Canadians light candles to mourn victims of Iran plane crash

Canadians light candles to mourn victims of Iran plane crash
By Moira Warburton and Rod Nickel

TORONTO/EDMONTON, Alberta (Reuters) – Canadians held candlelight vigils in several cities on Thursday to remember 63 citizens killed in a plane crash in Iran, in what Canada’s prime minister called a “tragedy that shocked the world.”

Canada has been in mourning since Wednesday’s crash of the Ukraine International Airlines flight bound for Kiev from Tehran that killed all 176 people aboard. It was the largest loss of life among Canadians since an Air India flight blew up in 1985 over the Atlantic Ocean, killing 268 people from Canada.

Prime Minister Justin Trudeau, citing intelligence sources, said on Thursday the Ukraine airlines plane was likely brought down by an Iranian missile. He added the airliner’s destruction “may well have been unintentional.” Iran denied reports the plane was hit by a missile.

The crash occurred hours after Iran fired ballistic missiles at two military bases in Iraq hosting U.S. troops, and when Iranians were on high alert for a U.S. military response.

“What happened yesterday was a tragedy, a tragedy that shocked not only Canada, but the world,” Trudeau told a news conference. He has said 138 people on the plane were connecting to a flight to Canada.

The flight was a popular transit route for Canadians traveling to Iran, in the absence of direct flights, and carried many students and academics heading home from the holidays.

In Toronto, where a crowd of more than 100 attended a vigil, some two dozen people with connections to Canada’s largest city died in the crash. They included a young couple and their toddler daughter, along with teachers and students.

“It was unbelievable to me at first,” said Vahid Golshaeian, 41, a construction contractor attending the vigil. “Almost all of us had a friend or knew somebody. Innocent people.”

People ranging in age from children to the elderly lit candles and shared figs stuffed with walnuts.

On Parliament Hill in Ottawa, mourners arranged candles on the ground in the shape of a heart. Braving chilly weather, they set photos of loved ones in front of the site’s Centennial Flame monument.

Mourners also gathered in Montreal, the home of two newlyweds who were among those from Quebec killed in the crash.

In the western Canadian city of Edmonton, a memorial was planned for Sunday in a sports facility. Thirty people from the Alberta capital died, accounting for nearly half of Canada’s death toll.

The University of Alberta alone lost 10 people with connections to the institution. Grief counselors visited the campus on Thursday and mourners left flowers at the office door of a professor who died.

Two married professors, two students and a recent graduate – all from the university’s engineering department – died in the crash.

“We are very tight-knit and everyone has been very affected by this,” said Steven Heipel, an assistant dean of engineering.

(Reporting by Moira Warburton in Toronto and Rod Nickel in Edmonton, Alberta; Editing by Peter Cooney)

U.S. Senate panel advances North American trade deal, final vote timing uncertain

By David Lawder

WASHINGTON (Reuters) – The U.S. Senate Finance Committee overwhelmingly approved the U.S.-Mexico-Canada Agreement on Tuesday, moving the revamped North American trade deal a step closer to a final Senate vote in the coming days or weeks.

The committee advanced the USMCA implementing legislation by a 25-3 vote, drawing opposition from Republican senators Pat Toomey of Pennsylvania and Bill Cassidy of Louisiana and Democratic Senator Sheldon Whitehouse of Rhode Island.

The timing of a long-delayed final U.S. congressional vote to approve the trade pact remains uncertain, as Senate Majority Leader Mitch McConnell has said its consideration would likely have to wait until after a Senate trial over the impeachment of President Donald Trump.

The trade deal, first agreed in October 2018 and revised last month, aims to modernize and broaden the 26-year-old North American Free Trade Agreement (NAFTA).

Trump’s Senate trial is also in limbo, because House Democrats have not yet sent articles of impeachment approved in December to the Senate as the two parties argue over terms of the proceedings.

Senate Finance Committee Chairman Chuck Grassley earlier told CNBC http://bit.ly/36vNLSN television USMCA would “pass the Senate sometime within the next few days or at the most the end of this month.”

Following the Senate panel’s vote, Grassley said the timing was up to McConnell, but articles of impeachment would take precedence over USMCA. A vote could occur quickly as there was little other legislation to stand in its way, he added.

The Senate’s parliamentarian has directed other some other committees to consider the legislation, which could delay a floor vote slightly, but Grassley said those panels were expected to quickly approve the trade deal.

“The intent is for the leader to get them to move quickly,” Grassley added.

The finance committee’s vote indicates broad bipartisan support for USMCA, which includes new chapters covering digital trade, stronger intellectual property protections and new requirements for automakers to use more parts and materials sourced in the region and from high-wage areas, notably the United States and Canada.

Toomey, an ardent free trade Republican, objected to the new automotive content rules, saying they were “designed to raise the cost to American consumers of buying Mexican-made cars.”

“It’s the first time we are ever going to go backwards on a trade agreement,” Toomey said during the committee’s debate.

Cassidy complained that the agreement weakens NAFTA’s investor-state dispute settlement mechanism, which will deter big projects such as a gas pipeline from the United States to Mexico.

Whitehouse, an ardent environmentalist, said he objected to USMCA because the trade deal does not mandate any action to fight global warming and rising sea levels.

(Reporting by Kanishka Singh in Bengaluru; Editing by Andrew Heavens and Tom Brown)

U.S. House passes new North American trade deal replacing NAFTA

By David Lawder

WASHINGTON (Reuters) – The U.S. House of Representatives overwhelmingly approved a new North American trade deal on Thursday that includes tougher labor and automotive content rules but leaves $1.2 trillion in annual U.S.-Mexico-Canada trade flows largely unchanged.

The House passed legislation to implement the U.S.-Mexico Canada Agreement 385-41, with 38 Democrats, two Republicans and one independent member voting no.

The bipartisan vote contrasted sharply with Wednesday night’s Democrat-only vote to impeach U.S. President Donald Trump. [nL1N28S09W]

The House vote sends the measure to the Senate, but it is unclear when the Republican-controlled chamber will take it up. Senate Republican leader Mitch McConnell has said that consideration of the measure would likely follow an impeachment trial in the Senate, expected in January.

The USMCA trade pact, first agreed upon in September 2018, will replace the 1994 North American Free Trade Agreement. Trump vowed for years to quit or renegotiate NAFTA, which he blames for the loss of millions of U.S. factory jobs to low-wage Mexico.

House Speaker Nancy Pelosi gave USMCA a green light last week after striking a deal with the Trump administration, Canada and Mexico to strengthen labor enforcement provisions and eliminate some drug patent protections.

Pelosi said she was not concerned about Democrats handing Trump a political victory on USMCA as they are trying to remove him from office.

“It would be a collateral benefit if we can come together to support America’s working families, and if the president wants to take credit, so be it,” Pelosi said during House floor debate before the vote.

CONCESSIONS FOR DEMOCRATS

The changes negotiated by Democrats, which include tighter environmental rules, will also set up a mechanism to quickly investigate labor rights abuses at Mexican factories. They have earned the support of several U.S. labor unions that have opposed NAFTA for decades.

U.S. Trade Representative Robert Lighthizer made a concession by dropping a requirement for 10 years of data exclusivity for biologic drugs, a provision that Democrats feared would keep drug prices high and that they called a “giveaway” to big drugmakers.

Some of the most ardent trade skeptics in Congress have voiced support of the deal, including Representative Debbie Dingell, who represents an autoworker-heavy district in southeastern Michigan. Dingell said in television interviews that she backed the bill, even though she was skeptical it would bring auto jobs back to Michigan.

Representative Ron Kind, a pro-trade Democrat from Wisconsin, one of the top dairy-producing states, praised new access to Canada’s closed dairy market under USMCA.

“A no vote is a return to the failed policy of the old NAFTA, the status quo, rather than this more modernized version,” Kind said in floor debate.

AUTOS, DIGITAL, CURRENCY

The agreement modernizes NAFTA, adding language that preserves the U.S. model for internet, digital services and e-commerce development, industries that did not exist when NAFTA was negotiated in the early 1990s. It eliminates some food safety barriers to U.S. farm products and contains language prohibiting currency manipulation for the first time in a trade agreement.

But the biggest changes require increased North American content in cars and trucks built in the region, to 75% from 62.5% in NAFTA, with new mandates to use North American steel and aluminum.

In addition, 40% to 45% of vehicle content must come from high-wage areas paying more than $16 an hour – namely the United States and Canada. Some vehicles assembled in Mexico mainly with components from Mexico and outside the region may not qualify for U.S. tariff-free access.

The U.S. Congressional Budget Office estimated earlier this week that automakers will pay nearly $3 billion more in tariffs over the next decade for cars and parts that will not meet the higher regional content rules.

(Reporting by David Lawder in Washington; Additional reporting by Andrea Shalal in Washington and David Ljunggren in Ottawa; Editing by Matthew Lewis and Leslie Adler)

Trump proposes rule on importing medicines which industry says won’t cut costs

By Michael Erman and Carl O’Donnell

NEW YORK (Reuters) – The Trump administration on Wednesday said it is proposing a rule to allow states to import prescription drugs from Canada, moving forward a plan announced this summer that the president has said will bring cheaper prescription drugs to Americans.

Importation of drugs from Canada as a way to lower costs for U.S. consumers has been considered for years. Alex Azar, secretary of the Department of Health and Human Services (HHS), called the move “a historic step forward in efforts to bring down drug prices and out-of-pocket costs.”

He said HHS would also offer guidance to drugmakers that wish to voluntarily bring drugs that they sell more cheaply in foreign countries into the United States for sale here.

Both pathways for importation were announced in July when Azar unveiled a “Safe Import Action Plan.”

Azar could not provide an estimate as to how soon Americans could start receiving drugs from Canada. He said the proposed rule would need to pass through a 75-day comment period before being finalized.

“We’re moving as quickly as we possibly can,” he said.

Governors of states including Florida, Maine, Colorado, Vermont and New Hampshire have already expressed an interest in importing drugs from Canada once the pathway to do so is fully in place, he said. States would be required to explain how any proposed drug imports would reduce drug prices for consumers.

The proposal faces opposition from large U.S. pharmaceutical and biotech companies.

Jim Greenwood, current head of biotech industry group BIO and a former Republican congressman, said that importation would not result in lower prices for consumers, citing nonpartisan budget experts and past FDA commissioners.

“Today’s announcement is the latest empty gesture from our elected lawmakers who want us to believe they’re serious about lowering patients’ prescription drug costs,” Greenwood said.

The Canadian government has also criticized the plan. The country’s ambassador said last month that importing medicines from Canada would not significantly lower U.S. prices. Reuters previously reported that Canada had warned U.S. officials it would oppose any import plan that might threaten the Canadian drug supply or raise costs for Canadians.

Drugs approved to be imported from Canada would exclude many prescribed drugs, such as biologic drugs, including insulin, controlled substances and intravenous drugs.

Trump, a Republican, has struggled to deliver on a pledge to lower drug prices before the November 2020 election. Healthcare costs are expected to be a major focus of the campaign by Trump and Democratic rivals vying to run against him.

The Trump administration in July scrapped an ambitious policy that would have required health insurers to pass billions of dollars in rebates they receive from drugmakers to Medicare patients.

Also in July, a federal judge struck down a Trump administration rule that would have forced pharmaceutical companies to include the wholesale prices of their drugs in television advertising.

Both the House of Representatives and the Senate are putting forth drug pricing bills that contain some of the proposals Trump has advocated, such as indexing public drug reimbursements to foreign drug costs.

But Trump has said he will veto the Democrat-led House bill if it comes to his desk on the grounds that it would slow down innovation.

(Reporting by Michael Erman and Carl O’Donnell; Editing by Leslie Adler and Nick Macfie)

Private detective investigation of Canadian billionaire couple’s death complete: police

TORONTO (Reuters) – The investigation into the deaths of a Canadian pharmaceutical billionaire couple by a private detective hired by the victims’ family has been completed, the chief homicide investigator of the Toronto police and the family said in a joint statement on Monday without revealing any of its findings.

Police reiterated on Monday that they are treating the case of Barry and Honey Sherman as a targeted double murder, Detective Sergeant Hank Idsinga told reporters. He called on the public to come forward with tips as the investigation headed by police continues.

Sherman was 75 and his wife, 70 at the time of their deaths, which stunned the worlds of Canadian business, politics and philanthropy, and drew public condolences from prominent figures including Canadian Prime Minister Justin Trudeau.

The case is “very active” Idsinga said, but he declined to provide any details of how the investigation is going or what information they have, aside from saying “we’re still combing through a lot of information.”

The private investigator’s report is being transferred to police. The Sherman family was not present at the briefing.

The Shermans were found hanging by belts from a railing next to a swimming pool at their Toronto mansion in late 2017, police have said.

Barry Sherman founded Apotex in 1974 and turned it into one of the largest generic drugmakers, earning a reputation for using lawsuits to gain access to sell cheaper generic versions of lucrative branded medicines.

He and his wife were known for their donations to hospitals, universities and Jewish organizations.

The Sherman family has criticized police handling of the deaths and hired a private investigator of their own to look into the case.

Unconfirmed media reports in the immediate wake of the deaths said that police were treating the case as a murder-suicide.

(Reporting by Anna Mehler Paperny; Editing by Bill Berkrot)

‘There’s a deal:’ Mexico says USMCA trade pact to be signed Tuesday

MEXICO CITY (Reuters) – Canada, Mexico and the United States have reached an agreement on a new North American free trade deal and they will sign it on Tuesday, but the pact still needs the approval of U.S. and Canadian lawmakers, Mexico’s president said.

President Andres Manuel Lopez Obrador said the three countries had agreed on tweaks to labor, steel and aluminum provisions in the United States-Mexico-Canada Agreement (USMCA), after U.S. Democrats pressed for changes, particularly to strengthen enforcement of new Mexican labor laws.

U.S. Trade Representative Robert Lighthizer, Canadian Deputy Prime Minister Chrystia Freeland and U.S: White House adviser Jared Kushner will take part in the signing ceremony at 1200 (1300 ET), a senior Mexican official said on Twitter.”On our end, there is now a deal. We’re convinced that it’s a good deal for Mexico, just as it is for Canada and United States,” Lopez Obrador said, adding that the signing would happen in Mexico’s historic National Palace.

“In the case of the United States, there’s a deal from the government, but we need Congress to ratify it,” Lopez Obrador said.

U.S. House Speaker Nancy Pelosi, who will hold a news conference on Tuesday morning, has said the deal is close to being finalized.

(Reporting by Daina Beth Solomon and Abraham Gonzalez, Editing by Frank Jack Daniel)

In gesture to Trump, US allies close to deal to pay more for NATO running costs

By Robin Emmott

BRUSSELS (Reuters) – NATO allies are closing in on a deal to contribute more to allied running costs to reduce the United States’ share of funding, three diplomats familiar with the matter said.

Agreement would meet a demand by U.S. President Donald Trump, though France has made clear it will have no part in the deal, which the alliance hopes to reach before its 70th anniversary summit in London next week.

Trump has accused European allies, especially Europe’s biggest economy Germany, of taking U.S. protection for granted and says they need to spend much more on their own defense.

The reform of financing for the U.S.-led military alliance would seal months of negotiations after NATO Secretary-General Jens Stoltenberg put forward a proposal.

The agreement would mean European allies, Turkey and Canada contribute more towards the annual $2.5-billion budget to run the North Atlantic Treaty Organisation headquarters, international staff and military assets under NATO command.

Compared to the hundreds of billions of dollars that allies spend on their armed forces each year, it is a small sum. But it is one that allies hope would silence Trump’s statement in July 2018 that the United States “pays tens of billions of dollars too much to subsidize Europe”.

“It is a political gesture,” one senior NATO diplomat of the possible deal. “There is no alliance without the Americans.”

France opposed the proposal long before President Emmanuel Macron described the alliance on Nov. 7 as “experiencing brain death”, French diplomats have said.

With 30,000 troops deployed and ships across the world, Paris says it already does more than its fair share in defense, maintaining a high level of combat readiness of French forces and pouring billions of euros into defense research.

Paris will not block the proposal, but will abstain, the three NATO diplomats said.

France’s defense spending is higher than Germany’s as a percentage of economic output, data shows. Paris says it will also meet a NATO target to spend 2% of national output on defense by 2025 at the latest, while Germany will reach that level only in 2031, according to French and German officials.

NUMBERS GAME

Canada has said its support for the funding agreement should not set a precedent for other international organizations, the diplomats said. Italy has yet to decide its position, they said.

All 29 NATO member states contribute to the budget on an agreed formula based on gross national income, but this formula would change after the proposed reform.

“It will be a more cumbersome mechanism,” a second NATO diplomat said.

Under the proposal being negotiated for the 2021 budget, the U.S. contribution to the alliance’s annual budget would fall to around 16% from 22%. Germany’s would rise to the same level as the United States and others’ contributions would also rise.

Only seven NATO countries currently meet or exceed the NATO target of spending 2% of national output on defense – the United States, Britain, Greece, Poland, Latvia, Lithuania and Estonia.

(Editing by Timothy Heritage)

China envoy warns of ‘very bad damage’ if Canada follows U.S. lead on Hong Kong

OTTAWA (Reuters) – China’s new ambassador to Canada on Friday warned Ottawa not to follow the U.S. lead and formally back protesters in Hong Kong, saying such a move would cause “very bad damage” to already poor ties with Beijing.

Canada, which has been locked in a trade and diplomatic dispute with China, has repeatedly expressed concern about the safety of its 300,000 citizens in Hong Kong, hit by five months of mass demonstrations for more democracy and autonomy.

The U.S. House of Representatives on Wednesday passed two bills to back the protesters and send a warning to China about human rights.

“If somebody here really tries to … have this kind of law like that in the United States, it’s very dangerous,” said Chinese envoy Cong Peiwu, speaking in English.

“If anything happens like this it will certainly have a very bad damage on our bilateral relationship and that is not in the interests of Canada,” he told a news conference in the embassy. He formally presented his credentials on Nov 1.

The uncompromising tone of his message indicated that while the ambassador may have changed, China’s approach has not.

Cong repeated Beijing’s demand that Canada immediately release Huawei Technologies Co Ltd Chief Financial Officer Meng Wanzhou, who is out on bail after Canadian police detained her on a U.S. arrest warrant last December.

“This incident has led to the severe difficulties the two countries are facing nowadays,” said Cong.

Shortly after Meng’s arrest, China picked up two Canadian citizens on state secret charges, and has since blocked imports of canola seed from Canada.

Prime Minister Justin Trudeau, asked on Wednesday what additional measures Canada would take to protect its citizens in Hong Kong, said “we will continue to call for de-escalation and an end to violence” while urging dialogue.

If Canada wanted to protect its citizens, it should ask “those rioters to stop the violence, otherwise those Canadians living in Hong Kong, how can they be safe?” Cong said.

(Reporting by David Ljunggren; Editing by Bill Berkrot)

Deaths, bad outcomes elude scrutiny at Canada’s indigenous clinics

Deaths, bad outcomes elude scrutiny at Canada’s indigenous clinics
By Allison Martell

TORONTO (Reuters) – Ina Matawapit was barely conscious – intoxicated and suffering from a blow to the head – when police drove her to the North Caribou Lake clinic in Ontario, Canada, one summer evening in 2012.

The nurse at the federal government-run clinic, the only source of emergency care in this remote indigenous community, told the officers the 37-year-old could sober up in jail, according to testimony at a 2018 inquest. Minutes after leaving the clinic, the police sped back. Matawapit had no pulse and could not be revived.

At the inquest, the nurse testified that in sending Matawapit on to jail, she had been following a standard protocol for intoxicated patients in the northern reserves. Government officials testified there was no such thing.

The coroner found that in the nearly six years between the death and the inquest, there was no evidence of any formal review of the case “or any learning from the events of that evening” akin to typical procedures in hospitals or emergency rooms. Matawapit’s death, attributed to heart disease, likely would have passed under the radar but for the fact that she died in police custody, which made the inquest mandatory.

Over at least nine years, the Canadian federal government has not consistently tracked, let alone investigated, poor outcomes at clinics on indigenous reserves, according to a Reuters analysis of documents, including internal reports and meeting notes obtained through public records requests.

Record-keeping on deaths and other critical incidents at the clinics, which provide basic and emergency care to about 115,000 people, has been erratic and fragmented, Reuters found. The incidents often are detailed in separate provincial computer systems, when they are tracked or reported at all.

As a result, there is no way for the federal government to know how often patients die or suffer injury at the clinics or how that compares to the rest of the Canadian health system.

The federal government’s First Nations and Inuit Health Branch (FNIHB), which funds 79 clinics and manages 50 of them, is hampered in identifying potentially harmful patterns and preventing future mistakes, documents and interviews with medical experts indicate.

Whether turning away apparently intoxicated patients in the northern reserves – described in the coroner’s verdict as the “northern protocol”- has been a widespread practice is difficult to say. Reuters was able to find one other similar death, detailed in Manitoba police records, that occurred five months after Matawapit’s. The federal government enacted a policy saying it was “not appropriate” to hold intoxicated patients in cells – but only after last year’s inquest brought the issue to light.

Reuters’ findings come as the country is in the midst of a public reckoning with the legacy of settler colonization, a hotter issue today than in nations such as the United States and Australia where European settlers also displaced local peoples.

With an indigenous population that is growing and gaining political clout, Prime Minster Justin Trudeau came to power in 2015 promising “reconciliation” with aboriginal people. Reduced to a minority government in this week’s election, he needs the support of other parties to govern and will face pressure from the left to address poverty, poor housing and health problems that are especially acute on remote reserves.

It will not be an easy task. Even reviewing critical health care incidents could be a challenge because of the multiple jurisdictions and providers involved, said Michael Green, a professor at Queen’s University who was once chief of staff at a small northern hospital that often received patients from clinics in indigenous communities.

But “without review, there’s no opportunity to learn and make the system safer for everybody,” he said.

Staff at FNIHB, part of Indigenous Services Canada, say they strive to provide the best possible care and have been working on a replacement reporting system, slated to roll out next year.

The effort, which documents show began in 2014, has been planned behind closed doors and has not previously been reported, although pilot programs are running in Manitoba and Alberta.

Documents reviewed by Reuters indicate the system is designed to provide national case tracking and a consistent process for investigating and following up on cases.

Robin Buckland, executive director of primary healthcare at FNIHB, said the current system is “not a bad policy” but the agency is working to build an environment in which staff members can learn.

“It’s taken a long time,” she said. “But we want it to be right, and we want to implement it well.”

Reuters was not able to reach the nurses involved in treatment described in this story.

“We truly believe that nurses are working hard to deliver the best health care possible, under difficult work conditions,” said Debi Daviau, president of the Professional Institute of the Public Service of Canada, which represents permanent staff nurses and other civil servants.

‘SECOND-CLASS CITIZENS’

For years, indigenous communities have complained about poor treatment on remote reserves, which are often hundreds of miles from top-tier or specialized medical services in major cities. Matawapit died in a community more than 300 km (186 miles) from the nearest major highway.

For a map of reserves see: https://tmsnrt.rs/32uE3yk

These federally funded clinics, usually called nursing stations, struggle to retain nurses, often filling gaps with the help of private staffing agencies.

Services there need more government scrutiny, not less, some critics say.

“We are treating members of the First Nations communities as second-class citizens,” said Emily Hill, a senior staff lawyer with Aboriginal Legal Services, which represented the Matawapit family at the inquest. “This is a large government health service. You would expect there to be layers of oversight and accountability.”

Documents reviewed by Reuters show FNIHB staffers have repeatedly called for a modern reporting system for poor or unexpected outcomes.

The FNIHB started to track critical incidents in 2006. By 2010, however, a federal audit found that “monitoring and analysis at both the national and regional level is not occurring.”

Four years later, a FNIHB working group said that a common national policy was needed with “clear processes for reporting and tracking” incidents, according to meeting notes reviewed by Reuters.

In 2016, an internal report by a member of the working group looked at how other public organizations, including federal prisons, reviewed outcomes. Every policy was found to be more “robust” than the one at FNIHB.

The report, reviewed by Reuters, said that while some patient safety incidents had been recorded in a national database between 2006 and 2014, regions had stopped using it because of the difficulty in collecting data.

Federal policy focused mainly on nurses’ well-being, not patients’, the report said.

The nurse at the Matawapit inquest illustrated that point, testifying that a debriefing after the patient’s death was geared “more to how we were feeling as opposed to what we did.”

A SIMILAR DEATH

On November 28, 2012, the Royal Canadian Mounted Police in God’s Lake Narrows, Manitoba, responded to a report that Tracy Okemow, 31, was drinking and threatening suicide. Police found her next to two empty pill bottles labeled “metformin,” a diabetes drug, according to a police review of the incident seen by Reuters. She agreed to go to the local nursing station.

The nurses told officers they had consulted with a doctor off the reserve who felt her “consumption of medication was not of concern and she could be incarcerated until sober,” according to the police report.

Okemow spent the night in jail. A witness later told police that she seemed to be in agony. In the morning, she was flown to a Winnipeg hospital, where she died the next day of metformin toxicity, the report said.

There was no inquest or federal inquiry. “In the case of Ms. Okemow, the death occurred outside of a federally operated facility – therefore FNIHB did not undertake a formal review,” Indigenous Services Canada said in a statement.

Off reserve, healthcare is under provincial jurisdiction.

‘THEY BRUSH US OFF’

The federal government has reviewed some patient deaths, often after they draw media attention. Documents reviewed by Reuters show officials have found serious systemic problems, including nurses who are stretched thin and do not always appreciate the seriousness of patients’ symptoms.

After two children died from complications of strep infections in 2014, an internal review looked at a “sampling” of young people who had died, and called for better recruitment and retention of nurses, as well as more physician services.

A 2018 review looked at a 15-month-old toddler seen on a Saturday night for a seizure and infections. The nurse on duty did not consult a doctor, and the child died the next day. The report called for better oversight of nurses, as well as changes to shifts and staffing to address fatigue.

FNIHB’s Buckland said the agency is working to improve hiring and retention amid a global shortage of healthcare workers.

In Manitoba, the family of Tyson McKay is suing the federal government, alleging that the 32-year-old man died of a heart attack 31 hours after visiting a clinic complaining of chest pain in 2015. The suit alleges the nurse did not perform the appropriate tests that could have diagnosed his condition.

In a court filing, the government said a staffing agency was responsible for ensuring the nurse was qualified. The staffing agency defended its care and referred questions to the government.

Kelvin McKay, Tyson’s 41-year-old brother, has been going to the clinics since childhood. He said he sees a pattern.

“Nurses come in and out of our community, and they fail to take the time to get to know our people, and they think we come in with fake illnesses. They brush us off. And that’s not how it’s supposed to be.”

For a graphic on clinics on indigenous reserves often distant from major cities, click https://graphics.reuters.com/CANADA-HEALTH-NURSINGSTATIONS/0100B2H81S6/canada-map.jpg

(This story refiles to add dropped word in paragraph nine)

(Additional reporting by Rod Nickel in Winnipeg; Editing by Denny Thomas and Julie Marquis)

Neurotoxin may have caused diplomats’ illness in Cuba: study

HAVANA (Reuters) – Fumigation against mosquitoes in Cuba and not “sonic attacks” may have caused some 40 U.S. and Canadian diplomats and family members in Havana to fall ill, according to a new study commissioned by the Canadian government.

The incidents took place from late 2016 into 2018, causing the administration of U.S. President Donald Trump to charge that diplomats were attacked by some sort of secret weapon. Canada has refrained from such charges.

The United States in 2017 reduced its embassy staff to a minimum and Canada followed more recently, citing the incidents and the danger posed to staff from what has become known as the “Havana Syndrome.”

Various scientific studies have yet to identify the cause of the diplomats’ cognitive ailments, ranging from dizziness and blurred vision to memory loss and difficulty concentrating.

The Canadian study by a team of researchers affiliated with the Brain Repair Centre at Dalhousie University and the Nova Scotia Health Authority studied Canadian victims and even the brain of a pet dog after its demise in Canada.

The study was the first to include diplomats for whom there was baseline medical testing from before their postings in Havana, so as to better compare with the tests from afterwards. Canada started implementing the practice after diplomats first started complaining of sickness.

The researchers said they had detected different levels of brain damage in an area that causes symptoms reported by the diplomats and which is susceptible to neurotoxins. They then concluded that cholinesterase, a key enzyme required for the proper functioning of the nervous system, was being blocked there.

Some pesticides work by inhibiting cholinesterase, the report said, and during the 2016-2018 period when diplomats became ill normal fumigation in Cuba was stepped up due to the Zika epidemic in the Caribbean.

The report said the diplomats’ illnesses coincided with increased fumigation in and around residences where they lived. One of the authors of the study, Professor Alon Friedman, clarified in an email to Reuters that both Canadian and Cuban authorities were fumigating.

“We report the clinical, imaging and biochemical evidence consistent with the hypothesis of over-exposure to cholinesterase inhibitors as the cause of brain injury,” the study concluded while cautioning that other causes could not be ruled out and more study was needed.

Friedman said it was not clear whether the broader Cuban population was affected by the fumigation and if not, why, but his team was planning a further study on this together with Cuban scientists.

(Reporting by Marc Frank; Editing by Leslie Adler)