CANADIAN COUNCIL OF PUBLIC ACCOUNTS COMMITTEES CONFERENCE
CONTENTS
Thursday 3 October 1991
Canadian Council of Public Accounts Committees Conference
Trip to United States
STANDING COMMITTEE ON PUBLIC ACCOUNTS
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)
Substitutions:
Fawcett, Joan M. (Northumberland L) for Ms Poole
Miclash, Frank (Kenora L) for Mr Callahan
Owens, Stephen (Scarborough Centre for Mr Hayes
Clerk: Manikel Tanis
Staff: McLellan, Ray, Research Officer, Legislative Research Service
The committee met at 1004 in room 151.
CANADIAN COUNCIL OF PUBLIC ACCOUNTS COMMITTEES CONFERENCE
The Acting Chair (Mrs Fawcett): This morning I think we are going to have a little discussion of the conference in Winnipeg. I think it would be useful for the members who attended, if possible, to give their impressions of the conference for those of us who were not able to be there, and then also a review of the trip to the US on drug and substance abuse.
Ms Haeck: I am not sure to what degree other people made notes from that conference. I do have some, and I would ask the other members who were able to attend, Mr Tilson in particular, since Mr Johnson is not here, to fill any blank spaces that I may have left.
I found a number of the presentations extremely interesting, though quite clearly the kind of discussions that we have had have not strictly related to crown corporations. The theme of the conference related to public accounts committees and accountability within crown corporations, so this is really how the various presentations were focused.
Various people who had experience in that area made presentations. One gentleman named Kevin Kavanaugh related things happening in Manitoba, and we heard Warren Justin from the Yukon speak very aptly and articulately on what was happening in his own area. Other topics? Accountability dilemmas of crown corporations, something that, again, I guess we all have to wrestle with at some point. Just looking at some of my notes: Too much accountability does not improve efficiency. There are definitely various aspects of the discussions that would probably lead to some heated debate as well.
Those are just some very quick notes that I made during the day. There was some other documentation made available to us from the public sector accounting and auditing committee of the Canadian Institute of Chartered Accountants. They passed out some materials -- and they are definitely of value -- and a comparative jurisdictional implementation survey by the Canadian Council of Public Accounts Committees. This was the 1991 report.
I think there is an awful lot that we can learn from participating in some of these, like some of the discussion by Mr John Kelly. Relating to accountants he says, "Why should you care about accounting?" It is not a topic, I think, for any kind of great dinner debate, but it is something that I think this committee does have to address. Comments that he made: Bad information results in bad decisions. Why would a government use inappropriate information? Well, he raises the point that it could use that kind of information to convince people that a situation is really different than it is. Consolidated funds? You have to really look at both sides of operations.
Anyway, there were a lot of things I found very, very interesting and related to what we are doing. He definitely brought out a number of points that I think we should be looking at in our deliberations when we are meeting with deputants from the various ministries or other areas, so that we ask full questions and try to get a clear answer on both sides of the operations that are in place.
I would end at this point. If there are some other questions or if Mr Tilson has some other comments at this point.
1010
Mr Tilson: I think you have covered pretty well what went on. A couple of other points to add: I certainly get the impression, listening to the public accounts committees from the various provinces, that our committee meets far more regularly than theirs. The range of topics that we cover is far more extensive than what those committees cover. There was one other topic which, I suppose, is interesting politically, particularly in this province. There was an interesting debate on deficit financing which probably did not bring us any closer together necessarily, but it was a debate.
Much of the time was spent, as you have indicated, on the accountability of crown corporations and crown agencies. I believe -- I hope I am not wrong -- that in our auditor's legislation, our auditor has far more ability to look into crown agencies and crown corporations than he does in other provinces. Christel, you can correct me, but that was the impression I got. The topics that were covered, I think you have summarized them. The meeting next year will be held in New Brunswick. I think in the scheduling, Ontario would host the meeting following that.
As far as our participating goes -- and I appreciate there was a change of government and many of us are new to the system -- I think it would be useful if members of this committee, whether all or some of them, attend next year in New Brunswick, specifically put forward suggestions to the New Brunswick chair as to topics that we feel would be useful to discuss. I believe the crown corporation and crown agency subjects will be discussed again, perhaps not to the extent they were this year. But I believe that if this committee has certain topics on which we would like the input and the experience from other provinces, then we should do that immediately; in other words, inform the New Brunswick chair that we hope those topics would be discussed, because I believe it is in their discretion, and quite rightfully so, as to what should go on.
There was no discussion whatsoever as to what is going to be discussed next year, other than, I believe, a continuation of the crown corporation accountability.
Ms Haeck: If I can interrupt for just one moment, Mr Tilson. There was a motion passed within the committee at that point which reads: "That the Canadian Council of Public Accounts Committees establish a task force to examine the role of public accounts committees and other legislative committees in the accountability process of crown corporations with a view to generating a statement on this issue for the information of member jurisdictions and to assist the CCPAC in future discussions in this matter."
There was a lot of discussion on this particular point and definitely a hope that something could be ready for the New Brunswick meeting, which would lead to what Mr Tilson has just discussed about the continuation of these discussions.
The Acting Chair: Yes, I wondered about that. Mr Tilson.
Mr Tilson: Our delegation spoke against that motion, not necessarily because of the content of it, but because it was being suggested that Ontario's resources and Alberta's resources and those of the committees that met more frequently would take charge of that issue. We were reluctant, simply for funding issues, to participate. I think there was a consensus among the members, the NDP and Liberal delegations and representatives there, that we certainly support discussing the issue further and perhaps even contributing some sort of paper or thought from this committee which could be sent in advance of the New Brunswick meeting. We spoke against it, yet we are in favour of it -- as usual, trying to speak out of both sides of our mouth, I suppose.
The Acting Chair: I was informed by Mr McLellan that the Yukon had a sort of executive meeting following any of the hearings and that seemed to help everyone because your thoughts were immediately recorded. Would you like to speak to that, Ray?
Mr McLellan: In the early part of the conference there was an opportunity for various provincial delegations to comment on what had transpired over the last 12 months in the Yukon. Immediately following each hearing, they commented from a procedural perspective on a strategy or an option they use, whether dealing with substance abuse or firefighting or what have you, not necessarily to draft recommendations, but at least to reach some preliminary conclusions on topics under consideration.
In the past we have waited in some instances three or four or five weeks before we actually get to the point of drafting recommendations. Over that period it is easy to forget information or to perhaps forget recommendations that were untimely at the time of the hearing. That seems to be a helpful process. Actually we did try to use this on the trip to the United States when we were looking at substance abuse in a somewhat different, less formal environment. It did help, I think, in reaching early conclusions.
The Acting Chair: Ms Haeck, did you have a comment on that?
Ms Haeck: I did. I think most of the deputations found the suggestion the Yukon made extremely useful. But, as Mr Tilson so aptly pointed out earlier, the reality is that our standing committee on public accounts probably meets the most frequently of all the public accounts committees -- though I cannot speak for the federal government. We did not really get into that with them but I do know, in talking to people from Nova Scotia and PEI, that they have a very limited meeting schedule. In the case of PEI, they only meet as a Legislature for about two months of the year, and that is the only time their public accounts committee meets. With that kind of a hiatus it could be quite possible to forget an awful lot of the details. What the Yukon has suggested is something that they consider to be extremely valuable.
Mr O'Connor: In your discussions with different people from committees across the country, did they have the same type of resources as we have, like Hansard recording of committee meetings and the same access to legislative research to try to draw it together when it comes time to writing reports? Did you get a sense of whether their structure is as formal as ours, while you were there?
Mr Tilson: I must confess those specific questions were not asked, even in private discussions. I certainly got the impression, though, that the organization of this committee was far more extensive than the organization of the other committees, even in Alberta. You can compare Alberta to PEI economically, but Alberta did not meet that frequently. Members from the Alberta committee were present and did not meet that frequently.
As regards Hansard, staff and resources, those specific questions were not asked. They seemed to be almost overwhelmed talking to us as to what topics we cover and the extent. I just listed education and health, the two most recent areas that we have been talking about, and they seemed almost overwhelmed that we would go into it in that detail. So I am afraid I cannot help you.
1020
Ms Haeck: I have just one or two comments. In talking to the Nova Scotia representative and some people from PEI, very clearly we do a whole lot better in the area of research and staff support, because I think, as the clerk also would substantiate, many times the clerk responsible for the various committees may, in fact, be only one person. Here, one individual is responsible pretty much for one committee, maybe two. In the case of New Brunswick, the clerk is responsible for all the parliamentary committees. That makes for quite a challenge, I would say, to meet all the demands that may in fact be there, be it scheduling, having resources there, keeping up to date on reports, etc, etc. I think we are doing very well, as Mr Tilson also pointed out.
The Acting Chair: Possibly our clerk could add something to this.
Clerk of the Committee: In the directory for the Canadian Council of Public Accounts Committees there is a summary showing the budgets for the different committees, the staff, research, number of meetings. I will send that information out to your offices during the week. But just from talking to people and having worked in Manitoba, I know a lot of the other jurisdictions do not have the resources in terms of clerks or researchers, and it does cause problems. But then again, their committees are not as active and are not going into as much depth as this committee, so it depends on how the committees have evolved.
Mr Tilson: Two final points before we get into other areas: One was what direction this committee should give the clerk to prepare. We have, unofficially at least, given our commitment to host the 1993 annual meeting. Maybe this is already in the works, I do not know, but what direction do we give the clerk to start planning for that meeting? Second, although we gave the impression we were negative with respect to the crown corporation and crown agency topic, whether this committee should direct the preparation of information on the status of accountability of crown corporations and crown agencies in the province of Ontario for purposes of submitting to the various committees across the country, I am sure that will be at least one topic we will discuss next year.
Ms Haeck: I would concur with Mr Tilson, as far as trying to be helpful to those other committees is concerned. At this point I think I have exhausted what comments I could make about it, other than to thank the organizers of the event. It was definitely a very pleasant stay. A lot of information came forward. There were some things that I had a chance to see and take home, and to talk to local people about things happening in Winnipeg, so I found the time spent very worthwhile.
The Acting Chair: I recall that in 1988 I was on a similar conference. Certainly it seemed then that we were leaders and much looked to by the other provinces and jurisdictions for the manner in which they would like to address the public accounts. I was just interested to know whether we are still leaders, and it would seem so.
Mr O'Connor: Another question I could ask of some of the people who were fortunate to go in that leg of our journeys this summer: Do they have the same relationship, those committees, with their provincial auditors? Are the mandates -- I suppose the researcher should best answer this -- of all the committees identical in legislative responsibilities?
Mr McLellan: As I say, I did not attend the full conference, so I could not really comment on their mandate. At least during my period with public accounts, we have not really sat down and gone through the specific mandate and done a comparative review of what each committee does during the year. It would be difficult for me to comment on that, but it is certainly something I could look into, if you would like me to, and report back to the committee.
Mr O'Connor: Because our resources are perhaps a little bit better than some of the other committees in the provinces across the country, perhaps when we, as a committee, come up with our reports as we did some months ago and introduced them to the Legislature, we can share our report with the other committees and recommendations. I do not think we need any more paper for all of us, but if we could review the recommendations they have put forward in their legislatures, there might be some information and tips, a kind of a sharing of ideas, that would be quite useful, I would think.
The Acting Chair: One thing I neglected to do was give the report of the subcommittee; possibly at this time I should do that.
Mr Tilson: Before you do, on the two questions I raised, does the clerk require any direction from this committee to prepare for the 1993 meeting?
Clerk of the Committee: We discussed this briefly in the subcommittee meeting and I also had a meeting on Tuesday with the auditors. The meeting with the auditors, because this will be a joint conference again, was quite helpful. The auditors felt, and I think I can safely say this, that they have gone about as far as they can go on the topics they have been dealing with and they have to take a new format as well. So Doug Archer and Jim Otterman and I were discussing the possibility of having more joint sessions between the auditors and the committee members.
My rationale behind this was: You have a great variety of people there and obviously the interests are not going to be all the same. We are looking at approximately 50 delegates or members on the public accounts side, so it is a little difficult to have concurrent sessions. But with closer to 100 people, when you put the two sections together, we felt we might be able to do something with concurrent sessions. This might give us a bit more variety of topics that more members felt were interesting.
This is something I have not talked to Bob Callahan about yet. I mean to speak to him about it, but we thought it would be a good idea if a letter went out over Bob's signature asking the different jurisdictions what they wanted to see in a conference. What are they looking for? I felt we would have the time to get together a very good presentation and a very good conference.
The other thing we talked about, and I do not know and I have not talked to any of the other member jurisdictions about this, is: With the time of restraint, should we be looking at holding the conference every two years? This was coming more from the auditors, I felt, because again they have been going to these conferences longer and they felt that maybe only doing it every two years might be a better idea. But we thought it might be worth while, because of the restraint facing all committees, to discuss it with them or at least raise it. I do not know that this will affect us for hosting 1993, but it could change the way we handle the conference at a later point.
These are some of the things we are looking at and I am hoping that either through a steering committee specifically set up to look at the conference, or through the subcommittee, we meet frequently and start working on this. One of the main things we have to decide soon is where exactly the conference will be held, because booking hotels will be one of the major things. I am hoping to get a few things put together for the committee members and then we can discuss this further.
1030
Mr Tilson: Would these things you are talking about be discussed at a subcommittee as opposed to --
Clerk of the Committee: Whatever the committee prefers. I thought it might be easier initially to start with the subcommittee, to hold it at times outside our regular meetings because we are going to be fairly busy, but we will have to go to the full committee to have it discussed there as well.
Mr Tilson: The second question I have is to Mr McLellan. Is there a paper prepared already that talks about accountability of crown corporations and crown agencies in the province of Ontario, that you know of?
Mr McLellan: I believe I have some literature on crown corporations in Ontario, the issue of accountability.
Mr Tilson: I say that without getting into a debate on Bill 118, of course.
Mr McLellan: I can share with the committee the information I have, some of which was distributed for the conference in Winnipeg. I will look for documentation and background papers on that specific topic. I know research was done about five or six years ago through legislative research on crown corporations and accountability. I have worked on accountability papers. I prepared one last year dealing with public accounts and the audit role and accountability, but not specifically on crown corporations. I will look into that and report back to the committee.
Mr Tilson: I think the committee members who attended the meeting were in agreement that we could make some contribution.
The Acting Chair: Possibly we will go through the subcommittee report now. We met on Thursday, September 26 to discuss the agenda, which you have in front of you. We agreed that the clerk would make arrangements for the committee to visit Bellwood and Donwood in October. The committee also agreed that we would not meet on October 17. The agenda is before you. Are there any comments on the proposed visits and the agenda?
Mr O'Connor: I was just wondering whether or not we confirmed the visit to Donwood as well or if that is still to be confirmed.
Clerk of the Committee: That is still to be confirmed. I have confirmed the one with Bellwood and they are looking forward to seeing us. Of course, members will have seen the letter they sent inviting us.
Mr O'Connor: I think at the subcommittee we had also asked that perhaps, when we have a discussion on the provincial Anti-Drug Secretariat report, there was the possibility of meeting again in this room. Have we checked out whether or not that would be possible?
Clerk of the Committee: I am working on it.
The Acting Chair: Anyone else? I would assume then that you would approve of the next meetings that are scheduled for us. I think at the discussion at the conference in Winnipeg, Dianne Poole, whom I am replacing today, wondered if John Kelly, who spoke to you, would be someone whom we might have appear before the committee at some future date. I am wondering if that is something you might think about.
Ms Haeck: I found his presentation extremely illuminating and I would be very happy if we could have him make a presentation to us. I think we would all find his comments worth while.
Mr O'Connor: With the indulgence of the committee, I was misinformed of the rescheduling of this committee. My notes are on the way down here right now. I was wondering if we could possibly take a 10-minute recess to allow my notes to come, because I think they would be useful with regard to what we have seen in US drug treatment facilities.
The Acting Chair: Is it agreeable to everyone that we have a 10-minute recess?
Mr Tilson: Agreed.
The committee recessed at 1035.
1046
TRIP TO UNITED STATES
The Acting Chair: At this time we will have a discussion on the visit to the US drug and alcohol abuse centres. Mr O'Connor, would you like to start this off?
Mr O'Connor: Just for those who will be watching us but have not been following this, as a result of the Provincial Auditor's annual report we were looking at the cost of OHIP billing for drug treatment facilities in the US. That is something this committee has looked at because of the rising costs. In fact, the costs for this year are estimated, I believe, to be up around the $53-million mark. They are rapidly increasing from a couple of years at around $20 million. It is something this committee found extremely important. We are looking at trying to provide that service in Ontario because it is important to us.
Some general comments: Before we went to the US to look at these treatment facilities, we had quite a few people come in to this committee and make presentations to us. We had Linda Bell from Bellwood Health Services and Garth Martin from the Addiction Research Foundation come before us in June. They mentioned quite a few of their concerns: the lack of servicing versus the lack of funding and how the two run hand-in-hand, the lack of accessibility to programs and, in some cases, US patients not even being able to access their own because of the cost.
We had Dr David Korn from the Donwood Institute come before us and explain some of the programming there. We also had George Mammoliti, who is the parliamentary assistant for the Anti-Drug Secretariat, and Mary Shantz from the Anti-Drug Secretariat come before us and highlight some of what they had seen in their tour of some Ontario facilities early last spring and in the fall of last year. That report is something this committee is waiting on and should receive by the end of the month. We also had the then Deputy Minister of Health, Dr Martin Barkin, come before us and share some of his concerns and views.
I will go into something of what we have seen in some of the facilities and be open to discussing some of it. The first was in Minnesota. We looked at the Hazelden Rehabilitation Center. It was a terrific centre, a non-profit organization. We found in just about all locations we went to that they seemed to take a strong stance in following the big book, the AA principles. It was something that they all had in common. Some of their approaches to it might have been a little bit varied, but they all took a pretty strong stance in that.
The Hazelden Rehabilitation Center was in a rural setting outside Minneapolis. It was very relaxed and it was an open concept. The patients all shared a certain -- not quite a ward, which would not be the appropriate way, but a unit, I guess you would say, and they all worked together at sharing their problems and trying to overcome them. We had some fun when we were delayed at the airport in Detroit by some hours. We were a little bit late in getting around, but we managed.
After we left the Hazelden centre we went to the Fairview Deaconess centre in downtown Minneapolis. One of the things we found there was that they had a little more diverse way of looking at things. They looked at the needs of aboriginal people. They had a special unit there that was geared to taking care of the deaf community. We were told some startling statistics. With people in the deaf community the substance abuse problems are very high, because of the lack of communication abilities with siblings and parents, which was quite eye-opening.
A large focus was on the adolescent centre of it. They put a lot of effort into that and tried to include a different way of planning around it. It seemed very successful. I guess one thing I should mention about our tours is that most people in these facilities, the people with the hands-on training with people or working with people, in many cases had a varying number of recovering alcoholics or addicts in helping, anywhere from 50% to 70%. In dealing with some of those instances it was very important that they tried to bring people on side who perhaps even knew in more detail some of the problems that people have to go through in trying to recover from a substance abuse problem, whether it be alcohol or drugs.
I think the average age in Fairview Deaconess was around 17. It is actually downtown, right in a hospital. They had access to any type of facility they needed as far as medical treatment was concerned, so it was very good in that relationship. I believe they had some tutoring facilities there, if there needed to be any tutoring of the patients while they were there. They also had a native advisory board there so that in dealing with substance abuse problems with the native culture they could deal with the special needs the native community has culturally. They have -- I could use a little help here -- the longhouse and the smoke pipe, different things that are unique to their culture. They made sure that was available there for them, so that they could --
The Acting Chair: If I might interrupt, concern with their spirituality was certainly stressed throughout.
Mr O'Connor: Yes, and I guess they could approach that through the advisory board. That was very important. Perhaps when we are looking at some of the issues in Ontario where there is a strong native component, if that needs to be looked at, then perhaps we should look at that as well. Right now I believe that a large majority of the native community in Ontario are in urban settings. I believe we have quite a few friendship centres right here in Toronto. So it is something we could look at as well when we are looking at that side.
From there we went to Illinois, to the Parkside Lutheran Hospital. Again, it was in Chicago, in the centre of town. They had a very good facility. As the patients were coming in they did two types of reviews. They did a medical review and a psychiatric review profile so that they were able to look at all the needs of the patient, try to get a broader overview, perspective, of the needs of the patient. So it was really good. Again, a non-profit centre in a hospital setting.
The hospital itself was designed exclusively to take care of substance abuse problems. On the adjacent property there was a medical hospital. Their costs were not quite as high as being in a general hospital, so they were able to be somewhat competitive because they did not have to provide all the services; all the services were readily available just across the parking lot, I guess you could say.
Mr Tilson: What was the name of that?
Mr O'Connor: That one was the Parkside Lutheran Hospital, in Park Ridge, Illinois, which is Chicago.
In the hospital settings there is more, I guess you could say, influence from the nursing aspect of it, taking a look at all the needs of different patients. I believe it was Parkside that also had looked at methadone treatments, looked at the multiple problems that different clients would have there, people who were bulimic and anorexic, so that they could tie all the treatments together. They had dietitians there to take a look at those special needs as well. I think each facility had a highlight that needed to be looked at, and that was probably one of the highlights of that committee, some of the eating disorders that compound the problems.
They also tried to treat the primary problem, solve the addiction problem, and then parallel that with some of the other disorders -- eating disorders, for example. Of course, the key was looking at the main addiction problem, the reason the patient was there to begin with. In every facility we went to there was a great deal of staff support. They were very supportive of all aspects of the patient's needs and a lot of recovering addicts were involved in the process.
From there we went to Dublin, New Hampshire, the Beech Hill Hospital. The Beech Hill facility was more of a rural setting, a little bit different than the strict hospital setting, though it was very well laid out. Again it was based on a mix of patient needs, a team approach to meeting the needs of the patient. It was a modern facility, it was fairly new, it had quite a nice setting for some of the special needs. They had a terrific lake just out front.
It almost seemed too nice as far as trying to take care of the needs, but they also pointed out in dealing with substance abuse problems -- for example, I think crack was one of the ones they mentioned there, cocaine -- the need for a special physical way of relieving some of the stress addicts had. They had a very good mix in trying to deal with the needs of recovering addicts from whatever different area. They dealt with quite a few youths and trying to solve the problems of youth.
From there we went to Spofford Hall in New Hampshire. That was one of the for-profit facilities. It again was an excellent facility, as all of them were. Spofford Hall, I suppose, was one of the more resorty of the bunch.
1100
Beech Hill was a hospital, and it reflected a hospital setting very much. The nursing staff seemed very proactive in trying to fill all the needs of the patients. Again, they had a terrific program for follow-up. They reached into Canada with their follow-up and seemed probably about the best for follow-up in Canada. Beech Hill was outside a small town, very much a hospital setting, but there was a communal approach to a lot of it, as for most of them. It has been around for a number of years, well established, and the follow-up was the most impressive I had seen during the tour. I am sure most committee members would likely agree with me on that.
Spofford Hall was a very new facility. It seemed to meet all the needs of the patients. Extra stress was put on the needs of the patients through the exercise of addicts of chemical dependencies, so that they could try to ease some of that tension. Probably more was put on that effort than in any other facility. They had a swimming pool, they had weight rooms, as quite a few did, but their gym had more equipment. How it was used, I suppose, depended on all the programming.
We have received reports on some of the programming and I guess we will look into that a little bit further and make our comparisons, as we later travel through some of the ones close to the Legislature here -- Bellwood Health Services Inc and the Donwood Institute.
I will leave it at that, unless there are questions, or other members want to share anything I have neglected to say. I think it was very worth while. We had a terrific eye-opener. Because we were travelling together from our sleeping accommodations to the facility, we had a chance to ask each other different things we would like to see before we got to the facility. When we were leaving the facility we also had a chance to talk about what we had seen. That really worked out well. It was like having a subcommittee meeting after every visit. I hope that when we tour the Ontario facilities we make an attempt to travel all together so we can share our thoughts, because I think that was really informative. We probably got a lot more out of it because we had an opportunity to review as we were travelling, while things were fresh in our minds.
The Acting Chair: What you are saying then is that the Yukon model is maybe a good one and that we should incorporate that more.
Mr O'Connor: I will leave it at that. Maybe Ellen has got more to add to it.
Mrs MacKinnon: One thing I think bears noting is that every place we visited had the highest praise for Ontario and the facilities it has and the treatment it gives. Ontario got high praise for what we have. It appears to me that perhaps what we need to do here in Ontario -- and this is just my own personal assumption, I am not taking anything from the committee -- is to expand on what we have. We -- I at any rate -- have neglected to look into what we really do have. We have it, but I think we are not using it all.
I do not know whether Mr O'Connor spoke about it, but I was impressed by the way every facility does a full assessment of each and every client-patient. This full assessment can take, if I remember correctly, upwards of a week. That impressed me, because I do not think you are going to treat anybody properly if you do not do that full assessment -- physical, mental, healthwise, every aspect of the human body.
Cross-addiction is quite prevalent. I was absolutely amazed at how much cross-addiction there really is. That was news to me. The other thing I found rather astonishing was how many airline pilots are clients, patients at these various places. I was just amazed. However, the Air Line Pilots Association is commended --
Mr Tilson: You know you are talking to people here who are afraid of flying.
Mrs MacKinnon: Sorry. But there is a positive side to this in that the Air Line Pilots Association has a great program in place whereby those people can get their treatment and they do not have to wait around. As a matter of fact, it sounded to me like management takes the lead and says, "You've got a problem. You go or you don't have a job." I think they get quite strong on that.
I am very pleased I went. I am not going to be a cry-baby, but I am going to tell you, it was gruelling. If you want a boss, you want to have Franco around. My word, he just really keeps you going, and when things do not go right, Franco straightens them out, trust me. But I enjoyed it and I really am glad I had the opportunity to go. I look forward to seeing the Ontario facilities, I really do. But it is a pretty sad note on our society, it really is, to see 13-year-olds being treated and babies being brought into the world already addicted. It is really sad.
Mr O'Connor: I guess there are a couple of things I should add. There was some concern raised when we were at one of the facilities. One of the presenters had mentioned that the addicts they get from Ontario seemed to be worse than addicts they see from the United States. But of course he went on to clarify that by saying that people with addiction problems whom we do send down there are in some of the later stages of addiction and definitely need an in-house sort of treatment. So out-patient treatment perhaps is not the best for these people.
We are getting probably the best value we could by sending these people down there. The assessments were proper and they concurred that our assessments up here to begin with, the initial assessments, were actually right on the mark and these people did receive the treatment necessary.
Another thing that was quite impressive was the different ways, as Ellen MacKinnon has mentioned, of assessment there, the group assessment, and utilizing all the possible people they could in trying to come up with a team approach to this group assessment. Beech Hill was probably the most impressive as far as that goes, because they utilized the nursing staff to the greatest extent and were very proactive. The nurses on the different wards taking care of the needs of the patients shared the shift-work approach to taking a look at the needs. There was always somebody there and they were very proactive to the needs, as opposed to reactive and trying to put out a fire after the fact. I was quite impressed with that.
The Acting Chair: I would not mind adding, it would seem that if a patient comes back again, they really look very carefully as to whether they can even help. It seemed to me they were not continuing to bring patients back, and I think that is what a lot of people in Ontario were afraid of: just wasting our money and continuing to milk the system for all it was worth.
At the facilities we saw they tried to assess how long it would be; that was the length of time and they did not seem to want to prolong it. Certainly it would seem a fairly expensive treatment, but then, how can you put a value on this? I agree with you, all of the facilities, while each had its little individual traits, were really very caring and wanted to help solve the problem. I think it was really good that they had the medical experts there, too, because so often there are medical problems with prolonged substance or alcoholic abuse.
The waiting lists, I do not think you mentioned that, are our problem here. Maybe that is something we would want to look at: why we have such waiting lists here and how we can best attack that part of the problem.
Another thing I was really impressed with was the aftercare. You mentioned Beech Hill, and I believe there are six aftercare facilities here in Ontario related to Beech Hill. They really do everything they can to track the patients afterwards to make sure they are remaining on track.
I am really looking forward to visiting Bellwood and Donwood. I do not know what their facilities are and it is really unfair at this point to even comment on our facilities here in Ontario. I am looking forward to those visits so that we can really do something positive to make our system better, because obviously it would be far better if we could treat them here.
1110
Mr White: Thank you, Mrs Fawcett. I am in receipt of a report from Mr McLellan about the waiting-list issue. Is that correct, Mr McLellan?
Mr McLellan: Yes.
Mr White: I am wondering if it is within this committee's mandate to consider that kind of report in regard to these centres at the end of our deliberations and to make recommendations from that and from our understanding of the situation, because, as I understand from some of the variables which were mentioned by Mr Lurie, it may well be possible for us to contain within Ontario the need for residential treatment facilities for adult substance abusers. If that is the case, we may be making substantial savings to the provincial Treasury and of course offering service here in Ontario which is more affordable and probably better than it is elsewhere.
The Acting Chair: I do not know about the "better," whether I could agree with you there. I have to wait to see what we have here, but certainly I agree that it would be far better to treat them, and maybe with the money that is not going to the US we could treat more here and so really address the problem that way.
Mr White: Perhaps that is our Canadian modesty, but certainly my experience from American facilities is that while there are some which are, as Mr O'Connor was suggesting, really top of the line, for the most part I think our facilities here in Canada, within this area and certainly in a whole range of mental health and other kinds of health facilities, are top of the mark overall.
The Acting Chair: Definitely. We just need more of them, so that we can help more people.
Mr White: Indeed.
Mr O'Connor: To say exactly where we are now, as far as the Ministry of Health goes, there was an announcement about a week and a half ago, on the 25th I believe. There was increased spending put into the coffers of the Addiction Research Foundation to develop a registry, and also more money put into assessment and referral centres which included increasing the staff to take a look at some of the needs. I think that was around $3 million.
Detoxification centres: there was more money allocated for them to take a look at some of those needs. The mixture of residential and non-residential was also addressed. That is something we have to take a look at because right now in the province there are about 20,000 patients being treated, and of course what we have going to the US is the overflow from this.
So maybe we can take a look at the increased spending in that direction and assess whether there should be a little more money or whether the money is actually going in the right direction. Perhaps a person to review that with us might be George Mammoliti, the parliamentary assistant for the Anti-Drug Secretariat, when he brings his report to us, because he will have a better grasp on exactly whether that is addressing the Ontario need as it exists today.
The Acting Chair: Right, and stressing the aftercare. I did not hear that when the minister made the announcement; maybe it is there, but that is something I really feel is absolutely necessary, because we know that with addiction it is so easy to fall back unless they have those support systems.
Mr O'Connor: When we were at Beech Hill Hospital, I believe it was, they mentioned the bell-curve approach to treatment and that perhaps we spend a bit too much time trying to assess people, and the in-house treatment is too quick, and then they are back out without having long term follow-up, and that is the approach we should be taking: the follow-up, the aftercare. Maybe what we need to do is look at reversing some of that and increasing the access and everything else, but making sure that the aftercare does take place, as you mentioned.
The Acting Chair: Right, and the waiting list. Obviously you cannot wait. With some other diseases or physical disabilities maybe there is a waiting time, but with drug and alcohol abuse, it is something that needs to be addressed as soon as possible.
I think it was a very beneficial trip. I would just like to say thank you to all the people here who went with us and organized our trip because we did learn a lot.
Mr White: Indeed.
Mr O'Connor: Perhaps we should in fairness ask our researcher, who is with us and took copious notes as we were travelling --
The Acting Chair: That is true.
Mr O'Connor: -- to add anything I have overlooked that should be mentioned at this time. I know there was discussion around the not-for-profit and non-profit aspect of it, but there could be other things that have been overlooked in this brief summary we have given this morning.
Mr McLellan: I would like to point out as well that we are at a middle point in this investigation. We have not prepared an interim report for release, so this is still very much in the preliminary stages. As Mr O'Connor pointed out, the announcement of September 25 pointed to four areas that the committee expressed concerned about in the United States. The registry system will address the waiting list and also the assessment referral and detoxification centres, as well as the new programs. That was subsequent to our trip to the United States.
I think the committee's work has dovetailed very nicely with previous work. Mr O'Connor referred to the report and that research is under way with Mr Mammoliti's group. Back in 1985 the Addiction Research Foundation released a report entitled Alcohol Treatment in the United States: a Review of Selected Programs. I had a chance, following our trip to the United States, to go back and look over the recommendations and conclusions of that report of some six years ago. It seems that a lot of our findings dovetail and, as I say, are reinforced by what was found in 1985. So I think we have certainly covered the main points, and our selection of institutions by the clerk has been effectively dealt with.
As we noted, for example, in the United States they have a strong focus on the Alcoholics Anonymous approach. They stress aftercare, as the Chair has said. They have a strong marketing force in the United States, which we acknowledged when we were down there. The question of accessibility some six years ago was also a factor in patients going down there from Ontario. The US and Ontario treatment methods are similar in many respects. They seem to use fewer professionals in the United States and more paraprofessionals than is the case in Canada. That was noted by the deputy minister when he was before this committee back in June. Also in the United States, I think the committee noted, there is a very heavy stress on residential treatment as opposed to non-residential. I think the non-residential is an option the committee has discussed with the Ministry of Health.
The anti-drug strategy: I had a chance to go back through its report of 1990 and again to look at its 30 recommendations. There were many points this committee considered in its trips to the United States. I will not run through those now, but some of those we will have a chance to look at as we consider our report. One of them the committee has been concerned about and that is the involvement of professionals and institutions with people in the prison system. But, as I say, we will have a chance to go through and look at those reports.
I think, in the committee's initial discussion and review session back in August, there were four or five main themes we raised that were of concern to us: (1) the inmate rehabilitation program; (2) the inpatient/outpatient treatment, those options and the whole issue of cost-effectiveness in that regard; (3) the adequacy of substance abuse facilities and in what way the committee could make recommendations or consider options to provide additional services in the most economical way; and (4) the question of substance abuse training for counsellors and professionals, not just in those institutions and facilities, but also in the police force for teachers and guidance counsellors.
1120
Mr O'Connor has done a very good job of going through the summary of the five facilities visited. From my summary notes, areas the committee may want to look at again in preparing its report might be the desired effectiveness of new programs for adolescents, women, multicultural and native groups and the university community as well.
The committee may want to consider the profile of Ontario patients, which has been touched on this morning, the issue of the correctional system and how effective programs are in dealing with people in the correctional system in Ontario, and the issue of waiting lists, which Mr O'Connor has touched on briefly. Some of these have also been dealt with in the September 25 announcement by the ministry.
The chair has touched on the question of aftercare systems, the cost of US programs versus the cost of Ontario programs, and the referral process and how effective that is within industry. We have requested information on the dialogue with industry and business and that will be coming to the committee for consideration. Other issues are innovative treatment technology, a point raised by Mr O'Connor; the educational preventative programs for substance abuse; home care as an alternative; facility design, a point raised at the Hazelden centre; counsellor training; and outpatient adolescent treatment programs, which we discussed at Fairview Deaconess.
Those are just some of the themes that came out of the discussions and out of my notes. They reinforce and stand behind some of the comments of the members this morning.
Mr Tilson: When we first look at this issue we are concerned with some of the promotional activities of some American institutions in trying to get citizens from Ontario to attend these institutions. This whole subject, which both Mr O'Connor and Mr McLellan have dealt with, needs follow-up. Were you able to have any candid discussions with individuals who worked at any of these institutions? I am sure the formal presentations were all very informative, but it would be useful to know whether these institutions send people to Ontario to encourage individuals to come on down to Spofford Hall and spend a few weeks. Those are the sort of almost scandalous remarks that we have heard, that the press has talked about. Were you able to determine whether that does exist?
The Acting Chair: I would think it does exist, but certainly at the facilities we visited I did not get the impression that it happens. They spoke of other facilities that certainly do that, and they made very disparaging remarks about those kinds of facilities. But, Mr O'Connor, maybe you would like to say something too.
Mr O'Connor: There was a formal presentation in every facility we went to. We also had a chance to tour the facilities. Of course, anonymity of the patients there had to be respected -- we could not very well intrude on their rights and their privacy. But in most cases we broke up into smaller groups as we were touring so that we could ask individual people who made the presentation about different aspects of the treatment. In smaller groups we were allowed to ask a little more candid questions and a lot of that was shared after the fact in our subcommittee meeting or caucus meeting -- you would almost say a non-partisan caucus meeting. It was refreshing.
Each facility had varying degrees of support for the AA principles. Some had a lot more meetings in-house. Some had a much better developed network for the patients who returned to Ontario to make sure they got out to the meetings they need, and the support network was there. Again, Beech Hill strikes me as one of the finer ones, because one of the things that struck me there was a new program that we had not even heard about. In the AA programs, Alcoholics Anonymous is the biggest part, and in the supporting aspects there is Alanon for the spouses and Alateen, but Alatot was something new that was mentioned there, and I thought that is a terrific thing, trying to deal with the whole recovery program -- and of course, the statistics of alcoholic parents and the next generation being alcoholics. I think this is something new. They worked through some of the day cares and early school programs, and it worked really quite well. It was something new to me. I had not heard of it before and I was impressed by the progressiveness of it. I had not heard about that in Ontario.
The Acting Chair: But they seem to have their connections here in Ontario whom they would check with and make sure that the patient was dealing with the Ontario-type groups, rather than, let's say, bringing them back to the United States.
Mr Tilson: Did you get into any discussions as to how people from Ontario came to find these places?
The Acting Chair: Through their own physicians in some cases.
Mr Tilson: What was the referral process? Doctors would refer people to these institutions.
The Acting Chair: Yes. Ellen?
Mrs MacKinnon: I think it is perhaps noteworthy -- I am not too sure which one it was; it was the one where they had the longest hill in the world. They have an office in Ottawa whereby people from here could make that contact out of sheer desperation. There is no place here, they are in very bad straits, and through the gentleman who runs the office in Ottawa they go down there.
You could go to Timbuktu. If you are going to get treated, best you get treated rather than be a calamity on society. Although I would like to see us doing it here in Ontario, I am thankful there is a connection in Ontario, that they can indeed get there, albeit they may be very desperate by the time they arrive there. But I also had the impression from some people I spoke to that the American population is not neglected at the expense of Ontario patients. Am I correct? I think their own clients perhaps come first.
The Acting Chair: To me there just are not any waiting lists there.
Mrs MacKinnon: No, there are not, are there? But their facilities are quite huge too.
The Acting Chair: People who want to go seem to be able to be taken in and then there are still opportunities for Canadians --
Mrs MacKinnon: I think perhaps there was in some of them -- not all of them, but I felt that in some of the facilities we visited -- there was just a tiny bit of apprehension that just maybe they will lose a few clients, not ones they have already but maybe we would not be sending as many down. They might be looking well to their own facilities and how they are going to handle it in order to keep themselves viable. I could have had that wrong impression, but there were a couple of times that came through pretty loud and clear to me.
Mr O'Connor: The facility you mention was the Beech Hill facility, the one at the top of the hill. That was probably most evident, as subtle as it was, in the one that was for profit. In most cases, though, I felt the staff were really concerned about serving the clients and, in fact, if it was possible to set it up in Ontario they were more than willing. I believe it was Fairview Deaconess that volunteered to offer their services in any way they possibly could to provide the information necessary. But Fairview went right out of their way to make sure that we would follow up. I believe they had a network that reached up into Ontario as far away as Ottawa.
The Acting Chair: Was it not at Hazelden where they even had a Canadian taking courses? They offer courses on how to deal with it.
Mrs MacKinnon: That is the gentleman I was referring to.
The Acting Chair: They offer the courses to Canadians so that we can come back up here and set up a good program. There seemed to be a sharing back and forth in the facilities that we visited.
1130
Mrs MacKinnon: But in all fairness to Mr Tilson's question, I do not believe the particular facilities we visited were aggressively seeking clients in Ontario. I do not think that was happening. It was more or less because of reputation, perhaps availability, but I do not think they had to go out and aggressively advertise or anything, I do not believe it was necessary. I do not think they were having a problem keeping their establishments full at all.
The Acting Chair: Is there anything anyone has to add? Then we will look forward to next week's visit. The clerk will be making contact with our offices to make sure we all can get out to Bellwood and make all those arrangements. I believe around 8:30 is the time we will leave, so if that is all, we will declare this meeting adjourned until next Thursday at 8:30.
The committee adjourned at 1131.