Thursday 20 June 1991

Annual Report, Provincial Auditor, 1990

Donwood Institute

Ministry of Health, Ministry of Correctional Services



Chair: Callahan, Robert V. (Brampton South L)

Vice-Chair: Poole, Dianne (Eglinton L)

Bradley, James J. (St. Catharines L)

Conway, Sean G. (Renfrew North L)

Cooper, Mike (Kitchener-Wilmot NDP)

Cousens, W. Donald (Markham PC)

Haeck, Christel (St. Catharines-Brock NDP)

Hayes, Pat (Essex-Kent NDP)

Johnson, Paul R. (Prince Edward-Lennox-South Hastings NDP)

MacKinnon, Ellen (Lambton NDP)

O'Connor, Larry (Durham-York NDP)

Tilson, David (Dufferin-Peel PC)


Dadamo, George (Windsor-Sandwich NDP) for Mr Johnson

Wilson, Gary (Kingston and The Islands NDP) for Ms Haeck

Cunningham, Dianne E. (London North PC) for Mr Tilson

Daigeler, Hans (Nepean L) for Mr Conway

Fawcett, Joan M. (Northumberland L) for Mr Bradley

Haeck, Christel (St. Catharines-Brock NDP) for Mrs McKinnon

Hope, Randy R. (Chatham-Kent NDP) for Mr Hayes

Clerk pro tem: Carrozza, Franco

Staff: McLellan, Ray, Research Officer, Legislative Research Service

The committee met at 1011 in room 228.


The Chair: We have before us Dr David Korn and Steven Sharpe. If you would like to make your presentation I am sure there will be questions from members of the committee.

Mr Sharpe: We propose, if it is satisfactory to the committee, to spend a few minutes hitting some of the highlights in the written document you have before you, which might serve as a roadmap for any questions members of the committee wish to ask.

Perhaps I could take a moment or two first to thank you, sir, and the members of the committee for the opportunity to appear before you this morning. The Donwood Institute is, as you may know, a public hospital in Ontario. It is unique in that its focus is solely on the treatment and prevention of substance abuse. Since 1967, over 25,000 clients have been served by the Donwood, with a remarkable rate of success. Drawing on that success and on its commitment to excellence in research and program development, the Donwood has moved ahead and undertaken a number of treatment initiatives which showed strong indications of success for efficiently and effectively dealing with cocaine and other substance abuse.

The Donwood has moved away from the traditional view of residential treatment to a more community-based ambulatory program. There are a number of implications of that movement for this committee and for the people of Ontario generally in that it is a far cheaper method of treatment and appears to have a much higher potential for long-term success. The Donwood has developed a number of strong links with others in the field of program development and treatment, and a number of collaborative efforts are presently under way which Dr Korn will describe in a moment or two.

We have looked at the report of the Provincial Auditor and in particular the findings with which this committee is presently concerned. It is clear to us, and I think it is fair to say it is clear to others in the field, that by and large the main advantage available in the United States is capacity rather than competence. There is, in our view, no doubt that the treatment community in Ontario can deliver programming more effectively and at a fraction of the cost of the American programs. Having said that, it would in our view be fiscally and socially irresponsible to simply turn off the tap. A rational plan has to be established to address the problem, a plan we believe is not all that difficult to conceive and simply recognizes the need for short-, medium- and long-term objectives.

In the short term, it is fair to say that we as citizens of Ontario should be able to ensure that the American facilities being used are delivering valuable and appropriate types and levels of service to Ontario residents. Second, we should expect OHIP to act as a responsible insurer and to pay only the true negotiated rate as opposed to a posted or rack rate for treatment. Third, in the short term, we ought to be able to expect some kind of gate-keeping function to ensure that American facilities and programs are used only when necessary.

The Chair: Could I interrupt you for a second? As you know, there has been a change in policy that you cannot just go, you have to get your own doctor's approval to be sent there to be covered. I hope the other members will appreciate I am not saying this in a partisan way at all. Do you see that as a real stopgap to this flow across the border? I can remember the days when, if you wanted to see a specialist and get paid for the specialist under the OHIP program, you had to have your family doctor approve it. But it always seemed to me to be a matter-of-fact thing that he was not going to question. If you thought it was good for yourself, he would sign it. Certainly it is a step that needed to be taken, but do you see this change in policy as a step to stem the flow of people to the US?

Mr Sharpe: It is certainly a step in the right direction. It is better than it was before, but it is certainly not going to stem the flow. Physicians are still going to consider the best interests of their patients and to the extent that the physician is not aware of, or cannot make an appropriate connection with, an Ontario facility, he is going to make the referral.

The Chair: I did not mean to interrupt you.

Mr Sharpe: That is okay. In the medium term, we would propose as an appropriate mechanism the establishment of a province-wide assessment and referral mechanism to ensure there is some body or mechanism aware of the capability and capacity of the Ontario treatment system and can then ensure an appropriate linkage is made, if you will, between client on the one hand and service provider on the other. It may very well be that the service provider, even at that point, will be an American or an out-of-province service provider but at least, as I say, there will be some effort made at responsibly linking the two.

Finally, and in the long term, it is our view that treatment for residents of Ontario should be available to them in their own communities. With that very brief, broad-brush overview, perhaps I could ask Dr Korn to take you through the written document you have in front of you.

Dr Korn: Thanks, Steven. I am going to take a few minutes to try and highlight some of our thinking as to a systematic way of looking at this both from a social policy perspective and a pure issue of the most intelligent use of finite resources. In this brief presentation I am going to outline why people are going out of the province, what is required to stem the flow, what role the Donwood can play and the importance of drug and alcohol treatment.

First of all, the causes of out-of-province treatment: clearly, initially, one has to address the lack of the range of resources necessary in Ontario; second, poor matching of people to programs; third, the marketing and recruiting practices of US facilities; fourth, the increased role played by referral agents, sometimes termed "brokers." The fact that OHIP supports US hospital-based residential treatment and is prepared to pay for it is an important consideration, I think, and also the public perception of a quick fix, that treatment is equated with a bed in a hospital for 28 days and often in the States.


The Chair: Is delay in getting into the Donwood, or any other facility in this province, one of those factors? Would delay be one of the reasons --

Dr Korn: That is one of the reasons, but in fact it is much more complex than immediacy. The advantage many American programs offer is exactly what you described. They have a spot available and are prepared to facilitate that. To compare that, as an example, with the Donwood, we can respond at any time to someone with a drug and alcohol problem. We have an outreach capacity and every Wednesday we have an information night where people can come without any referral whatsoever. Having heard what we have to offer at the Donwood, they can at that point sign up for an assessment appointment. There is often one as early as the next day, and the usual length of time is about 10 days. It has to do sometimes with how you design your services. Clearly, with the undercapacity in the United States, they are very responsive to providing immediate service, which is one of the attractive advantages.

The Chair: You said the attraction was of OHIP paying for US treatment; does OHIP pay the Donwood the total amount?

Dr Korn: About 85% of our moneys come from the provincial Ministry of Health. We are a public hospital so our primary funding is through a hospital global budget. In addition to that we receive some additional moneys from the community mental health branch for our cocaine, women and youth program. Because our physicians are salaried, we receive some money from the alternative payment plan of OHIP as well.

The Chair: Does a patient have to pay you anything?

Dr Korn: Not a penny.

The Chair: Mr Tilson, you wanted to ask something.

Mr Tilson: I do not know how you want to conduct this, Mr Chair.

The Chair: I guess I have broken the rule by starting off.

Mr Tilson: I was not implying that.

The Chair: You can ask it now.

Mr Tilson: With respect to the lack of range of services, what services, very briefly if possible, are not provided in Ontario?

Dr Korn: In Metro we really lack assessment and referral services. We clearly lack short-term ambulatory programs. Some people feel we lack residential capacity. We clearly lack strong capacity in aftercare. As well, there are some specialized services necessary for particular populations. The most obvious one is the lack of services for young people, both youth and transitional-age youth; other groups are women, cultural minorities, programs sensitive to cultural and linguistic needs. These are all populations that in the 1990s deserve programs appropriate for them. Those would be a couple of examples.

The Chair: Is that range provided in the US, for cultural minorities and all the rest?

Dr Korn: My understanding is that people are going essentially to accredited public hospitals that offer addiction treatment. The dominant American model is what is known as the Hazelden model based on Alcoholics Anonymous, which is a well-established model, and it is usually designed within a 28-day treatment regime with AA, or another 12-step program as the follow-up. That appears to be the main mode of treatment. But as you can imagine, in a system as complex as that in the United States, there is a huge range of treatment options, from the most sophisticated to really less-than-acceptable quality.

Mr Tilson: The question was whether or not the services are provided in the US specifically for cultural problems, people who come from different cultures. Is that specific service provided at the agencies in the US?

Dr Korn: They are, but I am not sure whether the services Ontario is using are those same services. Yes, they are available in the States, and there are a few of them in Ontario as well.

Ms Poole: I just wanted to explore your statement, "Poor matching of clients to programs." Is this simply that the range of programs is not there, therefore clients get shuffled off to a program which may not be entirely suitable for them? I would just like you to expand on that comment.

Dr Korn: There are a couple of issues. First of all, there is a whole spectrum of problems. Implied in that is a whole spectrum of resources. I think, in general, Ontario has done very well in offering a range of resources. We have some major gaps. Again, youth would be the dominant group that many people have pointed to, programs for young people. It is the amount of resources and the availability of those resources, particularly geographically, that is an important issue. As I have mentioned, the most attractive options are essentially ambulatory programs, community-based programs. Those programs, in order to work, have to be in the communities where people live. We have a pretty good range but we do not have enough, and they are not necessarily in the right places.

Ms Poole: So by "poor matching," you mean the regional problem. It may not be available in the local community, as opposed to some incompetence or ineptness on the part of the facilities in that they are not able to match up the clients properly.

Dr Korn: No, I do not think it is a matter of ineptness. This is a very new and evolving area, the concept of appropriate treatment for appropriate clients. One of the concerns in this whole area is the public perception that treatment is hospital-based and residential and for a month. There is a much wider range of treatment. The other is that because OHIP is paying for hospital-based treatment, that is the one option provided in the States. There are many other options that are available within the US, but that is the one that OHIP pays for.

The Chair: I think I made a mistake in opening my big fat mouth to start off with. I think we should go through it, because we only have a limited period of time and there are a lot of very interesting issues we would like to, more or less, get in point form as we go through. We will save our questions, if that is agreeable to the committee, till the end.

Mr Hayes: I was thinking, just browsing through here, that you are relating to some of the questions you have at the beginning. Maybe you could elaborate as you go. It will make it a lot easier.

Dr Korn: I will move to the page of why Ontario-based treatment is preferred. It is less costly. There is good data to support that. There is a more complete recovery program, and that is primarily assessment and aftercare. It is closer to community and family and it can be ambulatory and, where appropriate, less intensive. It avoids, I think, the social ostracism of sending people away. This is a stigmatic area and sending people away only reinforces that stigma.

What is needed to stem the flow? As Steven has already indicated, the gatekeeper function is critical. A few criteria that would be suggested are an independent, professionally based assessment; a demonstrated need for residential treatment; all Ontario options are explored first; there is a demonstrated timely need for treatment -- an example of that might be a pregnant woman as someone who needs timely treatment -- and arrangements for aftercare and community reintegration are planned in advance. Steven has indicated the redirection of US treatment dollars to Ontario for both infrastructure and for program operating dollars and the need to expand both the prevention and the treatment system in Ontario.

The next two pages speak to what we feel are the key areas for program expansion in Ontario: Expand the assessment and referral capacity, particularly in Metro. Broaden the base of treatment in the community. Use physicians, other health and social service professionals better. Strengthen the specialized treatment resources for drug and alcohol treatment. We feel the critical recommendation is the establishment of regional comprehensive centres appropriately located in the province. Develop culturally sensitive programs. Emphasize ambulatory care. Develop public information campaigns so that people can understand better some of these complex choices and then can make intelligent choices. Obviously there is a tremendous opportunity to train health and social service professionals so that they are better in this area.

Steven has spoken to the background of the Donwood. I want to speak, just for the remaining few minutes, as to what we feel we can be helpful with. It was established in 1967, so it has a long tradition in this area. It is an accredited public hospital dealing with prevention and treatment. We have seen over 25,000 people. We have 200 trained volunteers, actually more than our professional staff. We are predominantly non-residential and we deal with both drug and alcohol problems.


The flavour of our client profile may be a little different than the one you may have in your mind of the Donwood. For about half the people who come to the Donwood their primary problem is alcohol, for about 30%, prescription drugs and for about 20%, street drugs. About 30% of our people are under 30 years of age, so it is a fairly youngish population. About a quarter are women. About 30% are not working at the time they come to the Donwood. In terms of our geographic mix, we are actually a provincial resource. About 60% of the people come from the Metro area, about another 30% from outside Metro but in Ontario, and about 10% of our clients actually come from other provinces.

Our treatment program is what we call a health recovery program. It is one year in length. Learning new behaviour requires time. Our model is a wellbeing model of recovery and emphasizes a lifestyle free of drugs and alcohol, emphasizes healthy choices, self-responsibility, life skills and values, both community and learning. As to the cost per client for a year's program, our residential program, including detox, costs approximately $6,500 per person per year and our intensive day program is approximately $5,000 for a year's treatment. We have done client outcome studies and our success rate is about 80%. I would be happy to elaborate on that point during the discussion.

You can see on the next page that we see lots of people -- in our information night about 2,700 people last year. We assessed 1,300 people last year. In fact we are the largest provider, along with the Addiction Research Foundation, of professional assessment services in the province. We have seen almost 600 people in our residential program and another 400 in our day program. We are carrying 700 people in our aftercare program for almost a year's time. That accounts for about 7,000 units of service at a cost of less than $7 million. It gives you some flavour of the numbers of people that are served.

Recent developments at the Donwood: We have taken the time to prepare a strategic plan for 1990-97 which identifies the target groups we are working in and our core competencies and sets our direction into the year 2000. We have done an environmental scan and we feel we are very well integrated with the evolution of needs of the people of Ontario. One of our very important programs is a recently developed ambulatory cocaine program. It is unique in Canada. It is transferable and we now see about 100 people per year in this program. We have developed a distance aftercare program that emphasizes self-help, relapse prevention and distance education for those people returning to their own community.

We have worked collaboratively on a research proposal with the Premier's Council on Health Strategy's health innovation fund committee, research being a critical component of better understanding of what is going on. We do quite a bit of community outreach. We have held over 100 workshops this past year for women, youth and the workplace. We have expanded our programming to the special needs of women and I would be pleased to elaborate on that. In terms of the roles we could play, we would be pleased to assist in development of an independent assessment and referral centre for Metro.

Within the Donwood itself, we are willing, able and ready to expand our specialized resources for youth, women, workers and cocaine and in fact to double our treatment capacity over the next seven years. We are prepared to assist in establishing regional centres, to develop standards and evaluation guidelines, to do training and to collaborate in research priorities.

We are awaiting funding on a very interesting Donwood-YMCA joint venture for a treatment program for 14- to 18-year-olds, costed out at less than $4,000 a year. We have a vocational module that we have developed with the York region Education Foundation and Career Centre, to address the vocational and career needs of young people in our program. We are anxious to expand our ambulatory cocaine program further and could do that in the short term. In order to reach our objectives in terms of expanded appropriate treatment, we need support for enhanced facility expansion. We now have support for replacing some of our temporary structures but we will require additional capital resources, as well as operating resources, to meet the needs we have been planning for.

To conclude our introductory remarks and speak to the importance of drug and alcohol problems: In our view, money is simply and importantly one resource to better serve the people of Ontario. This is a profoundly important problem and it is one of the most pressing social and public health problems of our day. Treatment in the addiction field is really a form of prevention. Some of us in the addiction field express it simply as "Either you pay now or you pay later, but you pay."

In closing, although we are talking about resources and programs and a complex system design, I think it is really important to emphasize the rewards of treatment and successful outcome to the individual, to the family, to the economy and to society. I am very pleased to respond to questions.

Mr Tilson: I was listening with interest to your comments on the need for funds. Obviously health has a major problem with funds, whether it be for expansion, staffing, capital improvements, whatever. Is now the time for policies to be considered with respect to user pay?

Dr Korn: My personal opinion?

Mr Tilson: Personal or impersonal. I realize it is a political issue and it may even be unfair of me to ask the question, but the way you are talking, we are now on the threshold of getting into something needing vast amounts of money. If we are at that stage, whether one is in favour of user pay or not, is now the time at least to look at that subject in this particular area of health?

Dr Korn: When you work with people who have drug and alcohol problems, what you find is that most of these people's lives are in disarray. There is a total disorganization of life. With quality treatment, many of these people will come back and be productive members of society. In this population, where a lot of people are using illicit drugs, they are disorganized socially and their families may have disappeared. To put in place a user fee might be a very significant barrier to treatment. I would be very cautious about that in this area.

Mr Tilson: It is all very expensive.

Dr Korn: We are spending the money now. The issue is how we might better spend it.

The Chair: Reshuffling, I guess.

Mr Hayes: Just as a supplementary to the question, really what you are saying, what I hope you are saying, is that for those people who are in need there will be no barriers put in front of them. In other words, we are not going to start saying, "We'll look over your financial situation before we let you into our facility," as they do in some of the American states. Is that correct?

Dr Korn: Yes.

Mr Sharpe: You are in an interesting position at that point, because you have, by and large, clients who are non-productive members of society but who, one would hope, can be turned into productive members of society through the whole treatment program, who will start earning a living, paying taxes and using less of the social services that the province provides. I would have thought that even on a strict economic analysis, it would make sense to get them through the program and out the other end.

Mr Tilson: I just wanted to clarify what I was referring to as "user pay." It seems to me you are suggesting, "Oh well, nobody pays or everybody pays." I was not suggesting that at all. My speculation is that there is a large number of people who cannot afford any fee at all. That would be my speculation, not knowing anything of it. I would also suspect that there may be a number of people who can afford to pay. I do not know if you have any comments on that.

Mr Sharpe: If they can afford to pay for alcohol abuse treatment, they presumably could also afford to pay for a triple bypass.

The Chair: I think that is right and I think the present public hospitals and health care would not allow that anyway.

Ms Haeck: I have two questions. Part of it relates to the kind of discussion we are having relating to your 80% success rate, which I think you wanted to expand upon during your presentation. Also, I want to address the issue of co-dependency, and I see Mr Sharpe smiling here.


I have had a client, a constituent, come in with a referral to New Orleans because of a co-dependency. We are talking about someone who was sexually abused as a child and has a range of problems, drug and alcohol plus some obviously social dysfunctions brought about by childhood experiences.

To what degree can you or any facility in Ontario at this time address that kind of a situation and what do you see as being the kind of models or regimes that might have to be followed to provide that kind of care? How many hours do we have, right?

Dr Korn: Easy questions. Let me address your first question as to success rates. I will take a moment and indicate that the Donwood has done really quite high quality outcome research on a periodic basis since the early 1970s and some of the work done in the 1970s is still looked at as the best quality outcome research in North America.

What we do is follow a client after he completes the program and find out, among other things, what his use patterns have been. That is the simplest way of assessing success. We looked at a group of 100 clients who went through the Donwood in 1987 and followed them one year after completion of the program. About 45% of those people were clean from the time they left the Donwood to the time they were contacted one year later. About another 15% had had minor relapses, less than 15 days of relapse in the past year, and had stabilized abstinent. Another 20% had cut their use patterns to less than 50%, so they essentially had done something positive in terms of their pattern. The remaining 20% had completely relapsed and had a progressive course of drug and alcohol use.

I think those figures are obviously very impressive, but I want to give you some cautions. That is only one measure. We are dealing with human beings here, so other things that one wants to look at in terms of returning people to health are things like their self-esteem; their social skills; whether their coping strategies, their stress management, their resistance skills and their communication skills have improved; and whether in fact their relationships with family, work and community have improved. So there are a lot of other dimensions to look at as well.

Again, as you think about this, you have to realize that the more difficult the population you work with, the less likely you are to have good results. You have to be careful that you are comparing apples with apples. But I think in general it is fair to say that treatment does work. The major issue is selecting the appropriate treatment for the appropriate individual. That is the key concept.

Ms Haeck: How does this stand up with the results of the US 28-day residential care programs? The newspaper reports that I have read tend to give me the information that these really are not all that successful. The 28-day residential treatment program seems to give you 28 days away from home but does not in fact give you the long-term strategies or coping methods to deal with the problem.

Mr Sharpe: You have hit it on the head because it is only a piece of the necessary treatment. The 28 days may work, but you have to look at what the environmental factors were, what community supports are available for this person when he gets back home, what kind of aftercare you can provide to allow this person to continue in a healthful way as opposed to simply going back to the way he was before he went to the United States for 28 days. One of the reasons we believe that community-based programming is more effective in the long term is that the treatment is done within the community in which the person is going to continue to live, and it deals with all those factors.

Ms Haeck: In dealing with some of the psychologists, I have had the panicked phone call at 10 o'clock at night saying: "I've got this person ready. I want this person on a plane. Who's going to pay and how is this going to happen?" I think you can appreciate that there is a feeling we have to do something, but the comment received by me, and this is partly the co-dependency issue, is that there is no facility available here to deal with that, and also the whole issue of saying, "We have to remove that person from the environment that is allowing him or her to continue in this particular lifestyle."

Dr Korn: There is no doubt that there is a small subsection of people within the group of people who need drug and alcohol treatment who need residential treatment. I think the point we are trying to make is that it is not everybody, and you have to carefully select who those individuals are. There are some people who, for their own protection, need to be removed from the community. Some people are so out of control that they need a really structured environment for a period of time. Other people need exactly the opposite; they want to remain within their family and community, and we have lots of successful examples of people who have been through treatment like that.

There is a real concern, as I hear in your voice, about the calls you get in the night about a family crisis. Those are very real. They happen all the time in the workplace. They happen in families. They happen in physicians' practices and social workers' practices. I just want to say anecdotally that there are some people who are using chemicals or are in a social environment where either they need an emergency ward -- they are overdosed on a drug or are toxic because of acute use of a drug -- or are so dysfunctional that they need immediate removal from the community. You have to know who those people are and you have to respond appropriately. I think there are, on balance, sufficient resources to do that.

Our experience at the Donwood is with a long-standing kind of treatment program. We get a fair number of calls from people who feel that chaotic urgency. Sometimes when we make an assessment that we must respond immediately, I think on balance we do more harm than good. Although the urgency is there, it has to be dealt with sensibly. What I am implying is that it may not always be doing the individual a favour by getting him on a plane and extracting him from his environment immediately.

Ms Haeck: I do not pretend to be the professional in that field. If you ask me something about library science, I can give you a whole lot of answers, and we have a few legal minds here who could probably respond about that particular profession in that way. But I do not pretend to be a psychologist or someone who is an expert in drug and alcohol treatment, so when I have someone who hangs out his shingle and says that he is such an expert and that this person needs to be removed, I respond to that professional's assessment of that situation.

Can you comment at this point on the co-dependency issue?

Dr Korn: I have been hesitating.

Ms Haeck: That is called a politician's ploy.

Dr Korn: No, it is complex and quite controversial. I do not claim any particular expertise in this area. I speak on behalf of the work of the Donwood. The Donwood has recognized the issue of family dysfunction for 25 years and in fact has carried out family programming for the entire length of time that the Donwood has been in existence, and continues to do so. We continue to revise our program. We run programs for adult children. We do family outreach work and we have a family education component. Not only the Donwood, but a variety of other resources, both in the addiction field and more broadly, deal with the area of family dysfunction.

My concern, and I want to be careful about this, is that within the United States system there is clearly an overcapacity. If you think about the economics of for-profit health care, when you have open beds, you think of more ways to fill them. The area of expanding medicalization of health problems, what is known essentially as the diseasing of America, is a real issue that I think we have to be very careful about. So in terms of "we have a problem and they have space," there is a need for caution. But family dysfunction is a critically important area and is often at the root of the problems of many of the people we see.


The Chair: The Pied Piper syndrome, I guess. They play the flute, fill the beds and people flock down.

Dr Korn: Yes, but it is a legitimate issue in terms of family dysfunction. No question there.

Ms Haeck: I appreciate that and I thank you very much for your comments. I should really relinquish the floor.

Ms Poole: Thank you for your presentation today. I found your comments very helpful, particularly your suggestions as to what we can do to solve the problem, both in the interim and in the long term. Certainly the Donwood has a reputation par excellence in Ontario, and probably in Canada for that matter, and you are looked upon as a model and a leader in the field.

Now after those nice words, I have some questions.

Looking at the issue of how to stem the flow to the US, you have mentioned establishing criteria, and I assume this would be one of your more immediate responses that could be done in a relatively short time frame. You have said there is a need for independent professional assessment. Are you talking beyond the family doctor, actually an assessment by a team that is trained in the area of drug and alcohol abuse and treatment facilities and is aware of what is available in Ontario? It would seem to me, if you look at these criteria, that your average family doctor would not have the requirements to fill those assessment needs.

I see you nodding there, so I am assuming that yes, you are talking about someone beyond the family doctor or even some specialist -- that you are talking about a variety of professional teams across the province that could do this type of analysis. How do you see that set up? Would it be difficult to draw these types of teams together? Would you care to elaborate on that?

Dr Korn: Yes, and I just want to go back for a second. One of the things I have said, and I would guess other people have said before, is that one of the real challenges for us is to expand the basic treatment into the community. In terms of what is out in the community, family physicians, counsellors, social workers, teachers and prison people need to increase awareness. The major roles that these people can play in the community are identification of problems, short-term counselling and referral to specialized resources if necessary.

In Ontario now -- and I do not think this is widely appreciated -- there are 32 formal assessment and referral centres. These are specialized resources that exist. There is a huge gap in Metro. Metro always seems to be the exception to the rule. As I indicated in my remarks, the Donwood does a lot of this, the Addiction Research Foundation does a lot, and more recently there has been the rise of these independent groups that are doing it as well.

I think it is really important that the function be -- I want to be careful. This is an area that requires expertise. As long as the individual practitioner has the expertise, there is no reason why he or she cannot do it. On a system basis, it makes sense, at least to me and doctors at Donwood: some independent centre that could carry out information, assessment and referral for Metro, that was clean and had that sense of independence; not a conflict of interest between providing the service and meeting clients' needs and maybe some innuendo of economics as well. It would be very helpful. There is no reason why a competent professional who knows this area could not make that assessment also, but as I think you have indicated, there are not many of them out there. One of our challenges is to increase their skills in the community.

Ms Poole: But if you have 32 specialized centres right now that have those assessment skills, it would seem to make a very good base from which to move quickly on this.

Dr Korn: Absolutely.

Ms Poole: And it would be quite widely spread across the province.

Dr Korn: I am going to make an editorial comment. We have in Ontario the Addiction Research Foundation. They have been pioneers in the development of these concepts. It is really through their pioneering work in the English-speaking world that we have these 32 centres now in Ontario. I just think we have to have the confidence and awareness to use them better.

Ms Poole: Very good. The other question I want to ask you is regarding the cost of your treatment and health recovery program costs. It says here, "Program costs for clients" -- and I assume you are talking about the one-year program.

Dr Korn: Yes.

Ms Poole: It has residential, including detoxification, $6,500. That seems incredibly reasonable to me. You are asking less than $20 a day. Surely, if you have a person in a residential program -- you have your treatment program, your accommodation, everything else -- it is going to cost more than $6,500. Are there extras added to this for accommodation fees, other things?

Dr Korn: That is total cost. Let me indicate what that cost represents. It does not represent a person in a bed for a year. What would happen is, they would come to our information night and they would receive a professional assessment; they would then move into a preparation phase and would be matched with one of our intensive treatments, either residential, intensive day, or less intensive evening. They are usually in that kind of intensive phase for three to four weeks, sometimes longer, occasionally a shorter period of time. For the remainder of the year, they return to the community and participate in our aftercare program.

We are very proud of our aftercare program. We have recently taken it apart and put it back together with a heavy emphasis at the front end on relapse prevention. So they are with us for a year, but the intensive part of the treatment is only for several weeks. This is an issue of social learning. People move back to the community; we then engage them in the relapse prevention training activities, coping skills and stress management. They learn and practise those skills in the community and return to us. They keep connected for a year. We have therapy backup, where necessary, if people relapse; and we have a number of specialized resources; we have a lesbian support group, as an example of some special subpopulations that we feel we can respond to.

You have to be careful of what the denominator looks like, but it is very very reasonable and, I think, exceptional value for money, and cannot be done elsewhere.

Ms Poole: When it says "the residential program", that would be the three to four weeks of very intensive residential programming, after which they have weekly -- or whatever you set up, depending on the needs?

Dr Korn: Right.

Ms Poole: I could not figure that out. I know you said Ontario is more cost-effective, but $20 a day seemed quite impossible.

Mr Sharpe: Juxtapose that number, though, it means the numbers that you would see as the rates for the US programming, which could be anywhere between -- some of the numbers I have seen, $700 or $1,000 US per day.

Ms Poole: Yes, and this would probably be around the $200 mark, which includes an extensive follow-up for the balance of the year. That is a major differentiation between your program and what we understand to be the case in the US where follow-up is very limited, if it exists at all.

Mr Sharpe: Yes.

The Chair: It sounds to me as though the US should be travelling up here to look at our programs, rather than the reverse.

Dr Korn: I think one of the real sadnesses is that we do have quite an impressive range of programs. I think we lack the capacity and geographic location for many of them, but it really is sad to see those resources going to American centres when I think we could do so much more.

The Chair: I am just going to move on, Ms Poole, to Mr Hayes and then Mr O'Connor.

Mr Hayes: Actually my questions have been partially answered. But, dealing with the residential and the detox care and the intensive day program -- the $6,500 and the $5,000 -- do you have a figure to compare with the equivalent treatment that you get in the US, and what that cost would be?

Dr Korn: Just what we read in the papers. The numbers I have seen are the same as you see. As Steven has commented, on the high end it ranges up to $1,000 a day US, and some people are there for a considerable length of time.

Mr O'Connor: A couple of different things that I have picked up out of this, and one that I have not: One was recognizing the special needs of the female population and acknowledging that only 25% of your clients are females. Is there a hidden reason for that, or is that actual fact, or are there clients out there that are not receiving the care that they should be receiving?


Dr Korn: The evolution of addiction treatment was based essentially on the model of male, middle-class alcoholics. That is how, essentially, the understanding of treatment was initially developed and it was very closely linked to the evolution of social movements like Alcoholics Anonymous and to the employee assistance movement. Essentially you had employed males who had identified problems in a workplace; they were treated in sort of residential settings and then returned to the workplace and very closely monitored. So the programs that were designed were based on that experience. Not surprisingly, they were pretty friendly programs to that particular group.

If you are a woman, you have issues of child care. With most of the women we see, there are abuse issues. There are issues of self-esteem, body image, often complications of eating disorders and addiction, so that the needs of the client population are quite different. Initially the strategy was simply to take this male model and graft it on to other populations like women and youth. It has not worked.

On one hand there appear to be more men than women who have this problem, although Ontario data suggest a dramatic increase in drug and alcohol abuse in young women, particularly in the 20 to 35 age group. So it is an increasing problem and the needs are quite different, child care being a terribly important barrier to treatment. Among the things we do at the Donwood, we offer women female therapists, we have groups that are solely for women, we have a women and violence group, we support a women and sobriety 12-step community group at the Donwood and as I mentioned we have actually initiated a lesbian support group as well. Child care is the big barrier.

At the Donwood we have recognized the issues of women and in our strategic plan we have made a commitment to move towards half of our population being women and half being men. It does not suggest that necessarily that is the way it is in the community, but we feel the needs of women are sufficient that a special effort has to be made to address them over the next five to 10 years.

Mr O'Connor: You touched on something that I was going to ask you about. In my previous life I was a factory worker in Oshawa at General Motors. In a plant like that, with a lot of addiction problems, the solution seemed to be the quick fix far too often, and it did not work for obvious reasons: The support was not there. In this evolution, then, can we start seeing some change? Is the referral through networks and programs established by the unions operating as efficiently as it should, or are there problems there, or could there be problems there?

Dr Korn: One of our target populations is workers, so we deal with both corporations and unions and social agencies as well, community agencies. I think the rise of the employee assistance movement, employee support, both management-based and union-based, is a terribly positive movement that has taken place with some very fine quality programming, education, prevention and linking with specialized resources. But it is one of those areas where I think our most attractive population is those people who are productively employed, and who have drug and alcohol problems. They are a very important group to identify early, give appropriate treatment and return to the workplace. I think anything that will foster collaboration with unions, management and treatment programs is really quite important. We at the Donwood work actively with 80 workplaces as part of our outreach activity. We feel it is a very important group to work with -- both union and management.

Mr O'Connor: One subject you touched on several times was cocaine use. Is it on the increase? Is the treatment here or abroad more costly and why? What is more effective?

Dr Korn: Thank you for asking us about cocaine. Clearly, looking at general community statistics in Ontario and elsewhere, there seems to be a gradual but steady decline in the use of cocaine in the general population. Our school surveys show that, and the household surveys done by the Addiction Research Foundation. If you read the police reports you tend to feel that they are not talking about the same world: more cocaine on the streets, more busts, more crime. What I think is happening is that we are really talking about two different populations. In the general population the use patterns are declining, but there are some subpopulations where in fact the problems are extremely complex. Those remain and increase.

An example of that would be the street youth. A survey done, again, by the Addiction Research Foundation shows dramatic cocaine use, about four times higher than in the general youth population, in young people with a large amount of needle use, power drug use. So you are dealing with some very difficult subpopulations.

When I came to the Donwood four years ago, the staff told me they were beginning to see people with cocaine problems -- initially people were snorting, but then crack as well, smokable cocaine -- and they felt very inadequate in terms of a programmatic response. Without exaggeration, we spent two years looking at the issue of cocaine crimes, looking at the literature, looking at our own experience and that of others and we have now designed and implemented this ambulatory cocaine program. It is geared to 100 people a year.

We started it; our first group was in September. We piloted to the end of the year. It is now on stream and is quite active. It is known on the street, by our understanding, as a good program. It is totally accessible and we are very proud of it. It is unique in Canada. There are very few ambulatory cocaine programs in the States. We have looked and modelled much of our work on the basis of Arnold Washton's work in New York City. When you talk to the program people at the Donwood or at Washton's program in New York, there are lots of good reasons why people on cocaine fail in residential programs and do well in community-based programs. So we are very pleased with this program. We have signalled to the ministry that we would be desirous to expand the program and we would be very pleased to work with other providers.

The Chair: That is why we have the ministry staff here, so that they will hear this. We want to have some response from them.

Mr O'Connor: The part that you had not touched on was the dollars and cost-effectiveness. I know you talked about the sharing of research which actually helped promote your program effectiveness. Do you think there is any problem there, why we cannot offer the same --

Dr Korn: No.

Mr O'Connor: There is none. Okay, thank you.

Mr Tilson: On your overhead sheet with respect to stemming the flow to the US, I would like you to briefly return to your thoughts on financing. We hear statistics as to what it costs to send people to the United States. We hear your thoughts as to where we should be expanding in the province of Ontario and what is needed, although obviously there has not been a great deal of detail on the financing of all that. Have you, when you were preparing for all of this or any other topics that you are into, directed your thinking to that line?

In other words, how would you propose that US treatment dollars be redirected to Ontario? How would you propose that that take place? I am talking about a tremendous amount of money that goes to the US; and obviously, to develop what you are talking about here in Ontario is going to take a tremendous amount of money, an unbelievable amount of money. The overall subject of health is obviously in serious trouble around this province and this country, I suppose. We are talking about realistically making it happen. Have you directed any of your thinking towards that?


Dr Korn: Sure. I think in the presentation itself I spoke in a couple of different ways to the importance of assessment and referral, so you have a very rational basis for deciding who needs US treatment. People sitting behind us know this area much better, but there are very reasonable ways to provide options, negotiated fees and the use of non-hospital treatment that could diminish those costs where they were appropriate to continue in the States.

I mentioned earlier that you either pay now or you pay later with addictions. It is not usually the kind of situation that goes away. This is fairly simplistic, but you have a pool of resources that are being used in the States. There would be a need to put in place short-, medium- and long-term initiatives. In some cases, there is a need for infrastructure. For example, if you are going to go with regional centres that have enough resources to offer a mix of treatments, that is going to cost money for capital infrastructure.

But I think in terms of some of the material we have presented, that is appropriate in other places as well. You can do this on a cost-effective basis and, where appropriately matched, you can get good-quality results.

Those would be some general comments. In the presentation we spoke to eight areas we felt could be expanded, and clearly in terms of the Donwood's role we have indicated where we felt we could be helpful, both in the short term and in the longer term. We are prepared to double our capacity over a period of years.

The Chair: Have you ever been invited into or attempted to bring those programs into the correctional system? I say that because I understand we have someone here from the correctional system, Dr Humphries. Have you ever been invited in or have you ever tried? That would eliminate the problem of the immediate capital program because you have the facilities or you could adapt the facilities, I imagine, to deal with your programs. Maybe I should ask the question. Would it require less capital to go into the correctional system on, say, a contract basis than to start from scratch and create regional community centres?

It seems to me that in the correctional system that is one area where we have totally lost the ball game. We have the revolving door syndrome, people coming back on to the streets, and many of them when they are out wind up with you or some other facility. If we could get them going in there with a positive program -- and your program might fit very nicely. I would like to ask you if you have ever been asked or would you be available to do that if you were given the okay.

Mr Korn: It is an area that I think has been neglected, and obviously a really important area in terms of the prevalence of drug and alcohol problems in that population. The Donwood has not had any systematic involvement with the correction system, but we have had a few connections.

Just to give you a flavour of this, Helen Annis, a distinguished scientist from the Addiction Research Foundation who is on our board, is working with her relapse-prevention strategies to develop appropriate programming models for correctional facilities, so that is very high-quality work that is taking place now.

In our aftercare program, we have begun to formally get referrals from probation, and on a couple of occasions we have actually accepted people in our aftercare program who have been treated in the correction system, so there is lots of opportunity there.

In reality, we have lots of experience with people with criminal records. Everyone who has entered our cocaine program has a criminal record, 100%, men and women.

We have not had much experience. We would be pleased to work with corrections people in sharing our expertise. It seems to be a fruitful area.

The Chair: Another thing I was going to ask you was, obviously, over the years since 1967, you have taken a lot of case histories of people. Has it been definitively shown that alcoholism has a genetic carryover, that there is in fact a greater chance of it carrying over to the next generation because of genetic factors? Is there any proof of that?

Dr Korn: Yes. Actually, in the past five years there has been enormously exciting research at the biogenetic level into the genetics of alcoholism. It is a very hot area of research.

Clearly there is long-standing epidemiologic community-based studies that show that alcoholism does run in families. The risk of getting problems with alcohol or drugs if you come from an alcoholic family are three to four times higher. So there is clearly a family basis.

There has in the past two years been some very exciting genetic research, some neurochemical research, looking at where the place in the brain may be and what the chemical connections are.

But in my own personal view, the interest in genetics, as important as that is in the public mind and in some professionals' minds, is overrated. There is a genetic risk factor; no doubt about it. I would say in the next 10 years we will discover where that is in genetics.

Mr Sharpe: Then what do you do?

Dr Korn: But then what do you do, as Steven is saying, and it largely again reverts to the issue. You cannot change your heredity, at least not yet, and so it becomes an issue of behaviour, social learning and essentially reintegration in healthy communities.

The Chair: You cannot change your heredity, but it is kind of like kids with learning disabilities. If you know it is there, you can then structure your response. If you do not know it is there and you just let it carry on, it then gets out of control and we will all be back to the trees.

Look at New York City. Many of those are out of control because of lack of available facilities, although they seem to have a lot for Canadians. Americans cannot get in because I guess it costs too much, and they are roaming the streets with guns and knives and all the rest of it, and we are fast approaching that scenario if we do not take some real steps.

I like your concept about pay now or pay later. I say that all the time. It is not a question of influx of more money into the system, it is rearranging the money and spending it wisely in areas such as this. Rather than just caging people in corrections, put the programs in there to deal with it.

That is my speech for the day. I have got to go talk in the House. I am sure you will probably all be glad I am gone.

We want to thank you very much for coming. It has been very helpful. We now have people from the Ministry of Health. If you want to stay around and hear what their comments are, then perhaps we will give you a chance to rebut if you feel that they have maligned you or misquoted you.

Mr Sharpe: Mrs Denov will neither malign nor misquote.

The Chair: I really want to thank you for being here. We had the pleasure of the Bell clinic. Are you people connected?

Dr Korn: Not at all. We have a common past in Gordon Bell, who has been a pioneer.

The Chair: That is what I thought.

Dr Korn: But they are a private hospital. We are a public hospital.

The Chair: Our thanks to Dr Bell for having started those two excellent clinics.


The Vice-Chair: I would like to welcome the Ministry of Health officials back to our committee. We have Dr Barkin again, Dr MacMillan, and would you introduce your colleagues?

Dr Barkin: Celia Denov and Steve Lurie.

The Vice-Chair: Welcome back to the committee. We do have a slight logistical problem, which is actually a fairly major logistical problem. Originally we had scheduled you from 11 to 12 today. The Board of Internal Economy has requested the presence of the committee at its meeting at 11:30 today, so we now are expected to do --

Dr Barkin: I will talk fast.

The Vice-Chair: That is right. I thought maybe you could at least begin to deal with the follow-up matters from last week, see how far we can get, and if possible, we do have time available from 10 to 11 next week on the committee, if it can fit into your schedules or staff's schedules to come back, if there are further matters that cannot be covered today.

Dr Barkin: As I recall, there were only two major issues. One was a question of the summary of payments since 1985 to the present time. We did not have the 1985, 1986, 1987 numbers. We have them now, and I will leave them with the clerk, but basically from 1985, 1986 to now, the expenditure on alcohol and drug programs in Ontario has a little more than tripled. I will leave that table with you.

The second set of questions that was posed to us that we could not provide answers for because they related to another ministry had to do with questions around the corrections system. I asked Dr Humphries from the Ministry of Correctional Services to be here, and he is here behind me. If you like, I can bring him up to the dais to take any specific questions the committee might have of him.


The Vice-Chair: Certainly. He can take the chair right here, and then Dr MacMillan can stay with us. Welcome to the committee, Dr Humphries. Perhaps you would like to make some preliminary comments. We assume that you have been briefed by your Ministry of Health colleagues about the questions asked by the committee last week.

Dr Humphries: Actually, I would prefer just to respond to any specific questions you may have, because I realize there is a limited time period and I would not like to interfere with Dr Barkin's presentation.

The Vice-Chair: Then we will call for questions from the committee.

Mr O'Connor: Thank you again for coming. One thing that I do not think we had really touched was the out-of-province use of Ontario facilities. I understand from the parliamentary assistant on the drug strategy that something that was pointed out to them, especially, I guess, around the Ottawa area, was a large number of Quebec residents coming over to Ontario, receiving OHIP cards, returning to Quebec and then getting treatment in Ontario. We have a problem right now of undercapacity in Ontario, and now we have a drain, of course, to one of our friends, Quebec. Could you perhaps comment on that?

Dr Barkin: Yes I can, and then I will ask Dr MacMillan to give some of the details in his role as general manager of OHIP. The province of Quebec, at the border between Ottawa and Hull, has been a source of patients in the Ottawa area for quite a number of years and has been a source of revenue to those hospitals. Quebec in fact pays for the services rendered, at Quebec rates, which are our interprovincial hospital rates. It also pays physicians at Quebec rates, which are considerably lower than the physician rates in Ontario.

Over the last four or five years, the capacity on the Quebec side of the border has increased, and as a result, the revenue to Ontario hospitals from Quebec patients in the Ottawa area has been dropping, freeing that capacity for Ontario patients. That has been a steady decline. It has also left those hospitals with some financial difficulties, because they relied on that revenue for part of their budgetary integrity.

As far as the actual treatment services moving across that border are concerned, I will ask Dr MacMillan to give you those details.

Dr MacMillan: The member has asked about people acquiring an Ontario health card and then, using that, looking as if they were Ontario residents and acquiring services. That brings to mind what happened about a year ago when, recognizing in Quebec that Ontario was so beneficial to its residents as to pay for all this American care, a number of people crossed the border, came into care in Ontario, illegally acquired a health number and went off to the United States on the airplane the next day, all at the expense, of course, directly of the hospital and indirectly of OHIP. We were able to track down probably up to $500,000 in bills on behalf of these patients who actually came from Quebec and were not entitled to hold the card, but we did not pay the bills. We were able to withhold payment and take corrective actions.

Moving from our own family registration business into the unique identifier, we believe we are now getting the skills and tools in order to make certain that we are registering only Ontario residents and not somebody elsewhere in Canada or the United States.

The Vice-Chair: Just prior to going to Ms Haeck and Mr Hayes, last week the Chair -- the real Chair, not the pseudo-Chair who is here today -- Mr Callahan, asked a question about our correctional institutions and what facilities were available to the people who were in the institution particularly because of alcohol and drug abuse, to ensure that when they left, their problems had been resolved and assisted. Before we go to the other two questioners, could we ask you, Dr Humphries, for answers to that question; I think that is what motivated your presence here today.

Dr Humphries: Yes, I would be very happy to respond. Thanks to the foresight and guidance of our deputy minister, Robert McDonald, we have moved a fair number of resources internally into this area. We recognize that many of our clients have many different kinds of problems, so we have tried to approach it by developing a multidisciplinary approach across the province.

We have identified 17 catchment areas across the province. Within that we have 250 nurses; over 160 social service workers; and 127 full- and part-time psychologists. We tend to develop a multifaceted approach to deal with these people. To go with that, we have set up a number of treatment facilities. We have the Ontario Correctional Institute in Brampton, which is a 220-bed treatment facility with programs for driving while impaired and alcohol and drug awareness. At Guelph we have 84 assessment and treatment beds and we have similar alcohol and drug problems there. At Millbrook we have 26 maximum security beds and again the same multidisciplinary approach with emphasis on alcohol and drugs as well.

We have recently set up a new 84-bed assessment and treatment unit at the Rideau Correctional and Treatment Centre, which is at Burrits Rapids near Ottawa, at Smiths Falls, and we have set up a brand-new 96-bed treatment facility in Sault Ste Marie. It is the first of its kind and it is shared with Correctional Service Canada. It is funded jointly by Ontario and Correctional Service Canada, both capital and operating expenses, but it is run totally by Ontario and administered by Ontario, except for freedom of information and national parole.

We intend to set up an additional approximately 80 beds in western Ontario, probably at Burtch Correctional Centre near Brantford. In addition to that we have developed our probation and parole programs and we have also developed these kinds of programs within our young offender facilities.

Remember, because it is very relevant, that the size of the ministry is 51 institutions; approximately 55 open custody facilities; 31 community resource centres, which are like halfway houses; and about 125 or 126 probation and parole offices. We admit about 80,000 people per year behind bars. On any one day we have about 8,000 people behind bars and about 47,000 people in our community programs like probation, parole, restitution and community service orders.

In addition to those actual treatment centres and units I have just described, in all of our institutions we have alcohol and drug problems that may range from AA coming in to an actual multidisciplinary approach, as I have mentioned. In our probation and parole areas, driving while impaired, we have 11 programs at the cost of $225,600 and we have substance abuse programs. We have 25 of those at a cost of $758,000. With our young offenders, we really do use a multidisciplinary-program, caring approach because we recognize it is more than just alcohol and drugs. There are often educational programs and behavioural problems involved. It really is the whole child that is looked at.

The young offender is involved in planning the care program for him, as well as a parent or guardian, if such is available to assist. Perhaps I should stop at that point and answer any specific questions.

The Vice-Chair: Thank you. That was quite comprehensive. We only have about one minute left. I do not know whether the questions from Ms Haeck and Mr Hayes have been answered.


Ms Haeck: It was actually Bob's question that I wanted to ask because I did want to make sure that Dr Humphries got a chance to make a contribution in the light of the previously asked question.

Mr Hayes: On the same subject, last week someone indicated that you did not have this facility or the services in correctional institutions. What you are saying, I guess, is that you do have it and it sounds as though it is fairly intensive. Am I correct? Last week, I believe it was, someone mentioned they used to have a program within the institutions and that stopped in 1954 or 1956. I am just wondering whether there has been a change. I think you are saying it is not within those particular institutions but outside. Is that correct?

Dr Humphries: Yes, I am saying that rather than decreasing we have increased in this whole area. We do have the capacity now to move out into the community as the people go on to probation and parole.

The Vice-Chair: Thank you very much for coming, Dr Humphries. We appreciate your contribution and we will pass the Hansard on to the real Chair so that he will know the question he asked has been answered in full. It appears that -- you will notice that as a politician I will not say definitively -- the Ministry of Correctional Services has things well in hand with these particular programs.

Dr Humphries: Thank you very much and thanks for the invitation. We are very pleased to have been here.

The Vice-Chair: As far as the Ministry of Health is concerned, I gather you have provided us with the material we asked for last week. I think part of the reason you were invited back was to give the ministry an opportunity to have a wrapup relating not only to your own presentation but to those from the Bell clinic and also the Donwood.

Would you like the opportunity to come back next Thursday to do that wrapup, or do you feel it would be more appropriate to do it at such time that the committee is moving into the hearings stage later in the summer? I leave it in the hands of the ministry what you would like to do.

Dr Barkin: I am at the committee's disposal.

Mr Tilson: I do not know whether you have heard the presentation of the Donwood representatives. They made a number of comments. I would be interested in hearing some of the ministry's thoughts.

The Vice-Chair: In that respect, then, we would probably have to ask the ministry to appear next Thursday. I hope it does not inconvenience your schedules too much. I appreciate the fact that you have now appeared several times.

Ms Haeck: Just one small contribution here. George Mammoliti has headed up an anti-drug strategy secretariat review of programs across the province, and I am not sure to what degree the Ministry of Health has contributed to some of those presentations. Mr Mammoliti would be very happy to come and speak to us about their hearings across the province. In fact, Ron brought out what was happening in this particular area. Possibly we could consider him as an invitee to our committee as well.

Clerk of the Committee: As part of the ministry or as an independent?

The Vice-Chair: I think you meant as independent from the ministry, is that right?

Ms Haeck: Yes, that is right.

The Vice-Chair: Thank you for that suggestion. Can the ministry send whatever people are available next Thursday?

Dr Barkin: There will be a lot of people available. I have an engagement that I do not know whether I can get out of next Thursday, and normally the committee likes to have the deputy minister present.

The Vice-Chair: I think that may be up to the deputy minister.

Dr Barkin: If you could give me the time, I will try to juggle the other commitment around. Do we have a notion of the exact time?

The Vice-Chair: We meet at 10 o'clock on Thursday morning.

Dr Barkin: It will be for how long?

The Vice-Chair: Probably an hour.

Dr Barkin: An hour from 10 to 11?

The Vice-Chair: Yes. If it is more convenient for you to meet from 11 to 12, if that would help your scheduling --

Dr Barkin: That would.

The Vice-Chair: We certainly would be pleased to accommodate that and we could say 11 o'clock next Thursday. Then if we make separate arrangements for Mr Mammoliti and his group, we could do that prior to 11 o'clock. Is there an agreement to have Mr Mammoliti?

Mr Tilson: We have to listen to George for an hour?

The Vice-Chair: I knew you were going to say something like that.

Mr Hayes: Sometimes I sit here and wonder what direction we are going in. Here we are hearing presentations from the Minister of Health and from the private sector for the drug and alcohol abuse treatment facilities and also the public ones. At the same time we have another task force, I guess we could call it doing work out here and we are out here.

I think it is very important that we start coming together and make sure we are going in the same direction. We are talking about travelling to look at some of the US facilities. The committee George is on is probably doing the same thing. I am just wondering whether we are not doing a little duplicating here. Maybe we should have both parties together and decide what direction we are going to take.

The Vice-Chair: I suppose there are two major differences between Mr Mammoliti's task force and this committee. First of all, this committee is an all-party committee of the Legislature. Second, our mandate is to work with the Provincial Auditor and ensure there is value for money, which may not necessarily be the same mandate.

I do appreciate your comments though. I think it is very important we are not duplicating efforts and information. It would probably be quite helpful to have that presentation from Mr Mammoliti and his committee, but I think we do have a very different purpose. We just want to make sure we are not duplicating resources. Thank you for that comment.

If there are no further comments, we will convene next Thursday at 10 o'clock in this room. Right now we will adjourn over to the Board of Internal Economy.

Ms Haeck: Which is being held where?

The Vice-Chair: It is being held in the Speaker's office on the first floor, room 180, I believe. I think we are supposed to go en masse. Thank you very much for your presentation and also for your perseverance.

The committee adjourned at 1138.