Wednesday 13 October 1993

Owen Sound Little Theatre Act, 1993, Bill Pr35, Mr Murdoch

David Johnson, MPP

Isabel Draper, secretary, Owen Sound Little Theatre

Ruth Gorbet, president, Owen Sound Little Theatre

Cambroco Ventures Inc. Act, 1993, Bill Pr47, Mr Ruprecht

Tony Ruprecht, MPP

John F. Campbell, president, Cambroco Ventures Inc

Bill Bassett, accountant, Cambroco Ventures Inc

Association of Hearing Instrument Practitioners of Ontario Act, 1993, Bill Pr49, Mr Owens

Gordon Mills, MPP

Linda Bohnen, solicitor, Association of Hearing Instrument Practitioners of Ontario

William Hogle, executive director, Ontario Association of Speech-Language Pathologists and Audiologists

Richard Steinecke, legal counsel, Ontario Association of Speech-Language Pathologists and Audiologists

Alan Cheverie, chair, transitional council, College of Speech-Language Pathologists and Audiologists

of Ontario

John Ford, past president, Ontario chapter, Canadian Hard of Hearing Association


*Chair / Présidente: Haeck, Christel (St Catharines-Brock ND)

Vice-Chair / Vice-Présidente: MacKinnon, Ellen (Lambton ND)

*Eddy, Ron (Brant-Haldimand L)

*Fletcher, Derek (Guelph ND)

*Hansen, Ron (Lincoln ND)

*Hayes, Pat (Essex-Kent ND)

*Johnson, David (Don Mills PC)

Jordan, Leo (Lanark-Renfrew PC)

*Mills, Gordon (Durham East/-Est ND)

*O'Neil, Hugh P. (Quinte L)

*Perruzza, Anthony (Downsview ND)

*Ruprecht, Tony (Parkdale L)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Wilson, Gary (Kingston and The Islands/Kingston et Les Îles ND) for Mrs MacKinnon

Also taking part / Autres participants et participantes:

Burrows, Alan, director, professional relations branch, Ministry of Health

Hayes, Pat, parliamentary assistant to the Minister of Municipal Affairs

Clerk / Greffière: Grannum, Tonia

Staff / Personnel: Klein, Susan A., legislative counsel

The committee met at 1004 in committee room 1.

The Chair (Ms Christel Haeck): I call the meeting to order. Welcome back to all. It's been some months since we've had a chance to get together in this forum. Members of the committee, I'd like to advise you that you have a revised agenda. Have you found it?


Consideration of Bill Pr35, An Act to revive Owen Sound Little Theatre.

The Chair: I would like to call forward Mr Johnson, who will present, on behalf of Mr Murdoch, our first bill, which is Pr35, An Act to revive Owen Sound Little Theatre, if you would like to undertake that, Mr Johnson.

Mr David Johnson (Don Mills): It's been such a long time since we've had one of these meetings that I forget the exact routine, but this is special legislation to revive the Owen Sound Little Theatre. The applicant, who in this case is Isabel Draper, the secretary of the theatre, represents that she is the director of the ongoing organization and carried on in the name of the corporation.

The corporation was dissolved back on July 17, 1979, for default in complying with the Corporations Information Act, but the applicant represents that the default was inadvertent and that activities have been carried on in the name of the corporation despite the dissolution.

The applicant is here. You'll see she's before us, Isabel Draper, the secretary of the theatre. She's accompanied by the president, Ruth Gorbet. Their chauffeur is here as well, Norman Gorbet, but he hasn't chosen to join them.

The Chair: Very good, Mr Johnson. I thank you, ladies, for making the trek down to present this bill to us. At this point, if you have any comments to make, this is your opportunity.

Ms Isabel Draper: Owen Sound Little Theatre is a very active group. It was unknown to our group until a year ago that we had been dissolved. We were operating as though we were a full corporation, so as secretary, I took steps to revive us.

We are a totally volunteer group. Every year our executive changes, and that is the reason we did not file forms that were supposed to have been filed. We have now taken upon ourselves to have a proper manual printed up so that our secretaries and our treasurers to come have a guideline to follow so it will never happen again.

The Chair: Very good. At this point, I ask if there are any other parties who have any comment to make on this revival. Seeing none, are there any questions on behalf of the members present?

Mr Ron Hansen (Lincoln): I would say this is just straightforward. It's an oversight of the theatre. I don't have a problem and I don't think any of the members on the government side have a problem with this piece of legislation.

The Chair: Any comments from this side? Mr Hayes, as the parliamentary assistant, are there any comments that you would like to make at this point?

Mr Pat Hayes (Essex-Kent): The Ministry of Municipal Affairs does not have any objections to Bill Pr35 and we'll support it.

The Chair: Very good. It would appear that we are prepared to vote. Let me ask the question: Are the members ready to vote?

Interjections: Yes.

The Chair: Shall sections 1 through 3 carry? Carried.

Shall the preamble carry? Carried.

Shall the title carry? Carried.

Shall the bill carry? Carried.

Shall I report the bill to the House? Agreed.

Mr David Johnson: This is a charity. We're aware that money is in short supply and they're doing an excellent job. I would move that the fees and the cost of printing be waived in this matter.

The Chair: Are the other members in accordance with that? Agreed. That is then carried.

Ladies, I would say that it was a productive morning, and thank you for coming.

Ms Draper: I thank you very much for your time.

Ms Ruth Gorbet: When you're in Owen Sound, come and see us in our new theatre.

Ms Draper: We are in rehearsal for "Lend Me a Tenor," which takes place in November. Then we have another production in the spring called, "A Life." In between, we are doing one-act plays, because our theatre is under renovation and we have our hands full doing that.

Mr Derek Fletcher (Guelph): Good luck.


Consideration of Bill Pr47, An Act to revive Cambroco Ventures Inc.

The Chair: We will call, as the next order of business, Bill Pr47, An Act to revive Cambroco Ventures Inc. I believe, Mr Ruprecht, you are the sponsor, if you would like to bring forward the applicants.

Mr Tony Ruprecht (Parkdale): I'm happy to support An Act to revive Cambroco Ventures Inc. With us is Mr John Campbell, and Mr Bill Bassett, who is the accountant.

John Campbell has applied for special legislation to revive Cambroco Ventures Inc. This application represents that he was a director and shareholder of the corporation when it was dissolved. The corporation was dissolved on September 8, 1986, for failure to comply with the Corporations Act. The applicant represents that he did not receive the notice of default and that business has been carried on in the name of the corporation despite the dissolution. I'm here to support this bill and make this introduction.


The Chair: I would like to turn to the applicants at this point, if they would like to make any comments with regard to the bill that is before us.

Mr John F. Campbell: I really haven't any comments to add.

Mr Hugh O'Neil (Quinte): I just wondered, what does the company deal in? What is it, a property company or --

Mr Campbell: Originally it was put together as an investment vehicle. I was involved in the purchase of a farm property at that time and I had plans to develop that property.

Mr O'Neil: So the property is still owned by this particular company.

Mr Campbell: Yes.

Mr O'Neil: That's the reason you've asked for it to be --

Mr Campbell: Yes, right, with hopes to develop it further.

The Chair: Any further questions, Mr O'Neil? Are there any other questions on behalf of the members at this point?

Mr Ron Eddy (Brant-Haldimand): It's not really a question, but Mr Ruprecht has assured me that this is in order and I am pleased to see that he has sponsored it and I agree with it.

The Chair: I do have to ask if there are any other interested parties who are present who would like to make a representation at this time.

Mr Hansen: There seems to be a letter of objection in here. I would like to hear from legal counsel our position on passing this particular bill. We've run into similar situations in the past, and I believe that we're not judges on letters that come in to the point where there's a lawsuit or legal proceedings involved.

Ms Susan Klein: I think in the past when there have been legal proceedings involved, this committee has ignored that fact in deciding whether to revive a corporation. Any questions between the parties should be resolved in a legal proceeding in a court where they can assess credibility and issues of evidence. The committee has never found that revival has any effect on -- I shouldn't say has never found that it has any effect. It looks to whether revival has any effect on the legal proceedings.

Mr Hansen: I just wanted that answered by legal counsel, since the objector's not here and the letter was raised.

The Chair: Is Catherine Mak here?

Mr Bill Bassett: No.

The Chair: Okay. We have her correspondence enclosed. Have you all had a chance to peruse it?

Mr Eddy: There's also a letter, I notice, from the Ministry of Revenue at the bottom.

Mr Bassett: I'd like to answer.

The Chair: Yes, sir?

Mr Bassett: I was retained. My name is Bill Bassett. We did notify Miss Catherine Mak. Officially, she was taking it because there was no official form 1 ever tabled since 1982. We did send her a letter and it was returned to sender. She gave an address but apparently she's no longer living there.

Mr Campbell is the majority shareholder and always has been president, as set out in the original articles of incorporation. I've personally notified Susan Klein, legislative counsel, and she was satisfied.

The Chair: For members, I hope you've found the Ministry of Revenue letter which is dated July 30. It says, "Pursuant to my memorandum of July 16, the Ministry of Finance/Revenue has now been advised of the corporations branch," etc "and the ministry therefore has no objection to the revival of the corporation." I don't believe there's someone else here from the Ministry of Revenue.

Are there are any further questions relating to this particular bill? Are the members ready to vote? Shall sections 1 through 3 carry? Carried.

Shall the preamble carry? Carried.

Shall the title carry? Carried.

Shall the bill carry? Carried.

Mr Hayes: I have no objections.

The Chair: I'm sorry. I didn't allow the parliamentary assistant his rightful place in this. Mr Hayes, do you have any -- sorry. Anyway, shall I report the bill to the House? Agreed.

Thank you very much, and thank you, Mr Campbell and Mr Bassett.

The next order of business is Bill Pr49, An Act respecting the Association of Hearing Instrument Practitioners of Ontario.

Mr Hansen: Madam Chair, just before we go on, maybe it's a technical point, but in the first one we had, Bill Pr35, did we pass the preamble to be carried?

The Chair: Yes, I did.

Mr Hansen: Okay. Maybe it was just a different order you went in.

The Chair: No, no, maybe I moved along a little faster. I'm not sure if I definitely -- for those who wonder, I do have a cheat sheet that I do try to read, so we try to get through them all.


Consideration of Bill Pr49, An Act respecting the Association of Hearing Instrument Practitioners of Ontario.

The Chair: Is Mr Owens here as sponsor of the bill? All right, Mr Mills, you will act as the sponsor?

Mr Gordon Mills (Durham East): Thank you, Madam Chair. On behalf of Mr Owens, I'd like to introduce Bill Pr49, An Act respecting the Association of Hearing Instrument Practitioners of Ontario. I believe Linda Bohnen, who is the solicitor, is here, and Alan Burrows, the director of professional relations branch, Ministry of Health. Is that gentlemen here? Yes? We might hear from him later. There are some other legal counsel we should call upon as this bill unfolds, Madam Chair.

The Chair: Thank you very much. Nice to see you again, Linda. Would you like to introduce the two ladies you have with you.

Ms Linda Bohnen: Yes, I will. To my left is Christine Helik, who is the president of the Association of Hearing Instrument Practitioners of Ontario, and to my right is Joanne Sproule, who is the executive director of the association.

The Chair: Would you like to begin your presentation?

Ms Bohnen: Yes. Thank you very much, Madam Chair, ladies and gentlemen. I'd like to begin by telling you something about the association, then move on to why we believe this bill is necessary and in the public interest, tell you a few things the bill does not do and what the benefits to consumers will be from enactment of this bill.

First of all, the association is a voluntary professional association. It was incorporated some years ago as a non-share capital corporation under the Ontario Corporations Act. Unlike the two private bills you considered previously this morning, this bill has nothing to do with the corporate status, existence or objects of the association.

These objects, which are set out in the bill as well as in the corporate charter, include promoting the welfare of the hearing-impaired of Ontario, establishing and maintaining standards of education in conducting hearing tests and selecting and fitting hearing aids and sponsoring a code of ethics and improving the business standards of members of the profession.

The association represents about 85% of practitioners in Ontario, and these practitioners are directly involved in the sale of hearing aids to hearing-impaired consumers in Ontario. There are two subgroups within the profession. One, the hearing aid dispenser, as you would expect from the name, is involved in actually fitting and dispensing a hearing aid to an individual consumer. A hearing aid specialist is involved in performing a hearing test on the prescription of a physician and in helping to select a hearing aid, again on the prescription of a physician.


Why is this bill necessary? As I've already told you, it is not necessary to create or to continue this corporation. However, practitioners who belong to the association are not regulated in Ontario, which makes this province only one of two in Canada which do not regulate hearing instrument practitioners.

Hearing aid services in this province are provided by three groups of practitioners, this being the only one which is not regulated. The other practitioners are physicians, who diagnose diseases and disorders that cause hearing loss and may prescribe hearing aids, and audiologists, who assess auditory function and also may prescribe hearing aids, and they will become regulated later on this year with proclamation of the Regulated Health Professions Amendment Act and the Audiology and Speech-Language Pathology Act.

Hearing aid specialists, who perform the tests and select hearing aids, and hearing instrument dealers, who fit hearing aids and sell them to consumers, are not regulated in Ontario. Hence, the professional association is the only vehicle available to consumers to try to enhance the protection of the public from less-than-desirable business practices and unskilled practice in the delivery of direct hearing aid services to the public.

The association has found in its experience that without the restricted designations that are contained in this bill, it is difficult to do its job. That's because it has little clout to prevent a member of the association who misbehaves and who becomes subject to an ethics or grievance procedure from simply dropping out of the association and carrying on as before. It is sometimes also difficult to explain to practitioners the benefits of belonging to the association if their less than perfectly ethical colleagues can continue on as before without belonging to the association.

This association, like many others in this province, is seeking private legislation in order to be able to give the benefit of restricted use of a designation to its members. There's nothing particularly novel about this in Ontario; for example, I did a quick search yesterday and came across certified engineering technicians and technologists, who have private legislation, chartered industrial designers, certified translators, certified court interpreters etc.

I'd like to also point out, anticipating one of the objections you'll be hearing later on this morning, that private legislation which does confer the exclusive right to use a designation exists in other statutes in a regulated as well as unregulated environment. For example, the certified engineering technicians and technologists coexist with professional engineers, who are regulated under public legislation. The court translators and interpreters, who have this designation protection under private legislation, coexist with lawyers and other legal practitioners who are regulated under public legislation. So there's nothing particularly new or innovative with this particular bill.

Again, the content of the bill itself, I'd have to say, is not particularly innovative or extraordinary; it was based on other private legislation such as the ones I've just mentioned to you, where membership in the association confers the right to use a special designation.

What then does the bill not do? I think this goes to the heart of some of the objections you'll be hearing. First, as I've already told you, it does not create this association; it does not create new objects; it does not change the objects in any way; it does not change the function of this association.

Secondly, it does not authorize members of the association to do anything they can't already do in their practices. The activities that they perform in conducting tests and fitting and dispensing hearing aids are activities that are not regulated under the Regulated Health Professions Act; they are activities in the public domain. This bill does not change that.

Thirdly, it does not prohibit or restrict anyone else from doing anything other than using one of the designated titles, so that, for example, there is absolutely no impact on the practice of audiologists or physicians, of course, or any other professional in this province. The bill simply does not affect that, nor could it, being private legislation.

What benefits to consumers do we think will come about by virtue of this bill? Members of the association are required to achieve competency standards, including passing an examination set by the Ministry of Health; members must abide by a code of ethics; members are subject to a grievance procedure; members post recommended fee guides in their offices; they are required to issue carefully itemized bills to their customers.

For these reasons it is advantageous to consumers, we believe, to encourage membership in the association and it is similarly advantageous to consumers to help them to differentiate, through the use of designations, between members and non-members. To that end, the association, if this bill is enacted, has plans to increase public awareness of the designations through physicians, who are the gatekeepers to the service provided by hearing instrument practitioners.

Finally, I'd like to point out that, unlike other forms of regulation which are extremely costly to the public purse as well as to members of the profession, in this case all of these consumer benefits are fully borne out of the budget of the association. There is absolutely no public cost to enacting this bill and to granting the right to use these designations.

I'd be happy to answer any questions you may have about the bill. The two representatives of the association can speak better than I can to the nature of the association and the practices of hearing instrument practitioners.

The Chair: I will at this point, knowing that there are some other people in the audience who may wish to make some comments about this bill, ask any of the other interested parties to identify themselves. Linda, if you could possibly, with your group, move back, we could ask the other groups that have an interest in this bill to identify themselves and to come forward, please.

Mr Alan Burrows: As the Chair I think knows, my name is Alan Burrows. I'm the director of professional relations for the Ministry of Health. With me is Bogna Andersson, also on the staff of the professional relations branch of the Ministry of Health. I'm here on behalf of the ministry and the minister to express concerns about this private bill, because in the opinion of the Ministry of Health it has a potential for, at least in a small way, undermining about 11 years of work and legislation that this Legislature has passed and is in the process of getting ready for proclamation in December of this year.

I'd like to make a few comments and then again, if you have some questions, we'd be happy to answer them. As you've heard, the Association of Hearing Instrument Practitioners of Ontario is a voluntary association representing the interests of the profession. As head of a department that deals regularly with the health professions, I think it's safe to say that these professional groups certainly serve a valuable purpose, because if someone isn't going to represent well the interests of individual professionals, who is going to do it? So we're not here to question the validity of the association. In fact, during the long process leading up to the new legislation, the points of view put forward by voluntary associations certainly had a major impact on the outcome of that process.

I'd also like to say that it's certainly not the ministry's opinion that the positions taken by voluntary associations are always opposed to the public interest. Sometimes they are one and the same. In this particular case, we think some aspects of this bill, however, are not in the public interest.

Bill Pr49 would give exclusive right to AHIP to grant, withdraw and withhold the use of the titles "certified hearing instrument specialist" and "certified hearing instrument dispenser." Bill Pr49 would give the association the statutory right to register, discipline and fine up to $10,000 and would provide a statutory right to appeal to the Divisional Court.


You've heard about what Bill Pr49 doesn't do. These are some of the things it would do that concern us.

The model for this statute would be very similar to many elements of the profession-specific statutes under the Regulated Health Professions Act, 1991, which we commonly refer to as RHPA. It's specifically similar to those professions that will not have a controlled act per se. You've heard from the association that they will not have a restricted act in the scheme. However, all professions governed by this legislation will have elements such as title protection and registration, discipline and fines and penalties associated with them.

The Ministry of Health is in the process of enacting this new legislation, the Regulated Health Professions Act, in 21 profession-specific acts. RHPA will regulate 24 professions in Ontario. It's based on the recommendations of the Health Professions Legislation Review and many years of intensive consultation with professional and consumer-interest groups. As a matter of fact, 11 years of work is being concluded this year with a proclamation in December of this package of legislation. I think it's important to recognize the amount of effort that has been put into the development of this legislation and what it really represents.

You heard from the AHIP presenters that there's nothing new here. I certainly agree with that: private bills are not new. However, in the case of health professions regulation, there is something new here, very new. In fact, the Legislature went back and looked at a blank piece of paper, had before it legislation that was the result of six years of independent review of the issue of professional regulation of health professionals in this province. One of the cornerstones of that legislation is the fact that for all health professions, all existing legislation, including private bills, should be scrapped and replaced with a comprehensive system of health professional regulation, the purpose of which would be to protect the public interest.

From the view of the Ministry of Health, the logical position for title protection for any health professional or for systems of discipline and complaints and fines is within the framework of that legislation, not going back in time to recreate a system on which the government has spent several million dollars. I might point out that three governments and nine ministers of Health have supported us getting to this point, and having it come forward at the last minute in this way -- we're not questioning the merits of the arguments of the association, but rather the logic of coming forward at this time in this way to deal with this issue when in fact three governments have supported a complete scrapping of the existing system, including private acts for health professionals to deal with this sort of thing, and coming forward at this time with this particular point of view.

It's also a bit unfortunate, I think, in terms of timing, because the new legislation creates a new body called the Health Professions Regulatory Advisory Council. This is neutral body. It is independent of the health professions and independent of the Ministry of Health and bureaucrats. It's a neutral forum where issues such as this, who should and should not be regulated -- I put to you that title protection is a fundamental element of professional regulation -- can be dealt with in a neutral way and a recommendation made to the Minister of Health, who will be responsible for the administration of this new legislation, to weigh the merits of the arguments and in an unbiased way present the minister and cabinet and the Legislature, if necessary, if legislation results, with an independent point of view on these things.

We don't purport in the Ministry of Health to have the expertise to make decisions with respect to a lot of these arguments. In fact, in many ways, the best points of view come from the professions themselves -- not just the profession that wants to put forward its own self-interest but those other professions that may have an interest in the issue as well -- and last, but far from least, the points of view of the average consumer. This would provide that forum. It will be in place in January 1994.

The RHPA is founded on the concept that those health professionals who require regulation in order to protect the public from harm should be regulated under one umbrella statute so that the public has the same access and rights in dealings with any regulated health professional. An underlying principle of RHPA is to offer the freedom of choice of health care providers within a range of safe options. Therefore, only those health professionals who are regulated under RHPA will have protected titles, to enable the public to distinguish between regulated and unregulated professions. Restrictions on the use of professional titles are the primary method of enabling consumers to make these important decisions, and we don't disagree with what the association has said in that regard.

The question for the committee is, do you have enough objective information to decide whether or not you should give people a monopoly over this title? That's effectively what you'll be conferring if you pass this bill.

Allowing the passage of legislation such as Bill Pr49 or any other legislation -- you've heard that this is not new. We expect that there may be other private associations that will come forward with similar bills. I would put to you: What if this was the Ontario Medical Association that was coming to you and saying, "We don't have a college" -- assume they didn't have a college -- "but we want to protect the title `doctor,' we want a complaints and disciplines mechanism, and we want to be able to fine people," yet there was a College of Nurses of Ontario and there was a Royal College of Dental Surgeons of Ontario and so forth?

I would ask that you look at the issue in that generic sense. What is this really all about? In fact, what is regulation? There is direct regulation, where you have individual statutes, but there's indirect regulation as well. I would put to you that the reason there is a title protection component in each and every single health professions act under the new legislation is because title protection is a fundamental element of regulating health professionals.

Also, it's long-standing government policy that there should be separation of church and state in the regulation of health professionals. Through this bill, you would be conferring upon the association rights that it does not presently have with respect to complaints and discipline, giving it statutory responsibilities. You've heard that they can do many of these things voluntarily, and that's absolutely correct, but you would be giving them statutory authority to do so. In the case of the health professions, it's not like a normal marketplace. People's health is at stake, for one thing. What is the risk of harm? The risk of harm is damage to individuals, so it's very difficult to compare it to, say, many of the other professions, where the outcomes might not be as personal or as severe.

The issue of no public cost is certainly an important one to consider in these times, but if you were to accede to that argument, it is possible that you could see a proliferation of such groups. Would that really be in the public interest? What would be the public cost in the end, down the road, if there were other forms of restricted titles and confusion to consumers? What would be the cost of that? It's hard to predict what it would be, but certainly there would likely be some cost, perhaps of a different sort than monetary, by conferring this kind of protection.

This group of practitioners, by the way, did come forward during the Health Professions Legislation Review process too and did not convince the review team, independent of government, nor did it convince an all-party committee of this Legislature that this profession needed to be regulated.

They're coming forward again, as is their right. Our suggestion within the ministry is that having taken the time and the effort and consumed large amounts of the resources of this Legislature to develop what in fact is a new and innovative system, it would not make sense to necessarily end-run that or circumvent that in any way before the system that the Legislature has put in place is given a chance to work.

With that, I think I'll end my comments. Hopefully it is obvious that the Ministry of Health has a definite point of view here related to a rather sweeping reform of the health professions regulatory system, which finally after many years of work and effort is about to put in place.

The Chair: Before I recognize Mr Mills, I do have a personal comment to make. For those of you who saw me nodding possibly around some of the comments Mr Burrows made, I did have the privilege, along with Ms Bohnen and Mr Burrows, to actually sit on the committee that reviewed the Regulated Health Professions Act, so some of the arguments that are being made I have heard before, and they do sound very familiar. But I will restrict my comments to those which I've just made and recognize Mr Mills with his question.


Mr Mills: Thank you very much, Madam Chair. Usually I speak worse than today, but excuse me.

Mr Eddy: We'll bear with it.

Mr Mills: We'll bear with it. Okay.

Mr Burrows answered one of the questions I was going to ask. I think this committee must really consider that point, that this group went before a legislative committee of all parties and was refused on the basis that the committee discussed. I think we mustn't lose sight of that here. I'm afraid that to me is a very convincing argument, that these folks had the opportunity to appear before the regulated health professions committee and they were turned down not only by the government members but by a committee of members of all parties in the House. I think that is a convincing argument and I am not about to say anything else. Thank you very much, Madam Chair.

Mr Burrows: Just a point of clarification: The association did not seek regulation, in the end, from the review team. They certainly were participants in the review and certainly made a case for regulation. In the end, what they were seeking was a controlled act, which is the only element of health professions that will in fact be restricted turf, if you want to use the vernacular, under the new scheme. I didn't want to misrepresent that.

Mr Eddy: I realize that Mr Burrows's name is listed on the agenda we received this morning, but I do think it's unfortunate that we didn't have the advantage of reading the presentation along with the considerable material that was presented in our packet with this particular application. I don't know why it wasn't, but I think it's only fair to the members, when there is considerable information regarding an application, especially from a ministry, that we have the opportunity to read the cons as well as the pros. I resent the fact that it wasn't with our material, and I think it should have been.

I had a couple of questions. Mr Burrows mentioned in his presentation that the Ministry of Health is in the process of enacting legislation. I think that's a misuse of the word, personally. I don't think a minister or a ministry can enact legislation. That's what I caught, and I'm not sure which item it was.

I'd like to know also: On November 25, 1991, Bill 43, the Regulated Health Professions Act, received royal assent. Why has it taken two years between the time royal assent was received -- the bill was passed by the Legislature in royal assent -- and we're still awaiting proclamation? I think I need to know that. I think it's inordinately long. Why did we go through passing it? Why did it receive royal assent if we weren't proceeding to proclamation? I don't understand that. Maybe there's a valid reason, but it seems a long delay, and perhaps in view of that the applicant has decided to appear before us with the application.

When we say it's near proclamation, I would like to know, because some things that are near, in some people's view, are a decade away -- that's an exaggeration, of course -- what does "near" mean? Does that mean November 25, 1993, or indeed is it next year or the year after? I don't understand it. There may be a lot of reasons.

Thank you for the opportunity to ask questions.

The Chair: Thank you, Mr Eddy. Actually, I can give you a couple of explanations myself, having sat on that committee. One of them was that there were elements of the -- there actually wasn't just one bill. There were in fact about 21 bills that had to be dealt with. That was the range of professions that we dealt with at that time. In fact, there were parts of it that were stood down because of the -- Mr Burrows will probably help me.

Mr Fletcher: On a point of order, Madam Chair: I don't think it's the position of the Chair to be explaining certain situations.

The Chair: Well, I can always turn to Mr Burrows, and I know Mr Burrows will do a very adequate job in explaining that. Mr Burrows, since Mr Fletcher objects to it, why don't you go ahead.

Mr Burrows: Thank you. I'd like to respond to Mr Eddy's comments. With respect to the material, I'd like to clarify that the material we presented to the clerk this morning is not specific to this issue. It's some general information related to the legislation that has been publicly available for quite some time. We just thought it might be useful to you in your considerations. That's a public document and is not specific to the issue before you today. It's background on the Regulated Health Professions Act.

The second thing, if there was a slip of the tongue, is that certainly the Ministry of Health does not enact legislation. The Legislature does that. We are implementing enacted legislation. I may have got a little tongue-tied there and I apologize.

I think the significant question is, why has it taken since November 1991? There are, I think, several valid reasons. One must remember the complexity of the issue. It took the review six years to come up with a basic list of who should and should not be regulated under this scheme and the basic components of the legislative recommendations. It took the Legislature a long time to grapple with the issues, as the Chair said, and it has taken us an equally long time to grapple with a number of the regulatory issues.

Let me explain. First of all, we had to set up an administrative infrastructure. We had to set up the advisory council. That has been done. The advisory council chair was appointed last fall and the other members were appointed at the beginning of this year and they are getting themselves ready for business at proclamation.

We had to set up interim governing bodies for the new health professions, and they had to determine what work had to be done and to develop the necessary core regulations under the legislation.

Thirdly, we had to develop these core regulations in concert with the health professions. To put it in a bit of perspective, there are 800 theoretical regulations under RHPA and in the core there are more than 100, and if you look at the individual clauses within those 100, there are approximately 300 to 400 clauses minimal. In some cases, some of the regulatory proposals have 50 clauses. Each and every word has a policy issue associated with it that we have to work through with the governing bodies of the professions and with consumer groups and other people who wish to comment on these. We also have to develop ministry regulations.

In these times of constraint, there are limited resources. The transitional councils, for example, for the new professions were set up at the absolute minimum bottom-line figure that we could come up with so that they could legitimately function and yet not have any frills. This has meant that the amount of time taken certainly might have been a little bit longer than it would have been if we had been able to provide them with huge amounts of resources. It simply wasn't possible in these times.

Last but not least, it was recognized during the final phases of the passage of the legislation that there was a serious issue dealing with the sexual abuse of patients. Shortly after the passage of the bills, the task force of the College of Physicians and Surgeons' final report on this issue was received. The college had to have time to assess that report and make its recommendations to the government. Once that had occurred, the government decided that rather than proclaim this legislation it would like to amend it before proclamation, if possible, by bringing in other things to strengthen the issue of sexual abuse. That set of amendments, Bill 100, is currently before the Legislature right now. It's going to be heard by standing committee this fall and we expect that it will be dealt with.

Proclamation is intended for December of this year, and we are on target with respect to the development of the core regulations. All the governing bodies had until September to submit their final proposals. This has occurred. They are all being sent back to the governing bodies for sign-off and the first batch has already gone through a regulations committee. So we are on target in terms of the proclamation for the end of this year.

Mr Hansen: Madam Chair, I think I saw some nodding from our previous presenters of the bill, and I would appreciate if the Chair would call them back to maybe dispute some of the --

The Chair: I will do that.

Mr Hansen: I just want to make sure they have an opportunity, but I have no questions of the presenters.

The Chair: The only concern I have is that I know there are other people in the audience who have some concerns as well, so if we could ask Mr Burrows and Ms Andersson to possibly vacate these chairs, at this moment I would call Mr Bill Hogle forward with his contingent.

Mr Hogle, for the purposes of Hansard, perhaps you would take the opportunity to introduce your colleagues.


Mr William Hogle: I would first like to say how grateful we are at OSLA to have the opportunity to present to you this morning. I am the executive director of OSLA, which is the Ontario Association of Speech-Language Pathologists and Audiologists. Perhaps I should clarify right now that my background is in health care administration and I am a member of neither of the professions represented by OSLA.

With me this morning is Mr Richard Steinecke, of the law firm of Porter, Posluns and Harris. Mr Steinecke has been OSLA's counsel for a number of years and with your permission, Madam Chair, in a moment or two I will turn the presentation over to Mr Steinecke.

I have a written document for the committee and our oral presentations will follow that document. Has the document been distributed?

The Chair: If this is the document you're referring to, it has. The clerk has definitely distributed it to all members.

Mr Hogle: I would like to begin by offering members a little bit of background on this association. OSLA is the professional association representing over 1,450 speech-language pathologists and audiologists in Ontario, who are responsible for ensuring that the public receives high-quality assessment and treatment for communicative disorders and dysfunctions.

OSLA was formed in 1958 and established a voluntary system of non-statutory regulation for membership. Over the years, membership in OSLA has ensured that speech-language pathologists and audiologists have achieved the necessary professional qualifications and training for their respective clinical practices, and it protects the public from unqualified practitioners.

During the 1980s, OSLA made representation to Ontario's Health Professions Legislation Review, chaired by Mr Alan M. Schwartz, to become included in those new professions which should be given self-regulatory powers.

Some of what I'm going to say from here on in will sound a bit like déjà vu. You've heard it before; you've heard it from Mr Burrows and other speakers have also commented on it. However, it might help to put a little perspective to our position.

On April 3, 1986, the Minister of Health stated, "We are now in a position to determine which professions will be included in the new regulatory system -- a system which will modernize and replace the current patchwork of legislation." The Honourable Mr Elston went on to say: "The fundamental issue has been to determine which health care professions require statutory regulation to protect the public interest. The review team proposed a set of criteria to help determine which professions should be regulated. All professional groups participating in the review process have been assessed according to these criteria. As a result, the government has decided that 25 disciplines will be regulated."

Audiologists and speech-language pathologists were named among the 25 disciplines and are now included in the Regulated Health Professions Act. You've heard that it has received royal assent and is awaiting proclamation. A companion bill to that is Bill 44, An Act respecting the regulation of the Professions of Audiology and Speech-Language Pathology, and it too is scheduled for proclamation, together with Bill 43. With that, I would turn the podium over to Mr Steinecke.

Mr Richard Steinecke: A number of the points I'm going to be making have already been made, so I'm going to just touch on those. However, there are three concerns that OSLA wishes to address. First of all, the bill appears to create a new statutory-related health profession in an inappropriate fashion. Secondly, the bill may be inconsistent with the Regulated Health Professions Act. Thirdly, the bill combines a self-interest group with a statutory regulator.

I'd like to finish off with a brief response to the cost concerns position taken by Ms Bohnen.

The presentation to you this morning by the association has been that this statute creates a public regulating mechanism. However, it has a couple of novel features that I would submit are very unusual, if not unique among private bills, in particular the fact that there's a statutory right of appeal from a refusal to register an applicant or from a discipline finding against an applicant to Divisional Court. That's a feature that you give to a public regulator. It's not usually part of a private bill.

Also, the mechanism for protecting the title isn't the usual private mechanism of a lawsuit but rather, as you would for any trademark, it's an application for a compliance order on behalf of the Attorney General. Normally this is brought by the Attorney General, and this act specifically allows the association to bring that. That also is unusual for a private corporation.

As to why it is significant that this legislation creates a new public regulator, I would submit there are four reasons why it's significant:

First of all, hearing aid dealers were rejected as deserving of statutory regulation by the review. I understand Mr Burrows has qualified that somewhat, but in my review of the correspondence, as late as 1985, the hearing aid dealers, which was a forerunner of the current association, were seeking status as a regulated health profession under the RHPA. Mr Schwartz developed four criteria for which professions should be regulated and which should not, and they are contained at the back of your submission, in the appendix. It's the last page of the submission and the four criteria are set out in appendix 2. This was the product of a lot of thought, and at the end of that process, the applicants were not considered to meet those criteria.

Secondly, the RHPA provides a mechanism for assessing whether unregulated professions should be regulated. There's a particular body, the Health Professions Regulatory Advisory Council, and it's first duty in its legislation is to consider this very issue, whether unregulated professions should be regulated. The process set out in the RHPA contemplates extensive consultation and public input into that decision. I would submit to you that this bill circumvents that process.

Thirdly, this bill recreates the patchwork quilt of statutory regulation that exists now and is just being replaced with the RHPA. One of the major goals of the RHPA was to provide a uniform method of regulating all health professions. The old system had many different statutes with varying provisions. The public were treated differently, the members were treated differently, and this resulted in unfairness. I would submit that is a novel feature of this bill, to start that patchwork all over again, even before it has been replaced.

Finally, it is unusual to create a regulatory body in this way because there is a lack of accountability of the regulator. Public regulators must be accountable to the public, in my submission, and the RHPA provides a number of methods of accountability.

Each college has to report to the minister and those reports are filed with the Legislature. Each college has public members. Each college has an independent review of dismissed complaints by public members, by members who aren't members of the profession. Regulations are reviewed by cabinet. There is the right of the Minister of Health to make regulations. The minister is specifically designated to oversee each college. The Health Professions Regulatory Advisory Council is set up to monitor the operations of the colleges, and all of these colleges are covered by Bill 100 to prevent and deal with sexual abuse. None of those forms of accountability will exist in this current bill if it is passed, so in my submission, this bill is creating a statutory regulator by a back-door process that bypasses the whole history and purpose of the review.


My second point is that the bill may be inconsistent with the Regulated Health Professions Act. Section 1 of the Regulated Health Professions Act prohibits anyone from dispensing a hearing aid without the prescription of an audiologist or a physician. Mr Barr is a practising audiologist and he can tell you the details of what's involved in writing a prescription. It's not just signing a piece of paper; it involves an assessment of a patient and the patient's condition.

Our concern is that the objects of the corporation appear to overlap with the steps that are taken in the development of a prescription of a hearing aid. Therefore, OSLA wishes to ensure that the objects of the continued corporation are subject to the provisions of the RHPA and that AHIP members do not use this bill as a defence to any breach of section 31 of the RHPA.

I don't wish to overstate this, but what I'm saying is that the law is not as clear, as Ms Bohnen suggests to you, that there is no possible conflict. There is a possible conflict, in my submission, that would have to be worked out.

Thirdly, the bill combines a self-interest group with a statutory regulator in one body. It has always been the policy of every government of this province that it's a conflict of interest for the public interest regulator to also be the self-interest body for the profession. For example, the College of Physicians and Surgeons of Ontario cannot act as the OMA, or the Law Society of Upper Canada cannot act as the Ontario Bar Association, just like OSLA is separate from the new college that will be regulating audiologists and speech-language pathologists. This was one of the four criteria that you'll find at the back of our submission, and I submit that's exactly what the bill does: It creates both interests in one body.

My concluding comments deal with the submission to you that there are absolutely no cost consequences to this bill. I submit that this is not necessarily the case. This bill does generate costs. There are costs of Divisional Court appeals, of registration matters and of discipline matters that do not currently exist. There's the cost of provincial offences prosecutions. There's the cost of compliance order proceedings. These are additional costs that have to be considered.

Another factor to keep in mind is that this bill may generate future costs. As you know, the history of these types of legislation is that stage one is to obtain statutory recognition and stage two is then to come back and say, "Now that you've recognized us as requiring regulation, we want to have the same system that other regulators have." There's nothing wrong with that process. I'm not criticizing that process. All I'm saying is that we have to be aware that's what generally happens in these kinds of legislation and we have to be explicit that we may be generating cost consequences down the road by engaging in that process.

In my submission to you, the bill creates a statutory regulator but does it in the wrong way, without properly and fully considering whether this occupation really requires statutory regulation and without considering how this regulator will be made accountable to the public that it is to serve, whether the bill creates a conflict of interest within the organization and what are the true cost consequences of the bill.

In my submission to you, the best way to answer those questions is to have the association apply, through the mechanism that has been established in the RHPA, for new health professions to be regulated.

The Chair: Mr Hogle, did you have some additional comments to make?

Mr Hogle: Just one, Madam Chair, if I may. I failed to introduce the gentleman on my right, who is Mr David Barr. Mr Barr is a practising audiologist in the province of Ontario and would be available to deal with any issues or questions having to do with the practice of that profession.

The Chair: Are there any additional questions, on behalf of the members, of this particular group?

Seeing none, I have a couple of more people who have indicated a desire to address this issue: Mr Alan Cheverie and Mr John Ford. If you would introduce yourselves, since obviously the names I was given are not as accurate as they should be.

Mr Alan Cheverie: My name is Alan Cheverie. I have with me today Isobel Manzer. I am the chair of the transitional council that was entrusted with setting up the regulatory college for speech-language pathologists and audiologists. Isobel Manzer is our recently retained registrar for that college.

I am going to be very brief because the two speakers you heard before me have very ably covered most of the concerns that we have. However, I would like to just emphasize a few of those and then be available for any questions that you have.

The first thing I would like to say, being mindful of comments that were made earlier with respect to materials for review, is we were really only made aware of this process and this bill at the end of last week. We have some concerns that are not fully developed, and partly they have to do with that fact. However, certainly some, if not all, of the concerns you've heard from the last two presenters are ones that we would support, as I've said.

We feel very strongly that some of the comments you've heard with respect to the scope of practice that's identified within this bill could very well overlap with the core of the regulated services that our legislation provides. You've heard reference to a controlled or restricted act, and that act is prescribing a hearing aid.

Let me just mention that Ms Manzer is my Dave Barr. She has been a practising audiologist for the past 13 years. I'm a public member and, like Mr Hogle, am not a member therefore of either of the two professions that we're regulating.

With respect to the controlled act, we were entrusted with developing regulation that described the circumstances under which our members would be allowed to perform that controlled act. Those regulations are not fully developed and not fully passed, and so at this point, from our perspective, the definition of what would be involved in prescribing a hearing aid is not entirely settled. We would certainly suggest that assessment is one part of that and, as you see, that's part of the bill before you.

We feel as well that the mechanism that has been developed under the Regulated Health Professions Act that allows for the independent body of public representatives to advise the minister with respect to professions being added to the regulatory process is one that should be taken advantage of. We are all operating as though proclamation of the legislation that we're dealing with will happen this calendar year. That means we are looking at January 1994 for this matter to be referred to the advisory council that was mentioned by the last two presenters.

I anticipate that you might hear that the group before you is not seeking to be involved in that regulation and that what it is seeking to do here is somehow different. I have a concern about that only in so far as that certainly what they're doing can be seen to be support for being involved in that process. How that process will entirely be played out, if I can put it that way, is not yet determined, and again I'm concerned about the timing. Why at this time? Why can't we wait two more months? Certainly it has been a long time for some of the development of these things, as has been mentioned, but we all believe we're at the wire at this point.


Assuming that last comment is correct on the part of the AHIP group and that they're not seeking to be involved in the regulatory process under the Regulated Health Professions Act, I think it's important to add that there is an additional mechanism whereby the controlled or restricted acts can be performed by someone who is not regulated under the Regulated Health Professions Act, and that is through an application for exemption to regulation regarding the performance of that service or act.

Again, this process is not entirely developed, as far as I know. However, I feel a little discomfort, if I can put it that way, with respect to this private act and how that might be seen as positioning or support for that exemption when the process has not even yet been determined. I'm not meaning to suggest that there are any nefarious or covert actions taking place here, but merely that it is a concern and that there are processes that exist to deal with these areas. Again, we feel that the content of this legislation does at least overlap to some degree the controlled or restricted act that is contained in the Regulated Health Professions Act.

We had a couple of specific concerns with respect to the content of the legislation. These come from a historical appreciation of some of the reasons, as I understand it, that the group was not included in the regulatory process that the 20-some-odd professions are involved in under the RHPA. I again apologize that we have not had enough time to develop a detailed submission or something in writing, so perhaps I could just briefly touch on a couple of these areas and then, as I say, allow you to ask any questions of myself or Ms Manzer.

It's stated in clause 3(c), if I could just turn to it myself, that this group will be presenting a unified voice: "to provide a unified voice for those engaged in the practice of testing hearing, and selecting, fitting, counselling and dispensing hearing instruments." Again, part of our concern comes from the fact that we're not so sure that what is meant by "testing" isn't something that overlaps with what we're doing, and we certainly have not been part of developing that unified voice.

Again, these objects, as I understand it, come from the statement of objects of this organization as it exists now. But enacting these in a piece of legislation recognizes them in a way that I think is not entirely mindful of the objects of the new health scheme to protect the public and protect the public's interest with respect to services provided by health professionals.

With respect to clause 3(d), there's a similar concern in terms of testing.

Clause 3(f), with respect to establishment and maintenance of standards of education and techniques: It's certainly the feeling, from the little time I've had to consult with practitioners that have been involved in the historical development of inclusion in the RHPA, that standards and minimal educational requirements do not exist for these practitioners. That may not be true; they may exist and it's something that's just new and we don't know about it. This may be seen as a mechanism to allow them to develop those. We don't know, but we certainly think it has implications.

As I say, I think the two presentations that preceded mine ably covered all the other points I have jotted down here that I wanted to bring to your attention, so rather than repeat them, I think I'll end there and just ask if there are any questions of myself or Ms Manzer.

The Chair: Seeing none at this time, I will ask Mr Ford if he has any comments to make. If you would then introduce yourself.

Mr John Ford: Madam Chair, honourable members of the committee, my name is John Ford. I'm past president of the Ontario chapter of the Canadian Hard of Hearing Association. Our organization provides a voice for hard-of-hearing persons regardless of their age or level of hearing loss. I come before you today at the request of the current president to make some comments on behalf of the hard-of-hearing people of Ontario.

I cannot stress enough that the consumers desperately need to have certification and standardization for the jobs of those who work in the retail hearing aid industry. When the Ministry of Health assistive devices program took on the role of providing funding for adult hearing aids, everyone assumed the ministry would also act as watchdog, policeman, for the distribution of aids. It was argued that the ministry could withdraw the vendor number from a certain dispenser and starve them into cooperation or ethical practice. This has not proved to be the case. Many unethical hearing aid dispensers have simply opted out of ADP, the assistive devices program. It is the consumer who suffered, not the dealer.

People are being offered confusing and in many cases totally incorrect information on purchasing hearing aids from unscrupulous operators who mount extensive advertising campaigns claiming that they are authorized, certified or otherwise approved by either the industry or the government.

Ontario is one of only two provinces that have not seen the need to control the dispensing of hearing aids. We, the consumers, are not wishing to be involved in any internal industry battle as to which profession should be approved to dispense hearing aids. We are, however, deeply concerned as to whom the consumer must deal with to get one.

There is a dire need for clear-cut lines of definition in the titles of those who dispense aids. Audiologists, we know; they have their college and the Regulated Health Professions Act to identify them as such. However, in spite of all the laws and well-intended government regulations, it seems anyone can jump into the business of selling hearing aids that are non-third-party funded with less permit and regulation than it would be if they were to start selling tinned soda pop or candy bars in the parking lot. All you need is a mailbox number, a 1-800 line and the ability to look innocent seniors in the eye while telling them that this tiny, little, one-size-fits-all hearing aid is just what they need. Yes, mail-order. Just pay the postman; no expense of inconvenient medical tests needed. Parts of western Ontario were blanketed with these recently. Imagine if eyeglasses were being sold with a one-size-fits-all prescription.

Consumers need the protection offered by the regulation of the terms "dispenser" and "practitioner." Consumers need to know there is a body that can discipline those who do operate unethically. The consumer organization will mount a public education program to warn people of the pitfalls of dealing with fly-by-night operations and mail-order dealers, but first we need to have solid definitions to tell people what to look for. The consumers need Bill Pr49 to protect them from a system that presently leaves huge gaps in regulation and consumer protection.

The Chair: Thank you, Mr Ford. Mr Mills would like to ask a question.

Mr Mills: It's not a question, it's just a comment that in fact eyeglasses are sold in pharmacies all over Ontario, and you can go in there and fit your own up and you don't need to go to an optometrist.

Aside from that, my question is not to Mr Ford but to you, Madam Chair. Before I vote on this issue, I think it fair to say that we've heard a great deal of testimony here. If the other members are like me, I've lost sight of some of what they said, and I don't want to do that. I would like to suggest and ask that before we vote, Mr Burrows come forward again. I would like to hear specifically -- three governments have spent untold years on this -- the effects that this private bill will have on all the work and all the money that's been spent. That will hopefully help make me more aware of what I'm really looking at here, and I'd ask that this happen.


The Chair: Thank you, Mr Mills. I know that Ms Bohnen would also like to respond to a couple of issues, but at Mr Mills's request, I will ask Mr Burrows to come forward and then we'll return to Ms Bohnen to respond.

Mr Burrows: I'll try to keep my comments very brief. I think what you've seen here today is a perfect example of the complexity of these sorts of issues. This sort of thing is what the Legislature endured through the process of enacting these bills that are going to be proclaimed at the end of this year. It's because of the fact that these various interests need to be heard and unbiased decisions made about some conflicting information.

I think it's safe to say you've heard some rhetoric from everybody here, including myself, and there are some slightly bent pieces of information in some of the other presenters. I think they've muddied the water a bit by getting into a lot of scope-of-practice issues, because the fact is that this profession that's seeking some of the attributes of regulation isn't asking for a part of that controlled act. I'd like to make that clear. But they are asking for certain elements of what constitutes a form of professional regulation, and I think that is the issue.

The government has spent, as you've heard, many years and a great deal of effort and used up a lot of effort of the Legislature and a committee of the Legislature travelling around the province at substantial expense. It's heard from virtually everybody who has had a vested interest in this issue and made a clear decision with respect to who should be a self-governing regulated profession and who shouldn't.

I think you've heard other issues, and I'm not prepared to say whether or not they have weight. They certainly sound like they do.

You've heard consumer concerns.

One of the things that the new legislation does, as I mentioned before and you've heard some other people bring forward, is that it does create for the future an orderly way of dealing with these issues through the advisory council, in which a neutral and open forum would be available to anyone who had a vested interest: They could come forward and make a case, and then a recommendation could be made to the Minister of Health. If the decision were to regulate, it is not inconceivable that the recommendation could come from the advisory council that no, maybe the best answer is not a Ministry of Health act but perhaps some other form of regulation. I don't think they would approach an issue without an open mind. But it would seem to me to be a terrible waste of the taxpayers' money and time and effort to have gone to all this trouble, and three governments have supported it, to deal with this issue in kind of a roundabout way rather than grappling with the issues head-on. I think you've heard concerns of substance and I think that's really the basis of our position from the ministry: Why not give the new mechanism a chance to work?

Mr Hayes: One of the things I'm hearing here from the different people making presentations is, why can't we wait two months? It kind of struck me: Are we saying that in two months, when the Regulated Health Professions Amendment Act is implemented, this will meet the needs of these people here for the Association of Hearing Instrument Practitioners? I keep hearing: "Why now? We've worked on this for so many years and now we're going to have this in a couple of more months and the regulations will be there." Maybe I'm hearing people wrong.

Mr Burrows: No, I don't think anyone meant to convey that suddenly a magic wand would be waved in two months. As a matter of fact, this is now October 13. We expect proclamation will happen in December. The effective date will likely be December 31, so the new scheme will start operating January 1, 1994.

I think it would also be misleading to assume that each and every significant issue that resulted from the legislative process in 1991 would somehow all be dealt with at once. That's not possible either. What we're saying is that there's a forum, a neutral and unbiased forum, where this kind of turf issue among health professions can be addressed, hopefully in an orderly and neutral way. That was why the review was set up in the first place when two governments ago the Minister of Health of the day estimated he spent 25% to 40% of his time doing nothing other than mediating between the vested interests of various professional groups. And unlike engineering and unlike architecture and unlike other professions, the government of the day, then supported by the government that replaced it and the government now, made a decision to create an entirely new concept, a totally even playing field, including a mechanism whereby these issues could be dealt with in the future in as unbiased a way as possible.

What we're saying is that in two and a half months, that mechanism should be there. Right now the advisory council exists but does not have its full statutory mandate. The Minister of Health could informally ask the advisory council now for an opinion on the matter. But after proclamation, with its full statutory authority, the advisory council could, within its mandate, if requested -- and a request would have to come to the advisory council -- fully conduct a formal review of this issue and make a recommendation with respect to elements of this bill or other mechanisms or whatever the nature of the reference contained.

Ms Bohnen: You've had a long morning, but I request your indulgence to respond to a number of the points that you've heard. First, I'd like to make this as simple as possible, because you've heard a lot of complex arguments, some going back more than 11 years in time, so let me just bring some concrete facts to bear on this.

There are approximately 237 members of this association who dispense hearing aids, so we're talking about under 300 practitioners who will have the right to use this designation. There are something under 300 audiologists in this province as well. I point this out to you to say that we are not dealing with a problem or an issue or a matter of gargantuan ramifications.

I think the discussion this morning has pointed out and has unfortunately revived past turf battles between the players in this industry, and let's not forget that it is an industry as well as a health profession. But we also heard from one lone representative of the consumer voice, who has told you that hearing-impaired consumers desperately need some better form of consumer protection.

Much of the thrust of my opposition's arguments has been that if they want to be regulated and if they can demonstrate the need for regulation, they should be regulated under the RHPA and the Health Professions Regulatory Advisory Council should be providing the minister with advice on that. But I'd ask you to think about that from this point of view: First of all, one of the criteria by which professions should be regulated or not that the Health Professions Legislation Review applied was, was there some other regulatory mechanism in existence for a profession? If there was and there wasn't any need to bring them into the Cadillac of regulatory systems, the RHPA -- if it was the intention that the only forum of public protection in the health sphere could be under the RHPA, then I submit to you that the people of Ontario would be in trouble. As Mr Burrows's detailed description of all of the implementation work since royal assent has described to you, this is a very elaborate, costly system of public protection. It's the Cadillac system.

This profession, hearing instrument practitioners, did not satisfy the HPLR that it met its criteria for regulation primarily for three reasons. One was that there were too few of them to be regulated with a full-fledged college; secondly, that what they did did not carry with it a significant risk of physical harm; and thirdly, that there was not a distinctive body of knowledge. Those were the HPLR's criteria. Nowhere did they say that any other mechanism for public protection was illegitimate.


I'd also like to reinforce with you that it is not the role of the Health Professions Regulatory Advisory Council to advise the government on private legislation. As the act makes clear, the role is to advise the minister on whether unregulated professions should be regulated. AHIP is not seeking regulation. Their existing charter under the Corporations Act contains provisions for registration of the members. For discipline, the bylaws set out a whole scheme for dealing with complaints in disciplines, including the right to fine members. That is not what this legislation would provide. It would simply give them the right to restrict to their members the use of these designations.

I think Mr Burrows clarified for you the fact that nothing within the scope of practice of these practitioners does contradict the Regulated Health Professions Act or infringe the controlled acts that are granted to audiologists. If there's some misunderstanding about that after these proceedings we'll attempt to clear it up.

As to whether it is a conflict of interest for a professional association and governing body to combine the functions of advancement of the profession and public protection and the lack of public accountability, I think I just have to leave with you the fact that unless you're prepared to support voluntary professional associations and to support them with private legislation such as this, as other private bills on our books do support them, we are going to have less consumer protection than we would otherwise have.

It is simply impossible to regulate every practitioner under the RHPA. The public cannot afford it and the health system cannot afford it, so we are forced to rely upon voluntary associations such as this, and I would submit to you that the government ought to be supporting them, especially when we have a compelling consumer voice here telling you that the public want some protection so they know who is accountable to some body and who is not.

I'm happy to stop there and respond to any questions you may have.

The Chair: Any other questions on behalf of members at this time? Are members ready to vote?

Ms Bohnen: Madam Chair, could I just turn to my colleagues from the association and give them a chance to add anything if they wish to do so?

The Chair: Certainly.

Ms Bohnen: Is that it? Okay, thank you for that.

The Chair: Okay. Not having received a huge, overwhelming response to my last questions to the members, I'll rephrase it. Are the members ready to vote?

Interjections: Yes.

The Chair: Thank you. Shall sections 1 through 11 -- oh, I'm sorry; I forgot him again. My apologies. Mr Hayes.

Mr Hayes: This bill does not actually affect the Ministry of Municipal Affairs, and we leave it up to the committee, which has heard the different presentations, to make its decision.

The Chair: My apologies to the members for forgetting Mr Hayes. I will now turn to the voting procedure.

Shall sections 1 through 11 carry?

Interjections: Carried.

Interjections: No.

Mr Eddy: I think there's a provision --

The Chair: Yes, I believe there is, from what I hear.

Mr Mills: Maybe there's an easier way to do it.

Madam Chair, it's not for me to direct your role, but there's an easier way of doing this: We address the whole bill in a vote -- if needed, a recorded vote -- and then that's out of the way.

The Chair: All right. All those in favour of Bill Pr49 as presented before us? Shall we do it as a recorded vote?

Mr Mills: Sure.

Interjection: Not necessary.

The Chair: Not necessary? Okay. All those against Bill Pr49? The bill is defeated.

I would like to take this time to thank the various participants. For someone who has been part of the process in the past, it reminded me of several months of discussions we've had, but I know that the other members did find it an interesting discussion and I thank you for giving of your time this morning.

Mr Mills: I'd like to move that Bill Pr12, An Act respecting the City of Toronto, Bill Pr15, An Act respecting the City of Etobicoke, Bill Pr16, An Act respecting the City of North York, and Bill Pr20, An Act respecting the City of Scarborough not be reported, they having been withdrawn at the request of the applicants.

The Chair: Are there any questions among the other members here about those withdrawals? Seeing none, all those in favour of this motion? The motion is carried.

Mr Eddy: Madam Chair, what's the status of Bill Pr53?

The Chair: We're waiting for the applicant at this point to tell us to go forward.

Mr Eddy: Oh, so it may come forward?

The Chair: Yes, it may come forward. I believe there is no further business at this time, so I thank everyone. Our meeting for today is adjourned.

The committee adjourned at 1137.