified interpreters.

The California Federation of Interpreters sponsored Assemblymember Blanca Pacheco’s AB 1032, which would modify an existing framework governing the employment relationships between trial courts and court interpreters. 

In a June 28, 2023 letter signed by more than 75 interpreters, the Coalition of Working California Interpreters urged the California Senate Judiciary Committee Chair and Vice Chair to reject AB 1032, describing the bill as “a hodgepodge of misguided provisions.”

The Coalition took CFI to task for not seeking input from other stakeholders, such as working interpreters, legal and language access advocates, and populations with significant rates of limited English proficiency (LEP).  

“To garner support from interpreters and community organizations, the sponsors are promoting the bill as a pathway to benefitted union jobs for relay interpreters and contractors,” the letter stated. “In fact the bill does not provide benefitted positions for either and dangerously deteriorates language access for indigenous communities.”

Interpreting languages of lesser diffusion — more specifically, indigenous Mexican languages — features prominently in AB 1032. 

According to a July 8, 2023 analysis by the Senate Judiciary, several such languages, including Mixteco, Mixteco Alto, Mixteco Bajo, and Triqui, have entered the top 30 most-interpreted languages in California since 2014.

Presumably, to meet the growing need for interpreters in these languages, the bill would eliminate restrictions that limit the instances in which untested relay interpreters may work. The Coalition argued that this would create a separate and unequal standard of justice for LEP speakers of indigenous languages, and would set “a dangerous precedent for all linguistic minorities.”

A group of Mayan-language court interpreters offered their own suggestions for increasing the number of registered interpreters: California should encourage and provide funding for direct (into English) interpreters, and create Spanish-language tests for relay interpreters.

One Small Victory (So Far)

There is, however, something of a silver lining for AB 1032, in that the threat to independent contractors has been defanged, at least for now.

“As originally introduced, AB 1032 completely eliminated current provisions in the law allowing courts to use independent contractors when they don’t have enough employees to cover the work,” certified court interpreter Mary Lou Aranguren told Slator. 

Along with fellow former union representative Daniel Navarro, a state and federally certified court interpreter, Aranguren headed up a coalition called the California Alliance of Legal Interpreters (CALI) to express opposition to AB 1032.

The group collaborated with the American Translators Association (ATA) and the Coalition of Practicing Translators and Interpreters of California (CoPTIC) to share its analysis of the bill with other interpreters.

“Once the broader interpreter community understood […] there was a lot of push back,” Aranguren said. “The authors restored the status quo and removed those changes from the bill“.

Slator Interpreting Services and Technology Report

The Training Program No One Asked For

AB 432, sponsored by Assemblymember Mike Fong, proposes the Court Interpreters Workforce Pilot Program. If passed, AB 432 would provide training for up to 10 participants in four courts per year, with the goal of producing more court interpreters. 

The ATA has objected to AB 432 in several letters to the California State Assembly’s Committee on Appropriations.

“This bill ignores the underlying reality about why the courts have had trouble attracting applicants for employment: The salaries offered are lower than what interpreters can make in other legal or conference settings, where their skills are more highly valued,” ATA President Madalena Sánchez Zampaulo wrote. “As evidenced by the number of certified court interpreters in California’s state registry, there isn’t a lack of qualified talent.”

ATA Advocacy Committee Chair Ben Karl agreed with Sánchez Zampaulo’s take. “The latest version requires training program graduates to work for the court for three years or reimburse the court for the cost of the training program, without addressing the most pressing needs facing the courts,” he told Slator. “Until pay increases, the courts will have trouble filling their needs gap.” 

“The salaries offered are lower than what interpreters can make in other legal or conference settings, where their skills are more highly valued” — Madalena Sánchez Zampaulo, President, ATA

Indeed, court interpreters along California’s west coast decided to strike in March 2023 to protest depressed wages, joining colleagues in Nebraska, Colorado, and Massachusetts.

Among Sánchez Zampaulo’s recommendations: Increase court interpreter compensation; offer grants to aspiring court interpreters for existing training programs; reimburse continuing education expenses for interpreters; and offer oral exams more than twice a year. 

“The cost of additional exam sittings is surely less than creating an entirely new program to meet goals already being addressed by existing frameworks,” she pointed out.

Slator 2023 Language Industry Market Report

In a July 13, 2023 letter to the same Committee Chair and Vice Chair, Sánchez Zampaulo repeated the same suggestions, explaining simply, “The amendments made to the bill on June 26, 2023 did not address the concerns that we raised in [the previous] letter, and therefore, we must oppose AB 432.”

A Committee hearing date for AB 1032 is currently scheduled for August 14, 2023. AB 432 will be heard in the Senate Judiciary once the summer recess ends in August 2023. Karl told Slator that both chambers will have until August 31, 2023, to pass any bills, with a September 30, 2023 deadline for Governor Gavin Newsom to sign bills into law or to veto them.

“If interpreters do not speak up, this bill is likely to pass,” Karl said of AB 432. “If they share their views with their lawmakers, those same lawmakers will be able to represent the voices of their constituents, both interpreters and LEP individuals, and vote accordingly.”

CoPTIC President Lorena Ortiz-Schneider drew parallels between the two proposed bills and AB 5, the impetus behind CoPTIC’s founding, writing in an op-ed, “Together, these two bills […] will decimate the ability of professionals with hard-earned state credentials and even certifications to work in California.”

Justin Jackson did not lack for suitors when he became a free agent in March, but while a handful of NFL teams were interested in signing him as a backup running back/kick returner/jack-of-all-trades insurance policy, most were offering veteran-minimum type deals.

Jackson averaged 4 yards per carry as the Detroit Lions’ No. 3 running back and caught 12 passes in 187 offensive snaps last season. He ranked sixth in the NFL in kick return average. And while no one would confuse him for Saquon Barkley or Josh Jacobs, he spent most of the offseason in limbo, like his more famous running back counterparts, a victim of the league’s evolving views on what once was its premier position.

“For me, it was just, I wanted — it was a respect thing and I felt like I outplayed my contract last year, so I just wanted just a little respect,” Jackson told the Free Press this week. “And that’s really what I was looking for and I just trusted that I would get that and thankfully (the Lions) came back and offered some incentives to beef up the contract a little bit and that’s really all I was looking for.

“But yeah, I definitely think, obviously, the running back position is very devalued and that’s tough. I think we all feel it. But at the end of the day, we got to come out, we got to work. That’s what we got to do and just keep proving to everybody that we’re a very valuable position and that Super Bowl teams need that position to do well.”

Super Bowl teams may need a running game to do well, but the makeup of their running back rooms has changed over the years, and that’s helped drive down prices at the position across the league.

Jacobs, the NFL’s leading rusher last season with 1,653 yards — more than Hall of Famers Tony Dorsett, Marshall Faulk or Thurman Thomas ever had in a season in their careers — was one of three backs (along with Barkley and Tony Pollard) who were franchise-tagged this offseason.

Pollard, who emerged as the Dallas Cowboys’ lead back last fall, signed his one tender worth $10.091 million. Barkley, who helped the New York Giants reach the playoffs while rushing for 1,312 yards in 2022, signed a revised one-year deal this week worth a reported $11 million. Jacobs has not signed his tender and is not currently in training camp with the Las Vegas Raiders.

At just over $10 million, the franchise tag — which is calculated as the average of the five highest-paid players at the position over the previous five seasons, figured as a percentage of the salary cap — offers life-changing money for some, but it comes on a one-year deal and at a cost: It restricts the free agent market for the best players at a position, limits movement of those players and keeps top salaries from escalating too quickly, which in turn holds down the position’s middle class.

After kickers and punters ($5.393 million), running backs have the lowest franchise tag number in the league. Quarterbacks, at $32.416 million, have the highest, while tight ends ($11.345 million) and safeties ($14.46 million) are the only other positions with a tag south of $18 million.

Market forces have contributed to the middling salary growth of running backs, and from a team’s perspective, it seldom makes sense to spend big on the position. Running backs take more punishment than players at most other positions due to the nature of their work, and replacement-level backs can often be found in free agency or late in the draft.

Accomplished veteran running backs like Kareem Hunt, Zeke Elliott and Leonard Fournette, for instance, are currently free agents. None is more than 28 years old. And last year’s Super Bowl winner, the Kansas City Chiefs, used seventh-round pick Isiah Pacheco as their primary back.

WEDNESDAY’S OBSERVATIONS: Rookie tight Sam LaPorta earning his keep; pads come on Friday

“It’s one of the toughest subjects, man, because it’s so hard on both sides,” said Lions fullback Jason Cabinda, the team’s NFL Players Association representative. “You understand from a business standpoint. The running backs touch the ball so much. They get hit, they get tackled. Guys get hurt, etc., etc. But at the end of the day, they bring so much value to your team.

“Those rushing yards are huge, the first downs, the catches out of the backfield. I mean, they do a whole lot for an offense and you look at a guy like Saquon who got hurt and it’s easy for a team to label a guy who gets hurt. ‘OK, he’s not going to be the same guy, etc., etc.’ But when a guy like that comes back and he goes and has another 1,000-yard season, 10 touchdowns, those type of stats, and then he still doesn’t get the satisfaction of getting that long-term deal, I think it can be a very, very frustrating thing.”

And frustrating for more than just the player involved.

Cabinda said seeing a player like Barkley not get a fair-market contract “definitely rubs a lot of guys the wrong way, regardless of position.” And Los Angeles Chargers running back Austin Ekeler, a member of the NFLPA’s executive committee, hosted a Zoom call for top running backs this month to discuss the market forces affecting their position.

Ekeler told USA TODAY he hopes the franchise tag is abolished in the next CBA and called it “detrimental to us as players.”

Cabinda, who was not on the call, said other solutions are being brainstormed. Some possibilities include making rookie contracts for running backs different from other rookie deals in terms of length or value, or tweaking how much veteran running back contracts count against the salary cap.

It seems unlikely owners would agree to open either of those doors, given potential future ramifications, but Cabinda said “we hope that there’s some type of resolution” as an NFLPA “cause it’s necessary.”

“Obviously, you got to keep in mind it’s a business, you get that aspect, too,” Cabinda said. “But this game that we have, and since we’ve been playing since we were kids it’s all been about family, about the right things, about taking care of each other, all those kinds of things. You do need to stay along with that theme, of what our game means. And obviously, you add the business aspect and it can shake things up and kind of make things muddy, but I think at the end of the day things need to be made right.”

Jackson said the Lions ended up doing right by him, and neither he nor fellow Lions running back David Montgomery, who landed a three-year, $18 million deal in free agency this offseason — one of the biggest by a running back who changed teams — left free agency disenchanted with the league’s other 31 teams.

“Your value is what your value is,” Montgomery said. “That’s how I see it.”

Now, Jackson said, it’s up to running backs, individually and collectively, to boost their value and help teams realize it on the field.

“I know everyone’s got their own truth,” he said. “You just got to keep going out there and working. That’s mine.”

Contact Dave Birkett at [email protected]. Follow him on Twitter @davebirkett.

Exhibit A: Giants

Matchup: Lions (9-8 in 2022) vs. N.Y. Giants (9-7-1 in 2022), exhibition opener.

Kickoff: 7 p.m. Aug. 11; Ford Field, Detroit.

TV/radio: Fox; WXYT-FM (97.1).

For openers: Lions at Chiefs, regular-season opener; 8:15 p.m. Sept. 7, Arrowhead Stadium, Kansas City, Missouri; NBC.

In the 7th round of the 2022 NFL Draft, the Kansas City Chiefs selected Rutgers running back Isiah Pacheco with the 251st pick.  Not much was expected from him, or any 7th round pick for that matter.  However, by mid-season Pacheco had supplanted former first round pick Clyde Edwards-Helaire as the team’s starting tailback.

Even bigger things are anticipated from Pacheco this year, but fulfilling these expectations requires deliberate effort, not chance.  Judging from his comments provided below, I believe what is expected from him is indeed attainable. Please click the 13-second link, and afterward, I will share three essential steps that young leaders must take to achieve their goals.

“I want to run for 1,000 yards.”

Isiah Pacheco discussed where he’s working to improve heading into his second season as a pro. pic.twitter.com/b41NHdz9MC

— Matt McMullen (@KCChiefs_Matt) July 20, 2023

Just to recap, Pacheco said, “It’s the details.  (I’m) detailing my notes more, just finding little things to get better at.  For me, I want to run for 1,000 yards.  That’s the goal obviously but it starts here today at practice day-by-day.

3 Steps Young Leaders Must Take To Achieve Their Goals

The following are three steps I gleaned from Pacheco which all young leaders can take to achieve their goals:

Develop A Plan For Achieving Your Goals

A failure to plan is plan to fail.  Pacheco has a goal of running for 1,000 yards but is smart enough to know this will not happen by accident.  It will require a plan.  And for the Chiefs running back, that plan begins in practice.

Make A Big Deal About Little Things

How you do anything is how you do everything.  Pacheco knows the secret to going to the next level in his performance is found in his meticulous attention to the details. By making incremental improvements in the “little things,” he gains marginal advantages that ultimately lead to significant outcomes.

Do The Lonely Work

Lonely work done well eventually becomes lovely work.  The average person often over-values the results everyone sees in public and under-values the work done in private it took to get there.  You must love the grind.

It is the day-in and day-out work during practice which will allow Pacheco to get his 1,000 yards.

I would imagine almost everyone reading this article has goals they wish to achieve.  But to get there, you need a plan, meticulous attention to detail, and a willingness to do the lonely work.

Isiah Pacheco hopes doing this will result in 1,000 yards.  For you, it will be something else but if you do not take these three steps, your chances of success are unlikely.

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Jonathan Taylor’s agent and Jim Irsay are not playing nice on Twitter, making the Colts running back look even more likely to leave Indianapolis.

Jonathan Taylor, like all NFL running backs, wants to get paid the big bucks. And it increasingly looks like he’s going to have a hard time achieving that.

Contract negotiations on long-term deals this offseason didn’t go well for Saquon Barkley or Josh Jacobs. Taylor will be in a similar situation next offseason…and Colts owner Jim Irsay may not be in a position to bring the running back around on a new deal after pissing off his agent.

Irsay tweeted this on Wednesday evening:

“NFL Running Back situation- We have negotiated a CBA,that took years of effort and hard work and compromise in good faith by both sides..to say now that a specific Player category wants another negotiation after the fact,is inappropriate. Some Agents are selling ‘bad faith’..”

Malki Kawa, Taylor’s agent, hit back: “Bad faith is not paying your top offensive player.

Bad faith is not paying your top offensive player https://t.co/ZYvrLhxygG

— malki kawa (@malkikawa) July 27, 2023

When Ian Rapoport tweeted about finding a way to fix the relationship between Colts ownership and the agent, Kawa was skeptical.

“I doubt it,” Kawa tweeted.

— malki kawa (@malkikawa) July 27, 2023

Jonathan Taylor’s exit from Colts looks all but certain after 2023

Even if the relationship between Taylor’s agent and the Colts was as good as could be, we’d be best off predicting that Taylor will leave Indianapolis before long.

Taylor has been a workhorse for the Colts over the last three seasons. But that’s the problem. Running backs are being run into the ground during their relatively cheap rookie deals without cashing in on lucrative second contracts.

Running backs are still important in this era of the NFL. But star running backs are no longer seen as worth paying. Teams have figured out that they can win with running backs on rookie contracts, like the Chiefs with Isiah Pacheco last season, or a committee of cheap rushers, like the Rams the year before.

Teams that have dished out big contracts for running backs entering their late 20s haven’t exactly had success to point to in recent years. That’s working against Taylor, his agent and all the other running backs waiting on their next deal.

Calgarian Robin Arseneault visited her doctor’s office in Marda Loop recently for a routine physical. 

Along with her husband, Robert, the Arseneaults visit the neighbourhood clinic often. That’s because Robert has high medical needs as someone with primary progressive MS, heart and bladder dysfunction, diabetes and kidney concerns. 

So the couple was surprised to see an email land from the Marda Loop Medical Clinic in their inbox that same week, stating that the clinic would be moving to a membership system.

The pricing under that membership, shared with CBC News by Arseneault, is listed as $4,800 per year for a two-parent family membership, which covers two adults and their dependent children.

Other memberships include a $2,400-per-year membership that covers one adult and their dependent children, and $2,200 per year for an individual adult membership.

“First off, we can’t afford $4,000 a year,” Arseneault said. “Secondly, I fundamentally disagree with that tiered system of health care. I can’t stand the idea that if I have more money, I get more privileged care, than say, my neighbour. It’s just against my beliefs.”

In return for the membership, the Marda Loop Medical Clinic promises reduced wait times and extended appointment times, among other benefits. The clinic also says it will continue to provide care one day a week for non-members.

CBC News was told an administrator at the clinic wasn’t available for an interview. In an email sent to the clinic’s members, Dr. Sally Talbot-Jones wrote that the clinic’s aim was to alleviate stress expressed by patients due to extended waiting times, the challenge of scheduling family appointments, and more.

“This decision was driven by my commitment to providing you with the level of care you deserve. I have extensively researched the most successful healthcare models around the world, and I am confident that our new program is designed to deliver excellence,” Talbot-Jones wrote.

The program at the Marda Loop clinic isn’t the first along these lines in Calgary. Such arrangements date back years, and they aren’t all structured in the same way.

But as the Canadian and Alberta health-care systems struggle under the weight of increased pressure — whether that’s rural emergency room closures, ambulance shortages, or overwhelmed hospitals — experts say arrangements like the one being offered at the Marda Loop clinic are becoming increasingly common.

‘Skirting the boundaries’ of what’s allowable

Back in 2008, Alberta’s health minister at the time was asked whether he had any concerns about a private clinic, the Copeman Healthcare Centre, opening up shop in downtown Calgary, charging $2,900 per year.

The clinics didn’t contravene the Canada Health Act because they didn’t charge patients for medically necessary services, CEO Don Copeman said at the time. 

Given that, then-Alberta Health Minister Ron Liepert said there should be little need for such clinics if Alberta made changes to its publicly funded health-care system.

“The findings were that there was no contravention of the Canada Health Act so I wouldn’t be proposing to do any kind of review,” Liepert said.

The Canada Health Act stipulates that patients can’t be charged for “medically necessary” services, provided in a hospital or by a doctor.

There are some blurred lines here, though, when it comes to privatization in Canada.

Consider services like chiropractic services, which are not deemed medically necessary and aren’t covered in Alberta, meaning patients have to pay for those themselves, or through private insurance.

If private health-care providers charge patients for medically necessary services, the provinces that allow that have dollars clawed back by the federal government.

“So, it is not allowable that you would charge a patient as they come in to see a doctor for the care that you provide them,” said Fiona Clement, a professor who specializes in health policy in the department of community health sciences at the University of Calgary. 

“But what is being tried, and I think kind of skirting the bounds of what’s allowable, are these membership fees.”

Controversial, but no clear policy to regulate

Since the Copeman Healthcare Centre opened in 2008, many more such arrangements have followed — in Alberta, and across the country.

In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payment across the country.

At the time of the analysis, which was between November 2019 and June 2020, there were 14 private clinics in Alberta with a range of membership fees and private payment. During that same period, there were 24 in Ontario and 30 in Quebec.

“While reports have documented the operation of corporate or boutique clinics in Alberta and Ontario, we do not yet have national information on the extent of these practices,” the authors wrote in the report.

In any effort to document the number of such operations, there would be some error and misclassification involved, Clement noted, as there’s no formal registry list, and no necessity to register this sort of approach.

There have been ebbs and flows in the conversation at a policy level about what to do about this issue, Clement noted, but added that everyone’s a little bit hamstrung, as technically there’s nothing wrong about what’s happening.

“The college who deals with governing the professionals and making sure that doctors are adhering to their professional ethics, they’re still offering medically necessary care, and they’re not charging patients,” Clement said.

“So there’s technically no violation there. So, I really think it would have to come from the government to sort of ban these kinds of things.”

When the Copeman Healthcare Centre opened in 2008, a Calgary spokesperson with the public health non-profit group Friends of Medicare bemoaned the trend, questioning whether society wanted to allow people who have an “extra $3,000 to spend [to go] to the front of the line and everybody else can fall where they may.”

The group is increasingly concerned today.

Chris Gallaway, executive director of Friends of Medicare, called such arrangements “a violation of the Canada Health Act” and called for them to be investigated.

“We shouldn’t be creating two tiers, where some people pay to get into a certain clinic that others can’t access,” he said. 

Province says it will continue to monitor situation

In a statement, a spokesperson with Alberta Health Minister Adriana LaGrange wrote that the government remains committed to the principles of the Canada Health Act, adding that Albertans don’t need to pay out of pocket for insured health services.

“All physicians must also follow standards of practice set by their regulatory colleges. The government will continue examine these cases to make sure all legislation is being followed,” Scott Johnston, press secretary for LaGrange, wrote in a statement.

The Alberta NDP held a media availability in Calgary on Monday to draw attention to the clinic’s decision to charge membership fees, saying it was “very concerned” other clinics might follow suit.

While the province monitors developments, another health policy expert says it’s not surprising to see some doctors experiment with these kinds of solutions given the pressures they are under in terms of patient demand and rising financial pressures.

“A combination of pressures related to increasing rental prices, and for increasing staff wages, as well as just general inflation in their daily lives, I think there is a pretty large pressure to increase revenues, however possible,” said Rosalie Wyonch, lead of the health policy research program at the C. D. Howe Institute public policy think tank.

In provinces across Canada, there is a lot of grey area about what makes up a full, publicly-insured service, what could what is definitely a private service, and what could be either-or, Wyonch noted.

“All of that uncertainty, it creates in some cases opportunities to generate revenue or improve access to services with some fees,” she said.

“It could also create equity concerns in terms of only being able to access services if you can afford one of these concierge services.”

In the midst of all this uncertainty, some patients like the Arseneaults worry they’ll be left behind, without many options in front of them.

“I mean, we enjoy our doctor, we get good services from the clinic. And, yeah, it’s a upsetting situation,” Arseneault said.

“It’s actually quite frightening. And it causes a lot of stress for us.”

WATCH | How do we solve the family doctor shortage? 

How do we solve the family doctor shortage?

2 months ago

Duration 13:26

Many Canadians still don’t have access to a family doctor. CBC’s Omar Dabaghi-Pacheco explores short-term and long-term solutions to the problem.

How do we solve the family doctor shortage?

Calgarian Robin Arseneault visited her doctor’s office in Marda Loop recently for a routine physical. 

Along with her husband, Robert, the Arseneaults visit the neighbourhood clinic often. That’s because Robert has high medical needs as someone with primary progressive MS, heart and bladder dysfunction, diabetes and kidney concerns. 

So the couple was surprised to see an email land from the Marda Loop Medical Clinic in their inbox that same week, stating that the clinic would be moving to a membership system.

The pricing under that membership, shared with CBC News by Arseneault, is listed as $4,800 per year for a two-parent family membership, which covers two adults and their dependent children.

Other memberships include a $2,400-per-year membership that covers one adult and their dependent children, and $2,200 per year for an individual adult membership.

“First off, we can’t afford $4,000 a year,” Arseneault said. “Secondly, I fundamentally disagree with that tiered system of health care. I can’t stand the idea that if I have more money, I get more privileged care, than say, my neighbour. It’s just against my beliefs.”

In return for the membership, the Marda Loop Medical Clinic promises reduced wait times and extended appointment times, among other benefits. The clinic also says it will continue to provide care one day a week for non-members.

CBC News was told an administrator at the clinic wasn’t available for an interview. In an email sent to the clinic’s members, Dr. Sally Talbot-Jones wrote that the clinic’s aim was to alleviate stress expressed by patients due to extended waiting times, the challenge of scheduling family appointments, and more.

“This decision was driven by my commitment to providing you with the level of care you deserve. I have extensively researched the most successful healthcare models around the world, and I am confident that our new program is designed to deliver excellence,” Talbot-Jones wrote.

The program at the Marda Loop clinic isn’t the first along these lines in Calgary. Such arrangements date back years, and they aren’t all structured in the same way.

But as the Canadian and Alberta health-care systems struggle under the weight of increased pressure — whether that’s rural emergency room closures, ambulance shortages, or overwhelmed hospitals — experts say arrangements like the one being offered at the Marda Loop clinic are becoming increasingly common.

‘Skirting the boundaries’ of what’s allowable

Back in 2008, Alberta’s health minister at the time was asked whether he had any concerns about a private clinic, the Copeman Healthcare Centre, opening up shop in downtown Calgary, charging $2,900 per year.

The clinics didn’t contravene the Canada Health Act because they didn’t charge patients for medically necessary services, CEO Don Copeman said at the time. 

Given that, then-Alberta Health Minister Ron Liepert said there should be little need for such clinics if Alberta made changes to its publicly funded health-care system.

“The findings were that there was no contravention of the Canada Health Act so I wouldn’t be proposing to do any kind of review,” Liepert said.

The Canada Health Act stipulates that patients can’t be charged for “medically necessary” services, provided in a hospital or by a doctor.

There are some blurred lines here, though, when it comes to privatization in Canada.

Consider services like chiropractic services, which are not deemed medically necessary and aren’t covered in Alberta, meaning patients have to pay for those themselves, or through private insurance.

If private health-care providers charge patients for medically necessary services, the provinces that allow that have dollars clawed back by the federal government.

“So, it is not allowable that you would charge a patient as they come in to see a doctor for the care that you provide them,” said Fiona Clement, a professor who specializes in health policy in the department of community health sciences at the University of Calgary. 

“But what is being tried, and I think kind of skirting the bounds of what’s allowable, are these membership fees.”

Controversial, but no clear policy to regulate

Since the Copeman Healthcare Centre opened in 2008, many more such arrangements have followed — in Alberta, and across the country.

In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payment across the country.

At the time of the analysis, which was between November 2019 and June 2020, there were 14 private clinics in Alberta with a range of membership fees and private payment. During that same period, there were 24 in Ontario and 30 in Quebec.

“While reports have documented the operation of corporate or boutique clinics in Alberta and Ontario, we do not yet have national information on the extent of these practices,” the authors wrote in the report.

In any effort to document the number of such operations, there would be some error and misclassification involved, Clement noted, as there’s no formal registry list, and no necessity to register this sort of approach.

There have been ebbs and flows in the conversation at a policy level about what to do about this issue, Clement noted, but added that everyone’s a little bit hamstrung, as technically there’s nothing wrong about what’s happening.

“The college who deals with governing the professionals and making sure that doctors are adhering to their professional ethics, they’re still offering medically necessary care, and they’re not charging patients,” Clement said.

“So there’s technically no violation there. So, I really think it would have to come from the government to sort of ban these kinds of things.”

When the Copeman Healthcare Centre opened in 2008, a Calgary spokesperson with the public health non-profit group Friends of Medicare bemoaned the trend, questioning whether society wanted to allow people who have an “extra $3,000 to spend [to go] to the front of the line and everybody else can fall where they may.”

The group is increasingly concerned today.

Chris Gallaway, executive director of Friends of Medicare, called such arrangements “a violation of the Canada Health Act” and called for them to be investigated.

“We shouldn’t be creating two tiers, where some people pay to get into a certain clinic that others can’t access,” he said. 

Province says it will continue to monitor situation

In a statement, a spokesperson with Alberta Health Minister Adriana LaGrange wrote that the government remains committed to the principles of the Canada Health Act, adding that Albertans don’t need to pay out of pocket for insured health services.

“All physicians must also follow standards of practice set by their regulatory colleges. The government will continue examine these cases to make sure all legislation is being followed,” Scott Johnston, press secretary for LaGrange, wrote in a statement.

The Alberta NDP held a media availability in Calgary on Monday to draw attention to the clinic’s decision to charge membership fees, saying it was “very concerned” other clinics might follow suit.

While the province monitors developments, another health policy expert says it’s not surprising to see some doctors experiment with these kinds of solutions given the pressures they are under in terms of patient demand and rising financial pressures.

“A combination of pressures related to increasing rental prices, and for increasing staff wages, as well as just general inflation in their daily lives, I think there is a pretty large pressure to increase revenues, however possible,” said Rosalie Wyonch, lead of the health policy research program at the C. D. Howe Institute public policy think tank.

In provinces across Canada, there is a lot of grey area about what makes up a full, publicly-insured service, what could what is definitely a private service, and what could be either-or, Wyonch noted.

“All of that uncertainty, it creates in some cases opportunities to generate revenue or improve access to services with some fees,” she said.

“It could also create equity concerns in terms of only being able to access services if you can afford one of these concierge services.”

In the midst of all this uncertainty, some patients like the Arseneaults worry they’ll be left behind, without many options in front of them.

“I mean, we enjoy our doctor, we get good services from the clinic. And, yeah, it’s a upsetting situation,” Arseneault said.

“It’s actually quite frightening. And it causes a lot of stress for us.”

WATCH | How do we solve the family doctor shortage? 

How do we solve the family doctor shortage?

2 months ago

Duration 13:26

Many Canadians still don’t have access to a family doctor. CBC’s Omar Dabaghi-Pacheco explores short-term and long-term solutions to the problem.

How do we solve the family doctor shortage?

Calgarian Robin Arseneault visited her doctor’s office in Marda Loop recently for a routine physical. 

Along with her husband, Robert, the Arseneaults visit the neighbourhood clinic often. That’s because Robert has high medical needs as someone with primary progressive MS, heart and bladder dysfunction, diabetes and kidney concerns. 

So the couple was surprised to see an email land from the Marda Loop Medical Clinic in their inbox that same week, stating that the clinic would be moving to a membership system.

The pricing under that membership, shared with CBC News by Arseneault, is listed as $4,800 per year for a two-parent family membership, which covers two adults and their dependent children.

Other memberships include a $2,400-per-year membership that covers one adult and their dependent children, and $2,200 per year for an individual adult membership.

“First off, we can’t afford $4,000 a year,” Arseneault said. “Secondly, I fundamentally disagree with that tiered system of health care. I can’t stand the idea that if I have more money, I get more privileged care, than say, my neighbour. It’s just against my beliefs.”

In return for the membership, the Marda Loop Medical Clinic promises reduced wait times and extended appointment times, among other benefits. The clinic also says it will continue to provide care one day a week for non-members.

CBC News was told an administrator at the clinic wasn’t available for an interview. In an email sent to the clinic’s members, Dr. Sally Talbot-Jones wrote that the clinic’s aim was to alleviate stress expressed by patients due to extended waiting times, the challenge of scheduling family appointments, and more.

“This decision was driven by my commitment to providing you with the level of care you deserve. I have extensively researched the most successful healthcare models around the world, and I am confident that our new program is designed to deliver excellence,” Talbot-Jones wrote.

The program at the Marda Loop clinic isn’t the first along these lines in Calgary. Such arrangements date back years, and they aren’t all structured in the same way.

But as the Canadian and Alberta health-care systems struggle under the weight of increased pressure — whether that’s rural emergency room closures, ambulance shortages, or overwhelmed hospitals — experts say arrangements like the one being offered at the Marda Loop clinic are becoming increasingly common.

‘Skirting the boundaries’ of what’s allowable

Back in 2008, Alberta’s health minister at the time was asked whether he had any concerns about a private clinic, the Copeman Healthcare Centre, opening up shop in downtown Calgary, charging $2,900 per year.

The clinics didn’t contravene the Canada Health Act because they didn’t charge patients for medically necessary services, CEO Don Copeman said at the time. 

Given that, then-Alberta Health Minister Ron Liepert said there should be little need for such clinics if Alberta made changes to its publicly funded health-care system.

“The findings were that there was no contravention of the Canada Health Act so I wouldn’t be proposing to do any kind of review,” Liepert said.

The Canada Health Act stipulates that patients can’t be charged for “medically necessary” services, provided in a hospital or by a doctor.

There are some blurred lines here, though, when it comes to privatization in Canada.

Consider services like chiropractic services, which are not deemed medically necessary and aren’t covered in Alberta, meaning patients have to pay for those themselves, or through private insurance.

If private health-care providers charge patients for medically necessary services, the provinces that allow that have dollars clawed back by the federal government.

“So, it is not allowable that you would charge a patient as they come in to see a doctor for the care that you provide them,” said Fiona Clement, a professor who specializes in health policy in the department of community health sciences at the University of Calgary. 

“But what is being tried, and I think kind of skirting the bounds of what’s allowable, are these membership fees.”

Controversial, but no clear policy to regulate

Since the Copeman Healthcare Centre opened in 2008, many more such arrangements have followed — in Alberta, and across the country.

In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payment across the country.

At the time of the analysis, which was between November 2019 and June 2020, there were 14 private clinics in Alberta with a range of membership fees and private payment. During that same period, there were 24 in Ontario and 30 in Quebec.

“While reports have documented the operation of corporate or boutique clinics in Alberta and Ontario, we do not yet have national information on the extent of these practices,” the authors wrote in the report.

In any effort to document the number of such operations, there would be some error and misclassification involved, Clement noted, as there’s no formal registry list, and no necessity to register this sort of approach.

There have been ebbs and flows in the conversation at a policy level about what to do about this issue, Clement noted, but added that everyone’s a little bit hamstrung, as technically there’s nothing wrong about what’s happening.

“The college who deals with governing the professionals and making sure that doctors are adhering to their professional ethics, they’re still offering medically necessary care, and they’re not charging patients,” Clement said.

“So there’s technically no violation there. So, I really think it would have to come from the government to sort of ban these kinds of things.”

When the Copeman Healthcare Centre opened in 2008, a Calgary spokesperson with the public health non-profit group Friends of Medicare bemoaned the trend, questioning whether society wanted to allow people who have an “extra $3,000 to spend [to go] to the front of the line and everybody else can fall where they may.”

The group is increasingly concerned today.

Chris Gallaway, executive director of Friends of Medicare, called such arrangements “a violation of the Canada Health Act” and called for them to be investigated.

“We shouldn’t be creating two tiers, where some people pay to get into a certain clinic that others can’t access,” he said. 

Province says it will continue to monitor situation

In a statement, a spokesperson with Alberta Health Minister Adriana LaGrange wrote that the government remains committed to the principles of the Canada Health Act, adding that Albertans don’t need to pay out of pocket for insured health services.

“All physicians must also follow standards of practice set by their regulatory colleges. The government will continue examine these cases to make sure all legislation is being followed,” Scott Johnston, press secretary for LaGrange, wrote in a statement.

The Alberta NDP held a media availability in Calgary on Monday to draw attention to the clinic’s decision to charge membership fees, saying it was “very concerned” other clinics might follow suit.

While the province monitors developments, another health policy expert says it’s not surprising to see some doctors experiment with these kinds of solutions given the pressures they are under in terms of patient demand and rising financial pressures.

“A combination of pressures related to increasing rental prices, and for increasing staff wages, as well as just general inflation in their daily lives, I think there is a pretty large pressure to increase revenues, however possible,” said Rosalie Wyonch, lead of the health policy research program at the C. D. Howe Institute public policy think tank.

In provinces across Canada, there is a lot of grey area about what makes up a full, publicly-insured service, what could what is definitely a private service, and what could be either-or, Wyonch noted.

“All of that uncertainty, it creates in some cases opportunities to generate revenue or improve access to services with some fees,” she said.

“It could also create equity concerns in terms of only being able to access services if you can afford one of these concierge services.”

In the midst of all this uncertainty, some patients like the Arseneaults worry they’ll be left behind, without many options in front of them.

“I mean, we enjoy our doctor, we get good services from the clinic. And, yeah, it’s a upsetting situation,” Arseneault said.

“It’s actually quite frightening. And it causes a lot of stress for us.”

WATCH | How do we solve the family doctor shortage? 

How do we solve the family doctor shortage?

2 months ago

Duration 13:26

Many Canadians still don’t have access to a family doctor. CBC’s Omar Dabaghi-Pacheco explores short-term and long-term solutions to the problem.

How do we solve the family doctor shortage?

photo: Matt Koperniak (Springfield Cardinals)

The St. Louis Cardinals system went 1-3 on Wednesday. The Cardinal Nation’s Player of the Day is LF Matt Koperniak, who went 4-for-5 with a steal and run scored in Springfield’s extra inning loss. Other standouts include Alec Burleson, L.J. Jones, Edwin Nunez and Wade Stauss.

Results from games played Wednesday, May 18.

The Memphis Redbirds were edged by the Gwinnett Stripers in a one run game on Wednesday night. Recently sent down by St. Louis, Jake Woodford took the mound for Memphis. The right hander pitched three innings, gave up two runs on four hits and walked two.

Angel Rondon relieved and surrendered one run in two innings pitched. James Naile threw the sixth and seventh innings and allowed one run. Zach McAllister tossed a scoreless eighth. Naile took the loss, his second of the season.

Gwinnett took a 2-0 lead in the second inning, then increased the lead to 3-0 in the fourth. Memphis finally answered with a three-run home run by Alec Burleson in the sixth to tie the game at 3-3.

Game tying @IntlPaperCo HR for Burleson (7th)

The Stripers regained the lead with one run in the seventh. The Redbirds were unable to respond.

Nolan Gorman went 3-for-4, all singles. Burleson was 2-for-4 with three RBI. The offense scored three runs on six hits, struck out 12 times and was 1-for-5 with runners in scoring position.

On the base paths, Burleson stole his second base of the season. In the field, Scott Hurst had an outfield assist at third base.

Memphis has a record of 21-17 and is in third place in the International League West, five games back of first place Nashville.

Thursday’s game:  at Gwinnett, Zack Thompson LHP (2-0, 3.86) vs. Huascar Ynoa RHP (1-2, 6.41) 6:05 CT.

The Double-A Cardinals suffered a heartbreaking walk off loss to the Wind Surge in an extra innings road contest on Wednesday night. Edgar Escobar started for Springfield. The right hander pitched four innings, gave up two runs on six hits and fanned five.

Tyler Pike surrendered two runs in the fifth. Grant Black added two scoreless innings. Kevin Marnon hurled a scoreless eighth. Johan Quezada allowed two run in his two innings pitched. Freddy Pacheco gave up the walk off home run in the 11^th and took the loss, his third of the season. Pacheco was also tagged with a blown save.

Wichita got on the board first with two runs in the first inning. The Cardinals tied it up 2-2 in the third on a long ball by Jordan Walker.

The Wind Surge regained the lead with two scores in the fifth. Wichita held a 4-2 lead until the ninth when Springfield knotted it up despite not getting a hit. Delvin Perez led off with a walk, and Jonah Davis reached on an error. Jordan Walker drew a walk to load the bases. Moises Gomez was hit by a pitch and Perez scored. Davis came home on a bases loaded walk.

Neither team scored in the 10^th. In the top of the 11^th, Irving Lopez, who started the inning on second base, came home on a double play ball from Walker. Gomez then hit a solo home run to put the Cardinals up 6-4. It was his 17^th of the season.

In the home half of the 11^th, Pacheco could not protect the two-run lead. Via a walk and a three-run home run, Wichita walked it off 7-6.

Leadoff man and left fielder Matt Koperniak went 4-for-5 with a run scored and his sixth stolen base of the season. Nick Dunn was 2-for-5. Walker and Gomez each drove in two. The Cards fanned 14 times, went 1-for-11 with runners in scoring position and stranded 12.

Springfield is 14-21 and is in last place in the Texas League North, eight games back of first place Wichita.

Thursday’s game:  at Wichita, Connor Lunn RHP (2-3, 4.70) vs. Simeon Woods Richardson RHP (2-1, 2.20) 7:05 CT.

The Peoria Chiefs could only scratch one run out of six hits in a loss to the Sky Carp in Beloit. Starter Logan Gragg pitched 5 1/3 innings, gave up two runs on five hits and struck out three. Gragg took the loss, his fourth of the season.

Nathanael Heredia surrendered two runs in 1 2/3 innings of relief. Wilfredo Pereira tossed a scoreless eighth.

The Chiefs scored their only run in the fourth inning. Mike Antico began with a triple. Thomas Francisco was hit by a pitch. L.J. Jones singled to plate Antico.

In the sixth, Beloit posted three runs to take the lead. The Sky Carp added a fourth run in the seventh.

Jones went 2-for-4 with an RBI. Tommy Jew and Masyn Winn doubled.

On the base paths, Jew stole his 10^th base of the season. In the field, Winn made a throwing error. Matt Chamberlain had an outfield assist at third base, and Jew had an outfield assist at home.

Peoria is 14-21 on the season and stands in fourth place in the Midwest League West, 10 games back of first place Cedar Rapids.

Thursday’s game:  at Beloit, Michael McGreevy RHP (2-1, 2.52) vs. LHP Dax Fulton 6:35 CT.

Edwin Nunez threw two scoreless innings to earn his first win. The righty struck out four, yielded no hits and walked just one. Bryan Pope tossed two scoreless innings and was awarded his first save.

The Beach Birds scored first. In the second inning, Jeremy Rivas reached on a fielding error. Aaron McKeithan singled, and the runners advanced on a sac bunt by Wade Stauss. Ramon Mendoza grounded out to third and Rivas scored.

Bradenton plated a run in the fourth to tie the game and took a 2-1 lead in the fifth. The Cardinals answered in the sixth with two to take a 3-2 lead. Osvaldo Tovalin led off with a single. Rivas followed with a walk. McKeithan singled to load the bases. Stauss drove in two on a double.

Palm Beach added a fourth run in the eighth. Brady Whalen singled and stole second base. Whalen scored on a throwing error on a pickoff attempt.

The Cardinals scored four runs on seven hits. McKeithan went 2-for-4. Stauss drove in two.

On the base paths, Rivas stole his fifth base of the season. Whalen swiped his second base. In the field, Mendoza made a fielding error.

Palm Beach is 13-22 and is in last place in the Florida State League East, 11.5 games back of first place St. Lucie.

Thursday’s game:  vs. Bradenton, Carlos Guarate RHP (0-3, 5.40) vs. TBA 5:30 CT.

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