INQUIRY RE MINISTRY OF HEALTH INFORMATION
CONTENTS
Monday 24 February 1992
Inquiry re Ministry of Health information
Honourable Francis Lankin
STANDING COMMITTEE ON THE LEGISLATIVE ASSEMBLY
Chair / Président(e): Offer, Steven (Mississauga North/-Nord L)
Vice-Chair / Vice-Président(e): Miclash, Frank (Kenora L)
Bisson, Gilles (Cochrane South/-Sud ND)
Christopherson, David (Hamilton Centre ND)
Conway, Sean G. (Renfrew North/-Nord L)
Eves, Ernie L. (Parry Sound PC)
Harnick, Charles (Willowdale PC)
Hope, Randy R. (Chatham-Kent ND)
Mills, Gordon (Durham East/-Est ND)
Murdock, Sharon (Sudbury ND)
Owens, Stephen (Scarborough Centre ND)
Scott, Ian G. (St George-St David L)
Substitution(s) / Membre(s) rempliçant(s):
Elston, Murray (Bruce L) for Mr Scott
Kormos, Peter (Welland-Thorold ND) for Ms S. Murdock
Wood, Len (Cochrane North/-Nord ND) for Mr Bisson
Also taking part / Autres participants et participantes:
Cavalluzzo, Paul, counsel, Cavalluzzo, Hayes and Shilton
Clerk / Greffier: Arnott, Douglas
Staff / Personnel: Jackson, Patricia, Committee Counsel
The committee met at 1011 in room 151.
INQUIRY RE MINISTRY OF HEALTH INFORMATION
The Chair: I call this morning session of the standing committee on the Legislative Assembly to order. Committee members will have, I imagine, an agenda before them. I would just like to make a note on that agenda. For scheduling purposes Susan Colley will be following the Minister of Health. It is agreeable to Ms Colley and to her counsel and indeed to members of the third party who were next in line for questioning. I would like to thank all those who were involved and agreed to this slight change in the schedule.
HONOURABLE FRANCES LANKIN
The Chair: With us this morning is the Honourable Frances Lankin, Minister of Health. Good morning, Madam Minister.
Hon Ms Lankin: Good morning.
The Chair: With her is her counsel, Mr Cavalluzzo. Good morning.
Mr Cavalluzzo: Good morning.
The Chair: Madam Minister, in our proceedings we have administered an oath to everyone who is giving testimony in this matter and I would like to invite the clerk to administer the oath at this time.
Frances Lankin, sworn.
The Chair: Madam Minister, prior to our counsel, Patricia Jackson, commencing questions, I would just like to inform you that in the event that you are asked a question which you cannot properly answer without divulging confidential information, could you or your counsel please advise this committee? If an answer cannot be given without divulging such information, then this committee can proceed on an in camera basis where that question and answer may be dealt with. I just give you that warning as one which has been given to all witnesses who have come before this committee.
Hon Ms Lankin: Yes, thank you. I understand.
The Chair: Having said that, it is the structure of this committee that our counsel, Patricia Jackson, will commence questioning, after which time there will be a rotation from caucus to caucus. At that, I would invite Ms Jackson to start the questioning.
Ms Jackson: Thank you, Mr Chairman. Ms Lankin, I understand you have been the Minister of Health since April 1991 and that you took the position following the resignation of Evelyn Gigantes.
Hon Ms Lankin: That is correct.
Ms Jackson: Before that you were the Chair of the Management Board and the Minister of Government Services.
Hon Ms Lankin: Yes, and I retained the portfolio of Chair of Management Board for some time into the summer of last year in addition to the portfolio of Minister of Health.
Ms Jackson: But you did not retain that portfolio following the summer.
Hon Ms Lankin: That is right.
Ms Jackson: And you are, I understand, in your first term as a member of the Legislature.
Hon Ms Lankin: That is correct.
Ms Jackson: An initiation of fire.
Hon Ms Lankin: Absolutely.
Ms Jackson: You finished your educational career with a BA in psychology and criminology?
Hon Ms Lankin: Yes.
Ms Jackson: And following that and until you took up your present position in the cabinet you were, in the following order, a day care director, a correctional officer, a probation and parole officer, an economic researcher, an equal opportunity coordinator at OPSEU, a member of the Workers' Compensation Board appeals tribunal and a provincial negotiator with OPSEU.
Hon Ms Lankin: The order is a little bit incorrect, but the positions are all correct, and it is the Workers' Compensation Appeals Tribunal.
Ms Jackson: Sorry; okay.
Now, in respect of freedom of information, I understand that when you were the Chair of Management Board you had occasion to become somewhat familiar with that legislation. Is that correct?
Hon Ms Lankin: Yes. In that portfolio, the Chair of Management Board has responsibility for the office of the freedom of information and privacy commission and responsibility for carriage of the legislation and any amendments to it. During the period of time I was there, there was a parliamentary review taking place with respect to the legislation as well as implementation of the municipal portion of the legislation, so I had the occasion to become both generally and more specifically briefed on the workings of that piece of legislation.
Ms Jackson: When you became Minister of Health, particularly given the circumstances under which you became Minister of Health, did you have occasion to discuss with your staff the constraints upon their use, or your use, of personal information?
Hon Ms Lankin: Absolutely. To put it in context, of course, Ms Gigantes had resigned over this very issue, breach of confidentiality of private information contained within the Ministry of Health. In my meetings both with the staff who came with me from my former portfolio as well as the staff who were there who had formerly been staff of Ms Gigantes, whom we retained for a period of time, and directly with the deputy minister and at a later point with the assistant deputy ministers, I made very clear my concern about proper adherence to the legislation and also gave absolute direction that I did not want to be provided with any information of a confidential or private nature unless it was necessary in order for me to carry out my job, and it was a caution. I said: "I don't want too much information with respect to anything that is private or confidential. I'd rather have too little and we'll take it from there."
Ms Jackson: Now, you say you gave those instructions specifically to your staff. By that, do you mean the political staff in your office?
Hon Ms Lankin: And beyond. I had that discussion very directly with the Deputy Minister of Health, who at that time was Dr Martin Barkin, and at a later larger senior management meeting at which -- I cannot guarantee that all the assistant deputy ministers were there, but a senior management meeting, which usually involves having deputy ministers and various directors.
Ms Jackson: Now, with respect to the use of personal information, you indicated you told them it should not go to you unless it was necessary for you to do your job. Was there any discussion -- did you give any instructions as to when and under what circumstances personal information should go to members of your staff?
Hon Ms Lankin: No. I believe that my general statement -- although I used "I," the first person, my intent at the time was to convey that caution should be applied and that the mindset should be in place in the ministry that information that was not required should not be passed on, and that it should be screened at each level, myself being the very last level that would get confidential information, in a sense for two reasons: one, to protect the information and, secondly, to protect myself in the position as minister to avoid the kind of inadvertent event that happened to Ms Gigantes.
Ms Jackson: I think you have explained to the committee your thinking, but I understand from your answer that in terms of the instructions you gave, the instructions related to what personal information you personally should get, and not your staff.
Hon Ms Lankin: Yes. The instructions that I gave to the ministry, at any time I gave it my recollection is that I was talking about myself, "I don't want to see any personal or confidential information unless it is required." The more general instructions that I gave to the ministry and to my own staff in my office were to be vigilant and be concerned about the protection of private information.
Ms Jackson: I take it, having given that instruction, you do not know specifically what steps were taken to train the members of your staff or to make them familiar with the constraints on their use of personal information.
Hon Ms Lankin: No. I do know that the staff who came with me from Management Board had been exposed to the legislation and the briefings, as had I, and had a fair degree of understanding with respect to the legislation. We also had, subsequent to coming to Health -- and it was some time subsequent, a couple of months; I am not sure exactly when -- a briefing around the issue of health issues and privacy of information. The commissioner actually attended such meeting to implore me to think about changes that were required to pieces of health legislation with respect to this issue. We had a discussion there at which staff were present as well. The general training and/or briefing and/or ensuring that people were aware of their responsibilities, I would leave to my executive assistant, Ms Colley.
Ms Jackson: Who had come with you from Management Board.
Hon Ms Lankin: Yes.
Ms Jackson: Had Mr Howard come with you from Management Board?
Hon Ms Lankin: Yes.
Ms Jackson: Mr Corea had not.
Hon Ms Lankin: No.
Ms Jackson: I take it, from what you say, you would agree that it would be desirable to have in place a specific policy as to how personal information is to be dealt with within the Ministry of Health.
Hon Ms Lankin: Well, there is definitely a policy which is -- it is more than a policy; it is a law -- that we are not able to reveal that information outside the ministry. With respect to internal policy, within the ministry, again, following the events that happened with Ms Gigantes a stricter, more rigorous application of the policy was put in place, as far as I was informed at the time, in which Dr MacMillan and others in the OHIP branch had their own policies to follow in terms of assessing whether private or confidential information was necessary for whatever events were taking place within the ministry, whatever work was going on. So they put in place their own procedures to follow, to ensure that only necessary information was referred out of the OHIP offices directly.
Ms Jackson: And it would be desirable to have such procedures in place throughout the ministry.
Hon Ms Lankin: Yes.
Ms Jackson: Do you know if any such procedures were in place in your own office?
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Hon Ms Lankin: I do not believe there is a policy manual. I do not believe there is anything written down, other than what there is within the ministry in general in the security provisions that have been set out, which my staff would have been aware of. I do not believe we have our own policy directives in that sense. I do certainly have every confidence that the members of staff have been informed both by myself and/or by Ms Colley of their responsibilities to protect private information and the caution. There is not anyone, I would venture to say, within the employment of the minister who was not very aware of the disastrous effects of what happened in the Ms Gigantes situation, so it is something that people are attuned to.
Ms Jackson: Oh, I take your point that they are aware of the general issue and the importance of personal information, but in terms of procedures within your office, there are no procedures that would say, "These are the characteristics of personal information and this is what you should or should not do with it."
Hon Ms Lankin: I do not believe there is anything that is written down to that effect, other than the ministry's manual itself.
Ms Jackson: All right. Apart from Dr Donahue and the situation that we are going to explore, as you know, through the balance of the morning, are there any other circumstances in which -- and this question should not be taken to imply that you got personal information concerning Dr Donahue in this case, because we will explore that for the balance of the morning -- are there any other circumstances in which, since you became Minister of Health, you have received personal information concerning a particular doctor?
Hon Ms Lankin: None that I can think of.
Ms Jackson: Now, turning to the threshold agreement, while you were the Chair of Management Board, as I understand it, you were responsible for the negotiation of the threshold agreement between the OMA and the Ontario government.
Hon Ms Lankin: I was the lead minister of three ministers responsible for the negotiations, yes.
Ms Jackson: And in that context, then, you became quite familiar with the concept of the threshold and how the government intended that it be implemented.
Hon Ms Lankin: Yes.
Ms Jackson: And one of the significant elements of that threshold was that there was an exemption for doctors who were on the underserviced area program.
Hon Ms Lankin: Yes, that is correct.
Ms Jackson: Another feature of that agreement, we have heard, that required some further work was the question of what was included and what was not included in a doctor's income for the purpose of determining the threshold.
Hon Ms Lankin: With respect to --
Ms Jackson: Technical fees.
Hon Ms Lankin: -- technical fees or procedural fee codes, yes, that is correct.
Ms Jackson: And as I understand it, following the agreement itself, there was considerable work done on what should and should not be concluded as technical fees for the purposes of determining income. Is that correct?
Hon Ms Lankin: Actually, that is correct, but it is as a result of concerns that had been raised by certain groups of physicians and individual physicians applying for exemptions in anticipation that they would be affected by the threshold. In particular, the specialty of ophthalmology is one in which I recall we had significant discussions with members of that profession about certain procedural codes in their practice which were more akin to technical codes in other specialists' practices. As a result of those discussions and further negotiations with the Ontario Medical Association, we did arrive at a revised list of technical fee codes which transferred some of what had previously been treated as procedural codes, which would have been subject to the threshold application.
Ms Jackson: Over what period of time did this working out of a revised list of technical fee codes take place, approximately?
Hon Ms Lankin: The agreement was signed with the OMA, I believe, in June. I think it was in June of last year, and it would have been within a month and a half to two months after that that the first letters and concerns were starting to be raised by physicians, general practitioners, specialist groups and individuals. My recollection of discussions around this was late summer, September, October.
Ms Jackson: And once that revised list of technical codes had been worked out, did you then turn your mind to the question of whether and to what extent you should be granting exemptions under the other provision of the agreement, namely, the ability that you had as minister to give exemptions by specialty or by region?
Hon Ms Lankin: Yes, there were quite a number of meetings, during the period of time I am describing, with the Ontario Medical Association and representatives of the ministry working out some of these details, with backward and forward positions being taken, as you could imagine, essentially for the negotiations with respect to the detailed implementation of the threshold clause.
During that period of time there were also certain events or certain occasions we had to look at the application of the threshold in which we were able to find solutions or look for creative ways to deal with the problems that were being presented, which I can speak to later, like the Peterborough cardiology pacemaker clinic.
As a result of those ongoing discussions and actually resolving some of the problems like the ophthalmologists, like Peterborough, and in continued discussions with the OMA, and realizing that in fact the fiscal goal which had been established as what we expected to achieve from the application of the threshold which had been jointly established by the OMA and the government during negotiations, realizing that some of the decisions that we had made would erode the success of that fiscal goal, we arrived at a decision that we would not grant any further exemptions. That was around the beginning of November.
Some time prior to that in the discussions we had arrived at a decision that we would not look at individual exemptions, that we would try and deal with it only by group. After having explored that further, we came to the conclusion that we would not grant any further exemption. That was then later communicated by letter to the OMA, to physicians and to members of the Legislature.
Ms Jackson: Now, you said in the context of giving that answer that rather than giving exemptions, you were looking at creative ways of dealing with particular situations. Is that a phrase that you used at the time?
Hon Ms Lankin: Yes, it is a phrase that I often use. I push as much as I can for the ministry to look creatively at issues because I have felt sometimes that there have been standard responses to problems and that there is a need for the ministry to be much more responsive to the specifics of an individual situation rather than to simply respond on the black and white of what the policy may say.
Ms Jackson: During this period in which you were considering technical fees and the issue of exemptions, were you also considering the issue of epilation?
Hon Ms Lankin: Yes, that had been a matter of ongoing discussion from the point in time when I entered the portfolio.
Ms Jackson: What was the issue?
Hon Ms Lankin: The issue was whether or not we should delist epilation from the schedule of insured benefits.
Ms Jackson: What was the decision?
Hon Ms Lankin: The decision was that we would delist it and that delisting would be effective, I think, November 15. I think that decision was taken some time or announced some time in October. I am not sure of those dates.
Ms Jackson: What was the effect, then, of that decision, if any, on the question of the threshold income for physicians who were engaged in epilation services?
Hon Ms Lankin: Again, during the period of time while we were reviewing the threshold and the particular exemptions and the movement of some procedural codes to technical codes, and that this decision was taken with respect to epilation, we also decided that we would therefore exempt any billings over the course of the year that any doctor made that were with respect to epilation from the application of the threshold.
Ms Jackson: Do you recall when you took that decision to exempt those billings?
Hon Ms Lankin: That would have been prior to the decision in the beginning of November that no further exemptions would be allowed. I do not recall, but I am assuming it would have been in around October, at the time or shortly after we arrived at the decision about delisting epilation.
Ms Jackson: Ms Lankin, I would like to explore with you now what you came to learn about Dr Donahue. May I start by asking you to turn up exhibit 10, which is a transcript of an interview with Dr Donahue on November 8 concerning epilation.
Hon Ms Lankin: Yes.
Ms Jackson: Do you recall whether you saw this transcript or heard of this interview?
Hon Ms Lankin: Yes, I recall hearing of the interview around the time or shortly after the interview was given. I absolutely recall seeing the transcript of this in a package that contained the transcript of Dr Donahue's later interview around the thresholds and a briefing note with respect to Dr Donahue and the application of the threshold, dated November 14. I do not recall whether or not I saw the actual transcript of this interview prior to seeing it in that package. It is reasonable that I might have, but I do not recall that.
Ms Jackson: Do you have any recollection of the circumstances in which you came to learn or may have come to learn of this before receiving the interview attached to a briefing note?
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Hon Ms Lankin: I do not recall exactly. I expect that it was in the course of passing in the hallway and Paul Howard or someone from the communications department of the ministry indicated that there had been an interview with -- I do not actually even know that I knew the doctor's name or would remember it at that point in time. But it was a Sudbury dermatologist who was talking about the delisting of epilation and was going to be opening a private clinic to continue the epilation service. It was not at that point in time identified as a problem. It was in fact what we would expect would happen, that the services would be provided on a private basis.
Ms Jackson: Let me then take you to the following week, which would begin, I guess, on the morning of Monday, November 11, and ask you to turn to exhibit 28, an e-mail of the morning of the 12th from Mr Corea in your office to a number of people. Did you see that e-mail?
Hon Ms Lankin: No. The first occasion I had to see this was when I met with commission lawyers to give discovery of testimony.
Ms Jackson: Just to help the committee understand how your office functions, do you have a computer in which you get copies of e-mails?
Hon Ms Lankin: There is what is called a dumb computer, as opposed to a smart computer, in my office which I do not use. I do not communicate by e-mail nor do I receive e-mails.
Ms Jackson: If information comes to your office by e-mail that someone thinks is information you should have, then how do you get it?
Hon Ms Lankin: I am not aware of anyone having ever attempted to send an e-mail to me, because I do not actively participate on the e-mail system. The information I receive is primarily in the form of briefing notes, news clippings or verbal.
Ms Jackson: So if something comes in an e-mail that somebody thinks should be passed on to you, they would either do a memo or a briefing note to you, or they would tell you.
Hon Ms Lankin: Usually. There may be the odd occasion when they show me or hand me a copy of an e-mail. I do not recall that specifically. I would not preclude that as an opportunity, but I have not seen this one prior to having been shown it by the commission lawyers.
Ms Jackson: Apart from being shown the e-mail, were you told of its contents or any of the substance of its contents?
Hon Ms Lankin: No, nor was I told of its existence.
Ms Jackson: Did you become aware in or around this time, as this e-mail indicates, that Mr Laughren's office, and indeed Mr Laughren personally, were getting calls about the closure of Dr Donahue's office?
Hon Ms Lankin: Not that I recall specifically. I did at one point in time, and it was either in the Legislative Assembly or during a treasury board meeting, have a brief discussion with Mr Laughren in which he asked me if I was aware of the problem that had arisen with respect to the Sudbury dermatologist.
At that point, we had sent out a few days before that the letter with respect to no further exemptions. I think I explained that to Mr Laughren and he raised, very briefly, the issue of the fiscal realities and concerns about that, and yet on the other side concerns about continued delivery of services in the north. It was not an extensive discussion. I think I was under the impression at that point in time that my answer to him about no further exemptions actually was the final answer, and it was not until some time later when the issue became more prominent with respect to the broader Sudbury doctors that I revisited it in my mind.
Ms Jackson: Now, in terms of trying to understand when that meeting might have taken place, as I understand it, during the week of the 11th the Legislature was not sitting?
Hon Ms Lankin: That is correct; it was constituency week. I think the 11th itself was Remembrance Day. I was actually very sick during this period of time. I was supposed to have attended a Remembrance Day service and ended up at home sick in bed.
On the Tuesday I was in my constituency office -- which is the 12th -- with constituency appointments in and around my riding. On the Wednesday -- my memory is failing me. I know that towards the end of that week there were -- oh, I know. It was a very important speech I was delivering to the Ontario Hospital Association. It was their annual convention, and this was actually the thing that I had been focusing on the most. The weekend before, I had spoken to the district health council's annual action centre. These two speeches were sort of cornerstone opportunities for me to provide people with a sense of direction of what was going to be happening around the budget and transfer payments rollout, that we were going to be facing difficult times, that we were going to have to try and rearrange how we did business. It was a very major set of speeches. So that was on the Wednesday morning.
Then I attended estimates for a considerable period of time late into the evening on, I think, the Wednesday and part of Thursday, at which time, because I had been sick and because I was very tired, I had actually booked off an extended weekend and went out of town Thursday at noon for Thursday, Friday, Saturday, Sunday. And I recall hearing about the Sudbury dermatologist, and this is my first recollection of actually knowing his name, on the radio that weekend. There was a report that he had --
Ms Jackson: Okay.
Hon Ms Lankin: -- been public with his announcement about closing his office.
Mr Elston: On a point of order -- I am sorry to interrupt.
The Chair: Mr Elston.
Mr Elston: I hate to do this, except that it is causing me some confusion. If Ms Lankin was in estimates, was it in internal estimates as opposed to House estimates? Because if --
Hon Ms Lankin: Yes.
Mr Elston: It was internal?
Hon Ms Lankin: Yes.
Mr Elston: Okay, so it was Ministry of Health estimates that you were at.
Hon Ms Lankin: Sorry, I should have explained that. I am a member of treasury board and it was a treasury board estimates meeting with other ministries coming forward to present their requests for estimates.
Ms Jackson: And this is late on the 13th and on the 14th, is it, the Wednesday and Thursday?
Hon Ms Lankin: Yes.
Ms Jackson: And that at least would seem -- now, just so you have the time frame, if you can look at the back part of exhibit 8 you will see that you appear to have sent letters out to various interested parties announcing the end of the exemption, the prospect of an exemption, on the 13th of November. That would have been the Wednesday, and I think the evidence is from you and from Ms Colley that the decision had been taken some days before.
Hon Ms Lankin: Yes, that is correct.
Ms Jackson: So it is at least possible that this conversation with Mr Laughren took place in this treasury board estimates meeting on the 13th and 14th?
Hon Ms Lankin: It is possible. I cannot place it exactly for you. My best recollection is that it would either have been that treasury board meeting or it would have been the following Monday afternoon or Tuesday morning, afternoon being in the Legislative Assembly or Tuesday morning in a regular treasury board meeting. But I cannot be more specific in its placement except to say that I do recall when I heard the radio reports, because I actually tuned in and listened to the news several times because it was an issue obviously affecting my ministry. My recollection is that I had more information from that radio interview than I had had prior to that. There was some surprise for me in that radio interview, which does not definitely say that I spoke to Mr Laughren following that weekend, but it leads me to conclude that.
Ms Jackson: All right. And I am going to come back to that radio broadcast in a moment, but let me just review with you some specific documents and have you advise the committee whether you actually saw the documents.
First of all, could you turn to exhibit 13.
Hon Ms Lankin: I first saw this document when I was shown it by commission lawyers.
Ms Jackson: And before that had you heard about anything in the document?
Hon Ms Lankin: Yes. Subsequent to the Toronto Sun reporter calling our office on the 10th of December and her subsequent article on the 11th of December --
Ms Jackson: You learned something.
Hon Ms Lankin: I learned something about this memo being in existence, but I had not seen it.
Ms Jackson: And had you heard anything about it before the conversations arising from the Toronto Sun reporter's interview?
Hon Ms Lankin: No, nothing.
Ms Jackson: Then can you turn to exhibit 29, please. Have you seen that before?
Hon Ms Lankin: No; the same answer.
Ms Jackson: Did you have any awareness from Mr Laughren or Ms Colley or anyone that your office was engaged as a result of the calls that Mr Laughren had been receiving concerning Dr Donahue?
Hon Ms Lankin: I did become aware of that at some point in time following either the -- it would have been during, I should say, either the week of the 19th of November, which is the week we just talked about, or the following week, which would have been the 25th or so.
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Ms Jackson: Nothing; no awareness that you can now recall in the week of November 11?
Hon Ms Lankin: No.
Ms Jackson: Then could you turn to exhibit 48 please, which is an announcement apparently by Dr Donahue to his patients of his office closing. Do you recall if you saw that?
Hon Ms Lankin: I do not recall seeing this. I do recall at some point in time being made aware of it, I think again during that week of the 19th, having heard it on the weekend on the news and then following up on it, but I do not actually recall seeing this particular notice.
Ms Jackson: Exhibit 49, have you seen that?
Hon Ms Lankin: No.
Ms Jackson: Exhibit 50 is an edited version of an e-mail from Susan Colley, concerning her meeting with Mr Decter, to Mr Corea. Have you seen that?
Hon Ms Lankin: No.
Ms Jackson: Do you recall whether you were told of a meeting between Ms Colley and Mr Decter on that morning? That is the Friday morning.
Hon Ms Lankin: No. Again, I was --
Ms Jackson: That was when you were away.
Hon Ms Lankin: -- out of town from the Thursday at noon, Friday, Saturday and Sunday. I returned Monday morning and left very early in the morning for Ottawa and was not back in my office until Monday afternoon, and do not recall ever specifically being made aware of a meeting between Ms Colley and Mr Decter.
Ms Jackson: Exhibit 52, have you seen that?
Hon Ms Lankin: No, I have not.
Ms Jackson: Exhibit 53, have you seen that?
Hon Ms Lankin: No, I have not.
Ms Jackson: That I think takes us -- let me just ask you as well: Were you ever advised of a meeting on November 15 in Sudbury which Mr Laughren, Ms Martel, Ms Murdock and others attended and received a presentation from Dr Donahue, in which he delivered the last salary cheques to his staff?
Hon Ms Lankin: I think at some point in time I became aware that a meeting had taken place. I do not recall when that was, but I certainly do not recall the details of it. The events that have been described to me, of Dr Donahue delivering the cheques for Mr Laughren to deliver, are quite theatrical. It is the sort of thing I think I would remember if I had been told that, so I do not think I got a detailed report of it.
It seems to me that when I started to become aware of the issue, we then moved into trying to determine whether there was a serious problem with respect to service delivery in the north as a result of our policy with respect to the no exemption on the threshold, and whether or not that needed to be revisited. It was in a problem-solving tone and the discussions I had with anyone subsequent to that, Ms Martel and others, were in that respect. I do not recall hearing the details of that November 15 meeting.
Ms Jackson: Now, when you were up north on the weekend of the 16th, 17th and 18th -- you mentioned that you heard some radio broadcast. I think you said you heard a radio interview.
Hon Ms Lankin: No, I do not recall an interview; I recall news.
Ms Jackson: All right. What is your recollection of what you learned from those broadcasts?
Hon Ms Lankin: That there was a Sudbury dermatologist, that his name was Dr Donahue and that as a result of the OMA-ministry or OMA-government agreement and the specific provision with respect to thresholds, he was threatening to close his dermatology service in Sudbury.
Ms Jackson: Now, you said your recollection is that you got more detail than you had had previously. What was new then in what you learned?
Hon Ms Lankin: I have the impression that I was surprised by that, because I cannot recall whether I had specific information before. I cannot make that distinction for you. I think the information of a doctor, a Sudbury dermatologist, threatening to close his practice is sort of the kernel of information I remember being surprised by and responding to and being interested in hearing.
Ms Jackson: Surprised. Why?
Hon Ms Lankin: Pardon?
Ms Jackson: Why were you surprised?
Hon Ms Lankin: I was on a much-needed day off, listening to the radio and I hear something about the Ministry of Health and about the agreement, so being surprised in that sense of tuning in and listening and not being aware of the information before.
Ms Jackson: All right. Then you came back to your office and I think you said went to Ottawa but were back in your office on the 18th, after your visit to Ottawa. Were you?
Hon Ms Lankin: The 19th, are we talking about now?
Ms Jackson: No, Monday the 18th.
Hon Ms Lankin: I returned from Ottawa and then had a course of things. I do not know whether I was actually in my office. I assume I made it for question period. I am not sure about that, but I think I got back for question period that day. Then I would have gone straight in to P and P. I am sorry; without going back and checking my schedule, I cannot tell you what I would have been doing following P and P that night. So I assume I would have had a quick exchange of coming into my office, dropping off some things, picking up my House books and going out again.
Ms Jackson: Could you turn to exhibit 14 in these proceedings, which is a briefing note dated November 14, the prior Thursday. Did you receive that?
Hon Ms Lankin: Yes, I did, at some point in time. Along with that, I also received a copy of the transcript of the two interviews with Dr Donahue, one with respect to epilation and the other with respect to the threshold application and his practice.
Ms Jackson: Can you look at exhibits 10 and 11 and confirm that those are the transcripts you are talking about?
Hon Ms Lankin: Yes. I can only assume I received these on Monday the 18th, before I went into the House or when I returned from Ottawa.
Ms Jackson: What did you understand was the purpose in giving you these? What were you to do with them?
Hon Ms Lankin: Most briefing notes and those with press clippings or transcripts are to inform me of issues within the ministry or within my office, or by any MPP who has called in, that are identified as potential problem issues or contentious issues, something I may be required to provide further information on to members of the Legislature with respect to during question period, or to members of the media, something that has been reported in the media. For example, over the weekend I had heard this news report about a dermatologist threatening to close his office. That is a news item which one would expect would be followed up by questions from the media in a scrum outside the Legislature or potentially by a member of the Legislature wanting more information during question period.
Ms Jackson: In this case, the issue is what is the ministry going to do about this particular issue, Dr Donahue and the potential closure.
Hon Ms Lankin: I would assume that would be one of the questions I would be asked: "Are you going to grant an exemption? Is your policy with respect to thresholds going to limit services in the north?" I think there have been members who have asked me that directly, both on the record in question period and privately, so questions and concerns of that nature, "Is this going to cause problems with respect to delivery of northern health services?"
Ms Jackson: Part of the question of how the ministry will deal with this issue will depend on whether in fact Dr Donahue is likely to close his practice. That is one of the issues.
Hon Ms Lankin: That is one of the issues, yes.
Ms Jackson: Whether he is likely to close his practice or not would in part depend on whether his billings are seriously threatened by the threshold. Is that right?
Hon Ms Lankin: Whether they are threatened by the threshold, yes.
Ms Jackson: So you need to know, to answer that question, what his billings are and how they relate to the threshold.
Hon Ms Lankin: To be able to answer the question, is this doctor going to be affected, at this point in time in the year we would have needed more than that. The ministry would have been able to do a projection within OHIP, but given that we were only partway through the billing year, that could not be a sure thing. For example, the doctor may be intending to take vacation for a period of time. There are a number of things that could mitigate against the billings reaching a threshold if they were projected to head in that direction.
The way in which we handled both this and other issues -- because I am sure you will get to it -- you will find that in fact the dermatologist was a subissue of the larger Sudbury specialist issue and cardiology was the issue of most concern during this period of time. The way in which we determined to handle it was to ask the individual doctors to sit down with Dr MacMillan and others to go through their individual situations and be able to answer their questions with respect to the threshold.
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Ms Jackson: Okay. I will come to how you decided to handle it, but right now I am trying to focus on what you would need to know.
Hon Ms Lankin: Right.
Ms Jackson: It is clear, is it not, that one of the things you would need to know is some best estimate of the impact of the threshold on this doctor's billings?
Hon Ms Lankin: Ms Jackson, I am going to have to ask you what you mean by "you would need to know," because I think there are different levels of need to know within the ministry. I think what Dr MacMillan or Eugene LeBlanc would need to know in dealing directly with the doctors or in providing the deputy minister and/or myself with advice as to whether or not the threshold policy was going to cause a serious problem is a different level of detail than either my staff or I would need to know with respect to understanding if the threshold was going to cause a problem and disruption in delivery of services to the north.
Ms Jackson: Whoever formulates the response to this situation would need to know that.
Hon Ms Lankin: Right, and I would expect that would be done within the ministry.
Ms Jackson: All right. And whoever formulates the response to this issue would need to know if his billings are at a level that they are threatened by the threshold. Are his costs so high that the cap on billings is a problem? That person would need to know that, would they not?
Hon Ms Lankin: I am sorry; could you restate that question?
Ms Jackson: If the billings are likely to run over the threshold, the second issue that is going to determine whether Dr Donahue is likely to close is what the relationship of his costs are to his billings.
Hon Ms Lankin: That would be another issue that I would expect would be explored between Dr MacMillan and, for example, in this case Dr Donahue.
Ms Jackson: Well, again putting aside how you get it, it is a piece of information whoever is going to address the response from the ministry is going to need to know.
Hon Ms Lankin: In a generic case I would say yes to you; in this particular case I would say no. My reason for that, at least as far as I was led to conclude from later discussions with ministry officials about Dr Donahue's situation, is because Dr Donahue had been a member of the underserviced area program and because part of his practice was epilation, which at that time was an insured service that was not subject to calculation for the purposes of the threshold.
There was a question raised in my mind and I think for me, by my discussions with ministry staff, as to whether or not because of those two factors Dr Donahue would in fact be affected by the threshold. So although I do not disagree with you that that could have been one of the things in a general sense -- you could look to a whole number of things -- in this particular it case appears to me, from my discussions with the ministry, that the first two issues were of more importance and gave rise to a question that should be answered at that level first.
Ms Jackson: I think you are saying that when you learned a little bit more about his situation, in that he was on the underserviced area program and you already knew that he was doing some epilation, you had reason to doubt the statement that the threshold was causing him to close his clinic.
Hon Ms Lankin: I would say that I had reason to wonder if the threshold was going to affect this doctor and whether or not he was aware of or misunderstood the exemptions under the threshold.
Ms Jackson: But in any event you still need to know -- sorry; let me try it again. His involvement in the underserviced area program was over in the summer of 1991. You were told that eventually, were you?
Hon Ms Lankin: I believe so; August or September, I think.
Ms Jackson: You knew he had some epilation services in his practice.
Hon Ms Lankin: Yes, I was aware of that as a result of the first interview the doctor gave with the press.
Ms Jackson: Whether that combination resulted in a situation of whether he did or did not have a threshold problem would depend on the total level of his billings and what his other services were, would it not?
Hon Ms Lankin: Yes.
Ms Jackson: So you would need to know what the total level of the billings was. Yes?
Hon Ms Lankin: Again, that question was never answered for me, so I do not know that anyone in the ministry approached it from trying to answer that question first. What was drawn to my attention -- I assume it was the first thing the ministry reviewed and discovered as well -- was that he was on the underserviced area program and that he did perform epilation, which would not be calculated against the threshold, and that therefore that should be explained to him and Dr MacMillan should sit down and have a discussion with him and go over that and look at the rest of his billings, I would presume with respect to being able to answer the questions you have raised.
Ms Jackson: In terms of being able to answer those questions, you can get that information from Dr Donahue. That is one place you can get it.
Hon Ms Lankin: Yes.
Ms Jackson: But you could also get information on Dr Donahue's billings in a year, admittedly by projections, from the OHIP records.
Hon Ms Lankin: Yes, I would assume so. I have never seen any records of projections. I do not know how that information is contained within OHIP, but I would presume that from things I have seen like projections of how many doctors in total, in Sudbury or in northeastern Ontario, by projection would be affected by the threshold.
Ms Jackson: Similarly, from the OHIP records you could get a sense of what the mix of the services performed by Dr Donahue was in a typical year.
Hon Ms Lankin: I would presume that, yes.
Ms Jackson: One of the things somebody who is formulating a response on the Dr Donahue issue would want to know is, if Dr Donahue goes out of business, what services go out of business with him? Is that not fair?
Hon Ms Lankin: Yes, I think as a general statement. Again, I would like you to be specific in terms of at what level you are talking about it.
Ms Jackson: For example, if it were the case -- and I am not suggesting it is here -- that virtually everything Dr Donahue did was epilation, the ministry has already decided that is not something it is going to be funding through the medical budget. Is that fair?
Hon Ms Lankin: Yes.
Ms Jackson: Therefore, if it were the case -- and I emphasize for those in the room that I am not suggesting it is -- but if it were the case that most of Dr Donahue's practice was epilation, his going out of business would not be as serious a concern for the ministry as if most of his practice was, for example, skin cancer.
Hon Ms Lankin: Yes, I think that is a fair statement.
Ms Jackson: And if a good portion of his practice related to something that could be done in local hospitals or by general practitioners, you would be less concerned about his going out of business than, again, if it were skin cancer, which could not be.
Hon Ms Lankin: Yes. Again, in the hypothetical way you are putting it, I agree with you. I do not know whether those kinds of examinations were undertaken with respect to this doctor, because again --
Ms Jackson: I take your point.
Hon Ms Lankin: -- I come back to the first two exemptions having been raised as the reason why we needed to have further discussions with Dr Donahue.
Ms Jackson: But in terms of trying to understand what a proper ministry response to this situation should be, those would be important pieces of information.
Hon Ms Lankin: Yes, I think that is fair.
Ms Jackson: You agree it would not be wrong for your staff, in trying to deal with these issues, to try to get the kinds of information you and I have just been discussing?
Hon Ms Lankin: I do not think it would be wrong. It would not be my sense of the first action or the first necessary action. My sense is that my staff would want to have the answer to the question, "Do we have a problem if this doctor closes down?" using your example, Ms Jackson, of because his practice is primarily treating skin cancer and therefore that service would no longer be available. I think my staff would at first want the answer to the question, "Do we have a problem?" I do not think they would require the billing information and would require going through a process to come to that decision themselves. I would assume that review and that decision would be done primarily by ministry staff and that the response to the questions, "Is there a problem?" or, "Is there a reason for further exemption?" or, "Do we look at this?" would be the answers they would be looking for.
Ms Jackson: They would be looking for an answer, "Yes or no, we have a problem," but they would also presumably be looking for some indication of why you did or did not have a problem.
Hon Ms Lankin: Yes. I do not think that would necessitate, however, doing the examination of the practice or the billings or the various ratio of one kind of service versus another kind of service themselves.
Ms Lankin: But they would want to know something about the results of that analysis.
Hon Ms Lankin: The results of it, yes.
Ms Jackson: And to the extent that the results of that analysis told them something about Dr Donahue's practice, that would be appropriate for them to know?
Hon Ms Lankin: Yes. I am not saying the other would be inappropriate. It would just be surprising, because it is not their job to do the decision-making and work of the ministry. They are there to be able to convey answers to questions that we need to know, to me or vice versa.
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Ms Jackson: Now, we are in the week of the 18th and you have received this briefing note and the two transcripts and you may already have had a conversation with Mr Laughren -- that is a little less clear -- and you have heard the radio broadcast, so you now know this issue exists.
Hon Ms Lankin: Yes.
Ms Jackson: Do you recall during that week whether you had any discussion with Shelley Martel about it?
Hon Ms Lankin: I do not know when my first discussion with Ms Martel was. I do recall her at one point in time having very detailed notes of a meeting that she had had with Dr Abdulla, a cardiologist, and I know that my discussions with her were focusing on cardiology. If that helps you or the committee place it in time any, you might be able to be of assistance to me because I do not remember when that first discussion was.
Ms Jackson: I am afraid that evidence is not before the committee yet. I cannot help you; I am sorry.
Hon Ms Lankin: Okay. The other sort of piece that might help place it eventually --
Ms Jackson: I mean, I can tell you that there was a meeting with the cardiologists on November 30, but my sense of what you are telling me --
Hon Ms Lankin: No, this is prior to that.
Ms Jackson: -- is that this was before that.
Hon Ms Lankin: Yes, it was prior to that. I can tell you that my first sort of in-depth discussion -- I would not have described any of them as truly being in-depth, but my first substantive discussion -- let me use that word -- with Ms Martel was she was attempting to raise the issue with me about the Sudbury doctors, so in fact this issue had gone beyond Dr Donahue at the time that I had my first discussion with Ms Martel. It was Sudbury doctors in general, and talking in specific about cardiologists. Ms Martel has had a long involvement in support of establishment of a cardiology program in Sudbury and is now a fierce defender of maintaining that service. She was worried that in fact we were going to be losing that cardiology service. She had detailed notes which she wanted to go over with me of a meeting that she had had with Dr Abdulla. She was stressing that she thought he had some very important points to make.
Again, I need to stress that during this period of time, both in terms of the timing of meetings on my schedule and the fact that I was continuingly getting more and more ill during this period of time, I referred her to speak to Michael Decter and/or Eugene LeBlanc directly, and believe I called and left a message or directed that Michael should meet with her to discuss her concerns.
I can tell you that in the period of the time of that week that by the Wednesday -- I attended a cabinet meeting in the morning -- I in fact was so ill that everybody was concerned about it, including members of the opposition coming across the floor to me and saying, "Get to a doctor." My staff unilaterally cancelled the rest of my week and insisted that I leave, as did a couple of people at the cabinet meeting. I left and went home and was in bed for the rest of Wednesday, Thursday and Friday. I had seen a doctor and been put on antibiotics and was in bed for that period of time. I came back into the office on Saturday because I had a full schedule of meetings with groups and associations, people coming in from around the province, that I did not want to cancel. I left immediately after that and went back home to bed and was in bed sick the remainder of Saturday and Sunday.
Ms Jackson: So you were home sick from the 20th to the 22nd?
Hon Ms Lankin: I am sorry?
Ms Jackson: You were home sick from the 20th to the 22nd, Wednesday to the Friday?
Hon Ms Lankin: Right, and then Saturday night and Sunday.
Ms Jackson: This conversation with Ms Martel, as near as you can recall it, did it take place during that week?
Hon Ms Lankin: I am sorry; I do not know. I know that I had a couple of conversations with her the subsequent week, prior to the meeting on the 30th. I do not know whether the first discussion was this week of the 18th or the week of the 27th.
Ms Jackson: In that conversation, was there any discussion that you can recall of Dr Donahue at all?
Hon Ms Lankin: I do not recall any, no.
Ms Jackson: Did you have any discussion with Sharon Murdock concerning Dr Donahue?
Hon Ms Lankin: I had a discussion with Sharon Murdock in the Legislative Assembly, not specifically about Dr Donahue but about all the doctors in Sudbury. I do not recall the day. It was a day in which the OMA dues act was scheduled, I think, for second reading. I do not think we actually got to it that day, but it had been scheduled. I was awaiting that and was preparing, reading through some background notes and preparing myself for that. Sharon Murdock came over and wanted to discuss the Sudbury situation. She did not understand much about the agreement and the thresholds at that point in time.
Because, fortunately, in timing we were going to be doing the OMA dues act, Mr LeBlanc was sitting behind the Speaker's chair at that point in time awaiting this second reading. I suggested to Sharon that the person who could be of most assistance to her in a very immediate fashion would be Dr LeBlanc. I pointed him out and that she could go and talk to him and ask him to explain the thresholds to her, that I could not at that time because I was preparing for second reading. She did that and at some point later that afternoon, evening, returned and said: "Thank you very much. That was very helpful. I understand the thresholds a whole lot better. It will be useful for me in my meetings with doctors in Sudbury."
Ms Jackson: Any discussion at all about Dr Donahue?
Hon Ms Lankin: I do not recall being specific about any doctor with Ms Murdock. I just do not have that recollection. I recall it being a general request for information about the Sudbury doctors and the thresholds.
Ms Jackson: Did you have any further discussion, apart from the one you have already indicated, with Mr Laughren about Dr Donahue in this period, the week of the 18th?
Hon Ms Lankin: I do not believe so.
Ms Jackson: You have indicated you were in bed for most of the weekend and ill. Were you back and in your office on Monday, the 25th?
Hon Ms Lankin: Yes.
Ms Jackson: Do you recall the question of Dr Donahue and the Sudbury doctors assuming a greater prominence during that period of time?
Hon Ms Lankin: Yes. Again, I do not know exactly when this was, but I recall Ms Colley, my executive assistant, saying: "Frances, you really have to turn your mind to the issue of the Sudbury doctors and the threshold. It is becoming a very difficult issue and we may have a serious problem with respect to our threshold policy. It may be causing disruption, it may be that it will cause disruption of northern health services, and you've got to meet with Michael Decter and with Eugene LeBlanc and you've got to sort out where we're going to head with this."
Ms Jackson: Did you?
Hon Ms Lankin: Yes, I am sure that week I had several meetings with Mr Decter and Dr LeBlanc. I do not know the times. There are regularly scheduled meetings, which do not always regularly happen, between the deputy, his executive assistant, my executive assistant and myself. I recall at least a couple of those sorts of meetings where Dr LeBlanc was brought in to address this issue.
Ms Jackson: During those briefings and meetings was there anything said about Dr Donahue that you can now recall?
Hon Ms Lankin: Yes, I believe this is where I became most aware of the issue, that Dr Donahue had been enrolled under the underserviced area program and that for that period of time all of his billings would be exempt from calculations for the purposes of the threshold, and that further to that, those epilation services that he performed subsequent to coming out from underneath the underserviced area program to November 15, I think the date is, effective date of the delisting of epilation, any services performed with respect to epilation would not have been calculated with respect to the application of the threshold, and therefore there is a question as to whether or not Dr Donahue, one, understands the application of the threshold and, two, whether or not he actually would be affected by the threshold.
I recall this clearly over the course of a couple of meetings because I became very frustrated with this scenario that a doctor may not be affected and yet felt or believed he was affected to the point that he had threatened, and I cannot remember whether he actually did at that point in time carry through with closing down his office.
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Ms Jackson: Can you look at exhibit 34, please, Ms Lankin?
Now, this is an e-mail. You have told us you do not generally see e-mails, but were you provided with this kind of information during this period as to the anticipated number of physicians over the threshold in Sudbury?
Hon Ms Lankin: I certainly was provided during these meetings, which were earlier than the date of this memo, with the information about the number of general practitioners and the number of specialists in the Sudbury area who, on the basic projection, would be or could be affected by the threshold. I do not recall the information with respect to the case studies that are illustrated in the remainder of this memo.
Ms Jackson: So it was clear from the ministry's records that it could do projections as to who would and who would not be affected?
Hon Ms Lankin: Yes. This was explained to me, with all the cautions: "One, these are projections; second, we cannot get behind these without actually looking at the doctor's billings, and third, we need to get the doctor's permission for you to have any kind of a public discussion." I, at this point in time, wanted to say, "Can we find out, can we have a meeting or whatever with Dr Donahue so that it can become on the public record whether or not he is actually going to be affected by the threshold?" Because, as you can understand, I was feeling politically frustrated in terms of dealing with this issue as well as frustrated in terms of knowing if the dermatological services were going to be severely threatened or not.
I do recall that we had specific discussions during this period of time around the issue of privacy and confidentiality of information. More specifically, I remember questioning, "If I wanted the answer to this, how would I get it?" They would have to look at the billings and I would have to be aware of some of the more general billing information which was still confidential. We determined that I did not want to get into that level but that I wanted to cause to have open -- the books be opened by the doctors.
I made those suggestions to Ms Martel and eventually we actually wrote directly to Dr Donahue. The deputy minister sent a letter requesting Dr Donahue to open his books. I understood that Dr MacMillan was also going to be speaking to him to attempt to get this agreement and to review the situation so that I could be given assurance, one way or the other, whether this doctor was going to be affected by the threshold. That never occurred.
Ms Jackson: But from what you have said, a substantial indication of whether he had a problem or not could have been provided from within the ministry, from its own projections?
Hon Ms Lankin: It could have been. It was not in any explicit way. Again, what I recall was that I was told about the fact that he had been enrolled in the underserviced area program and I was told about -- reminded, because I was already aware that epilation services were not subject to the application of the threshold. I had known through public information that Dr Donahue did provide epilation services. In putting those things together, I think intuitively I came to the conclusion that he may not even be affected. I do not think that was in any way discouraged by the information and discussion that I had with people in the ministry. We did not take it any further than that.
Ms Jackson: Did you tell the people in the ministry you had concluded he probably was not affected?
Hon Ms Lankin: Not that I concluded he probably was not. We did have a discussion that, "This is a legitimate question as to whether or not Dr Donahue is even going to be affected." Not knowing the answer to this and not having Dr Donahue agree, because he eventually declined to open his books in response to the deputy's letter, I remember continuing to be frustrated by this because in late December when we reached a further agreement with the OMA, with respect to revisions to the underserviced area program, the details of which we released last week, to try and address the issue of retention of specialists in underserviced areas, I remember hearing a news report in which Dr Donahue said that as a result of that he was going to re-open his office. Because there was no detail in our announcement at that time which would have given him assurance one way or the other that his problem with the threshold, if he had one, would be resolved. I remember thinking, "I wonder whether or not he ever even had a problem," and I still do not know the answer to that to this day.
Ms Jackson: I take it from what you said, a source of growing frustration for you was to know whether he really did or really did not have a problem.
Hon Ms Lankin: Yes, and very clearly in those discussions with the ministry we had determined that the proper way to ascertain that was to have the doctor's agreement to sit down and review his agreement and to be able to discuss publicly. When he declined that, because we were being very careful about protecting information from me, I never got the answer to that question throughout all of this.
Ms Jackson: Without his opening his books and his consent, there is a constraint absolutely on what you can make public about his situation.
Hon Ms Lankin: Yes.
Ms Jackson: But that does not constrain the ministry from finding out from its own records what his situation is.
Hon Ms Lankin: No, and I do not think it actually constrains the ministry from telling me at all. But that was not the way we handled it at that time. We were making that separation because, again, I recall expressing frustration about, you know, "How do we get at this?" and coming from the point of view of not asking for the specifics but asking in general, "What can and can't I know and what can and can't I say?" and those two things being different, determining that I would only want to know what I could or could not say.
Ms Jackson: But you, as the minister, have a responsibility for dealing with a problem if it arises.
Hon Ms Lankin: Yes.
Ms Jackson: Whether or not this was a problem would depend on whether he had a threshold problem.
Hon Ms Lankin: Yes, but I remind you that at this time it has assumed an importance because of subsequent events. Dr Donahue and the dermatology services were one case and a subset of the issue of the application of the thresholds in Sudbury in general and in northern Ontario in general. More of the discussion and focus had been on cardiology and on my request for the ministry to pursue solutions, to be creative about how it looked at this. For example, we contemplated looking at an alternative payment plan for cardiology during that period of time. We actually were coming to the conclusion that the underserviced area program exemption -- the program itself dealing with recruitment -- was not perhaps the appropriate exemption because the problem was retention. We actually were entering into discussions with the OMA around revising it, so we were trying to solve the problem.
Ms Jackson: I take the point and it is clear that Dr Donahue is not the only thing on anybody's plate. It is clearly the case -- you have testified to it and so have others -- there are a lot of other significant threshold issues and a lot of other issues facing the ministry. But at this point, clearly one of the problems facing the ministry is Dr Donahue and his situation. It is not the only problem, it may not even be the most important problem, but it is a problem that is getting more and more attention. Is that fair?
Hon Ms Lankin: Yes, Ms Jackson, but what I am saying to you is that the focus at that point in time in those meetings is that I was arriving at a conclusion, not specifically because of Dr Donahue but because of the cardiology and the impact on cardiologists, which I could take a moment and describe but I will leave that to you if you want to bring that out, that there actually was a significant problem with respect to the application of the thresholds, the way in which we had relied on the enrolment in the underserviced area program to be that exemption for underserviced areas. Subsequent to all that, we entered into discussions, negotiations, and reached agreement near the end of December. Further refinements up until last week --
Ms Jackson: I understand that.
Hon Ms Lankin: Let me finish; I am sorry -- which allowed us to address that very issue. That is important in terms of a distinction from how you are asking me the question.
Ms Jackson: But in terms of Dr Donahue, the solution to Dr Donahue was to try to get him to open his books, at least to this point, right?
Hon Ms Lankin: Yes.
Ms Jackson: The reason that was considered appropriate was that you would learn something about his actual situation, whether or not he would be affected adversely and what the ramifications for the community might be.
Hon Ms Lankin: I am sorry. Repeat that again.
Ms Jackson: You wanted him to open his books to find out how he was actually affected by the threshold.
Hon Ms Lankin: Yes.
Ms Jackson: And also what the ramifications for the community would be in terms of the services he provided.
Hon Ms Lankin: Yes, that is correct.
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Ms Jackson: So that was something you wanted an answer to.
Hon Ms Lankin: Yes.
Ms Jackson: It would help you solve the problem.
Hon Ms Lankin: Absolutely, although again I point out to you that these things become subsumed by bigger issues, and the bigger issue became that there actually did appear to be a problem with the application of the threshold. Our focus then was on solving that problem, which would resolve it for Dr Donahue and all the other doctors in Sudbury and beyond.
Ms Jackson: That comes later.
Hon Ms Lankin: No.
Ms Jackson: At the point at which you are talking to Mr Decter and Dr LeBlanc about having Dr Donahue open his books, this looks like a solution, a way of dealing with the problem, having him open his books.
Hon Ms Lankin: That certainly -- and the other doctors as well.
Ms Jackson: At that point in time you could get that information in large measure, not perhaps as detailed but you could get that --
Hon Ms Lankin: I am sorry. I am going to have to correct you. You said that came first and these other concerns came later at some time. I am sorry; that is not correct and that is not what I was indicating. During the discussions that took place that week, the focus was on both the individual situations of the dermatologist, of the cardiologist, but also the recognition that there appeared to be a problem that was serious. Were there other solutions? Could we look at something like an alternate payment program for the cardiologists? What was our real problem? It was retention. Should we not talk about the underserviced area program again with the OMA? This was all happening at a series of meetings that week at the same time.
Ms Jackson: Over that time, that weekend, and I think for a while thereafter, the ministry did pursue efforts to have Dr Donahue open his books, did if not?
Hon Ms Lankin: Yes; a letter went out. With respect to what I am saying about the focus on revisions to the underserviced area program, and I am talking about the week of November 25 to the meeting on the 30th, the following week, on the Monday in the Legislature I was asked a question by, I believe, Mr Harris with respect to thresholds and the underserviced area program. I indicated in my response to him that we were in fact pursuing a review of and potential revisions to the application of the underserviced area program. So it is clear that was a matter of discussion at the same time as these other things.
Ms Jackson: At the same time, but you are still looking to have Dr Donahue open his books throughout that one, two, maybe three-week period.
Hon Ms Lankin: I have said yes several times.
Ms Jackson: All right. You say yes, and then you go on to the other, so I want to come back to the open --
Hon Ms Lankin: Only because I am trying to prevent you from making an artificial distinction between the two.
Ms Jackson: I am not trying to make an artificial distinction, but as long as you want to get the information from Dr Donahue, I am suggesting to you that information is in large measure available in the ministry, correct?
Hon Ms Lankin: Yes.
Ms Jackson: And the decision for that information not to come to you was your choice, Mr Decter's choice, or somebody else's choice?
Hon Ms Lankin: It was my choice. It was in the context of discussion with them, and no one disagreed with that, but it was my choice.
Ms Jackson: You specifically said to Mr Decter, "I don't want that information."
Hon Ms Lankin: Yes. I pursued this with the questions that I think I indicated: How much am I entitled to know? How much am I or would I be entitled to say? In getting answers that were different to those two things -- these are in generalities; this is not with respect to a specific case -- "Minister, you are entitled to know anything you want to know about the billings etc; Minister, you would not be entitled to say those things if they are not in the public realm, if the doctors have not agreed to that," at that point I indicated that I only wanted to know what I was entitled to say but that we should pursue the issue of having the doctors agree to open up their books so we could talk in public about this, because I actually felt there was a real disservice being done to the members of the public as well, particularly in the Sudbury area, if in fact it turned out that the threshold was not going to cause the kind of problem it was being projected it would by the doctors.
Ms Jackson: Can you turn to exhibit 50, please? This is one you have not seen, but you will see in the first paragraph Ms Colley reports she learned from Mr Decter a specific dollar figure of epilation services that Dr Donahue was doing. The specific figure is not there. It is hard for somebody from the outside, Ms Lankin, to understand, if Mr Decter is so willing to give this to your executive assistant, why he did not also give the number to you. Would he not also give the number to you?
Hon Ms Lankin: He did not also give the number to me. Because of the way those discussions went and the kind of direction I had given in the past, and that I gave at that meeting about being very careful about what I knew and did not know with respect to confidential information, I can only presume that is the reason the number was not given to me. But in any event, I was never made aware of that number or any other number.
Ms Jackson: In your discussion with Mr Decter and Dr LeBlanc, was there any discussion of the kinds of other services Dr Donahue did?
Hon Ms Lankin: No. Actually I assumed they were procedures with respect to dermatological speciality services. The reason I make that distinction is because yesterday when I met with you, you asked me about mix of general practitioner services or whatever and I was surprised by your question because I only assumed they would all be dermatological speciality services.
Ms Jackson: All right. I would like to just review with the committee what you knew about Dr Donahue, then. By late November you had met with Mr Decter and Dr LeBlanc. The issue had come to your attention in the ways you have described.
Hon Ms Lankin: Yes.
Ms Jackson: You knew he was a dermatologist.
Hon Ms Lankin: Yes.
Ms Jackson: And you knew, did you, that he was the only full-time dermatologist in Sudbury?
Hon Ms Lankin: Full-time, yes. I was aware of another doctor who provided a service on a part-time basis.
Ms Jackson: And you knew he did epilation.
Hon Ms Lankin: Yes.
Ms Jackson: Did you have any idea how much?
Hon Ms Lankin: No. I had an impression that in his claim in closing down his office, he would be laying off 14 staff. I can tell you that in my mind I had an impression that a certain number of those staff would likely be related to the delivery of epilation services, but that was my own impression from knowledge of other epilation services being delivered in doctors' offices.
Ms Jackson: Do you recall knowing, in addition to the fact that he had 14 staff, what kinds of staff he had?
Hon Ms Lankin: No.
Ms Jackson: Or the salary he paid them?
Hon Ms Lankin: No.
Ms Jackson: You learned that he was on the underserviced area program in your meeting with Mr Decter. Were you given any documents that reflected that?
Hon Ms Lankin: Yes, I had a document which is part of the exhibit.
Ms Jackson: Part of exhibit 8, the media package that was distributed on December 5? It contains a listing of specialists on the program.
Hon Ms Lankin: Yes. It is just entitled "Specialists on Program." I received that prior to it being put in as part of the package. I did eventually receive the entire press package, I think, on the day itself, on the 5th, but I had pieces of this entire package in the days and perhaps the week prior to that.
Ms Jackson: In addition to assuming that he did exclusively dermatological services, and knowing that he did some epilation that seemed to require a large number of staff, did you have any other idea or information about what services he did?
Hon Ms Lankin: No.
Ms Jackson: Do you have any information that he did any phototherapy services?
Hon Ms Lankin: I am sorry, yes. You are prompting me. Yes, I heard he had a phototherapy piece of equipment. It is not of any particular relevance or it is not notable. It is something that happens in a dermatologist's office. But yes, I was aware of that.
Ms Jackson: Do you remember where you learned that?
Hon Ms Lankin: I think I heard that from the deputy minister.
Ms Jackson: Do you remember how it came up?
Hon Ms Lankin: I think it was just in discussion. To tell you the truth, I think that was after December 9, when I became aware of the comments Ms Martel had made. I think it was subsequent to that, in discussion. I think it was something that had been heard from somebody in Sudbury. But I am sorry; I cannot be any more detailed than that.
Ms Jackson: Do you remember knowing whether or not he was in debt?
Hon Ms Lankin: No, I did not know that.
Ms Jackson: Did you learn anything about his overhead?
Hon Ms Lankin: No.
Ms Jackson: Did you learn whether his practice was under review by the ministry or the MRC?
Hon Ms Lankin: No, and I cannot give you a detailed answer about when I first heard anything of a possibility of that up to the period of time when the Toronto Star article of January -- can you help me? Mr Donovan's article?
Ms Jackson: Mr Donovan has an article that was produced on January 26.
Hon Ms Lankin: The 26th, in which it quotes Dr Donahue talking about --
Ms Jackson: It makes statements about the existence of such a review.
Hon Ms Lankin: Right.
Ms Jackson: Which have not been addressed --
Hon Ms Lankin: That was the first concrete --
Ms Jackson: Let me just tell you, the only indication this committee has had in these public sessions about whether there was or was not a review is the allegation in the Star article that there was.
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Hon Ms Lankin: Yes, and I can tell you that that is exactly the only indication that I have had as well. If you will give me a moment, I should describe that process. Would it be important for the committee to know what I heard and when about that?
Ms Jackson: All right. Why do you not do that now?
Hon Ms Lankin: Okay. Following the phone call from Ms Dawson of the Toronto Sun on the evening of the 10th of December, in discussions with Mr Howard who had taken the phone call and had written down the kind of questions Ms Dawson asked and subsequently, the next day, the 11th, in a meeting with Dr MacMillan and hearing from him the sorts of questions that Ms Dawson asked, I was left with the impression Ms Dawson asked whether or not or alleged perhaps that the content of the memo which has been produced from OHIP and had been recalled by Dr MacMillan might have made reference to this. I did not know whether it did make reference or not. All I know is that from the discussions with Mr MacMillan or Mr Howard, one or the other, I gained that understanding that Ms Dawson was alleging this might have been contained in that.
The reason I remember that is, a couple of days later Mr MacMillan -- perhaps a day later; the days were very compacted at this point in time -- told me in a meeting that he had received a phone call from another reporter who wanted to ask questions about the review process. When I say "another reporter," I do not mean necessarily that it was not Ms Dawson; I just do not recall who it was, so from "a reporter."
He explained to me that he declined to talk in any kind of specifics about what was or was not contained in any memo, but gave the reporter background information on the MRC process and the College of Physicians and Surgeons' involvement, at which point I said to him, "Well, perhaps you should explain that to me," because I did not know and was unaware of that process, how it worked or that it even occurred.
Ms Jackson: And he did?
Hon Ms Lankin: He explained that to me and then he said to me, "Minister, you should know that you are entitled to have this information with respect to any doctor if you choose to. You've never asked me for that, but I should tell you that you're entitled to know if you would like to ask me," at which point I said, "Dr MacMillan, I don't want to ask you and I don't want to know that information with respect to any specific doctor at this point in time or in general. I don't believe that's information I should have."
I should say that I was also at that point very specifically starting to protect myself, to ensure I did not gain any information I had not had prior to Ms Martel's statements and the revelation of them because I could see the importance of this unfolding.
Ms Jackson: We will come back to that. This arose from my question to you about what you knew about Dr Donahue by the end of November when you had had the briefing sessions with Mr Decter and Dr LeBlanc. After you had had those, did you have any further conversation with Shelley Martel? I think you have suggested, in the course of giving that evidence, you had a conversation with her about opening Dr Donahue's books.
Hon Ms Lankin: Yes -- not just Dr Donahue; in general. In fact, I recall her very specifically telling me at some point that she had discussed with Dr Abdulla and I think perhaps the other cardiologists and that they were more than willing to do that.
I know I had a further discussion with her that week of the 25th because a meeting had been scheduled for the 30th with a number of local MPPs, ministry officials and doctors. I remember Ms Martel coming to me very concerned -- I am guessing it was the Thursday, because on the Friday I assume she would have been back in her constituency office and I would not have had occasion to see her, but I remember her being very concerned because she had heard that Dr MacMillan wanted to cancel the meeting.
I did not know the reason why and called back over it and spoke to someone -- I think it was Ms Colley, but I am not sure -- to find out for me what was going on. I was informed that Dr MacMillan had thought this meeting would be unnecessary because there was a meeting scheduled for some time the following week and he did not think it was necessary to go up twice.
Ms Martel had explained to me that in fact this was a very important meeting she had set up, wanted some answers for some of the doctors in that area and wanted this exchange to take place, and that she and other MPPs would be unable to attend the subsequent meeting that was being set up. This was very important to her. I called back and gave direction, either through my executive assistant or directly through the deputy minister's office, to instruct that I thought it was very important that Dr MacMillan and Dr LeBlanc both attend this meeting on the 30th and that I wanted the meeting to go ahead.
Ms Jackson: Was there any discussion of Dr Donahue in that conversation?
Hon Ms Lankin: No. The conversation was only about the meeting and the potential cancelling of the meeting.
Ms Jackson: Up until the events post-December 5, did you have any other discussion with Shelley Martel concerning Dr Donahue?
Hon Ms Lankin: I cannot recall any of the conversations I had with Ms Martel spending any kind of detailed time talking about Dr Donahue. I would be surprised if the topic was not touched on in the context of the Sudbury doctors in general, but I do recall specifically how much time and attention she spent in raising the concerns about the cardiologists. Although there were other specialists besides the dermatologists who were raising concerns, it really was the cardiology group that she was focusing on in her discussions with me.
Ms Jackson: Do you remember learning anything about Dr Donahue's situation that you did not already know in those in-passing references, if there were any?
Hon Ms Lankin: In which time period again, now?
Ms Jackson: We are now talking from the period of November 25 forward.
Hon Ms Lankin: To?
Ms Jackson: December 5.
Hon Ms Lankin: No.
Ms Jackson: Do you recall telling her anything about Dr Donahue's situation?
Hon Ms Lankin: No. I might have said, "Information about the underserviced area program and the epilation and therefore there is a question as to whether or not Dr Donahue will be affected by the threshold but we need to ask him to open the books." It would be logical that I would have said that to her, but I actually do not recall that.
Ms Jackson: Could you turn up exhibit 61 in the volume before you, Ms Lankin?
Do you recall either seeing that or being advised of its contents in or around this time?
Hon Ms Lankin: No, neither.
Ms Jackson: Exhibit 62, the same question.
Hon Ms Lankin: No.
Ms Jackson: Were you told at some point that Dr Donahue had in fact closed his office?
Hon Ms Lankin: I actually do not remember at this point in time whether -- as I indicated to you earlier, Dr Donahue, in response to our late December agreement with the OMA around revisions to the underserviced area program and the threshold, I recall him on the news saying that that resolved his concerns and he was going to reopen his office, but I do not ever recall --
Ms Jackson: Learning that he had closed it.
Hon Ms Lankin: -- hearing that he had actually closed it.
Ms Jackson: Then on November 30 there was in fact, we have heard, a meeting of the cardiologists and some members of the Legislature in Sudbury. Did you subsequently receive a report on that?
Hon Ms Lankin: November 30 meeting: I would have been briefed by Dr LeBlanc, I believe, with respect to that during meetings the following week.
Ms Jackson: Was there any reference to Dr Donahue?
Hon Ms Lankin: No, not that I can recall. I think --
Ms Jackson: And did you --
Hon Ms Lankin: Sorry, if I could just continue, I think that I also heard directly from Ms Martel the following week in the Legislature.
Ms Jackson: I was going to just ask you if you had spoken to Ms Martel.
Hon Ms Lankin: Oh, okay.
Ms Jackson: Did you speak to Ms Martel the following week?
Hon Ms Lankin: Yes, I did.
Ms Jackson: And did you have a conversation with her concerning the Sudbury doctors?
Hon Ms Lankin: Yes.
Ms Jackson: What did she say?
Hon Ms Lankin: She indicated that the meeting on the 30th had been a good meeting and that she was very appreciative of the attendance of the ministry staff and that I had caused the meeting to go forward and not be cancelled. She thought a good exchange of information took place. Some time on the Monday, December 2 -- is that a Monday?
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Ms Jackson: This is the Monday after the meeting?
Hon Ms Lankin: Yes, December 2. In the Legislature, I assume during question period, Ms Martel asked me for clarification of some information with respect to some documents she had in front of her that were documents that were eventually contained in the December 5 Sudbury press kit; I think it is exhibit 8 that you have referred to.
Ms Jackson: Yes.
Hon Ms Lankin: For example, the list of the underserviced area specialists under the program and some other things. I cannot remember what the question was she asked me now in terms of clarification, but she sits behind me and she asked me about something. I stood up and went beside her and took a look at it and we had a discussion. She had either just come from or was just going to a meeting with a couple of doctors in the east lobby. I did not know who those doctors were. I subsequently, from media coverage, know who the doctors were.
Ms Jackson: How are you able to locate that in time as being on the Monday?
Hon Ms Lankin: I am presuming. Actually, I should make that clear. Because of subsequent media interviews with Dr Hollingsworth and Dr Kosar, which were subsequent to Ms Martel's December 5 comments in Thunder Bay, in which they indicated they had met with her in the east lobby, and because in questioning from commission counsel that date was fixed for me as December 2, I am assuming it was the same day, because I am not aware of any other two doctors Ms Martel met with in the east lobby.
Ms Jackson: There was a second meeting in Sudbury on December 5. Did you subsequently receive a report on that meeting?
Hon Ms Lankin: Yes.
Ms Jackson: The following week?
Hon Ms Lankin: No. I do not know from whom I heard about it, but I did hear about the bearpit and Michael Decter's attempt to provide some information, how that was responded to and that it was very much a media event and that there had not been a useful exchange of information. I remember hearing about that, but I am sorry, I do not know whether that was some time on the Friday, although I think I was off in St Catharines-Niagara on a field trip that day. I would have to check my schedule.
Ms Jackson: When did you first learn of the incident in Thunder Bay involving Ms Martel, which we now know took place the same night?
Hon Ms Lankin: Late morning on December 9.
Ms Jackson: That is Monday?
Hon Ms Lankin: Yes. I recall that very much because I was very angry to be receiving that information only at that point in time. I had gained the knowledge at that point from Ms Colley and Mr Decter that Mr Decter was aware of this from at least the Friday before and --
Ms Jackson: Can we just take this in stages? First of all, from whom did you learn?
Hon Ms Lankin: From Ms Colley and Mr Decter. We were about to start a meeting and Ms Colley was called off to take a phone call. I was getting some papers together, and as I was coming back over to the couch and chairs where we were sitting to meet, she came in and -- Mr Decter, I think, was just preparing to tell me the same information -- she indicated the nature of the phone call she had received from the Premier's office.
Ms Jackson: Did she say who in the Premier's office?
Hon Ms Lankin: I believe Melody Morrison, but I am not absolutely sure of that.
Ms Jackson: What did she say she had been told?
Hon Ms Lankin: She had been told that Ms Martel made some kind of statement at a reception, that was heard publicly by a group of people, about Dr Donahue and having seen his file or confidential information with respect to him. That is all I recall in terms of the first piece of information I received.
Ms Jackson: Did Ms Colley appear to have known that before?
Hon Ms Lankin: No. She appeared to be very surprised. I was shocked and I was about to tell you the reasons why, because I assumed that something of that nature would have been conveyed to me over the course of the weekend by my deputy. Additionally I spent the Sunday afternoon at a cabinet meeting, to which Ms Martel arrived late, but she did arrive. She did spend a fair amount of time out in the antechamber on the telephone. She sits beside me in cabinet, and so I know she is not there. I also chair cabinet, so I am aware of people going in and out.
Through the course of that whole afternoon neither she, nor if anyone one else in the Premier's office were aware of this, conveyed this information to me, and I was very angry, because I assumed I could well have been greeted by members of the media or anyone else on the Monday on this issue and would not have been informed, and I thought that was truly inappropriate.
Ms Jackson: You indicated that Mr Decter indicated he had known. For how long had he known?
Hon Ms Lankin: I know now, because of further information, that he had known from the Friday. I am not sure I actually knew right then that he received the information from Dr MacMillan on the Friday.
Ms Jackson: How did he learn?
Hon Ms Lankin: I knew that he was at this conference on freedom of information, and that it was being referred to in the media. Actually you informed me that Dr MacMillan testified that he phoned the deputy and informed him. I was not aware of that, or if I was, I had forgotten it.
Ms Jackson: Did Mr Decter tell you what he had done when he learned of this information?
Hon Ms Lankin: Well, the discussion immediately went into my questioning the deputy with respect to potential disclosure of confidential information, and the discussion back and forth was: "Do we know? Has anyone who had access to this confidential information revealed it?"
At this point in time I am thinking this information is securely contained within OHIP, and not aware that there has been any other -- I am not aware of, for example, the memo that was sent from OHIP and that was recalled, until the Toronto Sun reporter's call, and we can get into that in a minute. At this point in time I am saying: "Was Ms Martel given any confidential information? What's going on? I don't even have any confidential information on this doctor or any of the other doctors. How could she have?"
There was this sort of questioning, and I am assured by the deputy that from his investigation over the weekend or on Friday -- I do not know which -- speaking to Mr MacMillan and others, that he has assurance no confidential information was revealed to Ms Martel or to anyone else.
I asked him to be assured of that. I said: "I would like you to call Dr MacMillan and get that from him today, and I want it before I go into question period. I want to know for sure whether or not Dr MacMillan or anyone who had access to that information revealed any of that information."
I cannot remember whether Mr Decter told me right at that point in time, "No, I have already done that, and you have that assurance," or whether he actually -- I think he actually followed up and called Dr MacMillan and came back and told me, but I am not sure which of those two things, which of course led to my very bold pronouncement in response to a question in question period that no information had been revealed outside of OHIP, where it properly belonged.
Ms Jackson: Did Mr Decter tell you whether he had done anything else beyond conduct the investigation you have described?
Hon Ms Lankin: I do not recall anything else. I do not recall.
Ms Jackson: Did Mr Decter indicate why he had not contacted you earlier to advise you of this incident?
Hon Ms Lankin: I do not have a full memory of what he said. I certainly put the question to him; I know that. I think it was that he had taken appropriate steps and spoken to the people, and was assured that no information had left our ministry with respect to what Ms Martel did or did not say, that that was not an issue for our ministry, that Ms Martel would be dealing with that, and that he felt he could avoid concerning me with it that weekend and that he could speak to me on Monday morning.
Ms Jackson: Did you consider that was appropriate?
Hon Ms Lankin: No.
Ms Jackson: Did you tell him that?
Hon Ms Lankin: I think I did.
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Ms Jackson: Was there any discussion among you in this meeting as to what you would say about this incident, if anything, in the House?
Hon Ms Lankin: No. I do not think I needed to be told that. My questions were to find out whether or not there had been any revealing of confidential and private information, contrary to the legislation and contrary to our responsibilities within the ministry to maintain the confidentiality of that. Having pushed that question and having been assured that there was not a cause to worry, it would be obvious to me that was the response I would give. That is a question I knew would be asked of me. It is a question I was asking and was concerned about.
Ms Jackson: Did you have any information at that point as to what Ms Martel would say in the House about this incident?
Hon Ms Lankin: No. I think Ms Colley indicated that Ms Martel had -- if it was Ms Morrison from the Premier's office who had called, I think she had indicated Ms Martel said she did not receive confidential information. I am not sure about that, but I myself, before entering the Legislative Assembly for question period, directly approached Ms Martel in the east lobby and asked that question of her.
Ms Jackson: I am going to come back to that and ask you about her response, but let's just move this forward chronologically. Before you left the meeting, did you learn when the Premier's office had become involved in the incident?
Hon Ms Lankin: I may have but I do not recall.
Ms Jackson: Do you know what, if anything, the Premier's office did about the incident over the weekend?
Hon Ms Lankin: No. The only thing I became aware of -- and I am not sure if it was in the course of that meeting or subsequently in speaking with Ms Martel -- was that she had had the advice of and had met with a lawyer over the course of the weekend.
Ms Jackson: Now, you say you saw Ms Martel on the way into the House. What did you say to her?
Hon Ms Lankin: I said: "Shelley, I have to ask you this question very directly. Did you at any time receive or see, or were you told of any confidential or private information either from anyone in the Ministry of Health or from anyone who could have received that information from the Ministry of Health?"
Ms Jackson: And what did she say?
Hon Ms Lankin: She said no.
Ms Jackson: And was that the substance, the sum total of your conversation?
Hon Ms Lankin: Yes, because it was sort of late and we were being pressed to get into the House. She was also clearly very upset and had staff with her and was preparing to go into the House. The remainder of what I learned about what Ms Martel had to say was -- in the course of that day and the first part of the next day -- her answers with respect to questions that were put to her in question period and by the media.
Ms Jackson: In the House that day, as you noted, you made a quite specific statement to the House at page 3961 of Hansard. You said, among other things, "I have very specifically asked and received assurances from my deputy minister, who has heard directly from the director of OHIP, that no confidential information with respect to doctors' files and their billings and their incomes has been shared with anyone outside the OHIP department which has proper access to that information. I have not seen it, the Minister of Northern Development has not seen it and no other MPP has seen it." I take it from what you have said that statement was based on the conversation you have indicated you had just had with Mr Decter.
Hon Ms Lankin: Yes.
Ms Jackson: Now, during the balance of December 9, still the Monday, do you recall having any further conversation concerning the Thunder Bay incident or the potential leak of confidential information within the ministry?
Hon Ms Lankin: I do not recall specific conversation. I would have, I am sure, answered questions during question period that day, would have also answered questions from the media following question period. Monday is a normal P and P day. I would have gone to P and P. I do not know what I had subsequent to P and P. I do not know what event I had on that evening.
Ms Jackson: At P and P, was there any conversation that you can recall now concerning the Thunder Bay incident or the potential leak of confidential information within your ministry?
Hon Ms Lankin: No.
Ms Jackson: The next day, Tuesday, December 10, did you meet with Dr LeBlanc and Mr Decter?
Hon Ms Lankin: Yes.
Ms Jackson: Was there any further discussion at that time concerning the possible leak of confidential information in your ministry?
Hon Ms Lankin: Yes. I had been given the assurance by the deputy yesterday that those people involved in -- the principal people in my mind were Dr MacMillan and Dr LeBlanc, because I knew that they had been meeting with Ms Martel. I had been given the assurance that no information had been passed on, but it was my opportunity to ask Dr LeBlanc directly, and I asked Dr LeBlanc very directly and his response to me was that he had in no way shared any confidential information.
Ms Jackson: Was there any reference during that conversation to the document you now know as an e-mail that went from OHIP to Dr LeBlanc's office and further?
Hon Ms Lankin: None whatsoever. This is the amazing thing of this week. I go through two days of being assured that nothing has come out of OHIP. As a result of the call from the Toronto Sun, I find out that this in fact is not the case and I -- we will, I am sure, get to that -- order a big meeting to hear from people why. I find out that story and come back into the House and then I am hit with another press article with a quote from Dr MacMillan that I did not know about and go back and have to find that out. It was quite an amazing week.
Ms Jackson: All right. Still staying on the Tuesday of the amazing week, before you learned about the Sun article or the Sun inquiries that were being made, did you have any further conversation you can can now recall about the Thunder Bay incident or the potential leak of confidential information in your ministry?
Hon Ms Lankin: Not discussions -- again, it was, I think, the subject of question period and of media questioning -- other than the meeting with Mr Decter and Dr LeBlanc. I would assume Susan Colley was there as well. I do not recall any other specific meeting or discussion.
Ms Jackson: And the only conversation at that meeting was this seeking of assurances from Dr LeBlanc that he had not disclosed any confidential information?
Hon Ms Lankin: Yes, and then I believe we are actually still working on trying to resolve the threshold in the underserviced area program application.
Ms Jackson: Then later that day you became aware of a contact from somebody with the Toronto Sun to somebody in your ministry?
Hon Ms Lankin: I became aware of a contact to someone in my office. I was not aware of the contact to someone in the ministry until either later that night or the next morning.
Ms Jackson: What did you learn and when did you learn it?
Hon Ms Lankin: I was attending a late P and P meeting that evening. It was Tuesday evening. I think the meeting was scheduled to start at 8 o'clock and some time prior to that received information from, I believe, Ms Colley that a reporter had called Mr Howard in my office. I had a sketch of the information given to me at that point in time. My recollection of what I knew then which was -- fuller information came either later that night or the next -- no, later that night.
What I think I knew then was that a reporter had called and had asked Mr Howard specific information with respect to a memo, that in her questions it was alleged that a memo containing some confidential information about Dr Donahue was circulated in the ministry and then retrieved or recalled by Dr MacMillan. I think I heard that the nature of the questions that were asked gave rise to the concern that the reporter in question had either seen or been told of the contents of a memo, and that was described to me -- not that we knew that was the case, but that the questions were so specific, and I was not told what the questions were then, but that they were so specific that it sounded like the reporter either had the memo or someone had told the reporter something about a memo. I think that is all I knew at that point in time.
Ms Jackson: What did you do when you learned that?
Hon Ms Lankin: When I was entering the P and P meeting, before P and P had started, I approached Ms Martel and said, "I would like to speak to you, and if you are agreeable I would like to have Mr Agnew attend as a witness to this discussion."
Ms Jackson: That is David Agnew?
Hon Ms Lankin: Yes, because he was there; we were in the cabinet chamber for the P and P meeting which was about to start. We exited there through to the Premier's suite of offices and I sat down with the two of them and explained that -- I should put it in the context that I was absolutely floored at this point in time.
I mean, I now believe there has been some kind of, or potentially there has been, a leak of information. I do not know exactly what but it sounds like it could have been confidential information to a member of the press gallery. I now have a real problem, not to suggest that there is not a general problem going on in that this was an issue in the House about whether or not information had been provided to Ms Martel, but as a result of my assurances from the deputy and as a result of asking Ms Martel directly, I was believing that there in fact had been no revealing of any confidential information outside the ministry. Now I find out that in fact there has been. I am assuming that it has only happened in this period of time -- probably that day is the assumption I am making -- but I now have a serious problem. I have a leak.
I also have a real question. I need to know more information, I am thinking, about what is alleged was in the memo. But I also now have reason to re-ask the question of Ms Martel, because I have been made aware that a memo, which at least Dr MacMillan thought should be recalled, was circulated in the ministry outside of OHIP, which is different than I have believed up to that point in time. So I explained to Ms Martel and Mr Agnew what I know with respect to this phone call from the reporter, which is still sketchy information at this point in time, but that, one, it appears that there is a serious problem, that there potentially has been some revealing of confidential information to a Toronto Sun reporter, and that, second, it calls into question the kind of response Ms Martel has given to this point in time.
I said: "I want to very clearly ask you the question again, and it is the reason that Mr Agnew is" -- this is more familiar -- "the reason that David is here. Shelley, I have to ask you and I have to have from you directly, did you ever see or receive or were told" -- and I went through all the various permutations of that -- "any confidential information that emanated from my ministry in any way?" She said directly, "No, Frances, I did not." I pursued a second question with her at that point in time to try and satisfy myself.
Ms Jackson: The second question is one I have reviewed with you and advised the Chair will have to be dealt with in camera.
Hon Ms Lankin: Okay, I would like to say that we will give the specifics to the members in camera, but at this point in time I have heard two days, in question period, of Ms Martel's answer, which was a very scripted and repetitive answer about this not being based on or founded in truth; I cannot remember the exact words. So it would be natural for me to want to say: "How would you have come to this impression? Why did you say what you did?" Ms Martel gave me an answer, which I can provide to you and to the committee in camera, which actually satisfied me, which sounded plausible.
Ms Jackson: All right. The Chairman has advised me it is time to break for lunch, and we will come back --
The Chair: Seeing it is 12 o'clock, we will recess until 2 pm.
The committee recessed at 1204.
AFTERNOON SITTING
The committee resumed at 1406.
The Chair: We will call the afternoon session of the standing committee on the legislative assembly to order. Ms Jackson.
Ms Jackson: Thank you, Mr Chairman. Ms Lankin, later on December 10, following your meeting with Ms Martel, did you learn anything further about what had apparently been leaked to the newspaper reporter?
Hon Ms Lankin: Actually it was during the course of the meeting with Ms Martel and Mr Agnew. My executive assistant, Sue Colley, joined us and gave a more detailed description of what she knew at that point in time had transpired in the discussion between the reporter and Mr Howard, and I think she might have had some more information with respect to the conversation between the reporter and Dr MacMillan. I am not sure if I knew that that night or it was the next morning I got more detail on that.
Ms Jackson: What then did you decide to do?
Hon Ms Lankin: Well, I found myself needing to make it very clear to the people who were in the room. I thought that was the appropriate thing to do.
Ms Jackson: You needed to make it very clear to whom?
Hon Ms Lankin: To the people who were in the room, which was Ms Martel, Mr Agnew, and Ms Colley at this point in time, that I saw this as a very serious event, that there was in my view a potential or possibility that there had now been a leak of information, a revealing of confidential information to a reporter from the press gallery, that steps would need to be taken for me to investigate and to conduct a full investigation. I indicated a series of directions to Ms Colley at that point in time. I think I went back and for the record asked Ms Martel one more time while Ms Colley was there. I am just not sure when Ms Colley entered.
Ms Jackson: You asked Ms Martel one more time what?
Hon Ms Lankin: I am sorry, whether or not she had received any confidential information and all the permutations of that question, either seen, received, viewed, whatever, and her answer was no.
Then I gave a series of directions to Ms Colley. I wanted a meeting convened first thing the next morning with the deputy, Mr LeBlanc, and Mr MacMillan, and I wanted options to be prepared and ready for me with respect to what steps of investigation could be taken. I did not know whether we would be looking at an investigation involving police as a result of a breach of the statute or a potential breach of the statute, whether it would be just the freedom of information commission, so I wanted options prepared for me for that meeting for the morning.
I wanted the appropriate people -- at this point in time I did not know where this alleged memo had gone -- to the best of our ability to be gathered and in that room. I wanted Ms Colley to explore with all the members of my staff whether or not any of them had been in receipt of or known any of this information and what had been done with that information. Similarly, I wanted it conveyed to Mr Decter that I wanted that kind of information available for me from members of the ministry staff at the meeting the next morning.
There may have been a couple of other things, but it was in that sense of: "We have a serious problem. I am taking control of this. This is my responsibility within the ministry, along with the deputy, to behave appropriately." I was distancing myself from anything else that was going on with respect to Ms Martel's comments or with respect to the Premier's office or anything. I was making it very clear that this was a responsibility for me to undertake in the Ministry of Health.
Ms Jackson: Did you then have a meeting the following morning?
Hon Ms Lankin: Yes. I think there were perhaps two meetings. I am not sure that -- I think the 8 o'clock meeting was with -- or the very early meeting, I should say, was with Mr Decter and perhaps Mr LeBlanc and others. I do not think Mr MacMillan could get there in time for that and it was subsequent to that, midday, let's say, before I came over to the House for question period -- that is for sure -- that I met with Mr MacMillan. I think he had to come from Kingston to attend that meeting.
Ms Jackson: In the morning meeting, the 8 o'clock in the morning meeting, what were you told that you had not heard earlier?
Hon Ms Lankin: I am sorry, I cannot remember a distinction at this point in time between the two meetings. The majority of the information that I received that day took place in the meeting at which Dr MacMillan was present, and others. I do not remember what happened first thing in the morning, whether or not it was a long meeting or whether it was simply a meeting because I had demanded that it be first thing in the morning and people were saying: "But Dr MacMillan won't be here. Should we have the full meeting then?" So I do not really recall the difference. I could lead into what I remember before I went into question period that day over the course of the morning, the information that I had received that I had not had before.
Ms Jackson: When Dr MacMillan arrived, he joined you and Mr Decter and Dr LeBlanc in a meeting, did he?
Hon Ms Lankin: There was a meeting in the minister's boardroom and there were others there.
Ms Jackson: Who were the others?
Hon Ms Lankin: Diane MacFarlane was there. I believe Paul Howard was there.
Ms Jackson: Diane who?
Hon Ms Lankin: I think it is MacFarlane.
Ms Jackson: McArthur?
Hon Ms Lankin: McArthur, yes. Thank you. Paul Howard from my office; I believe Susan Colley would have been there. Rob Smalley might have been there, my legislative assistant. It would be normal for him to be with me in a regular contentious issue briefing before going into the House, and this was certainly a contentious issue briefing. Kimberly Bain might have been there. She is from the contentious issues unit. I think she was; I do not remember directly. It was a large group.
Ms Jackson: By the end of the two meetings, the early one and the larger later one, what had you learned that you had not known before?
Hon Ms Lankin: I had a clear impression of the exchanges between the Toronto Sun reporter and Mr Howard of my staff and Mr MacMillan of the ministry staff. In the course of that I developed a keener sense of what it was being suggested was contained in the memo. From Dr MacMillan I was informed of the details of the memo which had been produced by Mr Teatero, how it had been sent from OHIP with the approval of Mr McBride, I think the name was, who was acting in Mr MacMillan's place because he was in Toronto on that day, that it had come to Dr LeBlanc's office and a small group of people were involved in a meeting the following day which Mr MacMillan was at.
He reviewed the contents of the document and felt that there was sensitive information beyond what was required for the situation and was agitated about that having been produced from OHIP and sent into the ministry and that he had requested the memo be retrieved from all involved. At this point in time, what I had known from Mr Howard was that there was a suggestion it had come to his office but he had been away and had not received it at all and at some --
Ms Jackson: How did -- did he say that?
Hon Ms Lankin: Pardon?
Ms Jackson: Did he say that?
Hon Ms Lankin: He told me that he had received a notice from Denise Allen and Maurice Jones about a profile of Mr Donahue to come, on the 13th of November, I think, if I have got my dates right, and that -- I am not sure of the date of that. You showed me that one, did you not?
Ms Jackson: Exhibit 13.
Hon Ms Lankin: So on the 13th of November -- and that he had been away when it is alleged that this memo that had come, prepared by Mr Teatero, was circulated and that he did not know what the memo was and, from the questions that had been asked by the reporter, did not recognize it. What he did subsequently receive was the November 14 briefing note, which we have also referred to here. To his way of thinking, that was what he was given notice he would receive and he received something. So it was some time either in the course of that meeting with Dr MacMillan or later that day in a subsequent meeting with Dr MacMillan that I learned in going over the facts that perhaps a copy of this had been taken up to Mr Corea in my office. At that point in time I could not check that out because Mr Corea had left for vacation, and I instructed Ms Colley to attempt to locate him on his vacation to question him about this.
In terms of other information I had not been aware of before, I think that is the extent of it.
Ms Jackson: You said that Dr MacMillan told you the details of what was in the memo. Did he actually tell you what the memo contained or the kind of information it contained?
Hon Ms Lankin: He actually did not tell me either of those things. He told me what the reporter alleged it contained and he indicated to me that there were enough similarities to give him cause for concern that the reporter at the very least had been told about the content of the memo, but in fact that there were some inaccuracies in what the reporter alleged was in the document, so he had drawn the preliminary conclusion that the reporter did not actually have a copy of the document but had simply been told about the document and its contents.
Ms Jackson: Who did you understand, after these meetings, had received a copy of the document? You have told us that Mr Howard, you learned, might have, but then confirmed he had not. You had heard that Mr Corea might have and you could not take steps to deal with that until later. Was there any other information conveyed to you as to who had received the e-mail?
Hon Ms Lankin: Yes. I was informed that it had been sent to Mr LeBlanc's office, that Mr LeBlanc and his executive assistant, Diane McArthur, would have had access to it, that the people who were attending the meeting the next day, at which the memo was discussed and Mr MacMillan asked it to be retrieved, included Denise Allen, Maurice Jones and I believe, for a short time, Helen Ambrose. I have been told that a copy was sent to someone in the deputy's office, and I do not know who that was now; I cannot remember.
Ms Jackson: Tiina Jarvalt?
Hon Ms Lankin: It could have been Tiina, but I am sorry, I do not remember who it was.
Ms Jackson: Anyone else?
Hon Ms Lankin: No. I believe that was it, and I was told that all copies had been retrieved, including the copy which supposedly went to Mr Corea. I could not confirm that with him, but Diane McArthur informed me in that meeting that it had been returned.
Ms Jackson: You said that you had asked for a series of options to be prepared for you. Did you, following these meetings, in fact take a decision on a course of action?
Hon Ms Lankin: Yes, we determined that we would request the freedom of information commissioner to investigate. That was the best advice that the deputy made to me, and I took his recommendation on that and asked him if he would prepare that letter and send that letter before question period that day, which was done.
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Ms Jackson: Were you ever told what was in the e-mail that you had been discussing that day?
Hon Ms Lankin: No, and in fact, again, I took very careful steps from this point on to ensure -- I knew I had had no confidential information. So it was impossible for me to have been involved in any form of revealing confidential information, whether it be to the media -- which probably not very many people would suggest I had done -- or whether this continued to be followed up with respect to any possibility of Ms Martel having received confidential information. Just from my past experience, both in administrative law and with the justice system, I knew that the appropriate and wise thing for me to do would be take steps to protect myself so that I would not discuss evidence with anyone, I would not gain knowledge of information I did not have prior to the events etc, so I could be in a position like this to answer the questions and not have accusations made that there was collusion or anything else.
Ms Jackson: It follows, I think, from what you just said, but I want to ask you specifically: Have you ever seen the e-mail?
Hon Ms Lankin: I have seen an edited version shown to me by commission counsel, I guess.
Ms Jackson: Is that exhibit 44?
Hon Ms Lankin: Actually I do not think I have ever seen this one shown by commission counsel. I think I was confusing this with one of the other memos you showed me. But no, I have never seen this.
Ms Jackson: Have you received back a report from the freedom of information act commissioner as a result of your request for an investigation?
Hon Ms Lankin: No, and this is something that is of great concern to me, because at the same time as we had asked the commission to investigate, in the Legislature there was a continued request from members of the Legislature for a parliamentary committee, being this committee here, to be established to investigate this whole issue. When that decision was made -- two things; I am sorry.
During the course of the consideration being given to the request from the members of the Legislature, I received a copy of a letter back from the freedom of information commissioner, who made it clear that the focus of his investigation would be on the procedures contained within the ministry. I was quite concerned that in fact it appeared to me that there had been a potential revealing of confidential information and I felt that needed to be the focus of the investigation. How did material leave the ministry, or knowledge of the material, and go to a Toronto Sun reporter? It did not appear to me that the freedom of information investigation was going to get directly at that and I asked the deputy what steps we should take, because I felt this issue was going unattended to.
Subsequently there was a decision made that there would be a parliamentary committee that would look into this. I again spoke with the deputy about: "Do we need to take other action? Should there be an investigation? There appears to have been a potential breach of the statute. Should there be a police investigation?" We determined that with the parliamentary investigation going on, that could be very counterproductive and could be problematic, and I would hope that with information I have given to commission lawyers and others there will be some follow-up or you have already been doing that with respect to the actual leak of information to the Toronto Sun reporter, because I remain very concerned to see whether or not there is an answer, an explanation we can find with respect to that.
Ms Jackson: So in answer to the question whether you have received a report on his investigation from the freedom of information act commissioner, do I take it the answer is no?
Hon Ms Lankin: I am sorry, Ms Jackson, there is one further piece of information that I forgot in that. Once the parliamentary committee was established, the freedom of information officer wrote back to us and said that in light of this investigation that was going on, he was, I think, going to await the outcome before determining the next steps. So there is no active freedom of information investigation going on concurrently with this process here.
Ms Jackson: Ms Lankin, have you ever taken part in any discussion of how Ms Martel should respond to inquiries concerning this matter in the House?
Hon Ms Lankin: No.
Ms Jackson: Have you ever taken part in any discussion of how the government should deal with this matter in the House?
Hon Ms Lankin: No. The only caveat to that was that I took part in discussions about whether or not a parliamentary committee should be established, which position I agreed with.
Ms Jackson: Thank you. Those are my questions.
The Chair: Thank you very much, Ms Jackson. We will now continue the rotation, first to the official opposition. I would like to remind all members that after we finish this rotation there will be the need to move into an in camera session with the minister. Following that, we will then recommence with Ms Colley for both some questions by the third party, and then into an in-camera session with Ms Colley, just to give members of the committee an idea as to what is lined up for this afternoon. Having said that, I will then move to Mr Conway.
Mr Conway: Thank you very much, Mr Chairman. Do we know how much time --
The Chair: There is 50 minutes.
Mr Conway: Fifty?
The Chair: Yes.
Mr Conway: Thank you very much. I will not be using all of that and my colleague Mr Elston I know has some questions. I want to begin, Ms Lankin, by asking you to indicate to the committee how you would characterize your relationship with Sue Colley. She had been your executive assistant when you were at Management Board and moved with you over to Health?
Hon Ms Lankin: Yes, that is correct.
Mr Conway: How long have you known Ms Colley?
Hon Ms Lankin: I have known her in a professional sense since 1980. I have not worked with her directly since about 1981 or 1982.
Mr Conway: But you go back the better part of 10 years?
Hon Ms Lankin: Yes, I first met her involved in the day care movement around 1979 or 1980.
Mr Conway: You have worked together on and off over the 1980s?
Hon Ms Lankin: Not directly, but I was a founding member of the Ontario Coalition for Better Child Care and Ms Colley was also a founding member. As activists in that area, we had occasion to work on projects together; the volunteer sort but not direct employment.
Mr Conway: Did you know her socially as a friend outside of your professional relationship?
Hon Ms Lankin: No.
Mr Conway: So she was not a friend that you brought into the office as DA when you joined the cabinet?
Hon Ms Lankin: No.
Mr Conway: So it was basically a relationship that you had developed in the child care movement throughout the 1980s?
Hon Ms Lankin: Yes.
Mr Conway: Mr Howard: What can you tell us about Mr Howard? Did you know him prior to your becoming a member of the executive council in October 1990?
Hon Ms Lankin: No, I did not.
Mr Conway: I am trying to -- I find your testimony very interesting, very interesting, and I want to be candid with you and with the committee in saying some things, as I do some cross-examination.
The impression I have had of you, as someone who came to the Legislature in 1990, is the following, and I simply put this on the record because I want to develop some questions around that. I have been struck that in a very short period of time you seemed to take to the legislative business like a fish to water; that in addition to being a newly elected member of the Legislature, you took on quite effectively significant ministerial responsibilities for the government. Those are not easy things to do for a newly elected member of the Legislature and I have thought you have met those challenges quite effectively.
You have always struck me as someone who is very well briefed, tough-minded when you had to be, and very keenly aware of the political environment in which you operated, which I think is one of the reasons why you have been a good minister, a very effective minister. So it is against that backdrop that I now look to the situation before this committee, and want you to ask me if it would be an unfair characterization to say the following.
I think one of the areas where the New Democratic Party has been pathfinding and very effective over, say, the last five years -- I think at the time I was in government -- was in the whole area of northern health services. I have got a very keen memory of the NDP being extremely effective and active in the whole question of developing and maintaining a good high level of general health services and medical specialties across northern Ontario, where it has been a difficulty in much of the modern period at least. That would be a reasonable characterization, would it not?
Hon Ms Lankin: I think that is certainly what I have been told about that period of time. I do not have a personal recollection, not having been here.
Mr Conway: Well, I have a very keen recollection of some task forces that the NDP caucus was involved in in the mid-to-late 1980s which focused in on specifically some of the issues that are involved in this inquiry, the medical specialties in northern Ontario.
I am now thinking about the situation in the summer, around the time when you come to the department. You have become minister some time, I think late April after the Gigantes affair, and I thought your testimony was particularly helpful in helping us understand the sensitivity that you felt to the circumstances that caused the departure of Ms Gigantes from the post you now hold; that is, the breach of confidential medical information.
Very shortly after you come to the Ministry of Health, you successfully conclude the framework agreement, which is a major achievement for the new government. But a very short time after that, we understand, on the basis of your testimony and other testimony, there is a concern developing, at least in the Sudbury basin -- but there were other areas and you have identified some. I think the Peterborough example has been brought to light but we know that through the summer and early fall, there is a growing concern in the Sudbury basin around what the framework agreement might mean in the minds of some providers, that it might have an unintended impact in terms of certain kinds of medical specialties in northern Ontario, the Sudbury basin specifically. And so the agitation begins.
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I say that because it would be my understanding that for New Democratic Party elected members, that framework agreement, if it had that kind of unintended impact of the kind that Dr Donahue goes on to rightly or wrongly point to -- and I think we have exhibits which suggest that by October or November he is stating that there is a kind of north-south component in this agreement and that the government has unwittingly formed a policy that has an anti-northern feature and it is going to be very difficult for medical specialists like himself to continue. That is certainly the impression that he is casting widely by the end of October, early November.
So I am just assuming as well that elected members from the New Democratic Party, particularly ones who have been around a while, would find that a significant concern on the basis of their having been members of the Legislature a few years and involved in some of the issues that I spoke of earlier. So we get to November 10 and I am assuming -- and I do not think incorrectly but you can correct me -- that by the time we get to November 10, November 12, people like Ms Murdock, Ms Martel, certainly Mr Laughren, are feeling the heat around what doctors, Donahue and others, are generating by way of a concern about their interpretation of the framework agreement.
And we know, we have all kinds of exhibits to suggest, that from about November 12 onward, your office is actively involved and rightly so. This is where I need some help. You are the kind of minister that I have described and I do not do it disingenuously, I do it quite honestly. I am trying to understand your testimony of today because I must say I have been very impressed by what you have told us as to your reaction starting about December 11, when after that Toronto Sun article comes to your attention the gravity of this potential difficulty is immediately obvious to you.
My goodness, I forget your words but I was looking at the morning testimony -- "I was absolutely floored at this point in time." And I can well -- quoting you from this morning on page 1200-1 and, as you have just told the committee counsel, that you ordered a number of very specific things to be done. That is about December 11 or 12.
But my concern is this four-week period from about November 12 to December 9. Help me understand your testimony because the way I understand what you have told me, and what I know from other sources, from November 12 through to December 10, Mr Laughren's office is keenly concerned and, from my point of view, rightly so. Ms Murdock's office is involved. Ms Martel's office is involved. Dr MacMillan is involved. Dr MacMillan has stated that he was very concerned about the memo -- the famous Teatero memo of the morning of November 13 -- so much so that he ordered its recall on November 14. He knows, LeBlanc knows, Decter knows, Colley knows. Colley and Decter are sharing information by mid-November that is highly sensitive. Corea knows or has had the opportunity to know. The communications branch in the Ministry of Health seems to have had access to the Teatero memorandum. As I say, Decter seems to know. A lot of people: your deputy, your executive assistant, your special assistant for customer relations, some people in the communications branch.
By December 10 Anne Dawson, by virtue of your testimony, knows something significant, and of course Dr MacMillan said that when she called him whatever she said was enough to "blow me off my chair," or words to that effect. A lot of people know some very important information and Frances Lankin does not know and has not heard a scintilla of this --
Hon Ms Lankin: I am sorry, you are going to have to tell me what --
Mr Conway: -- has not heard anything of this at all. She has not heard it from her executive assistant; she has not heard it from Larry Corea; she has not heard it from Paul Howard; she has heard nothing from her deputy; nothing from Eugene LeBlanc, both of whom are intimately involved not just in this, but perhaps my friend here from Bruce is going to develop that the information around this surely also attaches to some of the controversies that you must have anticipated when that framework agreement was being negotiated. But no one tells Frances anything. They tell her absolutely nothing about the breach of the Teatero memorandum. Stop me if I am going too quickly.
Hon Ms Lankin: You are not going too quickly, I think you have covered a lot and I have disagreement with a number of things you have said and I am waiting until you finish.
Mr Conway: Please disagree.
Hon Ms Lankin: I would like to hear what the actual question is.
Mr Conway: My actual question is simply this. In that four-week period, the deputy knew -- now when I say knew, either knew or clearly had access on the basis of the documentary evidence now before this committee -- either knew or had access to the confidential information contained within the Teatero memorandum. The deputy knew, your EA knew, your customer relations special assistant knew, people in the ministry's communications branch knew, LeBlanc knew, MacMillan knew and was in hyperspace because, as of November 14, he was concerned that this memo existed. All of these people with whom you would be having daily contact on a subject of growing political controversy, on a main subject of the ministry's achievement, the framework agreement, and I am to believe on the basis of what you have told me that between November 10 and December 10 you knew nothing, absolutely and wholely nothing, in this connection.
Hon Ms Lankin: Is that the question?
Mr Cavalluzzo: Could I just interject before the minister answers. In the history of parliamentary democracy, that could be the longest question of all time.
Mr Elston: Not likely.
Mr Cavalluzzo: There is a misstatement of the evidence --
Mr Conway: I want to be corrected.
Mr Cavalluzzo: Okay. The misstatement of the evidence is you made a reference to her executive assistant --
The Chair: Mr Cavalluzzo, certainly if you would like to get to where you say there is a mistake, and if you would like to do that very briefly -- but there is the opportunity for the minister to respond, Mr Cavalluzzo. I remind you and everyone that certainly members of the committee can pose questions in the way in which they feel is warranted. That is what they are doing and that is their role and their responsibility, certainly in this committee. So if there is a particular point which you would like to bring forth, I will allow that, but I would like, and I think that we all would appreciate hearing the response by the minister.
Mr Cavalluzzo: The problem is, the minister was not here when previous evidence was given; I was. The reference that I would make is that you made reference, Mr Conway, that the executive assistant was aware. I would ask you to be far more specific on that because --
Mr Conway: I will be more specific. I will draw your attention to exhibit 50 which is absolutely clear. It is very clear to me on the basis of exhibit 50. This is a memorandum dated November 15 at 8:58 in the morning, the morning after Corea -- this is a memorandum from Sue Colley to Larry Corea re Sudbury and dermatologists. In that exhibit there are three specific deletions. It is quite clear to me, on the basis of having seen the full memo, that your executive assistant, on the basis of her discussions with Michael Decter last night, knew some very specific things about the matter before this committee, specifically about Dr Donahue. This is November 15. That is the reference to which I was pointing.
Mr Cavalluzzo: That is fine. I understand.
The Chair: Now that has been made, I will invite the minister to respond.
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Hon Ms Lankin: Thank you, Mr Chair. Starting off with the beginning of your statement, in which you talked about the issue with respect to northern health care and then the Sudbury doctors becoming heightened and being aware of it in late summer, early fall, that characterization is not my recollection or my knowledge subsequent to this event of when these issues actually came to light and were being worked on. So I think that you have backed up events in a way that is an unfair characterization of what happened.
Second, you talked about dates, things starting on November 10, and then you subsequently talked about November 12. You have used reference to dates November 10 to December 10 and stated that I have in evidence said that I knew nothing at all. I gave rather lengthy testimony this morning about what I knew at what points in time. For example, on the weekend of the 16th and 17th, what I heard with respect to Dr Donahue on the radio, what I had known prior to that with respect to his epilation services, that weekend hearing about his comments of closing his practice due to the thresholds. I have given evidence of the week subsequent to that. What I knew at what time, the week of the 25th; what I knew at what time, the week of December 2.
What I was unaware of, up to and including the first call I got with reference to Ms Dawson's telephone call to Mr Howard, until I got further confirmation of that, I was absolutely unaware of that document which we now have identified as the one prepared by Mr Teatero that was circulated to a small group of people.
Again, I have no knowledge that the deputy minister had any knowledge of that memo. You have indicated that he would have had knowledge of specifics and of confidential information. In my discussions with him I am not sure that he had confidential information on this file, but I do not believe he had knowledge of the memo and in my discussions -- again, this is the meeting on the morning of the 11th with people involved in the room -- the surprise with which Sue Colley reacted to this information that had come from Anne Dawson; it is my belief that she did not have knowledge of that memo either.
I can tell you that I was very concerned, and in fact angry, and obviously that would be a normal reaction in that situation -- to have gone through two days of assurances that no information had ever left OHIP only to find this out. I asked Dr MacMillan very directly. His response at that point in time was that he felt it had been something that was circulated to a small group of people, that there was nothing illegal or incorrect in the legal sense about their having that information, but that he felt it was too sensitive, or sensitive beyond requirement, and had withdrawn it at that point, or ordered its withdrawal, believed that had been accomplished, and believed that was the end of story and that it was not of significance.
I disagree with him on that point; I think it was of significance. I think I should have been told that, at least in the two days prior to this story becoming available from the Toronto Sun. However, I was not, and I became aware of it through the Toronto Sun phone call.
Mr Conway: Listen, I can completely sympathize with your anger. I mean, I can just imagine how angry you must have been when you found out. The difficulty I am having is that I have listened very carefully to what you have said and, again, some of us here are probably having more difficulty than we should because we were once ministers.
I try to imagine the situation in which you find yourself. It is just inconceivable to me, given what I know of Sudbury and what I know of this developing controversy, that you were just not beleaguered almost on a daily basis by the members from the Sudbury area. I can just imagine, from my own experience, the number of times members would have come to me with this kind of controversy boiling in a community of that size, and admittedly it came to a boil. But I will tell you, by the end of November it looked pretty hot, and got very hot on the night of December 5 in two places, widely separated.
Hon Ms Lankin: Mr Conway, I would say that from the date of about November 25 on that is a more accurate description and, as I have testified in terms of the discussions and the number of occasions on which it became an issue, I have indicated a couple of exchanges that took place that might have taken place before that.
The thing I would ask you to remember is that during that period of time on November 12 I was in my constituency office, and constituency week I was out around the constituency. For the Thursday afternoon, Friday, Saturday, Sunday, having been sick and having been very tired, I took a block of time off and was away. I remained very ill during that period of time and from the 20th -- or the Wednesday, if that is the 20th -- that Wednesday afternoon through to Friday night I was in bed sick, was on antibiotics, came back in to handle some specific meetings on the Saturday, went back home to bed on the Saturday night and Sunday. People knew that I was very ill during that period of time too, so I also believe that there was a point at which my staff were trying to handle a number of these calls coming in and I was unavailable during that period of time.
Mr Conway: I appreciate that, and I can understand that keenly. But I have exhibit 13 which is the famous memorandum. This is the Teatero memorandum of 11:41 -- sorry, what is the number of this?
Interjections.
Mr Conway: Forty-four. It is the memorandum of Teatero of 11:41, the morning of November 13. For me the main question here is: We know this memorandum ought not to have been sent; we know that if Dr MacMillan had been where he normally was it would never have been sent; but it was sent, and it was received in a number of places where it ought not to have been sent. It breached the tight circle of OHIP in a way that Dr MacMillan has described. It was made available to political staff. Whether or not they read it, we will have to decide. The testimony is that Mr Corea scanned it a couple of times and no more than that. We know that somehow Anne Dawson, a few weeks later, finds out, not all of the content, but enough of the content to cause very significant concern in high places.
My main concern in this is that this highly sensitive information, in a department where the minister has just lost her job because this kind of information got out in a way that was inappropriate, is for a period of weeks, from November 13 through to December 10, circulating. It is circulating around and about and you did not see it. You did not even know of its existence. Nobody, for example, ever told you of Dr MacMillan's concern to a point where he ordered its pullback -- you never knew that until after December 11.
Hon Ms Lankin: Absolutely not, and that was why I was so shocked. One, I had not heard about it at any time prior, and absolutely or specifically I had not heard about it on the Monday or Tuesday, the 9th or 10th while I was busy giving very strong assurances in the House that no information had been circulated beyond.
If I could respond to a couple of things that you said, you talked about this information or this memo being in circulation during these weeks. The information that I had been given was that the memo was produced and sent and withdrawn the next morning and copies of it had all been taken back. Dr MacMillan felt assured, as he explained to me when I asked him why I had not heard of this, why I did not know this had happened, that the situation had been taken care of appropriately.
You also tie in the fact that Ms Dawson became aware of at least this information. My assumption -- and I have to admit, this is only assumption -- my assumption all along has been that once the larger story with respect to Ms Martel's comments became a public and media interest point on December 9 and 10, with the attention being paid to it in the Legislature, for example, that it was at that point in time that somehow Ms Dawson made contact with someone and received this information. I have always assumed that it was some time on the 10th that she became aware of this. I do not know that to be a fact.
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Mr Conway: That is actually quite a reasonable assumption. But looking at it from a different perspective, for anyone who has ever been a cabinet minister, a ministerial aide, a good working journalist, the knowledge that exhibit 44 gets into the political staffer's stream is enough to make you understand Dr MacMillan's grave concern on the morning of November 14. "Get it back. It should not be out there." And it is out there, in a way that may very well cause it to jump a fence and get into the press's hands.
Hon Ms Lankin: Mr Conway, I want to say two things. I think that both people from the ministry and people from my minister's office staff have come forward and have provided, to the best of their abilities, information for this committee, and that evidence will be judged by the committee. I think the kind of innuendo, and I am perhaps reading this into your comments and perhaps that is unfair, but the innuendo that because someone is simply a member of a political staff or a minister's staff, somehow they would be less concerned with the protection of the privacy of information than someone like Dr MacMillan would be -- who I have the highest regard for. I believe the information that has been provided to me from the civil service and my staff. I think that should be made clear. I believe that these people have provided you with information and you will judge on that.
I suppose, in addition to the time frame in question and where I was or was not, when I was in the office and when I was ill during that period, I can also point out to you -- and I am sure that as a former minister you would be very aware of the numbers of issues that the Ministry of Health would deal with -- I can also tell you that we were dealing with potential closures of beds and hospitals and layoffs of staff, which are very important and very necessary to deal with in a quick and sensitive manner. I was focusing on preparation for the two major speeches that fall to the DHC Action Centre and the OHA, and there were a myriad of other issues. I could go back to the time and actually get you the details of them, but in the nature of it there was a lot going on, and decisions had to be made about what got brought to my attention and when.
The very last point I think I should make on this to you is that, although I understand from what you are saying you are having problems understanding this, or that this could be the case, I am testifying under oath, and I did not know of the existence of that memo or, at any time, of the contents of that memo. So I need to say that it is difficult for me to explain any more for you why that was the case. But I am telling you that was the case.
Mr Conway: I appreciate that. No, I appreciate that absolutely. But you have got to look at it from another point of view too, that your department is embroiled in a significant regional fight with a doctor who is attacking the main achievement --
Hon Ms Lankin: Mr Conway, I think that this morning I tried to make it very clear that in fact what we were involved in was trying to resolve a problem and became convinced that there was some legitimacy to what the Sudbury doctors were saying around the threshold and potential interruption of specialty services in the north, which is a different characterization than we were fighting a doctor.
Mr Conway: Let me put it this way. I will put the question and you can respond to it. By late November it is quite clear that this Dr Donahue is turning up the heat and there are a lot of people who are rallying to his side. I guess the point I am making is that you can appreciate the temptation, if one were embroiled in a public fight -- I am not accusing you of this obviously, but we know this memo has been circulating and it says -- you said yourself this morning that you were frustrated trying to separate all the pieces of this out, and I can understand this, the epilation business, the threshold, what applied where, and just trying to get a good database for what was happening.
Well, I have got to suspect -- and I am not suggesting this of you, but I am thinking about someone who might be involved at a more junior level -- and you are involved in this argument in Sudbury that is becoming more public and more heated. It just seems to me that if I had access to this exhibit 44 I would know some things that of course I would never want to make public -- I would not make public. But I will tell you, in a dark corridor where I had to put my cards on the table, boy, I would, for deep background -- do you know what those journalists refer to as deep background, the spin doctors? -- "You want to know the real story? This is of course not for attribution, but if you knew what I knew about troublemaker X, where the sacred trust of government policy Y is concerned, if you knew what I knew, you might come to a different conclusion."
You can see my point here in terms of the awareness of this exhibit 44 in that circle, in the context of a fairly heated public debate by late November, early December; how the temptation might be to make some use of the information in exhibit 44. But you say, and I have to accept it, that you did not know in that period.
My next question is to that weekend of December 7 and 8. I will put my wonder on the shelf for a moment. Now we get to the weekend of December 7 and December 8. Ms Martel and Ms Dodds have had their encounter in Thunder Bay. Ms Dodds leaves the meeting, gets on a plane and goes to a conference, ironically sponsored, I guess, or involving the Ministry of Health and touching on the question of the confidentiality of medical records.
At some point in the meeting, where at least Dr MacMillan is present, and I thought perhaps Mr Decter was for a while -- I cannot recall that, but I know Bob MacMillan is at that meeting -- Ms Dodds decides to tell all of what happened the night before in Thunder Bay.
Mr Owens: Mrs Dodds.
Mr Mills: Mrs Dodds.
The Chair: Order.
Mr Conway: Mrs Dodds. Thank you. So by noon on Friday, senior people in the Ministry of Health, one of whom had heart palpitations -- my words, not his -- three weeks earlier on the day of November 14 when he found out that exhibit 44 was out there and he wanted it back -- MacMillan is sitting in this seminar and up comes Mrs Dodds and she makes a speech about a speech the night before. That is Friday.
We know that by Saturday afternoon Ms Martel's staff is phoning people who were in that circle of the conversation and basically saying: "I made it up. I'm sorry." I will not go into what she said, but we know that by Saturday afternoon she is on the phone recanting.
On Sunday, December 8, you are at a cabinet meeting where, I gather, you sit beside Ms Martel. Is that correct?
Hon Ms Lankin: Yes. Sorry. I did not realize that was a question.
Mr Conway: As I say, I put my wonder about the other events on the shelf for the moment. Now I am at this cabinet meeting on Sunday afternoon, December 8, and we know that Ms Martel is on the phone talking to people up north about, "Sorry, I didn't mean this." You are at a cabinet meeting. She is sitting beside you. How long was that cabinet meeting?
Hon Ms Lankin: I do not recall. Ms Martel came late and for the majority of it was not there. But, absolutely, I was the next day not just shocked but very, very angry that, one, I had not received any kind of notification from my deputy minister about this, given that he was now aware of it over the course of the weekend and, second, that I could sit through a cabinet meeting at which for even however short the portions were that Ms Martel was there -- it does not matter to me if it was only five minutes that she was beside me -- that I would not have been provided with that information.
Mr Conway: But she did not say a thing.
Hon Ms Lankin: Absolutely not. I heard about it the next day, at the time that I have testified, and was just in a state of disbelief that no one had told me.
Mr Conway: Not a thing.
Hon Ms Lankin: No, Mr Conway. Again, not a thing.
Mr Conway: No one else said a thing to you either?
Hon Ms Lankin: No. I do not know actually what anyone in the Premier's office knew or did not know at that point in time, but the question sure went through my mind the next day: Did the Premier's office know about this? Did Mr Agnew know? Why did no one tell me at this point in time?
Mr Conway: Was Ms Melody Morrison at that meeting on Sunday?
Hon Ms Lankin: I do not know.
Mr Conway: Before I turn it over to -- again, that is spectacular testimony for me.
Hon Ms Lankin: It was just a spectacular thing to experience. There is not only that. There are two days of me giving absolute assurance of, you know, my belief that I am giving people absolutely correct information that nothing has come outside of OHIP. I find out through a call from the reporter and then subsequently from Dr MacMillan about the memo, something I have never known about. I am shocked and angered at that point in time that I was not told that, at the very least, in the two days preceding the morning of the 11th.
I go into question period. The first question that is asked of me is with respect to a quote from Dr MacMillan. I almost fell off my chair, and I think people know the quote. I think it was placed out of context. Once I read the article, I realized what it had come from. But I did not know about that and I went back after question period to ask Dr MacMillan and people at that point in time what that quote was about and where it came from.
This was a series of two or three days, as you can imagine, where I felt each day I was getting hit by something that I did not know, and I was -- "frustrated" is a an understatement of how I felt at that time.
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Mr Conway: Believe me, I, more than anybody in this room, can appreciate your frustration and your anger, when I think that this is a department where we have lost a minister in this kind of an issue just a few months earlier.
My final question comes back to the testimony of this morning. It is 1155-1. You do not have to refer to it, except you gave, I thought, a very clear response to Ms Jackson on this whole business about how it was that you came to give the answer in the Legislature on December 9 to Mr Harris, that very definite response of December 9 in Hansard where you said, "I have very specifically asked and received assurances from my deputy minister, who has heard directly from Dr MacMillan, the director of OHIP, that no confidential information with respect to doctors' files and their billings and their incomes has been shared with anyone outside the OHIP department, which had proper access to that information." That information was clearly, to put it charitably, incomplete.
Hon Ms Lankin: To put it charitably, yes, and believe me, I believed with every ounce of my soul that the information was correct and, as I said, was shocked to find out that for two days I had been giving people incorrect information in the Legislature.
Mr Conway: Can I just ask, what kind of relationship have you got with your deputy?
Hon Ms Lankin: I have a good working relationship with my deputy. I think the information with respect to the memo and its subsequent retrieval by Dr MacMillan was not information that he had or was aware of, and I believe, from my questioning of Dr MacMillan and his response to me, that he believed he had acted appropriately, which I also believe. His retrieval of the memo, his ordering of that -- and I have indicated this to him -- I think was absolutely appropriate behaviour in the circumstance. He felt that it was a handled issue at that point in time. I can tell you that I wish I had been informed prior to when I was, but that is the way it unfolded.
Mr Conway: I am really having a problem here, because --
Hon Ms Lankin: I can tell.
Mr Conway: -- because, quite frankly, it is a bit of the problem you had on December 11. One has to suspend one's experience and one's judgement to believe some of this.
Hon Ms Lankin: Oh, no. I would disagree with you on that point. I think that in a ministry the size of the Ministry of Health, with the number of things going on, it is not suspending belief that something like this could possibly happen. However, there is no way it should have happened. There is no way, at the very least, as I have said, that on December 9 and 10, someone, particularly those people who were involved and received the memo and returned the memo, would not have thought it important to ensure that that was passed --
Mr Conway: Let me be less charitable then. I am looking at what you said, and I believe that you said it in good faith, so I have to say, to whom did the minister turn for advice on this enormously sensitive, topical, controversial subject? She turned apparently to her deputy minister and, through him or directly, to Dr MacMillan. Those were the two people who supplied the information for that answer on December 9.
Hon Ms Lankin: At the very least, yes.
Mr Conway: And Dr LeBlanc probably as well.
Hon Ms Lankin: Yes.
Mr Conway: Now, either all of or some of or one of those gentlemen was very, very unhelpful in remembering what he had experienced throughout the previous four weeks. Would that be a fair characterization?
Hon Ms Lankin: I think that is exactly what I have been indicating, in that I believe during those two days I should have been told. I questioned Dr MacMillan directly. Dr MacMillan indicated to me that he had not remembered this until he got the phone call from the Toronto Sun reporter; that to him it was an issue that had been dealt with appropriately and was of no consequence. In retrospect, he was wrong. It was an issue of consequence, but that is what he believed at the time and that is the explanation he offered me at the time.
Mr Conway: And Michael Decter never told you, I take it, until later cross-examination -- did he ever tell you about the full contents of exhibit 50, the kind of information he and Sue Colley were sharing three or four weeks earlier?
Hon Ms Lankin: I am sorry, I have to look at exhibit 50. I do not know what it is. Exhibit 50 is whited out in a number of places.
Mr Conway: You know, it is Sue Colley's note to Larry Corea about her conversation with Michael Decter about the Donahue matter.
Hon Ms Lankin: If you are referring to specific dollar figures -- in this it appears that there is one that has been whited out -- with relation to epilation, no, I never had any knowledge of a dollar figure.
Mr Conway: By the way, a full version of this indicates that Michael Decter knew the Donahue file very well. Since he is one of the three people who, when the storm breaks, has briefed you so that you could give this firm answer, I am to believe that he never discussed with you what he knew and had talked to Sue Colley about three or four weeks earlier?
Hon Ms Lankin: I am sorry, are you saying he never discussed with me what he knew? In fact, he did. He told me he did not know about the memo. We did not discuss to what extent he knew any specific information. We discussed very clearly that he had not provided any confidential information to anyone outside the ministry. The details of confidential information were not discussed with me prior to this, as you know, and from this point on I take, which is very clearly in light of how this committee is shaping up, appropriate steps to protect myself from getting any other information.
Mr Elston: I want to pursue with you, Madam Minister, because I can only now imagine what it must be like to be the Health minister with so many issues probing your mind, you were actually involved with the Ministry of Health before you became minister, were you not? You were the lead minister on the settlement of the doctors' agreement, were you not?
Hon Ms Lankin: Yes, that is correct.
Mr Elston: So in preparation for those discussions and agreements you would be party to a whole series of bits of information about the effect of the settlement not only on the government and its revenues but probably also on physicians because you would need to know what the public policy issues that might arise would have to be, would you not?
Hon Ms Lankin: Yes, that is correct.
Mr Elston: So you were pretty well briefed on the effect of the issue of the 3.95% increase in fee schedule. You would be briefed as well on the threshold issue at that point, or not?
Hon Ms Lankin: Yes.
Mr Elston: Would you and the Minister of Health of the day also receive briefings with respect to the anticipated areas of dislocation resulting from the threshold?
Hon Ms Lankin: No.
Mr Elston: No anticipation whatsoever that service would be affected by a threshold being implemented on the physicians of the province?
Hon Ms Lankin: There were, during the course of those negotiations, a number of permutations and possible variations of the threshold that were explored and from time to time I saw different variations, I guess is the right word, of what that clause could look like. With respect to what information was attached to that around specialists, there was information that was projected and worked out with the OMA about the amount that could be predicted to produce fiscally for the government in terms of the agreement coming back into the government and the number of doctors that it could be expected to affect. But I do not believe there was any discussion that I can recall at this point in time, Mr Elston, about dislocation of services.
Mr Elston: In fact, the Ministry of Health was prepared to the extent that it would have isolated on specifically the numbers of people to be affected and probably the areas of practice which would be most likely to be over the threshold, would it not?
Hon Ms Lankin: I do not recall seeing that during that period of time. I am sorry, that was -- I mean, that was months and months ago now and the events that have followed in my involvement with the threshold issues and the underserviced area program at various points in time may have overtaken my recollection.
Mr Elston: Is it true that the reaction to the threshold began almost instantaneously in the area of Sudbury? Do you remember that at all?
Hon Ms Lankin: No, I do not. I do remember over the course, as I think I indicated, of a couple of months -- a month and a half to two months following the signing of the agreement we started to talk about the issue of the threshold and that doctors were applying for exemption and we were having discussions with the OMA around that, and that is when I started to be involved in giving direction and making decisions with respect to technical --
Mr Elston: The issue of cardiology in Sudbury had been hot for a number of months even before November, had it not?
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Hon Ms Lankin: I am not aware of that.
Mr Elston: You had not been told that by anyone?
Hon Ms Lankin: No. I do not recall that.
Mr Elston: No advice as to that as an issue at all, even though we have heard that Madam Martel had been interested in cardiologists for some time and had been advocating for an exemption for them and yet you knew nothing?
Hon Ms Lankin: I know that -- I am sorry?
Mr Elston: You did not know of that?
Hon Ms Lankin: I do not recall Ms Martel speaking to me about the cardiologists until the time period that we have talked about today.
Mr Elston: Even though Dr Abdulla from Sudbury was publicly known to be quite concerned by all of the ramifications of this as an issue there?
Hon Ms Lankin: I am sorry, that is the best information I can give you. There were certainly pockets of discontent with respect to threshold that we were dealing with. I specifically remember opthalmologists. I specifically remember the Peterborough pacemaker clinic. Later, there was an issue with respect to a couple of doctors in Windsor and the issue started to mount. You may well be right, but I was dealing with the issue more on a general basis as we were dealing with the threshold, knowing that there were concerns but not knowing that it was specifically in the Sudbury area until the time period in question.
Mr Elston: You recall Peterborough specifically. Why?
Hon Ms Lankin: Because it was a situation where we were able to resolve the problem by looking at this creatively. It turned out that in fact it was not the threshold that was a problem. As I recall it, the clinic had assumed some administrative fees that would normally be handled under the hospital's global budget and it was handled either by a grant or by transferring it to the hospital's budget. I cannot recall which it was.
Mr Elston: But you knew of it because it was an issue locally in Peterborough, and there had been meetings arranged, I presume, between the Ministry of Health and this particular operation to solve the problem. Is that correct?
Hon Ms Lankin: I assume that there had been a meeting. It is not, as an example, an issue that any member of the Legislature raised with me.
Mr Elston: Right.
Hon Ms Lankin: I came to knowledge of that through Mr Decter and Mr LeBlanc and solutions.
Mr Elston: So they told you they had solved this area which was problematic publicly. Is that true?
Hon Ms Lankin: I do not know that they told me they had solved it. I interacted with them prior to the solution and gave directions that we should be looking for creative solutions and alternatives to these situations, if that was possible. One of the things in my mind, which did not materialize with respect to the pacemaker clinic but which was initially pursued with the cardiologists as an idea, was the possibility of moving to an alternative payment plan. I have an interest in the issue of whether or not we can develop more alternative payment plans to the fee-for-service system. So those were the sorts of things that I would be looking for in terms of possible solutions.
Mr Elston: So while you had been advised by Mr Decter and others that they were successful in Peterborough, they did not advise you at all that they were actually having meetings to deal with the issues of cardiologists and now, in November, if I can take us that far in, meetings concerning Dr Donahue? They did not tell you about those as an issue around the threshold?
Hon Ms Lankin: Mr Elston, are you suggesting by the first part of your question that there were meetings with respect to the cardiologists earlier than this period of time in November that we are talking about?
Mr Elston: I am suggesting that you got told about the meetings in Peterborough, which you recall very clearly, but you have not been told anything at all of the circumstances in Sudbury where three members had been clamouring in your ministry for information that would help them.
Hon Ms Lankin: No, Mr Elston, that is not correct. I did receive information, as I have testified to. I am sorry if I am misunderstanding you. Are you saying prior to November 15 or November 18, in that period?
Mr Elston: Minister, what I am saying is this: You know about Peterborough very well, enough to recall for me details of why it is so clear and is an issue for you. But you have not been told by your deputy minister and others senior in the ministry about Sudbury as an issue, according to your testimony. You have told us little bits and pieces which came later to you.
Hon Ms Lankin: Later than what, please?
The Chair: Allow the question to be put.
Hon Ms Lankin: But I need to understand it too, Mr Chair.
The Chair: If we would allow the member to complete the question, that might be helpful.
Hon Ms Lankin: Okay, thank you.
Mr Elston: I am just trying to understand why it is you remember so much about Peterborough and no one thought to tell you very much at all about Sudbury, where there were meetings dealing with cardiologists. Information has come from Ms Colley that Ms Martel had been asking for information; it has come from Mr Corea that she had been asking for information; Mr Laughren had been asking for information, from meetings on November 15 and also from meetings which were to occur on November 30 and then December 5. Why is that you have so much information about the successful resolution of the Peterborough issue but nobody thought to tell you of this brewing and very public issue in Sudbury?
Hon Ms Lankin: I would ask that you take the opportunity later to review my testimony from this morning, because I did not indicate that no one thought to tell me about the growing Sudbury issues. In fact, specifically from the date of November 25, from that week on, I was involved in a significant number of meetings about it. I was aware of the November 30 meeting, absolutely, and I was certainly briefed after that meeting. I was acutely aware of the December 5 meeting and was in a number of meetings leading up to that with Mr Decter and Mr LeBlanc with respect to what information we --
Mr Elston: So it really was November 25 that was the key date for you in terms of you being keyed in on the significance of the Sudbury issue.
Hon Ms Lankin: In trying to go through that period of time, I became aware, obviously, of the issue with respect to Mr Donahue on the weekend of the 16th-17th by radio. I received briefing notes and transcripts probably on Monday the 18th and was aware of that then. Through the course of that week, as I have indicated to you, from the Wednesday on, I was away ill during that period. I do recall, as I testified, that Ms Colley urged me at a point in time, saying, "You must get into and get involved and get on top of this issue." I am assuming that was when I came back on the 25th from being ill, but I do not know exactly when that was. But my recollection from the 25th on is that I became more actively involved.
I also was aware of the meeting Ms Martel had with Dr Abdulla. As I testified, she had -- actually, I am not sure whether Ms Jackson asked me this question or not. She at one point had very detailed notes of a meeting she had held with Dr Abdulla and had expressed to me her concern in that she thought there were very legitimate points raised. I was in the middle of doing something else at this point in time and unable to deal with her directly and I suggested to her that she meet with Mr Decter and/or Dr LeBlanc and called and made those arrangements. I asked the deputy to make sure that he responded and that he would meet with her. So there is a growing knowledge during this period of time, but it is truly the week of the 25th and the week of the 2nd that I become very deeply involved.
The Chair: Mr Elston, the time has expired. I will permit one last question.
Mr Elston: Just one last question then. It is interesting to have that information for us when we already know from Ms Colley that you had been dealing with the issue of exemptions for underserviced area program physicians prior to this particular time and that you had also been dealing with the issue of de-insuring epilation prior to this particular period of time, yet you had no information at all from the ministry or from anyone else that the underserviced area program physicians were at least publicly causing concern in Sudbury.
You see, it is that sort of difficulty -- Ms Colley has already told us that you had made a decision on the UAP. In fact, there was some bit of relish given to the assertions by the questions from the New Democratic Party to Dr Hollingsworth when he was here that said he had been misunderstanding when he came to advocate for an exemption. How is it that you as minister had decided no further exemptions other than under the underserviced area program would take place and you had not been receiving any briefings on the public discontent asserted by either Dr Donahue -- I guess he was a little bit later, but certainly by the cardiologists, which had been publicly going on for some six months prior to the middle of November? How is it that you could have made that decision without any of that information?
Hon Ms Lankin: I certainly was dealing with the issue of thresholds and exemptions during the period of the late summer and early fall and have testified to that. I honestly do not recollect the Sudbury cardiologists being a public issue during that period of time.
Mr Elston: Shelley Martel thought it was.
The Chair: Order.
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Hon Ms Lankin: I am not disagreeing with you if you say that it had been for six months a public issue. I do not know that to be the case and I do not recall that to be the case. In the more general sense of the underserviced area program and the relationship of that to the exemptions and the thresholds and those sorts of things, you are very right, Mr Elston, I was dealing with that, but not in the specifics of the way in which the issue became public in late November.
The Chair: Thank you. That completes the questioning from the official opposition. Mr Harnick.
Mr Harnick: Thank you, Mr Chairman. Minister, we have on November 13 a memo being authored and distributed within the Ministry of Health. On December 5 we have Ms Martel at a cocktail party where she indicated she made certain allegations that she described as untruths; other people have described that as being a synonym for lying. Shortly after that, within a matter of days, we have got a leak that finds its way into the Toronto Sun. In between Ms Martel making her comments in Thunder Bay and the leak being reported, we have you -- I acknowledge with the very best of intentions -- indicating that you did not think that there was anything that was out there of a confidential nature that had been leaked from your ministry. We have really those four or five things going on all within a couple of days and then we find out, you know, that in fact there is a leak. It makes its way into the paper. We have a minister who acknowledges that she lied at a public reception. What is the public to think about what was going on within both your ministry and the Ministry of Northern Development?
Mr Owens: That is speculation, Mr Chair.
Hon Ms Lankin: Mr Harnick, I do not know that that is an answer that I can give with any assurance.
Mr Cavalluzzo: Objection, Mr Chairman.
Mr Harnick: Well, tell me this --
Mr Cavalluzzo: Is he withdrawing the question?
Mr Harnick: Well, she said she could not answer it. I am moving on.
The Vice-Chair: Thank you, Mr Harnick.
Mr Harnick: Were you satisfied with the explanation that Ms Martel gave in Thunder Bay? Let me start this way: Were you surprised at what she said and did in Thunder Bay?
Hon Ms Lankin: Yes, I was.
Mr Harnick: Was that conduct something that you as a very senior minister of the crown could condone from one of your colleagues?
Hon Ms Lankin: Mr Harnick, I am not going to answer questions passing judgement on individuals. That is what the committee is here to do.
Mr Harnick: In terms of what Ms Martel did, how did that reflect on your ministry?
Hon Ms Lankin: There was clearly the possible conclusion that either an individual in my ministry or my staff or myself had passed on confidential information to Ms Martel. I was obviously very worried about that being a conclusion that someone might draw.
Mr Harnick: Do you think, in light of the sequence of events, that that would be an unreasonable conclusion for people to draw?
Hon Ms Lankin: In light of the comments that had been made, and until there would be some explanation or some answer as to whether or not that had happened, it would be an obvious conclusion to draw.
Mr Harnick: Do you think that Ms Martel's explanation is an explanation that did anything to suggest to the contrary?
Hon Ms Lankin: Well, I think that Ms Martel's answer that she did not see confidential information -- because I believe she is a person of integrity -- is an answer that I accept. It is difficult, with the rest of what Ms Martel has said in question period and to the media, to understand. It was as a result of that that I posed the question that I spoke about this morning, received additional information which was a plausible answer to my way of thinking and which I can discuss with the committee in camera, as I have been instructed by the committee lawyer.
Mr Harnick: See, I found it interesting that you yourself were not particularly impressed with her explanation, because in your evidence you described it as scripted.
Hon Ms Lankin: Yes, I did.
Mr Harnick: That would lead me to the conclusion that you were not satisfied with the explanation that she was publicly giving the Legislature.
Hon Ms Lankin: I found it difficult to understand why that was the only answer. I would be searching for more of an answer. I am sure other people were, if they responded like I did. I had the occasion to ask the further question and to receive an answer.
Mr Harnick: Why do you suppose she would not tell the Legislature that?
Hon Ms Lankin: I believe that is something that I can discuss with you in camera.
Mr Harnick: All right, thank you.
The Chair: Mr Eves.
Mr Eves: Thank you, Mr Chairman. Your House leader has been quoted as saying -- I would not want to misquote him, so I am quoting exactly from a North Bay Nugget article of CP wire service February 19th -- "`It's simply a witchhunt and a character assassination,' he said. `That's what the whole process is all about and at the same time they are making a lawyer rich.'" Would you agree with your House leader's description of this committee's activity?
Hon Ms Lankin: I have had concerns, Mr Eves. Part of that comes from, I will admit, my own unfamiliarity with this kind of process. This is the first time that I have been elected. I have not seen one of these parliamentary commissions or committees in action up close before. When I had taken the position that I thought that this kind of a committee should be set up, I have to tell you that I was thinking in my own mind of experiences I have had in the past with various administrative law tribunals. I was a panel member of the Workers' Compensation Appeals Tribunal. I have participated in labour arbitrations. I have been involved in various court situations, not frequently but when I worked in the Ministry of Correctional Services. I had a sense of this kind of inquiry, of one that would follow rules of natural justice and due process.
I understand that parliamentary process or inquiry is slightly different. For example, there is not an opportunity for your own lawyer to lead evidence and then cross-examination. I was concerned during the first week of committee hearings that members of the committee were making statements. I read in the press that they had already concluded what they thought the evidence was going to show. I felt that you should at least have had a chance to have the evidence out and heard and reviewed before those sorts of statements were being made.
I raised my sort of sense of anxiety about that with a couple of people and it was explained to me that this in fact is a parliamentary and political process and that it is different than a legal process. I understand those differences now. So I think I had some of those same concerns as the House leader expressed.
Mr Eves: Have you ever referred to this committee's deliberations as a witchhunt?
Hon Ms Lankin: Yes, I have.
Mr Eves: Is your opinion still the same?
Hon Ms Lankin: Well, I think that I am being treated very fairly today and I have a sense that the tone has changed somewhat. Again, I was not here during the first week and I do not know exactly what went on, but what I saw in the media was members of the committee giving interviews following a particular person's testimony -- on a couple of occasions this was -- and indicating an assumption of what the whole result of the hearings would be. I thought that was a very unfair process and had that opinion and used that word, "witchhunt," myself. I think that in the last week or so the tone and the proceedings have changed and I feel more comfortable now.
Mr Eves: I might remind you, and perhaps other members of the committee, of the terms of reference of this committee, only one of which delves into the investigation and disclosure of confidential information emanating from the Ministry of Health. The second one I will quote from the Hansard of the Legislature the last day the House sat last December. "An investigation [into the conduct] of the Minister of Northern Development and Mines in Thunder Bay, Ontario, on December 5, 1991, and the events leading up to her attendance in Thunder Bay."
This committee is not only here to decide or try to find out whether or not in fact the Minister of Northern Development had access to confidential information and shared that. They are also here to inquire and look into her conduct and to decide whether that is appropriate conduct for a minister of the crown. That is part of our terms of reference and I would like to deal with that aspect of the terms of reference of this committee, because the committee does not seem to have spent a great deal of time on that aspect of the terms of reference today.
You know Shelley Martel very well. I have known her since she has been a member of the Legislature. My opinion of Shelley Martel is that she is a very sincere, honest, dedicated, hardworking member of cabinet and always has been. Does Shelley Martel have a reputation for making up things about different individuals that you know of?
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Hon Ms Lankin: No, I do not believe she has that reputation.
Mr Eves: Do you think that Ms Martel's comments that she made in Thunder Bay on the occasion in question on December 5 -- I believe it was a Thursday -- were appropriate comments for a minister of the crown to make?
Hon Ms Lankin: Mr Eves, I think I would like to discuss this with the committee in camera when I will be able to explain to the committee what I know of the further plausible answer that Ms Martel gave.
Mr Eves: Well, I am having some difficulty. Part of the difficulty I am having is what cabinet ministers of the current government perceive their proper conduct to be and what has been told to them by the Premier or the Premier's office as to how they are supposed to behave, what are the Premier's guidelines, does every member of cabinet fully understand what these guidelines are. I look at a list of a few ministers who are no longer there, because supposedly they did not understand what these guidelines are: Mr Farnan, Ms Akande, Ms Gigantes, Mr Kormos. Now those people are no longer there supposedly because they did not understand what the Premier's guidelines for conduct are. Is it appropriate for a minister of the crown, at a public reception, to make the sort of comments that Ms Martel made? Is that acceptable conduct, as you understand the Premier's guidelines, for a minister of the crown?
Mr Cavalluzzo: Objection before the minister answers. Once again, this is the very inquiry that is put before this committee, and I object to the question because surely the witness would be usurping the function of the committee.
The Chair: I am sorry, Mr Cavalluzzo, the objection to the question is one which I have some concerns with. Mr Eves can certainly pose the question. As I indicated to the minister at the beginning of the day, if any question is asked which, in her opinion, would require divulging something of a confidential nature, then we can deal with the matter in an in camera proceeding. But as to the question itself, certainly this is a matter which Mr Eves is asking and I see it as a matter of opinion from the minister. But again, if the minister wishes that she cannot --
Mr Owens: On a point of order, Mr Chairman.
The Chair: Please, if I might finish, if the minister cannot, in her opinion, respond to that question in the proceedings in public, then we can, as she is well aware, deal with this issue in camera.
Mr Owens: Mr Chairman, my point of order is that Mr Eves is asking the witness to speculate on the character of another individual. I do not think that that is an appropriate line of questioning for this particular type of hearing or any other type of hearing that this Legislature undertakes.
The Chair: Mr Owens, with respect, that is not a question of speculation; it is a question far from, in my opinion, speculation. He is asking a specific question of the minister, her opinion as to a particular term of conduct. It is well within order to ask that question, again reserving unto the minister or anyone who is here before us as a witness that if she cannot respond without divulging, in her opinion, confidential information, then we can deal with the matter in camera. But I am not going to rule that type of question out of order, because it is not a matter of speculation. Mr Eves.
Mr Eves: If I might, Mr Chairman, I am not asking the minister to pass judgement on anybody else; I am asking her what her understanding of the Premier's guidelines is. Surely they are not confidential and surely she has an understanding of what those guidelines are. It is a very simple question. Are comments such as those made by Ms Martel in Thunder Bay -- do those comments breach, in your understanding of the Premier's guidelines, the Premier's guidelines? Is that acceptable conduct for one of his cabinet ministers? I think the public and everybody has a right to know that.
Hon Ms Lankin: Thank you for clarifying that, Mr Eves. I think that the Premier's guidelines probably do not touch directly on these kinds of circumstances, but what I would say is that for someone to lose her temper and to make -- for a cabinet minister, because your question is directed there -- to lose her temper and to make statements in anger certainly is not what would be contemplated by the guidelines as being appropriate behaviour. It may be understandable but not appropriate. I think Ms Martel has indicated that she believes it was inappropriate and apologized.
Mr Eves: I want to go, just for a moment, to the circumstances. I can understand, believe me, your frustration of finding out some of this information on December 10 or 11. Do you believe that Michael Decter and Sue Colley acted appropriately with respect to this manner in keeping you advised of the knowledge they had? You have talked about the cabinet meeting on December 8, when you did not know any of this was going on. You were not really made aware of some of these things until a day or two later. You can correct me as to the exact day. But I do share Mr Conway's -- not disbelief. I am not questioning that what you say under oath is true. I am not doing that. I am asking you, having said that, if you believe the actions of your deputy and your executive assistant were appropriate in not keeping you informed or not making you aware of these matters?
Hon Ms Lankin: Mr Eves, up until, say, the 5th of December, I believe I was appropriately informed of information by my executive assistant and deputy minister, or appropriately not informed of some information during that period of time.
Over the course of the weekend of the 6th, 7th and 8th of December, when I was not informed by the deputy minister that the events of Miss Martel's visit to Thunder Bay had given rise to a potential allegation of a breach of confidential information from the ministry, I think it was not appropriate not to inform me of that before the Monday morning with respect to my executive assistant. She did not have knowledge of that during that period of time and gained knowledge only moments before I did on December 9.
Mr Eves: Mr Cooke has also made quite an issue, in the media at least, about the fees for the committee being paid to counsel and the substantial cost, in his opinion, that this committee is costing the taxpayer of Ontario. Could you please tell me when counsel was engaged to appear to advise the ministry officials, Mr Cavalluzzo, in particular, if you wish, Mr Corea, Ms Colley and yourself? Can you tell me when counsel was engaged, how much counsel was being paid and by whom is counsel being paid?
The Chair: Before responding, I see that your counsellor is moving forward with respect to that particular question being in order and appropriate to the terms of reference.
Mr Cavalluzzo: Just in terms of getting concerned about the solicitor-client privilege, but it is for the witness to decide whether to waive that privilege or not. If she wants to answer that question, that is fine.
Mr Eves: Let me perhaps say something else, Mr Chair. If in fact counsel has been engaged privately and is not being paid for by the taxpayers of the province of Ontario, then I would agree that it is a most inappropriate question and I would gladly withdraw it. If on the other hand, though, the taxpayers of Ontario are paying for it, it is just as appropriate as what counsel of the Legislative Assembly Committee is costing and what Shelley Martel's counsel is costing and what Dr MacMillan's and Dr LeBlanc's counsel are costing the Ontario taxpayers, all coming out of the same pocket.
The Chair: I understand Mr Cavalluzzo to say that this is a matter of solicitor-client privilege. I think we all fully recognize that. This question can only be responded to if there is to be a waiver of that particular privilege. Certainly that is up to the minister with her solicitor at her side and I would rule accordingly.
Hon Ms Lankin: Thank you. I have no problem attempting to answer the question. I actually do not have all the pieces of that information. The counsel with respect to myself, political staff in my office and ministry staff are in fact being paid for by the government of Ontario and by the taxpayers.
The point in time at which counsel was engaged -- I am sorry, I do not know the date of that, but it was very shortly before the hearings commenced. In fact I might be able to get some assistance from my counsel, but I do not know the date. I do remember expecting in fact that we would use ministry lawyers at that point in time. I did not think that ministry staff or anyone would have need to have anyone involved from outside of government. The deputy minister came to me and informed me, on Mr Gilbert Sharpe's advice -- he is the senior legal official within the Ministry of Health -- that he in fact is actually employed by the Ministry of the Attorney General on behalf of the government and that it would not be appropriate for him to give any advice with respect to these sorts of proceedings to ministry officials or to myself, and it was recommended that I engage legal counsel.
I rejected this recommendation for some period of time because it seemed to me that this was just getting out of hand, where this was headed. But I was seriously advised that -- and particularly because, if I can say it, at that point in time I started to hear back from individuals in the legal community that one member of the committee -- I have heard this only second and third hand -- was making statements with respect to my involvement in this case that seriously challenged my integrity and credibility. Those statements were being circulated among the legal community in Toronto. That gave me cause for concern, and I finally took the advice to engage counsel at that time.
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With respect to the cost, I signed a waiver for the ministry, which will be making the payments on this. It was set out clearly in there that it would be at the regular ministry rate of compensation of legal counsel, but I do not know what that is, Mr Eves.
I also signed in there that, should any culpability be found -- this is a standard letter that I believe went to everyone -- on my part or anyone's part for which the government had provided funding for legal counsel, we would undertake to compensate the government in return for those dollars.
If I can just say in general, I think the amount of money is an extraordinary amount. This is no reflection on the individuals from the commission who in my experience are working very hard on this hearing, lawyers etc, and preparing and being of assistance to the committee. But I can tell you, and let me be fair, that this is a political statement at this point in time. I spent a week last week travelling around southwestern Ontario and had an incredible meeting with one group that was just looking for a one-time grant of $45,000, which I am having trouble trying to find within the budget and with all of the constraint going on. I have to tell you, in light of what I know, that those kinds of moneys can do -- the speculation about how much this process will cost in the end is of concern to me.
On the other hand, I am tremendously concerned about what has appeared to be a potential leak of information with respect to the Toronto Sun reporter. It is difficult for me to balance out these issues of the costs and trying to get at this information for everyone's benefit, and yet on the other hand the very serious issues of confidentiality.
Mr Eves: I just have one or two other questions, Mr Chairman, if I might. One is directly related to, it would appear, a change of heart by the ministry with respect to specialists and their threshold, which was announced late last week or over the weekend. Can you explain to the committee why another change in policy at this point in time?
Hon Ms Lankin: I am not sure of the relevance to this hearing, but I can tell you the chronology of that which would be important to you perhaps. If you recall, in this morning's testimony I referred to the fact that in the meetings that were taking place with Mr Decter and Mr LeBlanc during the period in question, leading up to the end of the first week in November, we were focusing on trying to resolve a problem which was becoming more apparent to me. It was actually a problem of the way in which the threshold was being applied in the underserviced area program, focusing on recruitment and not retention.
I referred this morning to my Hansard comments in response to, I believe, a question by Mr Harris on December 2 with respect to the threshold issue in northern Ontario -- I believe a North Bay doctor, in fact, he was asking me about -- and indicated at that point in time that we were reviewing the underserviced area program and looking and having further discussions with the Ontario Medical Association about further refinements to that.
Near the end of December -- I do not know the actual date -- but you could find press clippings that talked about the fact that the OMA and the government had reached a further understanding with respect to the underserviced area program that would attempt to deal with the issue of retention, not just recruitment as the old program did, and that there were some more details of that to be worked out. Those details were worked out over the course of January and the first part of this month. What is in the press as news now is actually only the final technical details of an agreement that was arrived at at the end of December.
Mr Eves: I cannot recall the exact wording of the letters -- although I know I have copies of them and I know they are filed as exhibits with this committee -- you sent out I believe to the OMA, to different members of the Sudbury medical society. November 13 or 14 I believe are the relevant dates.
Ms Jackson: November 13.
Hon Ms Lankin: Yes. I have them before me, Mr Eves.
Mr Eves: I am doing this from memory until I can find the exact letter. It seems to me that letter indicated there would not be any further exemptions.
Hon Ms Lankin: Yes, that is correct.
Mr Eves: Can you see how the Sudbury physicians as well as other specialists in northern Ontario could be somewhat confused as to the application of the threshold policy to them?
Hon Ms Lankin: It depends on what point in time you are speaking of. This decision was arrived at at the beginning of November. Communication had taken place with the OMA at a joint management committee meeting, followed up in writing to the members of the profession, to the OMA as the association and to members of the Legislature to inform them. Following that, I believe it was clear that there would not be any further exemptions until I began to speak publicly -- it would be around the week of December 2 -- with respect to looking again at the way in which the underserviced area program itself was working and the issue of retention versus recruitment of physicians. During the period of time leading up to that, I think it was very clear that there would not be exemptions other than the exemptions that had already been provided for in the discussions with the OMA leading up to the early November decision, which is elucidated on in these memos.
Mr Eves: So are you saying -- correct me if I am wrong, and I am sure you will -- that you decided, in your own mind, to revisit this decision, or program, early in December?
Hon Ms Lankin: As the course of the meetings was going on with respect to the effect of the threshold on underserviced areas, and particularly talking about delivery of northern services, it became clearer to me, as I pressed more on the issue and as the issue was under discussion, that we had accepted -- I had; let me put it in the personal here -- I had accepted that the exemption of people on the underserviced area program would in fact address that issue. I think it was my lack of understanding -- and I became subsequently much more clear -- about the difference in the issue between recruitment, which is still a problem with respect to specialists, but retention in particular, and how in fact when people had moved off the underserviced area program the issue of retention was still a problem if the threshold was going to be having the impact it appeared it would be having with respect to the cardiologists, for example.
Here was a group which was saying, from the information I had -- forgive me if I have the numbers wrong -- but I think: "There are three of us and we've done a lot of work to try and recruit other specialist cardiologists to come in. We're not like some professions where it has been accused that we've kept people out and we kept the numbers down. We've actually recruited people. They're going to be starting in a few months. It's only between now and then that this is going to be a problem." Those sorts of things caused me to look at this again, Mr Eves, yes.
Mr Eves: The number, I believe, is five in the Sudbury area in terms of cardiologists. I believe Dr Abdulla was issuing press releases to the media in Sudbury as early as April 29, 1991, and I am looking at some newspaper clippings from Saturday, May 18, Friday, May 10 etc, where different cardiologists in Sudbury were expressing their concern about what they perceived to be, anyway, and they referred to as a threshold fee, in some cases of $400,000, and in other cases they referred to it as a billing cap. Obviously those words get interchanged. We know they are not exactly, technically correct especially when you are using the words "billing cap."
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It certainly struck me when I read your letter, and I was reading it in a totally different context on November 13 and 14 than had anything to do with Dr Donahue or anybody else. I was appearing, it just so happened around that point of time, at Northern Development estimates as the critic for Northern Development and questioning Ms Martel because I had asked a question, I believe, of yourself -- perhaps not; maybe of Ms Martel -- in the House about some specialists that had been in touch with me. I believe they were also from the North Bay area, and one was from Sudbury; I believe it was a cardiologist; it certainly was not Dr Donahue.
Hon Ms Lankin: Are you sure, Mr Eves?
Mr Eves: Yes, I am positive about that. You can cross-examine me if you wish on that. But it certainly did strike me when I received a copy of your letter that you wrote to Dr Linton, the president of the OMA, and to various other physicians on November 14. It seemed like a quite definite letter to me, that you were talking about a decision not to extend further exemptions, it would be open for review in the planning for the 1993 year but that this year, this fiscal year, there were going to be absolutely no other exemptions given. That certainly concerned physicians, especially specialists in northern Ontario. I just wondered how all that fit into this mix.
It seemed kind of interesting to me, I suppose, that there was a much larger issue out there, in my mind anyway -- all kinds of physicians and specialists in different specialties in northern Ontario were experiencing problems -- and yet we find that all these people in the ministry were running around worrying about this one particular physician who was a dermatologist who appeared to be quite vocal in the Sudbury media. It seemed to me that perhaps their efforts could have been a lot better expended on dealing with the problem as a whole than singling out one particular doctor and one particular speciality and one particular community.
Hon Ms Lankin: There is not a question embedded in there --
Mr Eves: No, there is not. It is more of a statement.
Hon Ms Lankin: -- but let me answer in any event. A couple of things: When you talked about earlier press clippings in April and May, I do not recall specifically Dr Abdulla or any particular doctor, but there were lots. A lot of response was going on to the nature of the agreement itself in the period leading up to ratification and I certainly was aware of the political debate that the agreement engendered within the physician community for and against the agreement and, as we know, the ratification took place. In fact, there was a lot of debate around the process of ratification itself. That became a political issue within the physician community for a period of time within the association.
I think that period of time I distinguish in my own mind not as having been problems that were real yet. I mean, they were problems that were in relationship to the agreement and pro and con the agreement. Over the course of late summer when individual physicians attempted to determine what their individual position would be with respect to the thresholds and started writing for exemptions, the issue started to take more of a focus, and that is when we actually were trying to deal with resolving some of the problems and made changes to the technical fee codes and made some other solutions in some areas.
At a certain point in time we took the firm decision which is communicated in the November 13 letter: no more exemptions. Subsequent to that, as we looked behind the issues that were being raised and being advocated on behalf of northern doctors by a number of members of the Legislature from my own caucus and from your caucus as well and from the Liberal caucus -- to be fair, Mr Miclash also raised concerns with me on that -- I looked again at the issue of the underserviced area program. I am one who has always said that I am not going to respond to things -- in my terminology; I hope no one takes offence -- in a macho response that because I have said it, I will not ever change my mind. I do look at issues and I do reflect on them. If there appears to be a problem with a policy that we have put in place, then I will try to address that. In this case I did that and I do believe that there was a problem with the underserviced area program that was brought to light.
The only thing that I would have real concern with what you have said is that during this period of time everyone in the ministry was running around dealing with this --
Mr Eves: I did not say everyone. I said several people, I believe.
Hon Ms Lankin: Were running around dealing with this one doctor. I assume you are speaking of people who have testified thus far, for example, who were involved in this, from the ministry and from my staff. I can only assure you they were dealing with many, many, many other problems. With respect to the threshold issue, in fact, in my mind at least, the cardiologist issue took prominence over that period of time and the dermatologist was subsumed as one of a number of other specialists in the Sudbury area.
Mr Eves: Thank you.
The Chair: Thank you very much, Mr Eves. Mr Kormos.
Mr Kormos: When Dr Kosar was here, he was telling us about the meeting that he, Dr Hollingsworth and Shelley Martel had in the east lobby of the legislative chamber here when, as I remember it, he, Dr Kosar and Dr Hollingsworth were down to get a lobby with Shelley Martel about the plight, as they perceived it, of doctors in northern Ontario. Dr Kosar told us that at that point in time, and that was at the very beginning of December of last year of course, he was not sure whether a UAP doctor was subject to the threshold or not. I was concerned about how he could not be sure about whether or not UAP doctors were exempted from the threshold, what was going on that could have possibly left him uncertain about that.
Hon Ms Lankin: There should not have been uncertainty, but my belief is there was, because I felt during this whole period of time there was a tremendous amount of misunderstanding among northern doctors with respect to the application of thresholds. I would have thought they would have had a clear understanding by that period of time, because there had been ample opportunity for exploring that with the ministry. There had been letters that had gone out, but clearly the nature of the response that was going on, I thought, indicated there was misunderstanding.
Mr Kormos: What was the status of UAP doctors at that point in time -- November, December 1991 -- with respect to threshold?
Hon Ms Lankin: Clearly any doctor who was enrolled under the underserviced area program -- the billings for that period of time were exempt from any calculation with respect to the threshold.
Mr Kormos: And the UAP was what, a four-year program?
Hon Ms Lankin: Three years or four years.
Mr Kormos: Three or four. So you are saying that during that period of time a doctor was under the UAP, he or she did not have to worry about whether or not they billed, well, any amount, because threshold was not applicable.
Hon Ms Lankin: That is right. For the course of the whole billing year of 1991 into 1992, that fiscal year, if they were for the course of that whole year under the underserviced area program, they would not even have to think about the issue of threshold. If they were for one month or two months under the underserviced area program, any billings for that one or two months would not have been part of the calculations for the threshold.
Mr Kormos: I thought there was a published list of doctors who were on the UAP program: their names, their areas of speciality or practice and either the date at which they commenced the UAP program -- it must have been, because apparently it was relatively easy to figure out the termination date. Was there anything secret about that information?
Hon Ms Lankin: No, not at all. I certainly had that information and that particular document. Ms Martel did. I testified earlier that that was one of the documents she had in front of her when she asked me for clarification either before or immediately after meeting two doctors in the east lobby. I am assuming it is the same two doctors on the same day.
Mr Kormos: Perhaps, because we have learned around here that just because something is not secret does not mean it is not confidential, was it confidential?
Hon Ms Lankin: No, it is public information.
Mr Kormos: Even I could have been given that document, had I inquired about it?
Hon Ms Lankin: I do not know. Should I disqualify you for some reason particularly? Any member of the public could access this information with respect to the underserviced area program.
Mr Kormos: It is simply a matter of saying, "What does the list of doctors on UAP consist of at this point in time?"
Hon Ms Lankin: Yes.
Mr Kormos: And you would get that piece of paper?
Hon Ms Lankin: Yes, without a problem.
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Mr Kormos: When you go off UAP -- not go off, but it is a contract. Is that the right way to describe it? You enter into a contract with the government --
Hon Ms Lankin: Yes.
Mr Kormos: -- with the ministry. It is for a fixed period of time, be it three or four years. When you go off it -- let's say you go off it January 1, 1992. When does the meter start running in terms of the application of the threshold? Because once you are off it, you know -- notwithstanding what happened last week in terms of announcement, but prior to that -- once you are off UAP, then the threshold did kick in, huh?
Hon Ms Lankin: That is right.
Mr Kormos: When does the meter start running, though, for the calculation of -- what is it? -- that first $400,000, 400 grand in billings?
Hon Ms Lankin: If your last day on the program is the last day of December, your first day on which your billings would start to be calculated for the purposes of the threshold would be the first day of January.
Mr Kormos: So there is no concept of fiscal years or things like that. Your new year, your fresh year, your threshold-subject year starts the day you are off UAP?
Hon Ms Lankin: No, it would not be a threshold-subject year; it would be for the months of January, February and March. For the remainder of the fiscal year, your billings would be subject to the test against the threshold, with all of the further exemptions of technical fees and those sort of things. I am not being clear; I am sorry.
Mr Kormos: No. I am not being very good at understanding. Is it prorated then?
Hon Ms Lankin: That would be one way to describe it. If I could take the fiscal year, from April to March, if you were on the underserviced area program from April to the end of December, none of the billings that you had processed during that period of time would be even looked at with respect to the threshold application. So it would be starting January, for the remainder of the fiscal year, whatever you had billed would be looked at, minus all of the technical fee codes etc. If at that point in time it exceeded the $400,000 threshold, your subsequent billings within that fiscal year would be reduced to two thirds etc.
Mr Kormos: Wait a minute. You mean that if there are three months left my fiscal year --
Hon Ms Lankin: Yes.
Mr Kormos: I mean, nine months of the fiscal year was the balance or the last period of time on which I am on the UAP program, so I have three months left in my fiscal year. How much can I bill before the threshold starts affecting how OHIP reimburses me?
Hon Ms Lankin: It would be, at the minimum, $400,000, but my expectation is it would be more than that because there would be technical fee codes as well as procedural codes that a physician in normal practice and specialty practice would be billing, and any of the technical fee codes would be discounted. So in order to reach the limit of $400,000 of those things that the threshold is applied to, most physicians would actually be billing more than $400,000.
Mr Kormos: Do you mean you will have $400,000 in three months?
Hon Ms Lankin: That would be the minimum if the threshold were to apply to you, yes.
Mr Kormos: Wow. So if I, coming off the UAP program, had been announcing that I was going to reach a threshold within that three-month period, or let's say four-month period, that would be as much as me telling people that I am doing $400,000 within that three- or four-month period?
Hon Ms Lankin: If you are aware of all of the exemptions and you have calculated those things in and you have the right information, yes, it would be.
Mr Kormos: Now, you are telling us that you are little bit concerned about the fact -- no, maybe you are not telling us that. In any event, you are not exactly sure why Dr Kosar would be confused about the threshold exemption that UAP doctors had even back in November or December. Is that fairly --
Hon Ms Lankin: I do not know why he would be confused. It is conceivable he was, but it was not a confused issue. The issue was clear that anyone on the UAP program was exempt. He may have misunderstood that.
Mr Kormos: Anybody who was interested in the issue and who similarly made inquiries about that facet of the issue -- are UAP doctors exempt? -- would have been told by you or people in your ministry that --
Hon Ms Lankin: Or Ms Martel, because she also has interest and responsibility for the underserviced area program as the Minister of Northern Development.
Mr Kormos: That is a joint program that both ministries administer. You administer it as Minister of Health, but jointly with, as it is, Shelley Martel as the Minister of Northern Development.
Hon Ms Lankin: Yes, that is correct.
Mr Kormos: So it would not surprise you to know that Shelley Martel knew full well, without doubt, without question, end of November, beginning of December 1991, that underserviced area program doctors were exempt from threshold?
Hon Ms Lankin: No, absolutely not. That information had been exchanged between us and discussed, and she also had the same list I had. She had it in front of her the day in the Legislature that I am talking about in which she had either come back from or was going to meet with two doctors in the east lobby.
Mr Kormos: You would expect her to know those things?
Hon Ms Lankin: Absolutely.
Mr Kormos: It is part of her job.
Hon Ms Lankin: Yes.
Mr Kormos: Mr Eves spoke of her in somewhat glowing terms, and as the conscientious and hardworking minister that she is, this would be the very sort of thing that she would learn in the course of performing her duties?
Hon Ms Lankin: Yes, and she was very concerned about this issue. As I had indicated, when she one of the first times approached me, she had very detailed notes from a meeting that she had held with Dr Abdulla and was stressing that she believed -- and these were very detailed notes about the nature of cardiology practice and the number of cardiologists in the area. There were several pages to this, as I recall. I at that point had directed her to the deputy, so she was very much into this issue, had been through thorough meetings with the deputy and/or Mr LeBlanc about it, had been to the meeting on 30 November with other members of the Legislature and the doctors and ministry officials, where the ministry officials went through and explained it to the doctors, the cardiologists there present. So she had had a great deal of exposure to the issue from an advocacy point of view as Minister of Northern Development.
Mr Kormos: In particular -- again, I am not asking you to speculate, but one can assume that Ms Martel was reasonably pleased about your announcement last week, because she was one of those several northern members who were advocating on behalf of doctors with regard to the threshold issue?
Hon Ms Lankin: Yes, absolutely.
Mr Kormos: She was making arguments to you and your staff about why doctors in the north should not be subject to the threshold.
Hon Ms Lankin: She was certainly asking me to look at that issue. She felt, from the point of view -- and in particular, I recall her being very, very passionate about the issue of the cardiologists -- that this service was going to be threatened, even though she believed that these doctors would do everything they could not to discontinue the service, but that it was going to be threatened as a result of this and that I really did need to try and understand better the issue of retention versus recruitment in terms of the north.
Mr Kormos: Tell me: You are from Toronto, but she was born and raised in the north, and she is doing as good a job as anybody could have done --
Hon Ms Lankin: Absolutely.
Mr Kormos: -- getting you to look at the special circumstances of doctors in the north?
Hon Ms Lankin: Yes.
Mr Kormos: And as it is, as a result of her work on behalf of those doctors, or at least in part as a result of her work, a decision was made that was favourable to those doctors?
Hon Ms Lankin: I would say certainly in part. I do want to be fair and indicate that there were certainly other members of the Legislature, from all three caucuses, who raised the issue with me. And I would say that I showed some sensitivity to it myself, Mr Kormos, in dealing with it. So I think that Ms Martel certainly was a very strong advocate and I agree with your characterizations. I would just add that there were others who were involved as well in lobbying me.
Mr Kormos: No doubt, no doubt. But Ms Martel certainly was not the least among them, was she?
Hon Ms Lankin: No, absolutely not. No.
Mr Kormos: And it was not a matter of her having her staff or constituency office staff or her legislative office staff deal with your ministry. She really rolled her shirtsleeves up and got into this whole issue very personally, did she not?
Hon Ms Lankin: Yes. She met directly with my deputy and/or Mr LeBlanc. She attended meetings with the doctors prior to her discussions with me subsequent to meeting with the doctor on the 30th -- the two doctors in the lobby. She knew a great deal, as time went on, about the workings of the Ontario Medical Association agreement, about the specific workings of the application of the threshold, what was exempt, what was not. She got inside the issue, I would say, and did it herself; that is true. This was not a matter of any of her staff working on this issue.
Mr Kormos: Very much a hands-on approach on the part of Shelley Martel, was it not?
Hon Ms Lankin: Yes.
Mr Kormos: And an approach that you certainly did not criticize at the time?
Hon Ms Lankin: No, and would not criticize now.
1610
Mr Kormos: If anything, an exemplary approach in terms of what an MPP ought to be doing for her constituents?
Hon Ms Lankin: Yes, I think that is a fair comment.
Mr Kormos: In the course of debating the issue of application of threshold to northern doctors, and you talked about this a little bit, it would be important to understand what the impact of threshold was on northern doctors, would it not?
Hon Ms Lankin: Yes.
Mr Kormos: And not so much a particular interest in what a given doctor's billings are, but an attempt to understand exactly how many doctors, for instance, out of the northern doctors would be reaching threshold or exceeding it.
Hon Ms Lankin: Yes, that is information that I had asked for, and that information had been provided to both myself and Ms Martel with respect to the Sudbury area in terms of the number of general practitioners and the number of specialists which projections could indicate might be affected, as well as on a provincial basis numbers for northeastern Ontario, northwestern Ontario, central Ontario, that sort of geographical breakdown.
Mr Kormos: We are not naming doctors and identifying what a given doctor's income is, are we?
Hon Ms Lankin: No.
Mr Kormos: We are identifying statistically what billings mean to northern doctors.
Hon Ms Lankin: That is correct.
Mr Kormos: Once again, we are not talking about secrets here, are we?
Hon Ms Lankin: No, and I guess one of the things that was difficult during that period of time is that I was trying to get out more information. In fact I remember I welcomed the question from Mr Harris on the 2nd, because I felt there was a lot of misunderstanding. One thing that comes to mind was not just the exemption for technical fee codes and the underserviced area program, but some doctors who had outreach clinics in the north, where they travelled from their centre, for example, Sudbury or Thunder Bay or any major northern centre, and travelled to outreach to provide services in an underserviced area there. Those billings were exempt from application of the threshold.
So I actually thought that there was a lot of misunderstanding that needed to be clarified. If not for the actual individual doctors if they had not got it clear by that point in time, I sure felt it needed to be clarified for members of the Legislature and members of the public because I felt there was a reaction taking place that was beyond the level of concern that actually should be engendered by this issue, although as I said then and still say and have subsequently acted on, I felt there was an issue of concern around the workings of the underserviced area program and had committed that we would look into that and attempt to revise that, which we have done.
Mr Kormos: The impression I am getting, and correct me if I am wrong, but if I am right tell me that too, is that Shelley Martel was very much involved in advocacy on behalf of the issue of threshold and in the course of doing that would have logically learned about who was on UAP and who was not and where they were. Is that a fair comment?
Hon Ms Lankin: That is correct.
Mr Kormos: And similarly, because she was involved in this debate on threshold and was advocating on behalf of those northern doctors, would have again logically availed herself of the statistics you had about, let's say, the numbers of doctors who were expected to achieve threshold as compared to the numbers who were not expected to, or percentages or numbers who were not expected to exceed threshold.
Hon Ms Lankin: That is correct. I am aware that Ms Martel was given those general numbers, as was I.
Mr Kormos: Because it was relevant to the argument at hand.
Hon Ms Lankin: That is correct. I mean, to put it in perspective, there is documentary evidence to this, but I think we were talking about three or four general practitioners in the Sudbury area and a number in the teens of specialists. It was not like 50 doctors; it was much smaller than that. But again, as I indicated this morning, there is a caution in that that was a projection and may not have been accurate because it was partway through the billing year.
Mr Kormos: I do not know if you read the column by Ms Blatchford in the Toronto Sun, and she makes reference to Dr Kosar as being a very nice man, but back in December in her column Ms Blatchford writes with some shock and horror that Shelley Martel would, for instance, know who was and who was not on the UAP. But you are telling us now that it was very much a part of her job to know that.
Hon Ms Lankin: Yes, and it was very much public information that is easily accessible.
Mr Kormos: And Ms Blatchford, in the same column in the Toronto Sun in early December of last year, with a similar sense of shock, dismay, in her own inimitable style, outrage, speaks of Ms Martel knowing that, for instance, I cannot remember whether it was three or four doctors in the north or in the Sudbury area who were going to be beyond threshold. Do you share that shock or dismay or outrage?
Hon Ms Lankin: No, and I think that that kind of coverage was very unfair during that period of time. I mean, I know that I answered some questions, either in question period or media questions about that sort of general information and made it very clear that this was information in the public domain. In fact, in the press package of information that was circulated on December 5 at the meeting in Sudbury, which is exhibit 8, there are some case examples that were used to try and give people a better illustration of how the threshold worked. It was an attempt to try and provide people with some concrete information.
Not much of a concrete exchange took place at that December 5 meeting, as I heard afterwards about it, but that was an attempt to try and provide people with helpful information. Subsequent to this becoming an issue in the Legislature, in the media, one member of the official opposition alleged that in fact this was detailed, confidential information and that a particular specialist could be identified. I remember having to go through a couple of press scrums with respect to that and assure people that this was very carefully vetted information; it was for illustration. You could not identify the doctors involved. So there was a lot of overreaction and/or unfair characterization of what was in the public domain and what was not during that period of time.
Mr Kormos: Would a phone call to your office by, for instance, Ms Blatchford or a researcher working for her have clarified this?
Hon Ms Lankin: Yes, and/or the kind of questions I remember being asked, both in the Legislature and/or in press scrums, would have clarified some of that information as well.
Mr Kormos: Hmm. Obviously she never bothered making one. I do not know if you had a chance to read the press reports of some of the participants' comments here over the last couple of weeks, but among other things, Shelley Martel was described as having I think the word was "disdain" for doctors, for the medical profession. Do you share that view of Ms Martel?
Hon Ms Lankin: No. Mr Kormos, in my dealings with her around this period of time in question, around the Sudbury doctors, as I have described, she was very much advocating on behalf of these northern doctors. She had, as I said, met with Dr Abdulla. She told me: "Frances, I think he makes legitimate points. You need to look at this." I think actually following the meeting on the 30th of November that was -- I might be mixing up my times. I think it was at that point that she came back and she had indicated that it was a good meeting.
Actually that does help place that discussion for December 2, which is the same day that she met with the doctors, because it was at the same time she told me she had been to the meeting on the 30th, that it went well. She appreciated the ministry's participation; that it was a good exchange of information; that there had been an indication that there would be some follow-up work by the ministry; that she felt very satisfied that the doctors and the MPPs had been heard. Then she went on to ask me for some clarification about the documentation in front of her.
Similarly, our own approach during that period of time was to recognize and try and deal with a problem. I both reject a characterization of Ms Martel and/or of myself, my ministry or the government as being anti-doctor. It is just not the case.
Mr Kormos: This is not the first time Shelley Martel got involved in issues regarding health care in the north, is it?
Hon Ms Lankin: No.
Mr Kormos: Throughout your term as Minister of Health she had regularly raised a number of issues regarding health care.
Hon Ms Lankin: There had been a couple of issues in particular, the northern health travel grant, and then subsequent to the amendments we brought forward to that there were additional problems with it and she brought that back to my attention, along with Mr Eves and others. So this was not the first occasion, no.
Mr Kormos: Just as she was well informed when it came to the issue of threshold and the north and UAP doctors and non-UAP doctors, of course she was similarly well informed when it came to the other issues that she raised with you and your ministry.
Hon Ms Lankin: Yes, that is true.
Mr Kormos: My impression, and if I am wrong tell me, is that not just well informed but thoroughly informed and clearly, in terms of the discussions you had with her and your staff had with her; she made sure she obtained as much information as she could from her community, from the people in her community, from her contacts there as well as from the resources that she had available to her at Queen's Park.
Hon Ms Lankin: I think you are describing Ms Martel as a very conscientious member of the Legislature. I would certainly agree with that, and I believe that most people, as has been indicated by Mr Eves and others, agree with that.
Mr Kormos: A person who is well connected with her community and well networked within her community of Sudbury?
Hon Ms Lankin: Yes.
Mr Kormos: I do not have any other questions, Mr Chair.
The Chair: Thank you very much, Mr Kormos.
Hon Ms Lankin: Excuse me. I am sorry, Mr Chair. Could you tell me how much longer is left? I would actually like to take a moment.
The Chair: Having said that, we will have a recess for 10 minutes.
Hon Ms Lankin: I do not need quite that long.
The Chair: Well, let's say five minutes. We will recess five minutes.
The committee recessed at 1622.
1633
The Chair: We will resume our hearing. Mr Kormos had completed his questions last off. Mr Hope.
Mr Hope: Thank you, Mr Chair. Ms Lankin -- Frances, I guess would be better terminology -- Frances, just to get a better understanding, as it seems like there is always some type of confusion out there: This agreement between the government and the OMA was a negotiated agreement?
Hon Ms Lankin: Yes, that is correct.
Mr Hope: And who does the OMA represent?
Hon Ms Lankin: As a result of the agreement, just about all physicians in the province.
Mr Hope: So they were representing their best interests on behalf of their members whom they represent, who would be the doctors, and the government was representing the best interests. This was not a forced policy on the doctors; it was a negotiated agreement?
Hon Ms Lankin: Absolutely. In fact we were quite pleased, both parties, because there had been a number of years of animosity between government and physicians, as people may well remember. This was quite a landmark coming together of the parties and a landmark negotiated settlement.
Mr Hope: Now, in negotiations there is always ratification. Do you remember what the ratification number was in favour of this agreement?
Hon Ms Lankin: Oh. The number coming to mind is around 80%, but I actually do not know because there have been a number of ratifications that I have experienced over the last number of months and I might have got mixed --
Mr Hope: It would be a good majority, though, in favour of it?
Hon Ms Lankin: Oh, it was overwhelmingly supported. I can say that with assurance.
Mr Hope: I noticed some of the selective views that Mr Conway used during his questioning when he stated that MacMillan went off his chair or whatever when he found out that confidential information supposedly got out. It never got out; it was still within the confinements of where information ought to be. But he forgot to share a view with you of Dr LeBlanc who felt that all he needed to do was take a black magic marker and jot a couple of things out and the information was fine. There was no invasion of anybody's privacy. That was something Dr LeBlanc had indicated.
During the questioning, as Mr Conway put out, he keeps referring to your staff. Should your staff receive confidential information?
Hon Ms Lankin: There is nothing wrong, and on many occasions they will require confidential information. That in and of itself is not a problem. The degree of confidential information is on an as-required basis to do the job. Certainly I would expect that there would be a lot of confidential information in OHIP, all of it, less that would come to the ministry staff working on the issue outside of that, less that would come to my staff and the very least amount required that would come to me.
Mr Hope: So this is not some new program that you put in place where your staff would get confidential information. This is a policy that has been in place for years, when the Tories were in government, when the Liberals were in government, where their staff received information?
Hon Ms Lankin: Absolutely. You give me an opportunity to perhaps just comment again, as I did a bit earlier, that I really think it is unfortunate through innuendo to suggest that because somebody is working on the direct staff of a minister and therefore can be characterized as political staff versus ministry staff, minister's staff versus civil service, somehow just by virtue of that there is something to be maligned about their character or their handling of things. That should be important for all us in the Legislature irrespective of what political party. People come and work very hard on behalf of the public and on behalf of members in those jobs.
Similarly, I understand that we are in a political arena here and that we have all subjected ourselves to that, but I do feel badly on behalf of the ministry staff and on behalf of the staff in my minister's office for some of the innuendo and some of what I think they have been put through. I believe that they are hard-working individuals. I have a lot of respect for all of them who have been here and have testified. I have full confidence that they are telling the truth, based on my knowledge of them as individuals.
Mr Hope: And all your staff have sworn an oath of secrecy when they receive confidential information, to the best of your knowledge?
Hon Ms Lankin: More than to the best of my knowledge. I personally conduct the oath with new members coming on to my staff, right from the beginning. I did with Ms Colley when she was first hired, and with every member of my staff since then who has been hired to work with me I have personally conducted the oath.
Mr Hope: I was reflecting on Dr MacMillan when he was mentioning something about this call from the Sun, I believe it was, this Ms Dawson. He was raising a question whether she or the articles that were put in the paper did have the document, because they were not using specific numbers. When you think about it, do you think that they actually had the document, or was it a flow of information some other way, or did they even have information? Did they maybe piecemeal things?
Hon Ms Lankin: This is assumption, of course, because we do not know this piece of information. I believe that Ms Dawson did have access to information. I believe it was a flow of information. Dr MacMillan indicated that the nature of the questions were specific and had enough similarity to what was in the actual document that he felt that she had at least been informed of it. There were some inaccuracies in what she stated to him, which led him to wonder whether she actually had the document. Subsequent to that, because there was never any printing of portions of the document, which is normally how the media deals with leaked documents that they have received -- they normally print captions of it; it has much more theatre to it -- we assumed that she actually had not received the document.
Mr Hope: Okay.
The Chair: Thank you very much, Mr Hope. Mr Mills.
Mr Mills: A brief question, Mr Chairman. Thank you very much, Ms Lankin. I refer to the purposes of this inquiry, and one of the purposes is an investigation into the disclosure of confidential information emanating from the Ministry of Health. I have heard your testimony and listened quite intently to it and your tremendous worries and concerns over the alleged leak of information of a confidential nature to the reporter of the Toronto Sun.
So my question would be then, can we as a committee -- and we are looking into that aspect in this inquiry -- look forward to anything that you are doing at the ministry as far as coming to grips with that leak and how you can best prevent it from ever happening again?
Hon Ms Lankin: There are two things I would want to touch on in response, Mr Mills, the first being that given that is one of the issues which is the subject of this inquiry -- and I have already indicated to the committee the problems the freedom of information commissioner sees with respect to that and that the issue rests here -- I would look to this committee to be attempting to shed some more light on the alleged breach of that confidentiality to the Toronto Sun reporter. I have speculations about the possibilities that I believe should be pursued. I am not going to speculate in public, because they truly are speculations. I have provided those speculations to the commission counsel.
With respect to in general in the ministry, we had hoped the freedom of information commissioner's investigation, when he indicated it would be to look into the procedures in place in the ministry, would give us further advice on this. Dr MacMillan and the deputy have taken steps to reaffirm the security provisions that were in place. We will take what other steps are necessary to try to improve the situation, although I would say that in terms of what actually occurred, there was not, in what the ministry did, anything that was notably wrong. I think Dr MacMillan acted appropriately to view a memo and say it was information beyond what was required -- it is not illegal to have been in the ministry, but beyond what was required -- and to have asked for the withdrawal of that memo. What is most troublesome to me, of course, is that the contents of that memo appear to have been made public to the Toronto Sun reporter.
Mr Mills: Thank you very much, Ms Lankin. Thank you, Mr Chair.
The Chair: Thank you very much, Mr Mills. If there are no further questions, thank you very much for this part of the proceeding that has been conducted. I understand this session will now go into an in camera session.
I would, however, like to make a note prior to us moving in camera.
As members of the committee will recall, when last we finished with Ms Colley, the third party members' rotation was up. I have been informed that there are no questions by members of the third party to Ms Colley in public. As such, what we will then do -- and I say this for those members who are interested, not only of the committee but watching the proceedings -- we will be moving into an in camera proceeding with the minister, to be followed by an in camera proceeding with Ms Colley, at which time we will then adjourn for the day.
Having said that, we will take a very short five-minute recess so that we can move in camera.
The committee continued in closed session at 1644.