Thursday 27 June 1991

Annual Report, Provincial Auditor, 1990

Task group on advisory committee report

Ministry of Health

Task group on advisory committee report

Severance and termination packages



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)


Miclash, Frank (Kenora L for Mr Conway)

Clerk: Manikel Tanis

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

The committee met in camera at 1000 in room 228.



The Vice-Chair: Mr Mammoliti, welcome to the committee. As you have probably been told, we are about to investigate and do a study of the drug and alcohol rehabilitation centres, and we thought perhaps in your travels you would have garnered information that might be helpful to this committee. We have about 20 minutes to half an hour. You could perhaps start by making some comments about your deliberations to date and then perhaps have some questions from members. Would you start by introducing the person beside you.

Mr Mammoliti: Mary Shantz works at the provincial anti-drug secretariat and was also a participant in my tour across the province on the committee.

The Vice-Chair: Welcome to the committee. Please begin.

Mr Mammoliti: Members of the committee, thanks for having me here today. I appreciate it. This area is a very important area and I appreciate your looking into it. It is an area that we have been learning a lot about and this tour certainly opened up our eyes somewhat.

In December last year the minister responsible for the provincial anti-drug strategy, Mike Farnan, received the report Treating Alcohol and Drug Problems in Ontario -- A Vision for the '90s. I am aware that you have all received this report and that Garth Martin, the chair of the Advisory Committee on Drug Treatment, who wrote the report, has also appeared before you.

In order to provide an opportunity for all concerned groups and members of the public to respond to the report, the minister requested that I chair a task group of other parliamentary assistants to hold public hearings and seek written submissions. This group consisted of parliamentary assistants from seven ministries and two secretariats. The vice-chair was the parliamentary assistant for the Ministry of Health.

Mr Cousens: Who is that?

Mr Mammoliti: It was Bob Frankford.

Mr Bradley: Everybody is a parliamentary assistant over there.

The Vice-Chair: Mr Mammoliti, if you would like to continue. We apologize for our members' interjections.

Mr Mammoliti: Oh, do not apologize for Mr Cousens. It is expected.

From 17 February until 29 April we toured the province and held 13 forums. Because of my own concerns, we held a special hearing at the Ontario Correctional Institute in Brampton, otherwise known as OCI. We heard presentations from the residents and staff of both OCI and the Vanier Centre for Women, which is just next door. By mid-May we had heard 173 oral presentations, and 245 written submissions had been sent to me personally. In total, there were 275 organizations and individuals who responded to the Vision for the '90s report.

I would like to impress upon you the fact that the task group and I, as chair, were very much affected by the consultation process. We met directly with people who came from different situations, backgrounds and environments across the province. Almost everyone struggled daily with the problems of addiction as counsellors, doctors, recovering addicts or alcoholics or they had been affected dramatically as friends or family or had memories of growing up in a family coping with alcohol or drug problems. We listened to people who gave thoughtful, clinical responses that were based on years of direct experience.

We also listened to many who told their stories, which were emotional, painful and yet full of hope. There was a sense of hope that the government did care. There was that sense of hope and it was something I wanted to leave with the presenters and I think we did leave it. It was very emotional; a lot of touching stories about wanting to improve the addiction services in Ontario.

There was unanimous approval of the minister's reaction to the report in setting up the task group. As a matter of fact, we were thanked a number of times for acting quickly and getting parliamentary assistants, for the first time I may add, touring the province and dealing with this particular topic of treatment.

For many of us on the task group, this was an extremely important learning experience. I believe I can speak for most, if not all, the members on the task group when I say we have developed a much better emotional understanding and factual knowledge of the impact of addiction. All of us now feel an urgency and commitment to improving services in Ontario.

Let me explain perhaps the mandate of the committee for those of you who are wondering. The mandate of the committee was basically to listen and to report back to the minister, Mike Farnan. We were out there to lend an ear, we did that and we are just preparing our report at this time. I hope you can respect me when I say my report is not out yet and it is going to be a little difficult giving you the meat of the report. I would be happy to come back perhaps at a later date, after my report is out, to talk about what we heard.

The Vice-Chair: When is the anticipated date that your report would be available?

Mr Mammoliti: I am hoping within the next few weeks, but that is very optimistic at this point.

The Vice-Chair: When it is available, if your staff could send maybe 15 copies to the clerk of our committee, we would appreciate it.

Mr Mammoliti: Most definitely. I kept it brief because I know you have a lot of questions. I would be pleased to answer any of the questions at this point, again understanding that the report is not out yet.

Mr O'Connor: One thing this committee has shared is the concern we have, not only as members of this committee but as members of the government representing constituents out there who have a problem. Of course, as the standing committee on public accounts, we are concerned about dollars being spent for treatment and making sure the dollars are being spent wisely.

One thing that has come to light from a number of witnesses who have come before us up to now is the fact that the money is not necessarily being spent in the correct way. Far too often people are put into facilities for treatment and the follow-up is not taking place. When money is spent for treatment in US facilities, the follow-up does not take place in many cases, and then the treatment does not have the continuing effect that it should have. Did you get the same sense during your tour that it is not necessarily the inpatient treatment but far more often outpatient and the follow-up that is more needed than the money spent on actual inpatient treatment?

Mr Mammoliti: In the United States, as far as the outpatient, you mean?

Mr O'Connor: As far as what you have seen in Ontario facilities, because we are looking at the money aspect and we are shipping them to the United States for that in-facility treatment.

Mr Mammoliti: I think it is important to mention that we heard a number of people who were concerned about the care in Ontario when we talk about outpatient care. The whole report that we were seeking input on talked about a solution, a way of implementing here in Ontario. Yes, there were a lot of people concerned about treatment in Ontario.

You mentioned aftercare as well. I think it is important to mention that we heard from people who have gone down to the United States and have sought treatment. The experts have told us that aftercare is very important, and even though they are going to the United States, they have a problem with aftercare as well. They are getting that 28-day program or whatever they have to offer in the United States, but it does not necessarily mean they are getting any aftercare in the states either. We heard that. We also heard from individuals from the states who have said that aftercare is available for them in the United States and that is why you are getting these big costs to OHIP.


Mr O'Connor: Just one other thing, because I am sure there are many more questions to be asked: In regard to the PAs' committee you were on that went around talking to constituents, I know that looking across at some of the other members of the committee, there appeared to be some scepticism as to whether or not the committee was then going to put together as useful a report as should be. I look forward to receiving that report because I think it will be a very useful tool. I applaud the minister for assigning you that task and making sure that our constituents out there realize we do think this is a serious problem, making sure that the best care is taking place.

If I could send a message back to the minister through you, when that report is available we would really love to see it because I think the work you have done is very important. It will be very useful to us and we should try to make sure that our report and your report are used as tools complementary to each other, because I think a lot of aspects you have looked at will be aspects that we have looked at.

Mr Mammoliti: I am certainly going to take that back and I can quite comfortably say that the report will reach all of you. I would make it a point to give you a copy of my report. But you talked about some of the members on the committee being sceptical about my committee and the seven parliamentary assistants. I think it is important to note the meat of A Vision for the '90s talked about a way of making treatment in Ontario a little bit better, being comparable to if not better than the United States. Some of the recommendations were actually pretty specific in how to do that, and it involved different ministries.

When we read the report we said the best way to do it is to get somebody very close to each of the ministers to let them know exactly what we hear, and what better way than to get the parliamentary assistants involved, so they can report back to the minister? It is consultation and we are very concerned about consultation and making sure that that communication was dealt with. That is why the seven parliamentary assistants were chosen, seven with myself. As for being sceptical, I hope I have made you feel a little bit more comfortable.

Mr O'Connor: I appreciate that and I think you have made a very valuable point. I appreciate your coming today, in spite of some members from the third party sitting around reading clippings.

Mr Tilson: Mr Chair, that is out of line. I happen to be reading an article on drugs.

Mr Cousens: Will the committee be making specific recommendations with regard to treatment centres outside Ontario and the impact of changes that should be made by the government, with regard to that, as it affects our present study?

Mr Mammoliti: I think it is safe to say at this point that the committee's mandate was to listen to the public and to respond to the minister, who will then address to cabinet exactly what we have heard during the tour. That was my mandate and that is what we are going to do. As for recommendations from our committee to the minister, no, we are not going to make any because it was not a part of our mandate. If the minister wants to change that mandate, I would be happy to oblige.

Mr Cousens: That is fine.

Mr Hayes: Thanks for coming, George, and the rest of the people with you. Now that you have seen our proposed agenda for our itinerary for August when we are going to visit various drug and alcohol treatment centres in the United States, what kind of concerns me being on this committee is that we are dealing with drug and alcohol treatment and probably our biggest reason for doing so is the fact that so many millions of dollars are being spent on centres outside the province. At the same time, I guess the question is, why can we not do it here, spend that money in Ontario and give the same kind of service or better? I want your opinion on this because I wonder sometimes whether in this committee or maybe in your committee with the parliamentary assistants there is a possibility or danger of our going in two different directions or duplicating some of the things that your commmittee may have already dealt with.

Mr Mammoliti: I think it is a good idea to go and visit some of the facilities in the United States, but I caution you at the same time. Even though I think your plan is a good one, ask the right questions when you go down there. Do not get yourselves caught up in a lovely tour with sandy beaches and everything else that is down there.

Mr Hayes: Not at these places.

Mr Mammoliti: I would strongly suggest you ask the right questions and try to get them to commit to a lot of information that you could use as a committee. If you do that then, yes, I could agree with your going down there; I would recommend your going down there. At the same time, when you come back, I would also recommend that in order to perhaps get a better perspective -- and we talk about comparison -- you visit some of the treatment programs we have here in Ontario. We would be happy to give you a list of those we have already visited, but I think in your capacity that perhaps it may be a good idea to visit our own as well.

Mr Hayes: I know this might be asking a little much of you, but could you or your staff maybe draw up some questions you think would be helpful for us to get the right information to bring back?

Mr Mammoliti: I do not think it would be too forward of me to say we could do that.

Mr Tilson: There is an article in the Toronto Star this morning, a report from Metro, of drugs killing 568 people over a four-year period. It is a shame. It is a serious subject and it is a shame that yours is not an all-party committee because I think it is something all parties are concerned with. That is the unfortunate part of what you are doing, that members of the other opposition parties have not been allowed to participate in your committee. That is incredible.

I assume your subject will be covering such areas as the Metro report that has just come out and that you will be studying those various reports. Our direction of course is with respect to dealing with US centres and the funding of people who are going to the US centres.

I have two questions. First of all, could you tell us what your terms of reference are? Could you be specific as to what your terms of reference are for what your committee is trying to do? Second, will your report be dealing specifically with the subject of funding to individuals going to US centres?

Mr Mammoliti: Could you just give me the second question again, please.

Mr Tilson: My first question is, could you be specific as to what your terms of reference are?

Mr Mammoliti: I got that one.

My second question is, would you be prepared to provide us with a report that includes the recommendations to whomever you are reporting to? I am not so sure who you are reporting to. I do not know whether your report is going to be made public or whether it is simply to go to the Minister of Health. I have no idea. Whatever recommendations you are doing, and I hope it would be made public, would the recommendations include those with respect to funding to individuals who are going to US centres?


Mr Mammoliti: Okay. First of all, let me just say that I have already said this. I do not know whether or not you were reading that drug clipping when I was saying it.

Before I answer your questions, however, I want to talk about what you said first. There was a comment that it was not an all-party committee. Of course, you are going to have to talk to the minister about that, but I explained why it was not and why we felt it important to involve the seven parliamentary assistants.

At the same time, wherever and whatever city we visited we made sure that we told the respective MPP in that particular area that we were coming and that we would be pleased to have that person sit up with us on the committee and ask questions and answer questions at the same time. So as far as participation is concerned, I think we have done a little more than what we were supposed to do as a committee.

Second, in regard to the question on the mandate, I told you that we were there to listen and that the mandate is strictly to listen and to report to the minister on what we have heard from the public, what the public wants in reference to A Vision for the '90s. That is what we are doing. We are comprising a report of what we heard and we are doing that today.

On recommendations --

Mr Tilson: But presumably there has been a list of what you are asking the public to provide to you.

In getting back to Mr Hayes's comments as to the issue of overlapping, I want to be certain there is not a certain amount of overlapping, because I would hope this committee, the public accounts committee, is going to be going to Ontario provincial institutions.

I think that, following all of Mr Hayes's questions, the committee is interested in knowing there is not an overlapping. Specifically, someone has given you a list of terms of reference as to what you are supposed to be doing.

Mr Mammoliti: Okay. Again, our mandate was to look, and that is why we went out there. Your mandate is a little different, from what I understand. So even though I do not believe there is going to be any overlapping, from what I have seen, even if there were some overlapping, your mandates are totally different. The reasoning behind your looking into this is a little different. You are concerned about the amount of money being spent. We looked at the Vision for the '90s report and we wanted to know how the public felt about the Vision for the '90s report. That is answering that particular part of it.

As far as it being public, my report is going to be public and it is going to be given to Mike Farnan first, of course. It will be public and, of course, you will have a copy of it when it comes out.

The Chair: Could I just stress one thing, Mr Mammoliti. The purpose of this committee is not quite as dry as that we are interested only in the cost. We are interested in value for the money, both from the standpoint of dollars and helping human beings. I can assure you that public accounts has a double purpose in looking at this.

Mr Mammoliti: If I may just finish off my answer -- and I just want to make sure that Mr Tilson is listening.

Mr Tilson: I listened to every word you said, George.

Mr Mammoliti: I will say for the second time, we are not going to be recommending any solutions as a committee. That will be up to my colleagues in cabinet and the minister.

Mr Miclash: Following up on what Mr Tilson had to say, I too feel the committee would have been maybe a little bit more well rounded had it been a three-party committee, especially after being able to sit on the committee once in Kenora and finding out the very good work it did. I have to commend them on that work and their travel across the province.

However, there was a problem in Kenora. It was a partisan problem where the chairperson of the committee made some very partisan comments which left a very bad taste in the mouths of the chairperson and the people of the Kenora Board of Education. I am just wondering whether that has been explained to the Kenora Board of Education and, even more so, if an apology has been sent to the board around those circumstances.

The Chair: With respect, Mr Miclash, this committee is one of the few in this place that is non-partisan. I am not sure that Mr Mammoliti, having come here as a deputant -- if he wants to answer it, fine, but I do not feel this is appropriate. We would not ask any other witness that type of question.

Mr Mammoliti: I think it is only fair to the member, with him being from Kenora -- I do not mind answering it. It is important to mention that we extended the tour for this particular member. He wrote us a letter and said there were a number of people who wanted to give us submissions and there was a deep concern in Kenora. We looked at it and said, "Yes, we should go up to Kenora," and we did.

It is also important to mention the thing he is talking about. It was a little distracting for me knowing that the board of education was holding a forum the same day we were holding our forum. I understand that this was inevitable; there was nothing I could do about that at that point. What I was distraught about at that time was that the previous minister responsible for the provincial anti-drug strategy was invited to speak at the last minute after finding out I was coming up there. I felt that it was a little bit of a blow to us. I was a little concerned and I still am. So in answering the question, I am still concerned about it.

Mr Miclash: The circumstances around this have been explained.

The Chair: Give him a chance.

Ms Haeck: On a point of order, Mr Chairman: I think the question was asked by Mr Miclash. It has been responded to and I think that is really where it should end. If we want to get into a political debate, we can all go back to the House and debate particular pieces of legislation.

The Chair: Without the benefit of the clerk, of course, who gives us all our wisdom, I am inclined to think that to preserve what I have always thought to be the integrity of this committee, you are right. I think we have had enough on this issue. That is something, I guess, we could take down the hall. In fact, that is why I am late getting here. I have just been speaking on a motion to try to take some of the partisanship out of this whole process. Good luck.

Mr Miclash: I did not make the comment.

Mr Hayes: Please don't start.


The Chair: Are there any other questions of Mr Mammoliti? I am sorry I did not get a chance to hear what you said, but I am sure I can read it in Hansard.

I do want to emphasize the fact that this committee, I think, to the man and woman, is committed to try to save money for the province. But we are also committed to the fact that at the present time -- and we have heard this through deputations from the Bellwood and the Donwood and the Alcoholism and Drug Addiction Research Foundation -- the facilities just are not there. That is not a partisan issue. That is, as Peter Trueman would say, reality. That is what we want to rectify, not only there but in the correctional institutions.

Mr Mammoliti: Mr Chairman, just as a point of information per se, I was listening to the radio last night and I understand -- I have not read that story, but I am assuming that story probably has the same content, which is that there is a light at the end of the tunnel here. There is a positive note to us spending money, in that the whole anti-drug strategy is prevention and education.

I understand the statistics are showing that fewer children are taking drugs now and it has a lot to do with the prevention and education aspect of it in our schools. So there is a good sign out there and I think we are doing the right things by making them aware.

The Chair: I should add to this that CBC reported that the police chiefs of Ontario said there are far more violent crimes on the streets and they anticipate much more unless something is done about the whole drug scene. Education is great; that will help the young people coming up. The people who are going through the correctional system who get no or very little treatment at all are coming back out on the street and they are going to be worse than when they went in. I think we have to deal with that.

Mr O'Connor: I hope that perhaps you will have the chance to come back later on after we have done our tours and we could share some of the information that we found up to this point. Then, upon sharing the information that you have collected so far, perhaps it would be useful for us to --

Mr Mammoliti: I agree. I think once my report is out and once you have done your thing, perhaps I can explain what my report is about and what we heard, how we heard, who we heard from and that sort of thing. I think it may be useful to your committee.

The Chair: Thank you very much, Mr Mammoliti. We appreciate that.


The Chair: We now move on to the next item on our agenda. We have from the Ministry of Health, the deputy minister, Dr Barkin, and David McNaughton. I am not sure we have microphones for all of you. We have asked these people to come back and they have very graciously come back. Are there questions from members of the committee?

Ms Poole: If you would like to take a seat at one of the microphones, it would probably be easier for you.

The Chair: In fact, if you sit over there, you can run for office. It is just a treat. You would take a cut in pay, but other than that, you will enjoy it.

Ms Poole: You should choose your seat very, very carefully.

The Chair: Now are there questions from members of the committee? Come on, please. I do not want to have brought all these people over here for nothing.

Ms Haeck: One of the things that I am concerned about, and possibly we could get a little more information on, we had the gentleman last week from the Ministry of Correctional Services talking about its particular programs. Following up on the recent comments of the Chair, I guess you have to look at the treatment that is given. He indicated there was a lot more there than I think people in the general public had known about and even a lot of people within the precinct had known about.

The question is, with the treatment that is provided, what kind of recidivism is there and what success rates are there? What does your ministry see as needing to be done to deal with this particular problem?

Dr Barkin: You are asking me a question about events and follow-up in another ministry. I am sorry; I did not bring the relevant doctor along. I am sure if we asked him the question, they have their own follow-up statistics on what has happened in the criminal justice system.

I think the general question you posed, that is, the rate of recidivism related to forms of treatment or where they are received, is a very valid question. As best we can determine from the data given to us by the Addiction Research Foundation, where there is a strong and ongoing and continuous community-based linkage, the rate of recidivism is much lower than where there is short-term residential intervention without that community component.

The second answer I can give, at least from the information given to us, is that the likelihood of recidivism for an institutional start with community follow-up as compared with a total community-based treatment system where that is appropriate -- and it is appropriate in the vast majority of patients with substance abuse -- is probably only slightly less for the community-based model. In that consultation I provided to you there is continuing community follow-up for both sides.

In terms of the criminal justice system, the substance abuser who finds himself in the jails is a somewhat different candidate for treatment than the one who goes voluntarily, who has not been caught in the process of committing a crime, drug-related or not. In the one case you have an individual who is not there voluntarily and who, because he or she is confined, is also offered and given drug treatment. In the other case you have an individual who consents to and of his or own volition is participating in the treatment program. It would be my estimate that the recidivism rate would be much higher in the former, for that reason -- not related to whether the treatment is adequate or not adequate. You cannot force treatment that is to result in behavioural modification on anyone.

The Chair: It is interesting that you say that, because the experience in the United States is not quite that definitive. In fact, in some of the states they now require treatment to be taken by persons who have committed crimes related to specific types of drugs or alcohol, and if they do not take the treatment, their parole is delayed until they do. You can get a lot of conning there, but at least you get some treatment for them.

The statistics, although they are not yet out definitively, seem to be that although the common theory has been that you can lead a horse to water but you cannot make him drink, it is not necessarily true. There are benefits that are being acquired from it.

Dr Barkin: That was not the nature of my comment. My question was, will forced treatment be as successful and will the rate of recidivism be as low as it is when a patient voluntarily seeks treatment? There is no study that I am aware of that would say the contrary. Does forced treatment work sometimes, which is the question you are asking? I am sure it may work sometimes. But the rate of successes is not that high.

Ms Haeck: Through your community branch, do you do any kind of surveying of specific populations -- I am thinking of, say, a group home or a halfway house or something like that -- to find out what kind of clients would be making use of programs that are in the community and, again, to be able to trace any successes?

Dr Barkin: We do some of that and ARF does a lot of that. I do not have the data readily available.

Ms Haeck: It is good to know it is being done.

Dr Barkin: There is a fair knowledge about who the highest-risk populations are; not as much as we would like to have, however. We wanted to get a fuller picture across the province, which was one of the reasons that the Premier's council launched and is in the process of a cross-province health status survey. That should give us a bigger general picture as well.

Ms Poole: Thank you for being so patient to come yet once again. I wanted to ask you about a presentation which we had from the Donwood Institute last week, which was excellent. I assume you probably would have seen the transcript by now. In fact, I think you may have even been --

Dr Barkin: I was here for the latter half of the presentation. If you have a transcript, I have not read it in detail, I confess.


Ms Poole: They proposed some short-term remedial action and some long-term action to help alleviate the problem with the large amount of Ontario dollars going to the US to pay for drug and alcohol rehabilitation. One of the things they did was to give us a list of things they felt could be done by the ministry and by the Legislature relatively soon that could help to at least alleviate the problem.

For instance, they said first of all there should be controlled access. Then they talked about the need for an independent professional assessment that would be required prior to anyone going to the United States. This would be not your general practitioner who may not be familiar with what resources are available in Ontario; this would be somebody independent, somebody who had been trained in assessment.

I asked whether this would be readily available in Ontario. Did we have these resources and this assessment facility available now? He said -- I believe the number was 34, or in the 30s anyway -- there were already a number of existing centres which did assessment and referral, they were based across the province and this system was ready to go.

Have you considered this as one of your qualifications: that there be an independent professional assessment by an assessor who would know not only the problems with drug and alcohol rehabilitation but also the resources we have in Ontario; and that the assessment be required by the Ministry of Health prior to allowing a patient access to OHIP billings for an American facility?

Dr Barkin: The answer to all your questions is yes, but let me give it some detail and flesh it out a little for you.

The presentation from the Donwood reflected very much the directions of the minister and of the government. The commitment of the government was contained as part of the minister's statement with respect to the changes in policy on out-of-country payments that will become effective in the fall. There will be more detailed announcements forthcoming as to how that will be implemented, and prior approval is one of the essential ingredients of that.

If I may, I will simply quote the minister's comment on that since it is a question of the government's intended policy. The minister's comment there is: " systems which will assist those patients currently needing to use out-of-country treatments. These will include: expansion of existing addiction services, residential programs, youth services, case management, detoxification services and day treatment" -- and this is the portion that relates to your question -- "as well as an enhancement of assessment and referral services. A new treatment registry is planned as well." So assessment and referral service requires that there be a coincident treatment registry of all of the available options.

I had a rather lengthy meeting the day before yesterday with the Addiction Research Foundation on exactly how and what it includes in its treatment register, since we know that there are a wide variety of community-based services, from church groups to Alcoholics Anonymous to Renascent Fellowship treatment centres to Narcotics Anonymous to other self-help groups to some of the more formal treatment and rehabilitation services. They assured me that their view of a registry is one that emcompasses all those services, so that clients are properly counselled as to what their choices are through an enhancement of assessment and referral services available. So, with some greater detail, the answer to your question is yes, that would be well within the government's range of policy intentions also.

Ms Poole: I appreciate that answer. Perhaps I could be a little more specific: Not only is the registry going to be set up -- that obviously is a good idea -- but the other consideration is who is going to be making these assessments and referrals? If it is going to be fairly widespread, and you are just sending out piles of documentation to doctors across the province, so that they would be able to make this kind of referral, sometimes they may not have the necessary training to know whether residential care is actually required or whether it could be outpatient or what exactly is needed. Is it the ministry's intention that the assessment centres already existing are the ones on which the Ministry of Health would make the final pronouncement whether it is necessary for the patient to go to the United States for treatment?

Dr Barkin: Those and others to be added to them.

Ms Poole: So it will be specific individuals or centres that will have this responsibility, as opposed to making it quite widespread as it is right now.

Dr Barkin: That is correct.

Ms Poole: That is very helpful.

Mr O'Connor: There is one thing that we have not talked about too much and I wondered if you can help me. As part of long-term care reform, something that has perked my interest in dealing with the drug aspect of it -- and of course now we are looking at it not from the youth aspect but the senior aspect of it -- concerns seniors in nursing homes. Do you feel there could be a waste of resources in the overuse of drugs in those facilities as opposed to trying to create a healthier resident through other means?

Dr Barkin: The ministry has quite a number of reports before it corroborating the concern which you have expressed, that seniors, wherever they are found, in nursing homes or in their own homes, are receiving too many medications and are not having them appropriately monitored in their own best interest.

We know that many physicians run programs where they ask all their senior patients to bring in the pharmaceutical agents they have in their various medicine cabinets; they get rid of them and review their medications periodically.

We are also aware from a report which we now refer to as the Goldberg report that this is a common problem in terms of additional cost to the health care system, not just because of the cost of the drugs that are used but of the consequences in illness that inappropriate drug prescribing produces in the elderly. For example, we have had estimates running from 10% to 25% of hospital admissions attributed to inappropriate medications for the over-65s.

The Chair: I am glad you clarified that issue about the minister's statement because I think many of us, including myself, thought it was going to be a scenario much as took place when you wanted to go to a specialist. You went to your doctor. If he said okay, you went to the specialist and it was covered by OHIP because you were referred by him or her. I am happy to see that it is going to be a much more critical test. I assume that is what you are interpreting the minister's statement to say.

Dr Barkin: Yes.

The Chair: I would hope that critical test would not click into place until we have appropriate facilities here, because I would hate to see people out there who have a drug or alcohol dependency having to go through the bureaucratic red tape that might make them kill themselves or somebody else before they got that treatment.

Dr Barkin: The purpose of the assessment centre married to the registry is to give Mr McNaughton's department the right to authorize payment for an out-of-country facility at the pre-approved or preferred provider rate that we negotiate if the appropriate service for that individual is not available in a timely way in Ontario. That is part of the minister's announcement.

The assessment process is designed to deal with that and to counteract what the committee heard about self-referrals, the patients who decide for themselves, "Gee, I would like to go to Texas or what have you, and having so decided, I can now send the bill back to OHIP."

If the patient decides to go to an American facility without prior approval, under the new policy guidelines that will be coming into effect in the fall only the rate which we have established for Ontario will be paid for that service. If the patient has to use an American service because it is not available in a timely way in Ontario, as determined by one of the assessment centres, then we will pay the full preferred provider tariff for that. That is the critical difference in the new policy that was announced.


The Chair: Could you help this committee? I can only speak for myself, but perhaps other members of the committee would like to know what that procedure is and what the time line is. I would hate to think that if someone went to the US and took the treatment because it was not available here and because they could not wait in line for what is sometimes the bureaucratic trip, they would be deprived of their reimbursement after they came back.

Dr Barkin: The one detail I can give you at this stage is that there is an appeal process available to the patient. But the details of implementation, as the minister indicated in her statement of 2 May, will be announced by the minister shortly.

The Chair: But that appeal process is like everything else with government: You have to get approval beforehand; you cannot get it afterwards.

Dr Barkin: No, that is not quite right. If I may, I will ask Mr McNaughton to give you the details, since they are administered through his portfolio.

Mr McNaughton: We are developing the fine details of the process. What you are concerned about is that someone might wait a week or two, or a month or two, God forbid, where there is a much higher urgency.

The Chair: Yes.

Mr McNaughton: In developing it, we are trying to study all the other systems we can find that are like that. British Columbia, for example, operates a system like this. They resolve all the paperwork and everything else and have the patients on their way to the facility in the United States within 48 hours. It remains to be seen exactly how we do that in Ontario, but the same kind of sensitivity as they are using in British Columbia is what we would be looking for.

The biggest challenge we face is weekends. But we understand the need to move and move quickly. This could be more critical in the area of cardiovascular care, for example, than addiction treatment. In general, I would not anticipate that we could not find emergency addiction treatment in Ontario. That would be my supposition. It is more the long-term care where a day or two or three, or quite frankly a week, would probably be adequate in those cases. But we still need that urgent process for other types of medical care as well.

The Chair: I wish you luck. I guess we are all still reeling from things like the Immigration Appeal Board and so on -- the things that were going to speed things up.

Mr McNaughton: By citing British Columbia, I am trying to show you that it is really happening. I have seen their statistics and their data; they are turning their cases around in a maximum of 48 hours.

Mr Cousens: Just a very brief paragraph from a submission to the provincial anti-drug secretariat with one issue, which was the time he had to wait at the Centenary Hospital's crisis centre in Scarborough. His son was addicted to crack cocaine in early December.

"By late December he had hit the proverbial wall. He had a $500-a-day habit, was totally out of control and was threatening suicide. The day he had bottomed we searched for help and tried for admission that day into some form of treatment facility. We ended up at Scarborough Centenary's crisis centre. After six hours of waiting we were advised -- " even then it wasn't much better.

First of all, do you think that is fast enough service for someone who is in that state?

Dr Barkin: I suppose the ideal would be to get everyone immediate service at any time, 24 hours a day, 365 days a year. I doubt that with the 200 million or so contacts that happen each year with the health care system we will get that record 100% of the time. We certainly would aspire to that. I do not know how to comment on that individual case or the voice of the anguished father.

Mr Cousens: Can I help in that? The only worry I would have is that in the admissions at the hospital, is there a way in which they can identify cases that are more crisis-oriented than others? They do it when there is no pulse; then they can quickly get things going. When you have a crisis that is really brewing like that, is there any way in which you can grade them?

Dr Barkin: If I can understand the question, you are asking me whether --

Mr Cousens: I am helping you out a bit.

Dr Barkin: -- the psychiatric assessment emergency has the same grading system as we have for medical emergencies.

The answer is no, it is not as clear. On the medical and surgical emergencies there are very fixed and hard criteria and good predictors, but they are not 100%. We have had lots of people who go into a hospital who get graded for some chest pain and are told they have nothing that turns out to be something because there is a limitation in diagnostic validity. It is a lot fuzzier in the psychiatric area.

Mr Cousens: I know that. It is not a trick question, but it may be one of those things you hear. You have seen the issue. This example illustrates the problems that come around it and maybe it is one of those things, and with your limited resources you look at ways of trying to target patients more quickly.

Dr Barkin: I think it is a very valid question. I faced that question wearing one of my previous hats when I was chief executive officer at Sunnybrook Hospital, which has a psychiatric facility and a crisis facility, and also dealt with youth because it was a centre for that as well. In talking to our most senior experts then -- Saul Levine was the head at the time -- they tried their best to develop criteria to assist them to recognize that usually the point of first contact is the emergency position. The point of contact is not a psychiatrist sitting in emergency waiting for patients like this to drop in. They try to develop guidelines for rapid referral. I think most emergencies are trying to develop such guidelines but, as your example illustrates, it is not as clear-cut on the psychiatric side as it is on the medical side. It is pretty tough.

Mr Cousens: I just presented a challenge there. It is a hard one, but if there are any developments made on it, I would enjoy the fact that it could be passed on to all 223 hospitals.

The Chair: Thank you very much. We appreciate your coming back again.

Dr Barkin: If I may, the first time there were a number of requests made of us. I was able to respond to some of them the last time I was here. One of the requests was for the correspondence we had received from and/or about some US facilities, and there was some concern expressed whether there would be any confidentiality violations if such correspondence were shared with the committee. I have asked the ministry's freedom of information and protection of personal privacy officer to review that correspondence. He is in the process of reviewing it, but has given me a preliminary report that if certain personal identifying information were severed from the correspondence, we could share the balance of it with the committee. He is now going through that process to protect the individual's privacy, and when he is done the correspondence, as per the committee's request, appropriately severed and screened by the protector of personal privacy, will be forwarded to you.

The Chair: Thank you very much, doctor. We appreciate your coming forward.


The Chair: Mr O'Connor had another question. He would like to ask Mary Shantz if she would come back; it is kind of like Jeopardy, you know. This is Final Jeopardy.

Mr O'Connor: I thank you for being willing to come back, and I am sorry to catch you off guard. It is something I had not thought of earlier. Something in our questioning sparked it. You were involved with the tour as well, and the committee?

Ms Shantz: Yes, that is correct.

Mr O'Connor: Great. Did the anti-drug secretariat look at all at any youth correction facilities and the treatment for substance abuse problems in them, or did you have any presentations before you from such a facility?

Ms Shantz: In answer to your first question, as Mr Mammoliti mentioned we did hold a special hearing at the Ontario Correctional Institute in Brampton. We also included residents and staff from the Vanier Centre for Women, and in addition to that we had a young offender, so we had a very full and useful presentation from people who are directly involved in the system. But that was the only correctional facility we visited as a task group.

Mr O'Connor: Great. So then you have not actually looked at a centre directly for youth?

Ms Shantz: No, not specifically.


Mr O'Connor: Through some of our questioning we have been talking about maybe looking at correctional facilities and I just thought that looking at a youth facility might be useful. I wondered if you could help us in that way.

Ms Haeck: Following up with you on my previous question to Dr Barkin, in your travels, and looking particularly at these two correctional institutions, can you speak about the kinds of programs that were available to inmates -- I guess that is the appropriate term -- and any comments on the young offender as to the use of some of these programs? Was this person making use of the programs within a correctional institution?

Ms Shantz: The young offender happened to be a woman, so she was able to speak about her experience in Vanier. Only one young offender appeared before the task group and spoke to us.

As for your other question with regard to correctional facilities, I feel the Ministry of Correctional Services is in a better position to respond very specifically with regard to what services and programs are available in its facilities.

Ms Haeck: They were there recently, and I was just wondering if you had a chance to sort of assess if there were programs at those two institutions in your visit there.

Ms Shantz: Specifically at OCI, yes, there are programs.

Ms Haeck: Vanier does not have something?

Ms Shantz: I think it would be unfair to Vanier to say it did not have anything. My impression was that the Ontario Correctional Institute had a more intensive program. That particular institution has been designed with more treatment components to it than some of the others.

The Chair: It is a first-rate facility. Unfortunately it is so small that there are waiting lists. I think that is part of the issue. Thank you very much.


The Chair: We are now going to deal with the motion, which I understand was discussed somewhat this morning.

Mr Tilson moves:

"(A) That the Provincial Auditor review severance and termination packages paid to senior civil servants (director and up) and political staff from September 1990 to the present in the following ministries and offices: Natural Resources, Government Services, Solicitor General, Premier's office, Cabinet Office, Treasury and Economics, Financial Institutions, Agriculture and Food, Environment, Attorney General, Industry, Trade and Technology, Municipal Affairs, Management Board, Health.

"(B) That the report of the committee on the review of these packages include, for each package, information on:

"(a) The name, position, length of service, and salary at time of separation of the individual who received the package,

"(b) the reason for termination or separation,

"(c) the total dollar cost of the severance or termination package.

"(C) That the auditor provide the committee with an assessment and comparison of the severance and termination payment practices of the Ontario government relative to those of the private sector."

Before we deal further with this, I am going to ask the auditor, because as I understand it you have put this on Orders and Notices as a question but apparently the minister involved indicates she is not able to provide the --

Mr Tilson: For the record, I have proceeded with two sources. Really I should have attached this to the motion. One was through order paper questions on severance, in which case I got back -- and I do not have it with me now -- a series of numbers showing a series of ranges of what appear to be identifications of ministries, but it is difficult to do that; in other words, complete protection under the Freedom of Information and Protection of Privacy Act.

Second, I asked a question in the House of the Chairman of Management Board, I believe it was, with respect to an item for severances that had come out of the Premier's office. I believe it was $700,000; I cannot recall. My question was for particulars. She undertook to give me what she could --

The Chair: She is hamstrung.

Mr Tilson: -- and she did. She honoured what she said she would do, but she could not give me anything further because of the act.

The Chair: I guess I am going to ask the auditor, or his representative here, does it present a problem for the auditor to get that specific information, or are you guys stuck with the same problem?

Mr Otterman: We certainly have no problem with being able to access the information and examine it, but in the reporting back at this stage, I do not think we have really had a test of this nature since the new act on privacy and protection of information has been in place. Our policy has always been not to name names, wherever that is possible, and in the past I think we felt that if we had to report something that was very sensitive and personal, we would do so in an in-camera session to get the advice of the committee. However, just how that would be interpreted is something we would be very careful of clearing with the Information and Privacy Commissioner.

The Chair: Okay. So you are not asking for names here anyways. It is your motion. Do you want to delete that?

Mr Tilson: My difficulty in this whole issue, is that no one knows the details of severance packages, the quantum, the reason why, the details, how long people have been here or anything. Someone must be able to monitor this and that is the intent of the motion. I am going to let the motion stand as is. If it contravenes the act, I am sure the auditor would take cognizance of that.

Mr Johnson: I would like to say --

The Chair: I do not want to rush you, but I think I am going to have to exercise the prerogative of the Chair. We are going to have to deal with this by five minutes to 12, regardless of what has happened. I am sure there is going to be a vote in the House and I would like to get to it.

Mr Johnson: There are a number of things I think the government side would be concerned about. Although I do not speak on behalf of my colleagues, I certainly speak for myself.

I am sure the Freedom of Information and Protection of Privacy Act, as we have already discussed, would come into play here. As I mentioned earlier in camera, the settlement packages that are negotiated or agreed upon between the parties who are leaving and the government are, as far as we understand, private and confidential. They are agreed upon and arranged based on information supplied to the government and on the severance and termination packages that occur in the private sector.

I may be wrong, but in moving this information I believe Mr Tilson has two purposes. One is that he sincerely wants to understand exactly what the costs are -- and that is the purpose of this committee -- for severance packages of all the people that he has pointed out in this motion.

The other thing too, most certainly, is that if the auditor were to find out this information and it were to be made public, it would not reflect what has happened in the past and it may not reflect on the packages as they are related to what happens in the private sector. In my opinion it would reflect negatively on the government, and I do not think that is something we on the government side would endorse.

I understand the purpose for wanting to know. It is public funds that are used, and I think that serves a useful purpose. But on the other hand, given the nature of the privacy and protection of information we are dealing with here, I think it is important to look at it in a broader spectrum. In the broader spectrum, I wonder what Mr Tilson's complete purpose is. I see the one, but I would suggest that maybe when this information -- and I do not think it will -- becomes public, it is the sort of thing I do not think the government would see as being in the interest of the government.

If this motion were to be amended to say something in the A part -- with regard to the date, if it were to say from, say, the first of 1985 to the first of 1990 --

The Chair: If you want to be truly fair, you should go back to 1982 so we all get raked over the coals.

Ms Haeck: Yes.


Mr Johnson: Sure. If we want to see how the process works and what packages have been paid, maybe we should look at the history of this process and not just identify a period in time as recently as from September until now. That would suggest to me that the interest is what has happened since this government took over in September, and I do not think that is a fair reflection on the purpose. If we were to look at it over a 10-year period, yes maybe, but I do not think I would support this motion, quite frankly.

Mr Cousens: To be very brief, respecting the time constraints, number one, it is really too bad that the auditor can no longer list the total salaries of all civil servants over a certain level. This freedom-of-information thing has gone so far that we do not know what is going on around here any more, and that is a travesty to the people of Ontario. It is another issue, but it is implicit to this one, because it happened in the mid-1980s, somewhere around there -- it does not really matter -- but it is one of those things where there is too much protection of information. They are public servants and I think we need to know what is going on. That is my first point.

The second point is that I do not see any cases coming up in the courts where people are grieving against or taking suits against the government for their settlements. You see them in private industry all the time, because industry is trying to watch the dollars more. But within government, I have a fear that there could well be very generous settlements. The reason you are not having court cases coming up is because they are too generous.

There is a need for us to know what kind of severance packages are being given to senior level people. It is hidden in the operating costs because it just becomes part of the salary. So instead of the people being there, they have had a certain period of time that they are gone. I know how it is done and it is not a pleasant scene.

I am supportive of this and to me if you go back too far -- just one more point, my third point -- the auditor will not get on to some of the other things he is doing. I see it as something that we do for this last period of time. It has to do with when the government changeover took place. Come on, let's open it up and see just what really has been going on there. There is secrecy right now and we have got to take the cloak of secrecy off.

Ms Poole: I would like to support Mr Johnson's comments about putting things in perspective and taking a look at the history of it and also what has happened when there have been successive government changes in Ontario. That has not happened too often, so I think there are only two periods we really will be looking at. If it is going to be done at all, I think that has to be put in context.

With relation to Mr Cousens's point about the threat of lawsuits, I think that is a reality. I suspect the severance packages given both in relation to the civil service and ministers' staff have reflected it, not necessarily at a time government changes, but also when staff is let go for various reasons.

Having talked to the Human Resources Secretariat not too long ago, I know it is recommending that although the limit is one week by provincial statute for employees under a probationary period, for instance, it is recommending something more generous than that, simply because of the rise in the number of lawsuits.

I think it is quite a comprehensive problem and while I support the intent that Mr Tilson is going after, I do not think this has been crafted with all these viewpoints in mind. I would propose that Mr Tilson, perhaps, consult with some of the members of the committee, rework it and bring it back to us the next time we are in public session. At that time perhaps we can have something we can all agree on that is good to refer to the auditor.

Mr Hayes: I pretty well reiterate the words Mr Johnson has said. We are all concerned about how much money is being spent and where it is going and who is getting it. But I do have to look at this and say it is kind of interesting. Why would we say from September 1990, as though something new has just happened here? I think if we really wanted to get the true picture, if we wanted to do this type of investigation, we should go back. One example is 1985 when the previous Liberal government was actually embarrassed because of a deal the government before had made. It was a golden handshake in this place and nobody knew about it. It was quite hefty and I understand it could be corrected. But I think the deal is still going on and that individual is probably still getting some money.

I think we should be looking at this if we really want to study this thing and ask what we can do to maybe change these kind of things from happening and if we are still following past practice here. I have no objections to disclosing things and members becoming aware of what is really going and where money is being spent. Also the public has that right. I would have to really question this as to what the real purpose of it is, and I would certainly have to vote against it.

The Chair: Mr Tilson, you have heard what has been said. I wonder if you would like to table this for the moment? We actually should have had unanimous consent to deal with it because it was a notice of motion. But maybe you want to craft it and bring it.

Mr Tilson: It has been suggested that there is something sinister with this motion. There is nothing of the sort.

The Chair: That is actually out of order. You are not supposed to question the motives of a member.

Mr Tilson: The whole purpose of this motion is to simply find out what is going on, and I am not prepared to make an amendment. If the auditor is telling us that there is violation of the act or some other act, then he will tell us. But most important, this committee should know what is going on, and this committee has no idea on this subject. No one in this room has any idea. I stand by the motion. I would like to have it voted on today. I am not going to make any amendments to it.

As far as the date is concerned, if there are some irregularities as a result of this, then perhaps another motion could be made at a later date to deal with other periods of time, but that is not the intent. The intent is not a witchhunt for any specific names. The intent is to find out what is going on in the spending of this government. I do not mean this NDP government; I mean this building.

The Chair: May I have unanimous consent retroactively to get this thing on the floor to begin with?

Mr Hayes: I make a motion that we table it.

Mr O'Connor: That is not his wish.

Mr Hayes: I know that.

The Chair: Till when?

Mr Hayes: When you table a motion you do not table it until when; you table it, and then if you want to bring it up again, you make a motion to take it off the table.

The Chair: All right?

Mrs MacKinnon: I will second that if that is what you need.

The Chair: That is basically a hoist motion. We would have to have far more conversation on it before I would be able, as Chairman, to agree to that motion. I would suggest that if you are going to move it, you move it to a specific date. We are going to be called in about 30 seconds for a vote.

Ms Poole: Might I propose a friendly amendment that it be tabled until the fall session?

The Chair: Okay, that would supersede a vote. Those in favour of that motion?

Mrs MacKinnon: Which one?

The Chair: That it be tabled until the fall session. Those in favour?

Mr Johnson: What are we voting on?

The Chair: We are voting on the motion that Mr Tilson's motion be tabled until the first meeting in the fall. Those in favour? Okay.

Ms Poole: I did not say the first meeting. I just said the fall session, whenever it fits into our --

The Chair: Okay. We are being called for a vote. We stand adjourned. Have a nice summer, everyone. We will see you on the tour on the route and all that stuff.

The committee adjourned at 1200.