Committee Transcript 2000-Dec-11 | Legislative Assembly of Ontario

Chair / Président
Mr Steve Gilchrist (Scarborough East / -Est PC)

Vice-Chair / Vice-Présidente
Mrs Julia Munro (York North / -Nord PC)

Mr Toby Barrett (Norfolk PC)
Mrs Marie Bountrogianni (Hamilton Mountain L)
Mr Ted Chudleigh (Halton PC)
Mr Garfield Dunlop (Simcoe North / -Nord PC)
Mr Steve Gilchrist (Scarborough East / -Est PC)
Mr Dave Levac (Brant L)
Mr Rosario Marchese (Trinity-Spadina ND)
Mrs Julia Munro (York North / -Nord PC)

Substitutions / Membres remplaçants
Mr Brad Clark (Stoney Creek PC)
Mr Monte Kwinter (York Centre L)

Clerk / Greffière
Ms Anne Stokes

Staff /Personnel
Ms Lorraine Luski, research officer,
Research and Information Services

The committee met at 1531 in committee room 1.

MEDICINE AMENDMENT ACT, 1999 / LOI DE 1999 MODIFIANT LA LOI SUR LES MÉDECINS

Consideration of Bill 2, An Act to amend the Medicine Act, 1991 / Projet de loi 2, Loi modifiant la Loi de 1991 sur les médecins.

The Chair (Mr Steve Gilchrist): Good afternoon. I call the committee to order for public hearings and clause-by-clause consideration of Bill 2, An Act to amend the Medicine Act, 1991. Mr Kwinter was up first but he's indicated he'd prefer to have a few words at the tail end to record comments. So our first presenters will be Citizens for Choice in Health Care.

Interruption.

The Chair: Not a problem. You can inform the clerk when your colleague-on the assumption we have someone to take your place.

CONSUMER HEALTH ORGANIZATION OF CANADA

The Chair: Are the folks from the Consumer Health Organization with us here? Excellent. If they could join us at the witness table here. Good afternoon, welcome to the committee. We have 10 minutes for your presentation, to divide as you see fit between either a presentation or a question-and-answer period.

Mr Marcel Wolfe: Ladies and gentlemen, on behalf of the Consumer Health Organization of Canada and its members, we wish to express our support for Bill 2, also known as the Kwinter bill.

This organization has supported the Kwinter bill since its inception more than three years ago, and our members have written thousands of letters of support whenever this bill came up for debate in the Ontario Legislature. The basic principles on which this bill is founded are central to Canadian thinking. We believe in human rights. That's why we, as a nation, signed the Helsinki accord in 1989.

We also believe in medical science. That's why Canadians have, ever since Sir William Osler a century and a half ago, contributed so greatly on the international scene to the advancement of medicine. We also believe in our health care system. Without the kind of protection Bill 2 is intended to provide for the freedom of medical practice and the freedom to choose the treatment that works best for the individual, Canada will not be able to continue to be a leader in science and a protector of human rights. Without personal choice in health care modalities, no competition among therapies will be fostered and both science and the patient will suffer.

Tragically, so many excellent Ontario doctors leave Canada for the US and other countries, many because they are tired of the arbitrary prosecutions by the College of Physicians and Surgeons of Ontario, who seem to fear excellence and innovation in medicine. We have a shortage of doctors, and our medical climate lacks innovation. Even more tragically, many excellent doctors, without patient complaints against them, have actually had to fight for their licences, sometimes losing that fight only because they were practising innovative and internationally recognized medicine.

The press has covered the astonishing cases of Drs Jozef Krop, Frank Adams, Sukhdev Kooner, Gerry Green, Felix Ravikovich and so many others over the last decade. All of them are doctors of excellence for whom their grateful patients have fought big fights in the press and with the governments. We have covered these cases in our publications extensively. Indeed, it was Dr Green's use of nutritional medicine in conjunction with traditional cancer therapy that caused him to lose his medical licence; and it was through Dr Green that MPP Monte Kwinter learned of the great need for Bill 2 to become part of the Medicine Act of Ontario.

On behalf of our members and all those Canadians who demand freedom of choice in health care as a basic human right, and who agreed to Canada signing the Helsinki accord more than a decade ago, we urge you to pass Bill 2 as soon as possible. It is badly needed and very timely.

The Chair: That leaves us time for questions, if you wish. The rotation will start with the Liberals.

Mr Monte Kwinter (York Centre): Thank you very much for your presentation.

I think that I'd like to really put into the record at a very early stage in this proceeding that, to my knowledge, the only opponent to this bill historically has been the College of Physicians and Surgeons. You've alluded to the problems that these various doctors have had with them. I think it's quite significant that when the clerk contacted their representatives, they declined to come to the meeting, indicating that they had no problem with the bill, which was a relatively dramatic change, not in the short term but in the long term, because when I first introduced this bill in 1997, they were quite opposed.

What has happened, of course-and I think we're going to hear from the Ontario Medical Association-is that they now have a section on alternative or complementary medicine and it has been given permanent status. So things have changed quite dramatically and I think they've changed because of organizations like yours. I want to thank you for that.

Mr Wolfe: Thank you. We are solely dedicated to educating the public and it is due to the public's increased awareness that a lot of the positive changes that are needed are going to be taking place.

Mr Brad Clark (Stoney Creek): The way the act that Mr Kwinter has put forward is worded now-I'm reading the actual wording from it and then I read in your documentation about this one particular case where the individual doctor's use of nutritional medicine in conjunction with traditional cancer therapy caused him to lose his medical licence.

Now, I don't know all of the details of that particular case but I'm wondering whether or not this section couldn't be used in the exact same way by the College of Physicians and Surgeons as it is written here. They've added the terminology "solely" to the section, "on the basis that the member practises a therapy that is non-traditional or that departs from the prevailing...." There's a comparison. At what point does it become the judgment call in terms of what actually failed the patient?

Mr Wolfe: Again, I don't know specifically the case in detail, but I'm sure that it's all a matter of record.

The Chair: Thank you very much for taking the time to come before us here this afternoon. We appreciate your comments.

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GATEKEEPERS OF HEALTH

The Chair: Gatekeepers of Health, you're up next, if you're prepared. Welcome to the committee.

Dr Aileen Burford-Mason: A word about Gatekeepers, first of all. We are an issues-driven consumers group that was formed in 1997 to lobby for freedom of choice and access to reliable, safe and affordable complementary medicine and therapies, practitioners and health care products. We were actually driven by the issues that were related to the natural health care product controversy at the time. Our name, Gatekeepers, reflects our interest in extending the rights and freedoms of individuals to choose health care options which they believe will promote and maintain their own optimal health status. That is why we support Bill 2.

I might add that none of the surveys suggest these therapies are used solely. If you look at the opinion polls, as well as at the academic surveys that have been done on the use of non-traditional medical therapies, they are used in conjunction with mainstream medicine. Only about 5% of the population ever use them as alternatives, so "complementary" is perhaps a better term.

Therapies like acupuncture, chiropractic, homeopathy, vitamin and mineral therapy and herbal treatments are growing in popularity. The latest estimate is that about 50% of Canadians are using these therapies. The reasons they use them are that they consider them to be safer, gentler and more natural, with fewer side effects than conventional medical care, or because they have failed to respond to conventional medical care for ongoing chronic problems. That is well documented.

The medical profession has been generally skeptical about the benefits of these treatments and, therefore, have taken up a position where they have fought the use of such modalities by their own members. The College of Physicians and Surgeons of Ontario has a long-standing history, as we've just heard, of disciplining doctors who use complementary and alternative practices. I personally know some very fine people who decided not even to stand up to the college in terms of the disciplinary hearings, but just to give up practising medicine. Certainly in Toronto we lost a number of good people that way. Most of the cases in recent years have involved doctors who have been fervently supported by their patients. Nonetheless, the College of Physicians and Surgeons appears to have pursued these doctors with almost fanatical zeal. We feel there is such a polarization of viewpoints that it's worthwhile trying to understand what is at the root of this polarization.

I think there are two reasons there is a polarization in terms of the allopathical, the conventional or traditional medical care and those doctors who want to use both. The new buzz term is integrative health care, where we integrate both types of medicine, doctors who want to use mainstream medicine alongside some of these new, and many of them very old, therapies. The mainstream conventional doctors say that these practices are not proven, that there's no convincing evidence they work or they're safe. That's their first argument. The second argument they put forward is they say the biological basis-maybe I should have explained beforehand that I'm a PhD immunologist with a background in medical health care research, and I also am director of scientific affairs for the Acupuncture Foundation of Canada, so I'm very familiar with these arguments. The other argument is that we don't know how these things work, therefore they can't work and we're like to stop them happening.

We at Gatekeepers believe both those arguments are untenable. We believe that healthy skepticism is important in an evolving health care system, as we have at the moment, but that some of the arguments are not rational. That's where we're concerned and that's where a Bill 2 would fit in: when the response to the use of non-traditional therapies becomes irrational.

There are two particular points we'd like to make. First of all, we live in a very highly multicultural society in Toronto. We have representatives of every nation on earth, and many of what we call non-traditional are actually traditional in those societies. They have a long history of use.

But even within western medicine, there's no standard medical scientific practice. If we look at the simple examples I have listed, in Germany herbal medicines are frequently used as a first line, and it's only when herbal medicines don't work that they turn to pharmaceutical drugs. Recently there's been a lot of research looking at the evidence for something like St John's Wort, which they have always used as a first-line treatment for depression. Sure enough, when you put it to the test, it is as good as pharmaceutical drugs but has fewer side effects. The evidence and the reference is in there.

Homeopathy in the UK: there are six hospitals in the UK that are supported by the National Health Service. Family physicians can refer their patients to those hospitals, and those hospitals cover the full spectrum of medical specialties from allergy treatment to behaviour problems to adjuvant treatment following cancer therapy, surgery etc. The hospitals are free to patients and they're funded by the National Health Service.

An issue we had in Ontario: for some of the doctors who were censored by the College of Physicians and Surgeons, one of the rationales for censoring them was that they suggested mercury amalgam in fillings was not a good idea and might be detrimental to health. Sweden has banned mercury amalgam since 1994, but the College of Physicians and Surgeons was still listing this as an acceptable practice for doctors to be recommending to their patients, rather than that they don't have mercury amalgam or that they have mercury amalgam they already have in their mouth removed.

The other point we want to make is that there is an awful lot of good research out there that tends to get lost in the information explosion. We have an unprecedented explosion of information. The first time I came to Toronto-I didn't live here-was in 1986 when I came to an immunology conference. There were 7,000 of us here. We were told then in 1986 that there were 2,000 new papers a day being published that were relevant to us. This is becoming a major problem, that you can have traditional doctors saying there is no evidence, but they don't know how to search for the evidence and they perhaps don't even know how to evaluate it when they do come across it.

There's an enormous amount of good research in the literature that is not being pulled together. Fortunately the people who are accessing it are patients. They are going through all sorts of resources like libraries, the Internet and the media. They are looking at many of these good peer-reviewed studies and are going to their doctors with them. So the pressure is for the doctors. We cannot say there is not good evidence for some of these modalities, nor can we say we don't really understand the biological rationale, because that's not a good enough argument.

We had a study published last year done by some Italian doctors, where they looked at something called moxibustion which is the burning of a herb on an acupuncture point to turn breech-birth babies rather than manual turning, which our traditional doctors do. They burn a herb on a point near the nail of the little toe, and when these Italian doctors-not Chinese doctors-set up studies comparing manual turning and moxibustion for breech births, the moxibustion won hands down. So just because we don't understand something doesn't mean to say it doesn't work. The fact of the matter is the public is going to all sorts of alternative resources. They need doctors who are prepared to take the time to find the information, to actually bring together the body of knowledge, to pursue research in alternative and complementary medicine.

With an amendment like the one in Bill 2, we at least have protection for doctors who are prepared to take a non-traditional look. We hope, at Gatekeepers, that with the adoption of this bill we will have more open-mindedness, that we will exclude irrational prejudice and that there will be a greater emphasis on preventive health care.

As consumers who value their access to complementary and alternative practitioners as well as to top-quality conventional medicine, Gatekeepers of Health feel that Bill 2 is a good first step to ensuring that practitioners who are open to the possibilities of health care practices from other cultures and perhaps even other times, and who carry out those practices with due regard for the safety and health of their patients, remain free to do so. We support the bill as in the papers.

The Chair: Thank you very much. That's slightly over the 10 minutes, but we certainly wanted you to able to-

Dr Burford-Mason: Sorry.

The Chair: No, that's fine. That's the advantage of having a handout. We could follow along and knew you were getting near the end. Thank you very much for taking the time to make your presentation before us here today.

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JANE BALLOW

The Chair: Our next presenter will be Jane Ballow. Good afternoon. Welcome to the committee.

Ms Jane Ballow: Ladies and gentlemen, I am Jane Ballow, a member of a recently formed group, Friends and Patients of Dr Frank Adams. We are a group of chronic pain sufferers who finally found help with our excruciating pain when we found Dr Frank Adams. I am here to speak without prejudice in support of Bill 2, not only on behalf of the group but myself as well.

Bill 2 puts into Ontario law the principle of human rights as they affect doctors and patients and the practice of medicine. I understand that in 1989, Canada's Minister of Foreign Affairs signed the World Health Organization's Helsinki agreement, which spells out the essence of Bill 2. This agreement was signed on behalf of all Canadians. I find it very interesting that the College of Physicians and Surgeons of Ontario, the CPSO, has disregarded these principles and needs the enactment of this bill. This agreement should have been adopted as merely a matter of course at that time. Since the essence of Bill 2 was good enough for Canada's representative and the world to sanction, surely Ontario could have no reservation in incorporating it into the existing laws governing medical practice in this province.

On October 4 of this year, Dr Frank Adams, an internationally known and well-respected pain specialist of Kingston, had his licence suspended by the CPSO. Dr Adams has the knowledge and the skill and was practising within the World Health Organization guidelines for non-malignant chronic pain management, and still the CPSO disregarded this and suspended his licence. Not one patient had complained. No patient was proven harmed at Dr Adams's hearing. Dr Adams, as one of Canada's recognized authorities on pain management, helped formulate the pain guidelines for the World Health Organization and for the federation of medical licensing boards of the United States.

The mandate of the CPSO is to serve and protect the public and to guide the profession. I feel assured it was established with all good intentions, but it has lost its focus. It is failing not only the public but also the profession. Due to fear of the CPSO, many doctors are reluctant to use any, let alone non-traditional, means of alleviating pain. When Dr Adams's licence was suspended, approximately 200 of his former patients were left without a doctor, without medication and without anywhere to turn for the quality of care, the expertise and the compassion that he, our world leader in chronic pain management, afforded us.

The CPSO registrar, Dr John Bonn, on Michael Enright's Sunday Edition of October 22, 2000, wanted the public to be well assured that we, Dr Adams's patients, were being cared for. This is not true. After Dr Adams's suspension, I personally called the CPSO, asking for the name of an Ontario doctor who would help me with my pain management. I was shifted from one person to the next and was finally told it was not the job of the CPSO to help me find a doctor, and my call was disconnected. I can only conclude from the cavalier handling of this simple request that the CPSO is not interested in helping chronic pain patients like me.

The CPSO claims that opioid use is addictive in chronic pain patients, even though recent research has proven that we are no more likely to be addicted than the general public. The CPSO appears to disregard this fear of addiction in cancer patients because they are terminally ill. Are we any less sensitive to excruciating pain than they are? Why should chronic pain sufferers be doomed to a life of pain because the CPSO arbitrarily chooses to disregard international standards of pain management? Why should the CPSO be so self-serving to its own prejudices that it sentences us to a life of continuous suffering? Why aren't we worthy of better treatment? Why aren't our rights being addressed?

Bill 2 is long overdue. It should have been passed long ago to prevent the unfair persecution of doctors who are practising the excellence and the advancement of medicine. Bill 2 will go a long way in stopping turf wars, power struggles and sheer ignorance from contaminating the doctor-patient relationship.

While it is my belief that Ontario likes to perceive itself as the province in Canada that is on the cutting edge, it is certainly not so in this arena of medicine. Nova Scotia has already adopted the World Health Organization pain guidelines. In 1996 the Alberta Legislature enacted legislation that "allows Alberta doctors to perform any alternative therapy provided that it cannot be proven to do more harm than conventional drug and surgical treatments." All three readings were passed on the same day. Yet in Ontario doctors stand to lose their licences to practise pain medicine even if they follow the World Health Organization guidelines on pain management. I know this is true because our doctors have told me and many members of our group that they were afraid of repercussions from the CPSO and its attitude toward the prescribing of opioids for chronic pain.

We know through pain management expert Dr Peter Rothbart of the Ontario Medical Association that pain doctors are especially targeted for harassment by the CPSO because of its outdated attitudes toward pain medications. Why is the CPSO so far behind and out of touch in pain management? How could it suspend the licence of such a well-known and well respected doctor as Dr Adams? An action like this is stifling the doctors of Ontario in their ability to deal not only with chronic pain sufferers, but I have to assume other areas of medicine too.

The human rights of patients appear to be of no interest to the CPSO and they have stated, "Patient outcome is not relevant." I like to think that if a patient who has been denied proper medication should happen to die, then patient outcome world be quite relevant. Some of Dr Adams's patients might be suicidal because the rate of suicide in chronic pain sufferers is higher than in the general population.

Medication that has been in existence for many years is available. It will ease our suffering, thus allowing us to function more normally, not only as family members but as members of the community at large. The CPSO has failed Dr Adams's patients abominably. I feel the CPSO would better protect us if they allowed doctors like Dr Adams to monitor our medications rather than have us self-medicate on large amounts of legal substances like over-the-counter drugs, or alcohol, or maybe even other substances of a less legal nature or a mixture of any or all of the above.

Dr Adams's patients have been left with drastically reduced amounts of medication and many have been left to go off their medication cold turkey, which any pharmacist will tell you is not wise. I feel this is not only unjust, but shows a real lack of foresight on behalf of the CPSO. What is the matter with the CPSO?

Please give us Bill 2 to allow our physicians the freedom to prescribe effectively for our needs and to explore, within sensible and safe guidelines, all avenues of pain management without fear of the CPSO.

The CPSO claims it is protecting us. It cannot protect the public from something if it isn't first doing something for us, if it isn't first servicing our needs. The government has an obligation to the public. It must get to the root of this large provincial problem. It must ensure that the CPSO fulfills its mandate to serve and to protect the public and to guide the profession by "considering first the well-being of the patient."

The Minister of Health and Long-Term Care has the duty to ensure the public is treated with sensitivity and respect. Where is the sensitivity to my, my group's or the public's needs?

It is my hope, as a chronic pain sufferer of 11 years, that the government of Ontario will see fit to pass Bill 2 in an expeditious manner. By doing this, persons like myself and the public will be able to receive proper treatment and have our medical needs served. Let the government of Ontario ensure our rights to personal, professional and progressive medical treatment. Pass Bill 2.

The Chair: You, too, have timed your presentation on the button. Thank you very much for taking the time to come before us here today.

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CITIZENS FOR CHOICE IN HEALTH CARE

The Chair: I am told that both parties of the Citizens for Choice in Health Care are now with us, if they'd like to come forward. Good afternoon and welcome to the committee.

Mr Bruce Lofquist: We're making this submission in support of the Act to amend the Medicine Act, in particular in support of Bill 2, commonly known as the Kwinter bill.

Eleanor and myself are both members of Citizens for Choice in Health Care, a public interest organization. We focused our work on attempting to ensure that people have freedom of choice in health care in terms of both products and services.

"This government is determined to make Ontario a place where new ideas and innovations are encouraged." In other contexts the government has emphasized the importance of encouraging new ideas and innovations. This is an important aspect of the Kwinter bill, in addition to protecting freedom of choice and fairness for both physicians and patients concerned with safe and effective therapies that depart from the prevailing medical practice.

Similar choice-in-health-care legislation is already in place in Alberta and eight American states: Alaska, Washington, North Carolina, Oklahoma, our neighbour New York state, Oregon, Georgia, and Colorado.

The Helsinki accord on human rights, signed by Canada in 1989, made provision that such choices of new diagnostic and therapeutic measures be available. Passage of Bi11 2 is necessary to make Ontario legislation consistent with the intent of the Helsinki accord.

Bill 2 is consistent with the objectives of the health professions legislation review process that lead to the current regulatory system, including the RHPA and the Medicine Act.

Status quo thinking can be enforced by using the inherent bias of the current regulatory system. Physicians are judged by how well they maintain the unwritten standard of practice of the profession as interpreted by experts of the CPSO's choosing. The choice of experts is crucial. By definition, approaches that depart from the prevailing medical practice are not considered standard by mainstream physicians regardless of how good a patient outcome they achieve. Positive patient outcome is therefore essentially irrelevant to the CPSO. It would not be fair to a physician to hold him or her responsible for the outcome of the inevitable progression of terminal cancer or unavoidable side effects of chemotherapy if he or she had provided a high standard of practice of conventional care. Likewise, it would be extremely unfair to physicians, patients and progress in medicine to find a physician incompetent for failing to maintain the standard of practice when the physician is achieving good patient outcomes using safe and effective innovative approaches. If true peers, that is physicians with expertise in the relevant areas of medicine, are selected to do the assessing, a fair assessment is possible.

The discipline process can be misused to settle differences of scientific approach that should be reviewed in broadly based, ongoing professional discussion and weighing of ideas by knowledgeable peers. A discipline hearing is not a level playing field or an avenue to deal with turf wars.

Despite the inherent bias of the system, we are not at present aware of serious problems of this nature at colleges other than the CPSO.

The CPSO's actions in a number of cases have shown very serious procedural improprieties that CCHC believes threaten all physicians and patients concerned with innovative approaches and seriously undermine public trust in the regulation of the health care system. CCHC sponsored a press conference on May 10, 2000, at which Michael Code, former assistant Deputy Attorney General, criminal law, described his findings after reviewing nine cases of CPSO's investigations against physicians. A transcript of Mr Code's comments at the press conference is attached.

Serving and protecting the public interest should include serving and protecting the interests of those whose medical needs are not met by current prevailing medical practice. Medicine does not yet have effective treatments for many conditions and therefore must have a climate open to new ideas, a climate that allows physicians to assist patients now, while research continues searching for better answers. Patients are willing to pay for such treatments because they are pleased with the results. Patients do not want to be protected from accessing safe and effective therapies that meet their needs or to be forced to go outside of Ontario to receive such care, with further inconvenience and expense.

Methods that depart from the prevailing medical practice are particularly important to patients with chronic conditions which represent an important sector in health care.

Should complementary or alternative medicine be available from physicians? This of course is a rhetorical question. Complementary or alternative medicine covers a very broad range of approaches, in effect everything that is not conventional, and much of it is practised by lay people. From this broad wage of approaches physicians responsibly select, based on training and available research, those therapies they judge may be helpful to offer patients in particular circumstances in conjunction with conventional care. There is increasing professional interest and research in complementary areas. Eventually some complementary ideas or therapies may become mainstream.

Complementary therapies are within medicine's scope of practice. Scope-of-practice statements are very broad. However, not all practitioners would choose to acquire skill in and use all possible therapies, just as not all physicians choose to be neurosurgeons. Scope statements are usually read in conjunction with the controlled acts that a profession is authorized to use. The medicine scope and list of controlled acts is substantially different from those proposed for the regulation of naturopathy. We do not understand how the Health Professions Regulatory Advisory Council's report on naturopathy would be particularly relevant in considering the passage of Bill 2.

Some complementary therapies are available only from physicians. Other health professionals are not allowed as broad a range of controlled acts. Physicians practising orthopaedic medicine and environmental medicine both involve controlled acts 1, 5 and 8, and environmental medicine also act 12. Clearly patients could not get such care from non-physicians.

Guidelines and training programs from relevant professional organizations are important in advancing knowledge and promoting high quality of care. Many, however, are outside Canada and have been arbitrarily rejected by the CPSO.

Provisions for safeguarding high standards of care and professional conduct already exist in the current professional misconduct regulations-if a true peer, knowledgeable and experienced in a particular therapy or area of practice, assesses how well a physician maintains the standard of practice. If a patient receives a complementary therapy, they should be confident that the physician is skilled in the complementary therapy in addition to conventional medicine.

Unfortunately, the ministry's intention is being circumvented. Although CPSO's words say that it is currently safe to offer complementary therapies or therapies that depart from the medical practice, CPSO's actions show that physicians risk being treated most unfairly and risk being found guilty of professional misconduct or incompetence for offering such therapies, regardless of how safely and effectively they are used. Therefore the public interest is not being served and protected.

Quality assurance regulations procedural protections cited by the CPSO as evidence of CPSO's fairness to physicians using alternative or complementary treatments are a red herring. Quality assurance provisions in sections 79.1 to 83 of the RHPA do not apply to complaints and discipline processes, with their much more serious consequences for professional misconduct or incompetence in sections 25 to 56 and sections 75 to 79. The only reason those procedural promotions exist in quality assurance is that Health Minister Ruth Grier, in May 1994, in response to concerns raised by members of the public, insisted over CPSO's strenuous protests that the procedural protections be added.

The College of Physicians and Surgeons has been entrusted with the mandate to regulate the profession in accordance with the Medicine Act, the RHPA, the regulations and bylaws and has a duty "to serve and protect the public interest." It appears that the college in a number of circumstances has failed to abide by the procedural requirements and has failed to serve and protect the public interest. These are serious failings. This is like a police force that has gone bad.

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It is appropriate for the public to turn to the government for action under these circumstances. The public wants and needs the protection of Bill 2 and the assurance that the provision is in a form that the college can't readily alter. Bill 2 is a useful step, possible within the limitations of a private member's bill.

Historically, professional misconduct has been dealt with by regulation, but we doubt that another college historically has acted in such a way as to undermine the intent of the regulatory framework. Decisive action is required, especially given the requirements that provincial legislation be in keeping with the provisions of the Helsinki accord. Self-governance is a privilege that should not be abused.

Physicians and patients and progress in health require passage of Bill 2 so that it will be safe for physicians who want to use therapies that are non-traditional or that depart from the prevailing medical practice to "consider first the well-being of the patient," as the Canadian Medical Association code of ethics requires, and without living in constant fear of the college.

The Chair: Thank you very much. It sure makes our job easier when everyone obviously timed their presentations. You have used just fractionally over 10 minutes, but we appreciate your taking the time to come before us here today.

Our next presentation will be the Canadian Society for Environmental Medicine. Is their representative here?

Interjection: They seem to be stuck in the snow.

The Chair: Well, we will keep juggling if folks are late arriving, given the circumstance of the weather. Have we a representative from the Ontario Society of Physicians for Complementary Medicine?

Ms Helke Ferrie: They are coming in the same car.

The Chair: OK. How about Jarmila Onley? Rainet?

Ms Ferrie: A similar problem.

HELKE FERRIE

The Chair: How about Helke Ferrie? Good afternoon. Welcome to the committee.

Ms Helke Ferrie: Ladies and gentlemen, my name is Helke Ferrie. I'm a science writer specializing on issues of medical politics. I write for both mainstream and alternative publications here in Canada and in the United States.

I came to this work by two routes: (1) through my training in physical and medical anthropology, and (2) through contracting a degenerative illness mainstream that medicine considers incurable. Because my anthropological training predisposed me to researching diseases in terms of environment and biochemistry, and because academic training inculcates doubt about everything, I found my way out of medical labelling and into the practice of Dr Jozef Krop. Today I am here before you, able to speak and move because of his treatments.

The experience of recovery led to many questions, such as why an excellent doctor was being prosecuted for putting current knowledge of biochemistry to clinical use; another being why there was this "Kwinter bill," now Bill 2. Reading it made me wonder what could possibly have made it necessary. Why state the obvious? I decided to find out.

I interviewed MPP Monte Kwinter and learned that he had decided such a bill was needed after finding out that Dr Gerry Green had lost his licence for using nutritional therapy in conjunction with cancer treatment. I also attended many disciplinary hearings at the college and researched the cases of more than 40 doctors, all greatly cherished by their patients, all prosecuted by the College of Physicians and Surgeons for reasons that made no sense. Lawyer Morris Manning once said that the disciplinary process at the CPSO is "truly Kafkaesque."

Writers like to focus on specific events which have the power to illuminate an entire issue dramatically. I will therefore give you three short scenes, real events I witnessed. Each of these will tell you why Bill 2 is vitally needed in Ontario.

Scene one is now also found in the more than 7,000 pages of transcripts from the disciplinary hearings in the case of Dr Krop. The college sought to prove incompetence on the basis that Dr Krop was not meeting Ontario's standards of medical practice. However, there are no written standards, which is only logical. Medical science in the past 50 years is like a video stuck on fast-forward. By the time the standard has been formulated, it would be outdated.

Dr Krop's lawyer, in an effort to nail the Jell-O to the wall, put the deputy registrar, Dr John Carlisle, on the stand for cross-examination on this point. Dr Carlisle is in charge of the discipline process in the CPSO. Mr Manning asked him if there were any written standards and Dr Carlisle said no. So Mr Manning asked, "So, who sets the standards?" To this Dr Carlisle answered without hesitation, "I do."

Scene two has been repeated several times in a number of physicians' disciplinary trials, most recently in the cases of pain expert Dr Frank Adams of Kingston and allergy and asthma physician Dr Sukhdev Kooner of Windsor. Both have a flawless record of practice and are supported by hundreds of very angry patients. They sent thousands of faxes to the CPSO and the government, and hundreds of letters detailing harrowing stories of illness and pain and how Dr Adams and Dr Kooner were able to help.

In both cases, the lawyer for the prosecution, Mr Donald Posluns of the CPSO, instructed the disciplinary panel as follows: "Patient outcome is of no relevance to your decision. You have to determine whether" Dr Adams and Dr Kooner "have met the standard of practice in Ontario. They have not and, therefore, must be found incompetent."

Patient outcome is, by the way, the fundamental criterion by which medical practice in the United States is judged through their equivalent of the Canadian colleges, namely, the Federation of Licensing Authorities. Not that things are perfect south of the border, but at least they acknowledge this most fundamental principle of medicine.

The next time you have to deal with a child's asthma attack or sign up for a vasectomy or pick up a prescription, remember what our provincial medical authority thinks of patient outcome.

The third scene took place in October of this year during the trial of Dr Sukhdev Kooner. He is a member of the Pan American Allergy Society, which has some 20,000 members worldwide. Its methods of treating allergy and asthma were developed in mainstream universities in the United States before antibiotics came on the market and they are now part of many current university medical textbooks. Several hundred Canadian doctors are trained members of this organization. Dr Kooner's patients seek him out because these methods are especially effective in asthma and allow patients to be weaned off all drugs.

The CPSO is seeking removal of Dr Kooner's licence. In his summation for the prosecuting CPSO, Mr Donald Posluns told the disciplinary panel: "You have never heard of the Pan American Allergy Association and therefore it is not part of the standard of medical practice in Ontario and you must rule against him." The decision yet has to be rendered.

To summarize: the CPSO seems to prosecute modern medicine and does so arbitrarily. This sanctifies the meaning of the word "parochial" to the level of an absolute, scared value. That is why MPP Monte Kwinter noticed and decided it was high time for Bill 2.

Indeed, Bill 2 should be seen as a piece of emergency legislation. Ontario needs Bill 2 for the same reasons that more than a decade ago the Helsinki accord on human rights considered it vital to define medical practice in terms of basic human rights, both for doctors and patients.

We need Bill 2 because medicine in Ontario is in crisis. An excellent measure of this is the number of angry patients. Three years ago it was possible for me to interview most of the patients supporting an accused doctor. Today it is necessary for me to meet them in groups of hundreds.

Another measure is public perception. Three years ago people would say, "Oh, that Krop case. Surely there must be something wrong with him or the authorities wouldn't have gone after him." Now people say to me about whichever doctor I am writing about, "Oh, he must be good if they went after him."

We need Bill 2 because human rights-by this I mean especially the rights of the patient-must take precedence over arbitrary, autocratic rule in medicine. We need Bill 2 because the abuse of power in medicine is intolerable in a country that professes to be civilized and a democracy. This bill will begin to put medicine back on track in this province.

The Chair: Thank you very much. We appreciate your bringing your presentation before us today and having your comments. Have we had anyone else join us, who's on the list? Might I ask the last presenter, you seemed under the impression some were on their way. Have they given you an idea what time they expect to arrive?

Ms Ferrie: The driving is terrible. I expected they were coming.

The Chair: I would be pleased to call a recess if you had a way of contacting them. Do you have a cell phone number?

Mr Kwinter: Mr Chairman, might I ask for a few minutes. If we were going to have a recess, maybe I can use my time.

The Chair: Excellent idea.

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Mr Kwinter: I just want to bring to the attention of members of the committee some of the key concerns that led me to bring in this bill, and to also address Mr Dunlop's comment about how Bill 126, which was the initial bill, was reintroduced as Bill 2 after the House prorogued. It was identical to Bill 2 with the exception of one word, and that was "solely."

You should know I had no idea this would turn into an attack on the College of Physicians and Surgeons by virtually everybody. That was not my intent. I think the college, by and large, does a good job. I think they somehow or other have a problem in this particular area. One of the concerns they had was that my bill, and that was when it didn't have the word "solely," would be used by doctors who were practising beyond the bounds of what anybody-I'm not just talking about the college-was doing, that they would use this particular amendment to justify what they were doing. Their feeling was that they had found doctors guilty of practices that were not acceptable, and that notwithstanding that some of these doctors were proposing it was only because of their practice of complementary or alternative medicine, this wasn't the case.

When I took a look at the Helsinki accord again, I found, really to my almost embarrassment, that the Helsinki accord actually had the word "solely" in it, so this was really proposing that no doctor would be found incompetent or subject to discipline solely because they practised alternative medicine. That is why the bill was amended and that is what it is.

Having said that, I want to give you a case history of mine. It wasn't me as a patient; it was me as a member of the board of directors of Branson Hospital. On January 14, 1997-I'm going to read verbatim from a letter by the president and CEO to the board members. I remember it exactly. What happened was that the head of the physiotherapy department came to a board meeting as an information item only. There was no requirement for any action; it was just information because the College of Physiotherapists of Ontario is a self-governing profession under the Ontario health practices legislation.

The head of physiotherapy announced that at Branson Hospital two of her physiotherapists had been certified as acupuncturists and as a result would be offering this treatment to patients who came in. They didn't require the approval of the doctor, unless a doctor had prescribed or referred a patient to them. Then they had a professional obligation to let the doctor know what the treatment was and how it was progressing. You could actually walk in off the street to the physiotherapy department of Branson Hospital, claim you had some problem and they could determine on their own that acupuncture was the required and preferred treatment.

Immediately the chief of medicine, who has since retired-he retired only because of age, but he was, and I don't mean it in a derogatory sense, an old-time doctor. As soon as he heard this, he said: "There is no way that acupuncture will ever be practised in my hospital. There is no way." The chief of physiotherapy was a little embarrassed to say: "With all due respect, doctor, we're not asking for your approval. This was an information item only and we are within our mandate to do it."

Here is a letter that, as a result of that meeting, the president sent out to the board members: "At the January 7 meeting of the board of directors, a request from the physiotherapy department to introduce acupuncture at North York Branson Hospital was introduced. Acupuncture is within the scope of the College of Physiotherapists of Ontario and the board appears to be looking with favour upon introducing the practice at Branson Hospital. However, the board is also anxious to demonstrate due diligence, and for this reason has asked the physiotherapy department to make a brief presentation at the February 4 board meeting to discuss the scientific support and evidence-based analysis which supports this practice."

I should tell you that at the February 4 meeting it was approved. Mount Sinai Hospital has a department the Minister of Health attended when they opened it, for acupuncture. There are all sorts of treatments that have become mainstream.

The problem you have is that there are people at the College of Physicians and Surgeons with the attitude, "If it ain't invented here, it ain't invented." This isn't what they were taught, and as a result they are not prepared to support any additional treatments that don't fall into what they consider to be good medicine.

As a result of my bill, Bill 126, immediately after it was given unanimous consent at second reading in 1997, the college had an ad hoc committee hold public hearings, very much like the hearings we're sitting in today. Nobody came to this meeting and opposed it-nobody. Everybody, and I haven't heard from everybody on this list, came supporting this bill. As a result of that, they have changed their policy. They issued a statement saying that doctors have nothing to fear from the college for practising complementary medicine.

Having said that, it did not stop them from continuing to prosecute and persecute doctors. You've heard doctors who have suffered as a result of this. There was a doctor who came to see me, Dr Rave Kovitch, who has a treatment where his patients-I mean, they were desperate. It was such an important treatment that he had hundreds and hundreds of patients. He was the feature of a television show where these people came to the television studio-they couldn't accommodate them-to say that their children cannot survive in a way that is acceptable without this kind of treatment. Notwithstanding that, the college said to him he can't do that because it isn't within the realm of what is taught at medical schools.

Just to address that particular situation, in the United States the majority of universities now teach complementary medicine, either as an additional subject or as a required subject. I don't know if we have anybody here from Hamilton, but-

Mrs Marie Bountrogianni (Hamilton Mountain): Yes.

Mr Kwinter: Of course. Allan Rock is in negotiations with McMaster University and they're talking about a $100-million facility in Hamilton to deal with alternative medicine.

So the basic thrust of this bill is not to second-guess doctors. It is absolutely constrained to medical doctors only. This is all we're talking about. This is an amend-ment to the Medicine Act and it is for doctors only. It is meant to give freedom of choice for the doctor and freedom of choice for the patient, with informed consent, provided it can be shown that the patient isn't put at any greater risk than with conventional medical treatment. That is the basis of the bill.

I want to go back to a statement that I made at the beginning of these hearings, that the college-and it's interesting. They have a publication, and when my bill came back as Bill 2, they had an announcement in their monthly publication basically saying, "Monte Kwinter's Bill 2 has been given unanimous consent in the Legislature, and when it goes to the committee we will be there to aggressively object to this bill."

Subsequent to that, we had the Ontario Medical Association establishing a probationary section, which meant they had to follow the general precepts of the Ontario Medical Association, they had to have at least 200 members who were prepared to affiliate with this, and they had two years to show that they could maintain this. After two years they were given permanent status and they are now a section of the Ontario Medical Association.

So you have this anomaly, and I have copies of a document where the Ontario Medical Association is holding conferences on complementary medicine where they have speakers from all over the world coming in talking about it, and their licensing body is still fighting as to whether they should be doing it or not. We have that problem. All this is going to do is to ensure that doctors have the comfort level that if they are doing things always with the same criteria, in the best interests of their patients-and we're talking about outcomes, the best interests of their patients-they will not have anything to fear from the College of Physicians and Surgeons. So it's freedom of choice for the doctor, freedom of choice for the patient.

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Mr Clark: If I may, I'd just like to ask a question of MPP Kwinter. I'm not opposed to what you're proposing here; I'm just trying to get my head around it, OK? We do support it in principle and in intention. Section 26 of the CPSO's quality assurance regulation states, "The fact that a member uses or recommends a non-traditional treatment is not, by itself, determinative of deficient clinical ability." It seems remarkably similar to what your wording is in 5.1 of your amendment to the Medicine Act.

The question that I have is, if this bill does pass, I don't want it to be perceived in public that this is going to be the great fixer, that this is the panacea of all that ails the CPSO. Because as I read the two acts, in theory, we shouldn't be here talking about it. Based on their own regulation, we shouldn't be here, this amendment shouldn't be before us. If they were doing their job, we wouldn't be here, because it's already covered off and they would not have gone after any physician because they were solely using an alternative form of medicine.

So the concern I have is that we're moving this regulation to an act into the Medicine Act. That's my first concern. I'm not sure how it's actually going to work and I'm not sure if you have a handle on it.

The next question I have is, under the Regulated Health Professions Act, there are 21 professional colleges and 23 professions. Any one of them could be using alternative forms of medicine, but we're only talking about an amendment to the Medicine Act.

Can you comment on the two concerns that I've raised?

Mr Kwinter: I agree. You're absolutely right that when you think back, at the 1989 Helsinki accord, where Canada, as a signatory, in fact committed all of the provinces to this particular concept. The wording is virtually verbatim in the Helsinki accord as to what I've introduced in this bill. So you're quite right. You would think that the first reaction would be, "What do we need this for? We already do it."

Mr Clark: And it's in the regulation by the CPSO-

Mr Kwinter: But if that were the case, then you say, "OK, I agree with that." Why then are you opposing this bill, not saying it's redundant, we don't need it, we already do it; just saying no, no. I didn't want to bring this in, because I'm not trying to bash the College of Physicians and Surgeons. That's not my purpose. But anyway, they violently objected to this bill. They also had public hearings. So you say, "Why would you have to have public hearings if there's no need for the bill?" And then why did they say in their publication that when it comes to committee, they will be aggressively opposing it? You ask that question. Why do you have doctors-I am not prepared to re-argue that whole thing; I brought this to the House three times and got unanimous consent three times. But at that time I had letters from doctors all over Ontario saying, "This is absolutely critical because I'm being harassed by the college. I am not allowed to do the things that I think are in the best interests of my patients." There is a definite sort of miscommunication between the college and the profession, because when you talk to doctors, they tell me all the time, "Great, this is what we need."

Now all it's really going to do is give doctors, who are responsible practitioners, that comfort level that they can do the best for their patients. This doesn't in any way absolve the doctor of any responsibility or any responsibility to the college. It is absolutely critical that the licensing body be responsible for the licensing and management, if you want, the professional qualifications, of the medical fraternity.

Mr Clark: I guess my concern is that in conversations with the CPSO this morning, they're basically stating that it's redundant; that's exactly what's in their regulation already. So how is the new act, the amendment to the act that you're proposing, going to change anything? How is it going to change the behaviour of the CPSO? If it's basically redundant to what the regulation already says and based on what we're hearing from testimony they didn't honour that-my concern is that this is going to be seen as the panacea; we all go home, everyone's happy, we're now moving forward.

Mr Kwinter: If I could just respond to that, the main reason for putting this in-in a perfect world there would be no reason to put it in, but unfortunately we don't have a perfect world. The other problem we have is that we are subject to the vagaries of the administration who happens to be at the college at any given time.

Again, I didn't want to get into this, but I have a letter that was written to the then Minister of Health, Jim Wilson, when the bill came forward the first time, by Dr Geoffrey Bond, who is both a lawyer and a doctor, who wrote in effect that if this bill goes through, it will be the end of medicine as we know it, and not only that, but went on to use two examples. Those two examples, I maintain, are probably the reason why he's no longer the president of the college.

The first one was an example of a baby who had been wrapped in cabbage leaves. This baby had been wrapped in cabbage leaves and had died. Then he put in brackets "by a non-practitioner." What relevance does that possibly have to anything, that he says it's a non-practitioner? It would be like saying, "In the jungles of Africa they have witch doctors who do things, and if you allow this bill to pass as it is, we're going to be subjected to that." That was just one example.

The second example was, he said doctors would be able to sexually assault their patients and claim that this was an alternative treatment. Again, doctors are subjected to the same laws as everybody else. Without trying to knock doctors, if you take a look at the publication of the College of Physicians and Surgeons that we all get, if you bother to read it, by law they must publish the results of their disciplinary hearings. More often than not there are five, six, seven, eight cases every month, and most of them are sexual assault cases by doctors on their patients.

The point is that this will, if nothing else, emphasize that there is a need for the college to recognize or for the act to recognize that doctors should have the freedom of choice for themselves and freedom of choice for the patients, the patients certainly with informed consent. Secondly, there's the old precept "Do no harm"-as long as it can be shown that it's not going to create any greater risk for the patient than conventional treatment.

That is why it's so important, and if it wasn't, you wouldn't hear the stories we're hearing today. This is absolutely just the tip of the iceberg, and I can tell you, when this first came to light, when I first introduced this bill in 1997, I was inundated. I was going to public rallies where I was talking to them; I was going to meetings of doctors, who were all saying, "Go for it. It's about time we had something like that."

So you're right; in a perfect world there would be no need for it. But there obviously is a need for it and all you have to do is listen to what has been happening here today.

Mr Clark: If there aren't any other witnesses, we're ready to go on to clause-by-clause.

The Chair: We do have one other witness, who has appeared so far, but Mr Marchese has been waiting to say something.

Mr Rosario Marchese (Trinity-Spadina): Just briefly, I obviously support this bill and would like to suggest to the next speaker, who might be Dr Krop, to comment on the question that Mr Clark has raised, because I'd be interested to know the answer to that question.

He raises another question about how this act only changes the Medicine Act, as opposed to many other areas of interest. I would be interested in that as well. Hopefully Dr Krop or others might want to comment on that. I'm interested to know whether Mr Clark is saying that we should be broadening this, which I would support. I don't know whether Mr Kwinter has any suggestions, and I'm not sure whether you're proposing that or not, but I would be interested to know the answer to that question as well.

Mr Clark: The Health Professions Regulatory Advisory Council is already conducting a review of the act, looking at a number of things. It's a five-year review and we should be getting it sometime in December or January at the latest. I'm not sure exactly what all is going to be in that review, but they're supposed to be looking at all the colleges, all the professions, everything. We'll have to wait and see what happens.

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CANADIAN SOCIETY FOR ENVIRONMENTAL MEDICINE

The Chair: With that, Dr Krop has joined us. Come forward to the witness table, please. Good afternoon and welcome to the committee.

Dr Jozef Krop: Mr Chair, do you want me to address the question of Mr Clark first or would you like me to present and then address-

The Chair: Whatever you're more comfortable with, Doctor. Normally it's up to the witness to make those decisions. Make sure you get all the points on the record that you would like to make.

Dr Krop: I will make you my points first, and we will come to it once you get excited.

First of all, it is with pleasure and deep conviction that I am here today to support Bill 2, also known as the Kwinter bill. As a doctor I fully appreciate the great importance of this proposed legislative amendment to the Medicine Act of Ontario.

I represent my colleagues, physicians in the Canadian Society for Environmental Medicine, which is a subsection of the approximately 400 members of the complementary medicine section of the OMA. In environmental medicine we deal with links between human health, poor nutrition and contamination of food, water and air in our communities, homes, schools and workplaces.

In Europe, complementary medicine is fully integrated, giving patients the best possible options for their individual health care. I assume that Canadians want the same options.

Bill 2 originated when Mr Kwinter learned three years ago that physicians were terrified of losing their livelihood if they trained in and offered complementary methods to meet patients' needs. Patients with chronic illness who are not helped by mainstream medicine want to try other safe modalities. They rely on their physician to assist them to make informed choices.

Bill 2 is of fundamental importance for the health of Ontarians, for illness prevention, for containment of skyrocketing health care costs and for advancement of scientific medicine.

For practising physicians, this bill serves two purposes: first, to protect valuable old knowledge. We are referring here to traditional medical knowledge that is not readily replaced and to which people wish to have access because it is, quite simply, working. The frenzy for the "new and improved" may be fuelled in part by patent applications and may not live up to initial high hopes. The second purpose of the bill is to protect valuable new knowledge from being stifled and to help insure that Ontario physicians are able to offer effective treatment for their patients.

I have personal experience of the need for Bill 2. Without patient complaints, the College of Physicians and Surgeons charged me, in effect for teaching my patients to change their lifestyle in an effort to improve their health. My investigation and prosecution lasted a decade and ended with a misconduct conviction for using safe therapies, techniques and philosophies of environmental medicine, even though my patients gave informed consent and were satisfied with the results, with the good outcomes.

The emotional, physical and financial costs of this ordeal have been immense. Nevertheless, I am appealing to overturn the CPSO decision so that the internationally recognized therapies I use for chronic illnesses and environmentally linked diseases may be recognized in Ontario. My prosecution occurred despite the fact that members of the Canadian Society for Environmental Medicine had repeatedly attempted to dialogue with the college about the difficulties encountered in trying to help patients with chronic illnesses not responsive to mainstream medical methods.

My situation is not unique in Ontario. Other physicians are highly intimidated. It is intolerable that the patients of this province never know which doctor will be prosecuted next and on what arbitrary grounds. The 1989 Helsinki accord, to which Canada was a signatory, specifically recognized the need for medicine to be protected as a human right for both doctors and patients. It stated:

"In the treatment of the sick person, the physician must be free to use a new diagnostic and therapeutic measure, if in his or her judgment it offers hope of saving life, re-establishing health or alleviating suffering.

Yet in the 11 years since Canada signed the Helsinki accord, doctors have continued to be prosecuted in Ontario because of their use of internationally recognized, safe and effective innovative treatment methods.

On May 10 this year a press conference was held in this building. One of the speakers was one of Canada's leading criminal lawyers, Mr Michael Code, formerly assistant Deputy Attorney General of Ontario. He spent a year studying 10 such doctors' cases and he said in his press conference:

"I reviewed ... these doctors and the replies to them from the college which revealed to me a consistent pattern of unfairness in the way they were dealt with and a consistent pattern of improper use of powers and-arguably in some cases-even an abusive way of using powers. And, finally, what came through loud and clear, was a very strong bias against doctors working in innovative areas of medicine ... and trying to find new solutions to new problems....

"I would certainly invite the responsible government officials to look closely at whether the college is exercising its powers appropriately; whether this is the kind of Ontario, and the kind of medical climate, and medical community that we would all like to live in, whether it is appropriate that doctors are treated in this fashion."

After providing a detailed analysis of these 10 doctors, Mr Code observed further on, "It is my view that there is a very serious public policy issue here that the government ought to look at carefully, to see if the people of this province are being served properly."

Ladies and gentlemen, with such serious abuse of process impacting on the needs of patients, it is essential that this government ensure that the Helsinki accord on human rights in medicine finally become recognized as a basic human right in Ontario and be protected by law. Bill 2 follows the example of eight states in the United States as well as Alberta, where similar bills have already been legislated.

Bill 2 was intended to protect Ontario physicians' freedom to offer expanded diagnostic and therapeutic options to their patients in harmony with the Helsinki accord. We urge you to pass Bill 2 as soon as possible so that medical science and innovation in health care can progress in Ontario.

The Chair: That used the allotted 10 minutes. Thank you very much for taking the time to make the presentation before us. We appreciate it.

1650

ONTARIO SOCIETY OF PHYSICIANS FOR COMPLEMENTARY MEDICINE

The Chair: We have Dr McAlister joining us from the Ontario Society of Physicians for Complementary Medicine. Good afternoon and welcome to the committee.

Dr Kenneth McAlister: Good afternoon. I'm a little out of breath; I was rushing to come here from Richmond Hill. As you will soon find out, it's slow going out there. So I'll just have to speak to you between breaths.

I'm a general practitioner; I've been in practice about 15 years doing complementary medicine. I'm a founding member of the Ontario Society of Physicians for Complementary Medicine. With this group we managed to establish a complementary medical section of the Ontario Medical Association.

I've been at this long enough to see how things are changing in a very positive way. My practice is full; I have many, many people who are on a waiting list. Most of the patients I see-in fact, all of them-are very excited about the possibility of having a conventionally trained physician who understands something of what most Ontarians are trying now in terms of vitamins, herbs and various traditional forms of medicine. Certainly this is what the people of Ontario want: an integration of conventional medicine with other modalities. I think this is the way of the future as well, a so-called pluralism in medicine and in science.

Just a word, then, about the patients. This is what I think they really want. From the point of view of the professional, I've been in the trenches long enough to know how difficult it was even five years ago to practise anything that fell outside the parameters, definitions, directions of the conventional medical training. As a physician, many times I'd find myself sitting in front of a person suffering from one illness or another that I couldn't understand with conventional methods and I couldn't help with conventional treatments. Almost from compassionate grounds I developed these other modalities, which I have not found helpful in all cases, but in many cases I can bring something to the patient that I wouldn't able to bring from the conventional point of view.

In the early years of my practice I did this at great peril, recognizing that at any time the college could stop my practice just really on the grounds that I was doing something that they couldn't understand, wouldn't acknowledge or wouldn't recognize as being valid. So I'm very excited about this bill coming out of Parliament to state once and for all that physicians, within careful guidelines which we have created and which I think need more work, can practise other forms of therapy in their office, with the consent of their patients, in addition to what they have learned in medical school.

That used to be the definition of complementary/holistic/alternative medicine: what you didn't learn in medical school. This definition no longer applies because many medical schools in the United States, and some in Canada, are now also offering courses in complementary medical therapies. So this whole definition is really outmoded. Nonetheless, as a physician I'm very happy that this august body is considering passing such a law so that we in the trenches are able to bring modalities to our patients that maybe some of our other medically trained colleagues don't necessarily understand or support for a variety of reasons.

These very basic comments were what I wanted to bring today, and I wanted in the time remaining to give you the possibility to ask questions if you have any.

The Chair: Thank you very much. This time the questioning will start with Mr Marchese.

Mr Marchese: Thank you, Doctor. Mr Clark raised a question earlier on; you weren't here at the time. His question is that the College of Physicians and Surgeons says that already in regulations we have that which permits people to practise complementary medicine. I don't remember the language, but it's in regulations now, so they're saying this is redundant.

Dr McAlister: Although the time doesn't allow me to pursue the details of that regulation, I was one of the people who wrote many of the recommendations-

Mr Marchese: Sorry, Doctor. Could we have Mr Clark read that same clause again?

Mr Clark: The question I asked was that under section 26 of the CPSO's quality assurance regulation, "The fact that a member uses or recommends a non-traditional treatment is not, by itself, determinative of deficient clinical ability." If you look at that and you compare it to the amendment to the Medicine Act that is proposed-a little bit different wording-it means exactly the same thing.

So the question I had was, if we're not doing it now, how are we going to do it with the act?

Mr Marchese: So Mr Clark, the surgeons presumably made the case that-

Mr Clark: That it's redundant.

Mr Marchese: -it's redundant. Is this redundant on the basis of what you heard?

Dr McAlister: I don't think so. First of all, I think we were very active in getting the college to move to the position it's in now. I don't think they would have gone as far as they have without our organization and without our lobbying and without the support of the people of Ontario.

If you read the whole document, you'll find that there are other areas that are open to interpretation, depending on who wishes to enforce that particular regulation. They have really failed to grapple with the central concept of plurality in science. From that point of view, depending on who interprets the regulation-it's not an act, but a guideline-I think physicians such as myself would possibly be put in jeopardy.

Many physicians are supportive of this kind of medicine. There are still a core group of physicians who are very opposed to anything different than what they've been taught. My concern, as a practitioner, is that these people could possibly interpret that act in a way that would be repressive. From that point of view, I think it's very important in the political arena, in the arena of our rights, that this body make a statement supporting this kind of medicine.

I also want to point out that the word "solely" in this act came from our organization.

Mr Marchese: We don't have much time. That's why I wanted to ask this other question. The point that others have made is that doctors who practise in this field continue to be prosecuted and/or persecuted. That's part of the point. So I'm not quite sure that-in spite of the fact that someone said to Mr Clark that this is redundant, persecution seems to continue. In your mind will the wording of this legislation diminish the persecution or prosecution of doctors, do you think, or do something that will be good for you folks?

Dr McAlister: Yes, I think it will be very good for us, because it will send a message to the medical community that the people of Ontario want to have this medicine developed and believe in a so-called integrated medical approach.

The Chair: Time for one more question, or if you don't have one, Mr Marchese, if anyone else in the committee has a question.

Mrs Bountrogianni: I basically just want to get on the record to support this bill, as a psychologist and a member of another health profession, and also as a patient of Chinese medicine.

I would like to also go on record as saying that the physicians should really be cringing at their college's lawyer's comments that patient outcome is of no relevance. Both in my field and in every other health field that I know of, patient outcome is the only thing that's relevant.

So Chair, I just wanted to get on the record to say those things. Thank you.

Mr Marchese: I've got a last question. Mr Clark again raises the question that we're only changing the Medicine Act, as opposed to the other regulated professions that might be affected by such an act that we're proposing today. He was arguing that perhaps we should make this broader and make it affect and/or relate to other regulated professions. What do you think of that?

Dr McAlister: I can't comment on that in any official way, but as a citizen of Ontario and as someone who knows people in other therapies, I think broadening this would be a tremendous asset. For example, the physiotherapists and the massage therapists are struggling under similar constraints by their colleges. There is some progress there in opening up the fields, but nonetheless I think such an act would also send a message to these other professions and it would be definitely progressive.

The Chair: Thank you for taking the time to make the struggle to get down to us from Richmond Hill, given the weather outside. We appreciate it.

JARMILA ONLEY

The Chair: I'm told that Jarmila Onley has joined us now, if she could come forward, please.

The clerk informs me that your handout isn't quite ready, but if you want to talk, as soon as it comes in-

Ms Jarmila Onley: Good afternoon. Actually, I need them. I put everything on paper.

The Chair: OK, if you could just have a seat there, as soon as the clerk gets those back we can recommence.

Mr Clark: For the record, because Mr Marchese was asking the question also in terms of review by HPRAC, in 1994 HPRAC was requested by the then Minister of Health to review naturopathy and acupuncture. The review was done and submitted back to the ministry in 1996, and then the ministry, in 1999, asked them for additional advice on it. So that review is also-the report is pending in terms of naturopathy and acupuncture.

1700

The Chair: Thank you. Mr Kwinter.

Mr Kwinter: I want to address both Mr Marchese's comments and Mr Clark's comments.

When I started getting interested in this particular bill, having in mind that it was a private member's bill, I was besieged by people who said, "What about me? Why don't you include this? Why don't you include that?" I said that is beyond the scope of what I as a private member could get involved in.

What I did feel was within the scope and would really serve the people of Ontario was to come up with a very simple statement. This bill has got 67 words in it and it's really a statement of principle: freedom of choice for the patient, freedom of choice for the doctor, do no harm and don't be afraid to use your best judgment within the confines of the Medicine Act to do it.

I think that's an important statement, and we've heard from many deputants talking about the problems they have actually endured. I agree, this is a first step. This is a platform on which to build all of these other things, but I think that's a role for the Ministry of Health to deal with, not for me as a private member.

But I do think that we as legislators could send a signal to the profession and to the public that we are receptive. From a statistical point of view, and I don't know exactly how it is right now in Canada, in the United States for sure more people seek out alternative care or complementary care than seek out conventional care.

Professor Merrijoy Kelner did a study and she suspects that same thing is happening here, because a lot of patients go to their doctors and won't tell them they're doing these other things for fear that they will be criticized. But that is a fact of life and I think it's important that we do this.

Mr Clark: When I spoke of the 21 professional colleges and the 23 health professionals, don't take that as offensive to you in terms of your bill. I just raised it from the simple standpoint of being a parliamentary assistant to the Minister of Health, when I'm looking at this particular bill. I recognize that the other act that deals with health professionals has all of these colleges and professions and it's not being addressed there.

You've raised some valid concerns, so the question in my mind immediately became, what about the other professions? It's a question that we must deal with within the Ministry of Health. I'm not sure whether we deal with them one off as acts or whether we deal with them all at once. That's something for the minister to decide.

The Chair: Thank you. Ms Onley has her presentation back, so welcome to the committee.

Ms Onley: Good afternoon, ladies and gentlemen. Let me introduce myself. My name is Jarmila Onley. I was born in the former Czechoslovakia. I came to Canada about 10 years ago and I have two little children.

I'm here today to support Bill 2. If this bill becomes law, all of us will benefit. It has been a deeply rooted tradition for centuries in civilized countries around the globe to cure people with what nature had to offer. For example, homeopathy is over 150 years old.

When we deal strictly with only the physical and omit the mental and emotional complexities and completely ignore the spirit, or the soul, if you will, we get a one-leg-limping health care system in Ontario. We are missing true care. That's the other leg.

My recommendations are as follows: please notice on page 2 my graph, which I am sure you will like. On the left we see traditional medicine and on the right we see alternative medicine and they are working in balance together.

If we are to catch up with the rest of the world, I encourage this government to amend the Medicine Act, 1991, and make the bill into law in Ontario so we can become a healthy part of this country.

Extend this bill by adding to it as follows: part of the medical curriculum should be a wide range in alternative medicine, such as aromatherapy, reflexology, shiatsu, craniosacrum therapy, to name just a few.

Educate ordinary people and children in alternative healings. Let people be in charge of their own health and promote that. Fulfill the Helsinki accord, which Canada signed in 1989 and which states, as we all know, "In the treatment of the sick person, the physician shall be free to use a new diagnostic and therapeutic measure, if in his or her judgment it offers hope of saving a life, re-establishing health or alleviating suffering."

I want fairness and justice in the health care system. It is my responsibility to be in charge of my well-being. Therefore, it is inconceivable that my very right of free choice in health care would be ignored. This is Canada, a free country. I want a physician who is capable of offering natural remedies besides a pill. For example, the mind, body and soul have to be recognized and treated as a whole, not as apart. That is a mistake.

Today there are 15,000 people, and I'm one of them, demanding Bill 2 become law. Tomorrow there will be hundreds of thousands of us. You can't defeat what has been proven healthy, safe and natural. As an example, take a look at the enormously expanding health food stores, organic nutrients stores, holistic stores, and of course the sale of self-help books exceeds high above the average parameters. This government can only succeed by accepting Bill 2, and by doing so making balance in the health system.

I also would like to point out, just from my perspective, economics, if you could consider them, please. Put together the alternative medicine with the traditional and you'll get the much-needed wholesome health care system that people have been calling for now for years. Now is the time for us to work together for betterment. The alternative with the traditional has enormous potential, an incredible future. As an example, if people are properly educated and have, therefore, health tools to work as a team in their own community with their doctors, the savings to society will be enormous.

Within each neighborhood are people who practise alternative health strategies. Instead of having the doctor as my only choice, imagine that in my community I can go to see a polarity healer or nutritionist. Therefore, the huge stress on the exhausted medical system would be greatly reduced. If basic alternative health skills were taught at the community level, then society's health would truly become a community-based process.

The Chair: Thank you very much. That leaves us a couple of minutes for questions if any member of the committee has any.

Mr Kwinter: I have noticed that in many of the presentations there's been an interchange of words to the same thing, and I found, after having worked on this thing for nearly four years, that what we should be doing is talking about "complementary" medicine as opposed to alternative because "alternative" implies that it's either/or, complementary, and the other one is traditional and conventional. Many of the complementary treatments are traditional as opposed to conventional, and the conventional is what is taught at medical schools in Ontario or in Western society. Traditional could be quite complementary but not conventional.

Ms Onley: I'm sorry if I misguided you or confused you. It's my second language and I'm just trying to support-

Mr Kwinter: No, I wasn't being critical; I was just suggesting, because there is a-

Ms Onley: Thanks. OK.

The Chair: Thank you very much for taking the time to come before us here this afternoon. I appreciate it.

1710

RESEARCH, ADVOCACY AND INFORMATION NETWORK ON ENVIRONMENTAL TOXINS

The Chair: Ms Hilary Balmer has joined us. Come forward, please. Good afternoon. Welcome to the committee.

Ms Hilary Balmer: Good afternoon. I thought I wasn't going to get here. It's really fun out there. You don't know what you're in for.

I'm Hilary Balmer and I'm executive director of RAINET, which stands for the Research, Advocacy and Information Network on Environmental Toxins. That's why we call it RAINET. I wish to thank the committee for giving me the opportunity to make our submission in support of Bill 2. RAINET is a non-governmental, not-for-profit organization that provides advocacy on behalf of persons who have become injured or ill and to whom help and/or disability benefits have been denied.

Bill 2 would amend the Medicine Act, 1991, in order to ensure that physicians who provide non-traditional therapies or alternative forms of medicine are not found guilty of professional misconduct or incompetence unless there is evidence that proves the therapy poses a greater risk to the patient's health than the traditional or prevailing practice. This bill will help to bring the Medicine Act, 1991 into the 21st century.

The work of RAINET highlights the fact that many individuals suffer from very complex medical conditions, often chronic in nature, that not only do not respond well to current standard treatments but in many cases are made much worse by standard and accepted treatments. However, these same individuals very often derive a tremendous benefit from complementary modalities of treatment.

Unfortunately, physicians who use complementary methods are constantly at risk of being found guilty of professional misconduct or incompetence by the CPSO, the College of Physicians and Surgeons of Ontario, for "failing to maintain the standard of practice of the profession," despite good patient outcomes. Consequently, physicians may not be able to place the well-being of the patient as the highest priority.

Positive patient outcome does not appear to be of any interest or particular concern to the CPSO. In fact a former registrar of the college has stated previously, "while we're talking about standards of practice and potential harm to patients, the fact that patients are benefited is not necessary information that is terribly helpful." This statement was made despite the mandate of the CPSO to ensure that the public is protected and that licensed physicians practise within the law.

Historically, over the past two decades, the College of Physicians and Surgeons of Ontario has not only failed under its own mandate to "protect the public" and "guide the profession," but this self-regulating body has conducted itself in a shameful and dishonourable manner. Physicians who have caused great harm are ignored, while those who have brought about a "positive patient result" have been harassed, persecuted and punished for providing help.

Without Bill 2, consumer access to complementary tests and treatments from physicians is constantly under threat. Perhaps the most glaring example of this is highlighted by the recent case of Dr Frank Adams. The risk to his patients who suffer from chronic, debilitating and unrelenting pain is extremely high. Many cannot find a physician who will provide essential treatment. As a result, many have been sentenced to once again endure excruciating and unrelenting pain. Some are extremely fragile and at high risk of suicide.

In assisting clients with claims for disability benefits from various agencies, including the Workplace Safety and Insurance Board, which was formerly the WCB, Canada pension, Ministry of Community and Social Services and private insurance carriers, it has been our experience and observation that the negligent and improper conduct by some physicians is the most glaring reason for refusal to provide and withhold benefits.

Despite receiving a significant number of complaints, the College of Physicians and Surgeons of Ontario has refused to take appropriate action. This failure on the part of the CPSO continues to cause tremendous social fallout. When appropriate disability benefits are withheld, many persons who are already injured or ill are forced into impoverishment and into the ranks of social welfare. Thus the burden on the social welfare system continues to remain very significant.

The College of Physicians and Surgeons of Ontario is governed under the law, and by failing to uphold this legislation and to ensure that the protection of the law is provided, they have become party to violations under the Canadian Human Rights Act, the Canadian Charter of Rights and Freedoms, the World Medical Association Declaration of Helsinki and the United Nations International Covenant on Economic, Social and Cultural Rights. The College of Physicians and Surgeons of Ontario continues to interfere with the rights of the people of Ontario and to violate the basic mandate of all physicians, which is to do no harm.

We hope that it is absolutely clear why the Medicine Act, 1991, urgently needs to be amended.

The Chair: Thank you very much. There is time for questions. Does any member of the committee have any questions?

Mrs Julia Munro (York North): I just wanted to welcome you. We certainly appreciated that you took the time to come here today. It's nice to see you again.

Mr Marchese: I just want to compliment people like Hilary Balmer, and others who have spoken earlier, because I think there has been a movement of people saying, "This has to become part of what we accept as normal practice." It has taken a long for the college of physicians to adapt to it. I think if it wasn't for the fact that people were pressing the college to begin to accept complementary medicine as an accepted practice, they would not have yielded. So they're relenting, it seems to me, because of the pressure you're putting on them and because of the research one of the previous speakers has talked about. There has been an explosion of new research, she commented, which I think forces the college of physicians to look at that a little more favourably. I think because of those various reasons we're getting progress on this issue, and it's because of the work that people like you have done that they're forced to relent a little.

Ms Balmer: If I could just comment further, I'm a member of the College of Nurses of Ontario, and we of course are also governed under the Regulated Health Professions Act. As a health care professional, I am shocked and dismayed at the way that the college has been acting. Doing the work that I do, as I said in my submission, the single reason that disability benefits are denied, and certainly not just locally but federally, is because there are physicians who are medical prostitutes who will write anything for which they get paid.

When Bill 2 is enacted, this will mean that it will put physicians who practise a holistic type of medicine, which can incorporate traditional and less familiar modalities-it will make it much better and their reports will be given the same weight by authorities.

The Chair: Thank you very much, Ms Balmer. We appreciate you coming before us here today.

I am told that Dr Rothbart has indicated he won't be able to make it this afternoon, and so we have a handout from the Ontario Medical Association that the clerk will be distributing to the members of committee.

Do we have a representative from the Environmental Illness Society of Canada? While I am sensitive to the fact they may be struggling to get here, I also have to respect the time of the committee members. So I am in your hands.

RICHARD PATTEN

The Chair: Mr Patten?

Interjection.

The Chair: Well, you can do it from right where you're sitting, actually, since you're not a member of the committee. Strictly speaking, members should be making their-

Interjection.

Mr Richard Patten (Ottawa Centre): No, I asked to be a presenter here.

The Chair: The clerk asked, and my ruling is that you can do it from there, Mr Patten. I'm happy with you doing it there.

Mr Clark: We like you. You can stay there.

The Chair: We've had too many issues in the past making a distinction between presenters and members.

Mr Patten: First of all, my name is Richard Patten. I am a member of the Legislature and I am the member for Ottawa Centre. But I speak to you today not as a member but as a patient. I discovered a little over a month ago, on November 9th, that I have lymphoma B cancer. I want to share my experience with you.

I have supported this bill ever since its first introduction in the House and I have spoken to it I believe each time, perhaps short one, because I believe in the concept of holistically examining and responding to people in need, regardless of what level that may be. But I must tell you when this came forward today at the committee, I asked if I might share for a few moments my perspective, because of course as a patient now my perspective changes quite dramatically.

I must say to you that our so-called Western conventional medical model is a very narrow model. It was suggested to me by my particular doctor, "Stay with the Canadian food plan, get rest when you need it and good luck. We'll see you at chemotherapy time which will be in two days." I asked to speak to a dietician, I asked to speak to other nurses. Because of my background in the YMCA and knowing a little bit about nutrition and diet and physical fitness and things of that nature, and looking at people in terms of body, mind and spirit, this was my inclination to begin with. I did not find that to be there. I did not find resistance to it, I must say, and I must say that my doctor is a highly respected doctor and oncologist and I have great respect for him and this is in no way putting him down. But I suggest that it has something to do with the background and the training of our medical professional specialists. My understanding is that there is very little time in medical school spent dealing with people and other aspects, especially in diet, especially in nutrition and especially in psychological or mental health areas. We spent some time in the mental health area exploring this too.

Therefore, I very much want to support this bill. Does it go far enough? Of course it does not, but it is a step forward. It is a symbol and I believe a very important one.

1720

I personally took advantage of initiating a meeting with some naturopaths, whom I found extremely supportive, especially in the area of looking at diet, nutrition, vitamin supplements and cleansing one's body in preparation. I said to my doctor, "I see preparing for chemotherapy as if one might be a football player, a hockey player, an athlete. I have to do whatever I can, not simply as a receptor of what the medical officer suggests, but as a participant in assuming that I have some responsibility in this process, that I want to share in it and that there are things I can do. Certainly I can do some things on the spiritual, mental, emotional and physical side, in terms of preparing for all this."

That was not present. It was only when I began to look outside the model that I got the encouragement. I got some support and extreme knowledge. I've discovered things about my condition that I did not discover in terms of the medical model.

I refer you to two things. The thing that becomes quite obvious to me now is that as I try to maximize, during this period of time, finding organic food and look at minimizing the effects of those things that have preservatives and all kinds of additives and chemical enhancements, it disturbs me to no end how little information is out there.

I see advertisements such as Uncle Dave for Wendy's, proudly talking about this double hamburger with processed cheese. They use the term "processed cheese," which has vacuous calories in it and is no damned good for anybody, as if this is something great. This is pure junk that people are eating. It seems to me there is such an incredible industry weighted in favour of processing things that taste good, rather than what is truly good for you, let alone the air and the water we drink and all that is in there.

I see the need obviously for a more holistic approach. I believe only BC has adopted a model where naturopaths and homeopaths become part of a system of medical practitioners. I don't know why it's always California and BC. There must be something in the mountains or the air or the water or something that leads them to be a little more open around various-

Mr Marchese: Or the NDP.

Mr Patten: Yes, even that. I brought a bottle of Pepsi with me. I will not drink it because you wouldn't believe some of the chemicals in it. I won't go through what they are. It is quite incredible.

Interruption.

The Chair: Order, please.

Mr Patten: When I see the advertisement of the mother bear encouraging the baby bear to swim over to the other side of the iceberg and Coke is the attraction, I find that a very sad message. So I think we have a lot to do as a society.

I support this bill. In terms of the idea Monte mentioned of what is traditional and what isn't, traditional is not conventional. There are lots of traditional things. There is the arrogance our society has in rejecting two thirds of the world's approach to attempting to heal people, without having some support to provide some of the clinical studies. Of course, not too many of the drug companies will provide some of that support, and therefore governments follow suit with tripartite funding. Unless they have private funding, along with government funding, we participate in not supporting some excellent and very important things to discover.

In the short term, in the very near future, I think this will be a major breakthrough for us, as we begin to look at ways of treating people, because when we look at the cancer rates that are incrementally increasing in North America, it is quite something.

I will stop there. I don't know if I have any time left, but if anybody has any questions, I would be happy to respond.

The Chair: Do any of the committee members have questions?

Mrs Bountrogianni: I am sure I speak for all of us in the Legislative Assembly in wishing you well in your treatment, and welcome back when you come back nice and healthy.

The Chair: Seeing the last group has not made it-I'm sure it may not be through any fault of their own-our next order of business is to move to clause-by-clause consideration of the bill, unless any member objects. Seeing none, it is one of the shorter bills, Mr Kwinter. It should not take long to go through this.

Section 1 of the act: any comments, questions or amendments? Seeing none, I'll put the question. All those in favour of section 1? Contrary? Section 1 is carried.

Section 2: any comments, questions or amendments? Shall section 2 carry? Carried.

Section 3: any comments or amendments? Shall section 3 carry? Carried.

Shall the title of the bill carry? Carried.

Shall Bill 2 carry? Bill 2 is carried.

Shall I report the bill to the House? Agreed. I shall do that tomorrow.

Thank you all. Congratulations, Mr Kwinter. We thank those who took the time to make presentations and to send in their written comments over these past few months.

With that, the committee stands adjourned until 3:30 on Wednesday.

The committee adjourned at 1726.