Wednesday 21 August 1991

Regulated Health Professions Act, 1991, and companion legislation / Loi de 1991 sur les professions de la santé réglementées et les projets de loi qui l'accompagnent

Ontario Association of Consultants, Counsellors, Psychometrists and Psychotherapists

Christian Science Committee on Publication for Ontario

Canadian Hard of Hearing Association, Ontario Chapter

J. Serge LeClerc

Eugene Strauss

Harald Dienes

Church of Scientology of Toronto

Kim Scott

Ontario Dental Association

Commercial Dental Laboratory Conference

Ontario Psychological Association

Ontario Board of Examiners in Psychology

Union of Ontario Indians

Denturist Association of Ontario



Chair: Caplan, Elinor (Oriole L)

Vice-Chair: Cordiano, Joseph (Lawrence L)

Beer, Charles (York North L)

Haeck, Christel (St. Catharines-Brock NDP)

Hope, Randy R. (Chatham-Kent NDP)

Malkowski, Gary (York East NDP)

Martin, Tony (Sault Ste Marie NDP)

McLeod, Lyn (Fort William L)

Owens, Stephen (Scarborough Centre NDP)

Silipo, Tony (Dovercourt NDP)

Wilson, Jim (Simcoe West PC)

Witmer, Elizabeth (Waterloo North PC)


Jackson, Cameron (Burlington South PC) for Mrs Witmer

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

Marland, Margaret (Mississauga South PC) for Mrs Witmer

Miclash, Frank (Kenora L) for Mrs McLeod

Wessenger, Paul (Simcoe Centre NDP) for Mr Malkowski

Clerk: Mellor, Lynn

Staff: Drummond, Alison, Research Officer, Legislative Research Office

The committee met at 1004 in committee room 2.


Resuming consideration of Bill 43, the Regulated Health Professions Act, 1991, and its companion legislation, Bills 44-64.

Reprise de l'étude du projet de loi 43, Loi sur les professions de la santé réglementées et les projets de loi, 44 à 64, qui l'accompagnent.


The Chair: The standing committee on social development is now in session. I would like to welcome everyone this morning. I call our first presenters, from the Ontario Association of Consultants, Counsellors, Psychometrists and Psychotherapists. Please come forward and introduce yourselves to the committee. You have 20 minutes for your presentation. We ask if you will please leave a few minutes at the end for questions from committee members. Welcome. Would you please begin your presentation now. The committee members have all received copies of your written presentation.

Ms Moroney: I am Elaine Moroney, president of the association. I am joined this morning in our presentation by Rick Willick, the chair of our public policy committee, Laura Mestelman and Leslie Langdon. We thank the committee for this opportunity and commend the Minister of Health for moving forward with the Regulated Health Professions Act and its companion legislation, particularly Bill 63.

We would be remiss if we did not acknowledge the contribution, leadership and direction of Mrs Caplan, the former Minister of Health, in this very long process. As well, we would like to publicly acknowledge the patience, co-operation and assistance of Ministry of Health staff during the past number of years, particularly Mr Alan Burrows and Ms Linda Bohnen.

The Ontario Association of Consultants, Counsellors, Psychometrists and Psychotherapists is a provincially incorporated professional association established in 1978 to serve as the representative voice for non-registered practitioners in the field of psychology.

Our membership consists of approximately 400 individuals who are trained in psychology and related fields. Their current professional responsibilities include psychological assessment, counselling, various forms of psychotherapy, teaching, behavioural intervention, consultation and research.

We work in a variety of settings with a sample breakdown as follows: 31% of our members work in schools, 23% work in hospitals, 13% work in mental health clinics, 12% work in private practice and 7% work in colleges and universities.

Our members are mostly the non-PhD service providers, with 90% having at least a Master's level of training and an additional 8% having at least a Bachelor of Arts preparation.

We are a female-dominated group within psychology, with 68% of our members being women. We have been active in this process because our specific concerns have not been satisfactorily addressed by the Ontario Psychological Association nor the Ontario Board of Examiners in Psychology during the almost 10-year review process.

Our members provide services to the public under many titles because we are prohibited by the current Psychologists Registration Act to use the terms "psychologist," "psychological" or "psychology," although we are trained in psychology, although many of us work in professional positions within psychology departments and services, although our professional responsibilities are often identical to those of our registered psychologist colleagues and although colleagues with equivalent training are eligible for registration in psychology in half the provinces of Canada and in many countries throughout the world.

Data from the 1980 Canada census and our own employment surveys indicate that approximately two-thirds of all providers of psychological services in Ontario are not regulated under the present legislation. For example, a recent survey of psychological services provided within Ontario government ministries, including psychiatric hospitals, indicated that 62.5% of the practitioners providing service are non-registered providers.

OACCPP believes that the present legislation governing psychological services does not adequately reflect the reality of psychological service provision in Ontario. We have been disenfranchised from our profession even though we deliver the majority of services to the public.

The new health professions legislation must provide for regulations which will ensure that the proposed college of psychologists includes non-doctoral providers of psychological services as participating members with equitable representation on the board of the college.

What we are seeking is regulation rather than supervision, and we do so for the following reasons. Supervision means that a registered psychologist stands between a non-registered provider and the college. Supervision can be merely nominal, as it usually is, or strict, depending on the needs and perspectives of the individual supervising psychologist. In a number of situations, the skills and experience of a non-registered person may be superior to those of the supervisor because of specialized training and more extensive experience, but we still must be subservient to the registered psychologist. Therefore, there is a danger that such skill and experience could be lost, to the detriment of the consumer and the taxpayer.


I share with you my own personal working experience in the area of deafness. I was hired over a number of registered candidates because of my specialized background, training and experience. I, like many of my colleagues, work independently. I consult with school staff, parents and the child. I determine assessment questions, develop and conduct a test battery, analyse the data, draw conclusions and write the report. However, under the current situation, I must then have that report co-signed by a registered psychologist who has never met or seen the child or parents involved. I would like to add that this is not an unusual, nor exceptional, situation for people like myself. I think my colleagues here could describe working under very similar circumstances. There appears to be an assumption that I am permanently undertrained and therefore in need of endless supervision.

In addition, under the current statutory framework, the non-registered person is not subject to regulations, is not required to take part in continuing education and is not subject to the disciplinary and complaints procedures of the college, even though this group provides the majority of direct services to the public. It is for these reasons that we emphasize regulation rather than supervision.

In addition, the non-registered providers are currently denied the opportunity to participate in the discussion of ethical issues and policies being debated within the college, except as private citizens. In OACCPP's view, deliverers of fully professional and important services should be directly connected to the regulatory body of their profession. Regulation for our members would therefore more appropriately protect the public.

OACCPP supports the proposed statutes. However, we believe that non-doctoral practitioners in psychology must be included in the regulations which will ensue. We believe this is important for the protections of the public.

Therefore, OACCPP has repeatedly advocated that our members, and I should say other qualified practitioners who are not members, be included within the regulations as legally recognized members of the college of psychologists with opportunity for representation on the council and committees of the college of psychologists, with opportunity for involvement in the development of regulations for the college, with no restriction to the right of private practice in one's area of competence and with the establishment of a finite period of professional supervision after which application for registration may be pursued.

We recognize that most of our objectives will be the subject matter for the new advisory council and the regulations required to support Bill 63.

We ask the committee to support our position that the right of entry to a profession should be based on training and experience which can be measured against standards of competence to be established by the college, rather than an outdated élite approach to credentialism. It should not be a matter of who has a PhD. Rather, it should be a matter of who is trained, experienced and judged to be competent. It is a matter of the best use of the talents, expertise and experience of people like ourselves who are already serving the public.

We are encouraged by the decision last month by the Alberta government to continue to accept master's-level providers as members of the profession of psychology in that province.

Since 1984 we have repeatedly attempted to negotiate the right of entry to the college on the basis of a fair and equitable measure of competence with both the Ontario Psychological Association and the Ontario Board of Examiners in Psychology without success. During the last two years, we held a series of meetings with OPA directly on this issue that were equally unproductive.

However, I am very pleased this morning to say that as a result of a meeting held on Monday of this week between OACCPP, OPA and OBEP we are hopeful that an amicable and equitable resolution to our concerns may be possible through the establishment of a task force to be chaired by the registrar of the Ontario Board of Examiners of Psychology. I table with the committee a copy of a joint letter to the Minister of Health outlining the proposed process. I have a copy of the letter here.

We thank you for inviting us to appear this morning and we request that this standing committee recommend that the Minister of Health, under the mandate of the new Health Professions Act, ensure that qualified non-doctoral providers have the opportunity to gain entry into the new college of psychologists.

Mr Owens: I would like to begin by thanking you for your excellent presentation and I congratulate your association and OBEP for coming to an agreement with respect to sitting down and developing a task force. I think you folks are not too far apart. This demonstrates that this legislation can work in getting the parties to sit down and work out their concerns without resorting to legal means. Again I congratulate both your association and OBEP and I will pass on the same remarks when I testify later today.

Mr Beer: I want to understand two things here. My first question will be to the parliamentary assistant. Am I right in assuming that the reason the review did not make reference to this situation was that it did not get directly involved in who would be a member of any particular college, or was there a review?

Mr Wessenger: I will refer that to counsel.

Ms Bohnen: The review was not concerned with requirements for registration.

Mr Beer: In terms of your own association, at the present time how does one become a member?

Ms Moroney: I will answer that. We have an application process. The application form requests the position the person is holding and proof of academic training. Our association is open both to bachelors and masters level people. We are a professional organization, but in the foundation of the organization in 1978 with five people in Kitchener-Waterloo, the raison d'être for the organization has been to change the existing structure in terms of entry to practice.

Mr Beer: Am I right that basically the only thing that is missing between the people who are members of your association and those who are currently within the college is that they happen to have a doctorate?

Ms Moroney: Well, some of our members have doctorates.

Mr Beer: As well?

Ms Moroney: Yes, some of them are all but dissertation appeal. Some of the members may not have fulfilled the present requirements for doctoral programs that OBEP makes. Some of them would have PhDs in associated areas such as a doctor of education, but working within a department of psychology as a psycho-educational consultant.

Mr Beer: Is there some clinical component that is necessary as well to become a member of the college, or essentially, if you have your doctorate in psychology, are you virtually assured of being a member of the college?

Ms Moroney: No, that is not the case. OBEP will be presenting this afternoon as well and could describe in more detail all the requirements for entry.

Mr Willick: There are master's-level members of OPA, people who in 1960 were grandfathered in and have continued to practise as registered psychologists with masters level training.

Mr J. Wilson: Thank you for the presentation. For the purposes of this committee and these hearings, do you have confidence at this point that you are going to get a positive result out of your negotiations, and do you still have a request of this committee that we include you in the bill now or, as the minister has contended, can it be done by regulation later for the non-doctoral practitioners?

Ms Moroney: Yes. Our issue is entry to practice, which is not part of the Psychology Act. It will be covered under regulations which will be set up through the transitional council of the new college of psychology.


Mr J. Wilson: But a number of non-doctoral psychologists have asked if we could do it at this level rather than wait for regulation.

Ms Moroney: I am not sure that is possible within the act as it is written now.

Mr J. Wilson: Anything is possible.

Ms Moroney: What we have requested is that the Minister of Health, with the mandate she should be given through the act, can make her wishes known to the advisory council and also directly to the new college of psychology as to her approval or disapproval of regulations as they are being set, or once they are set.

The Chair: Thank you very much. We appreciate your coming before the committee today. In the course of our hearings, if there is any additional information you think would be helpful for committee members, please feel free to communicate with us in writing through our clerk.


The Chair: I would like to call next the Christian Science Committee on Publication for Ontario. Please come forward and introduce yourselves. You have 20 minutes for your presentation and we ask that you leave a few minutes for questions from committee members at the end of your presentation. Please be seated and speak right into the microphones for the benefit of Hansard. We ask that you begin your presentation now, please.

Mr Fulton: Thank you, Madam Chairman. My name is J. Don Fulton. I am the Christian Science Committee on Publication for Ontario manager. We appreciate the opportunity of appearing briefly before your committee. We also appreciate the fact that you have allotted us 20 minutes. Frankly, I think our presentation will be less than 10 minutes.

I am talking on two specific points. One is the appreciation of the Christian Scientists of Ontario for the recognition or accommodation of the prayer aspect in Bill 43. This, of course, is a continuance of the health discipline accommodation of 1974 under the part on medicine. We appreciate that section 28 states treating a person by "prayer or spiritual accordance with the tenets" of the religion of the person giving the treatment is recognized as acceptable.

In 1974, at the time that this accommodation was approved by free vote under Mr Frank Miller, then Ontario Minister of Health, it was understood that it was granted on the basis that healing through prayer would be in good faith; it would be in accordance with the tenets of an established church; and the practice and profession of the religion itself was to be the cure. Diagnosis did not form a part of treatment through prayer. We all realize, of course, that this accommodation has now been operative for 17 years without a single concern having been raised about its operation by the government, the Ministry of Health or the public during that lengthy time.

Copies of two court cases considered in forming section 52 of the Health Disciplines Act are in the appendices. I think one is of particular interest, appendix B, and that was a ruling made by Benjamin N. Cardozo, who was also a Supreme Court justice in the US.

In this particular case of the people versus Vogelgesang, he points out that the tenets to which the law accords freedom of practice in a profession "are not merely the tenets, but the religious tenets of a church. The profession and practice of a religion must be itself the cure. The sufferer's mind must be brought into submission to the infinite mind, and this must be the healing." The operation of the power of spirit must be direct and immediate. As I say, we much appreciate this continuance. There are a number of churches, of course, that do practise healing through prayer in Ontario.

Relating to the controlled acts, under which I have noted newspaper accounts by Dr Evans, chairman of the Coalition of Unregulated Practitioners, I want to state that section 26 in Bill 43, referring to controlled acts as it now stands, is totally acceptable to the Christian Scientists of Ontario, whom I represent. We do not consider it to be restrictive in any way since diagnosis does not form any part of the treatment of healing through prayer. At the same time we recognize the concerns those people who identify themselves as unregulated counsellors may have in their dealings with the public.

If your committee should decide to accommodate these concerns, giving the unregulated counsellors freedom from the diagnosis or communicating restrictions of section 26 entitled "prohibitions," may we suggest they be given a separate exemption dealing with their concerns. This would allow them to describe exactly what it is they want and would also free other sections from the mumbo-jumbo that could follow when attempting to define and delineate their interests in a way acceptable to all.

The Chair: Thank you very much for your very thoughtful presentation. Mr Beer, question?

Mr Beer: In a sense there really is not a series of questions because basically it would appear that the process worked and the way in which the legislation has been drafted meets your concern. Regarding your point at the end, as we go forward to deal with the unregulated counsellors, I just note that we look at doing that through some other process so as not to affect the wording you have agreed to, just by way of comment.

The Chair: Thank you very much. We appreciate your appearing before the committee today. If you feel there is any additional information you would like to share with the committee at a future time, please feel free to communicate with us in writing.


The Chair: I call next the Canadian Hard of Hearing Association, Ontario chapter. Come forward, please and introduce yourselves to the committee members. You have 20 minutes for your presentation. We would ask that you leave a few minutes at the end of your presentation in case there are questions from committee members. Welcome. Please begin now.

Mr Ford: I am John Ford, president of the Ontario chapter of the Canadian Hard of Hearing Association.

Ms Kortright: I am Kathy Kortright, secretary.

Mr Ford: Madam Chair, honourable members, as executive members of the Ontario chapter of the Canadian Hard of Hearing Association, we are here today to bring you the hard-of-hearing consumer viewpoint on the problem issues pertaining to Bills 44 and 55. We have heard arguments at these hearings such as, "This is a contentious issue," and, "The fighting of turf wars." From the very beginning we want to make it clear that the consumer group is not taking sides in this war. Indeed, we are finding that both physically and figuratively our ears are becoming the battlefield of this turf war.

Once and for all, I want to state clearly that CHHA-Ontario's one and only interest in these hearings is to see that all hard-of-hearing people in Ontario have the resources available to provide them with the best possible hearing health care for their own lifestyle. In Ontario we have become accustomed to living with one of the best health care systems in the world and we in CHHA-Ontario are determined to see to it that the hard-of-hearing people are not going to be discriminated against by having that level reduced or limited by these bills or any other laws that the government of Ontario may try to present. It has been a long, hard, uphill fight to get a reasonable level of access for those of us who have a hearing disability and we will jealously protect our rights to that access.


In her April 2, 1991, speech to the House, the Minister of Health said: "We believe the laws that regulate health professions must be changed to better serve the public interest.... Consumers...have the right to receive health services that are competently performed...which suit their needs and desires."

We fully agree with this comment. To this end, we most strongly protest any move by the government of Ontario to limit the availability of access devices by removing the individual's right to free choice in the purchase of one's personal hearing aids.

Yes, there is most certainly a need to regulate the audiological profession. This is clear to us in that CHHA-Ontario received more complaints about the conduct of audiologists last year than we did about hearing aid distributors. No, there is categorically no justification for this government to deny hard-of-hearing citizens the right to purchase the hearing aid of their choice from the source of their choice at the time of their choosing.

Earlier in the proceedings of this hearing we heard statements from another group that they felt hearing aids were a hazardous device and thus should come under the blanket cover of the minister's definition of regulated activities. "Legislation is based on the concept of controlling potentially dangerous acts," is how it was worded in that same April 2 speech. We, as the users of hearing aids, would like to make a comment on this.

Very few of the aids sold in Ontario last year were in fact of such high power as to have even a potential for doing damage to the wearer. This danger is in the fact that the aid can be turned up too loud and could, under certain circumstances, over a period of time do some damage to the wearer's remaining hearing. To deny someone needing such a device the free access to purchase it is like arguing that there is potential danger for some paraplegics in some wheelchairs from which they could fall if not properly belted in, and therefore the government should perhaps restrict the sale of all wheelchairs and crutches by prescription.

Since childhood I have been a wearer of such high-power aids myself, most of which were purchased without the services of an audiologist. I could not even spell the word "audiologist" when I got my first aid. None of these potentially dangerous devices, however, has injured me.

To put this level of danger into perspective for you, the Ontario chapter of the Canadian Hard of Hearing Association took the time to do a bit of comparative research. We contacted several large hearing aid dealers in Ontario and asked them to give us an educated guess as to what percentage of the aids they sold last year were in a category that might be considered as having the potential to be hazardous if misused. We received figures in the range of 5% to 15% of the aids sold even had the potential to do some harm.

At the same time, we conducted a few tests and found the following results: 100% of the portable stereo tape players tested, for example Walkman, exceeded these same safety limits; all of the television sets tested exceeded these safety limits; 100% of the car radios tested exceeded these safety limits; all the car horns tested exceeded these safety limits.

Dare we ask when the government of Ontario will make it a licensed act to prescribe a stereo? How soon after protecting the consumer from their hazardous hearing aids will we see a law making it an offence to sell a car without a prescription?

We are certain that those who developed the wording of the bills had only good intentions in mind. However, we can only take the concept of not allowing the user to have a free choice in purchasing his or her own hearing aid to suit his or her own needs as an aggressive action of discrimination against a group of disabled persons in Ontario.

Over the years, many such negative factors have been placed in the laws by ignorance on the part of lawmakers. From what I have observed, it is usually much harder to remove discrimination from existing law than to prevent it in the first place.

So we again ask you to strike any part of this proposed bill that would in any way require a prescription for the purchase of hearing aids or any other hearing-assistive device. We, as the purchasers and users of hearing aids, do not feel that the recommendation or dispensing of hearing-assistive devices is in any way engaging in the practice of medicine, as the act refers to it.

We would also like to note to the committee that in no place that we have seen in the proposed legislation is the term "hearing aid" defined. The generic term "hearing aid" is not as finite as, say, the term "television set" or the term "automobile." Just where did the ministry plan to draw the line between a hearing aid and other hearing-assistive devices?

This is one of the reasons that there is such widespread consumer displeasure with the proposed bill. We have learned through past experience not to blindly trust those professionals who presently make recommendations in the field to select the best possible device for each of our individual needs. Now we see a law being proposed that would entirely remove all consumer input and decision-making, with no limits or guidelines as to just what devices would even be restricted. In a typical day, I use perhaps eight different devices to aid me in hearing. There is no mention as to which of these devices the government wants to deny me the right to purchase without a prescription.

Fear of the unknown is a major element in this controversy. Hard-of-hearing people in Ontario have just started to gain access through technology. They jealously guard that access and will not allow this or any other government to take away from them the ability to live a comfortable and normal lifestyle.

It is the policy of the Ontario chapter of the Canadian Hard of Hearing Association, when making presentations like this one, not only to point out the serious flaws in the legislation, but also to give positive recommendations as to how the situation can be remedied. I would therefore like to turn this presentation over to Ms Kortright, who is both the secretary of the Ontario chapter and the president of the Toronto area branch of CHHA.

Ms Kortright: Thank you, Mr Ford. As hard-of-hearing consumers in this province, we feel that flexibility is paramount in the hearing health care delivery system. As one of the committee members pointed out earlier in these proceedings, and as the hearing instrument practitioners made very clear, there are presently rural areas in this province where there is little or no service. This constitutes undue hardship for many hard-of-hearing consumers, especially those of us who are seniors.

We feel that if the legislation were to go forward in its present form, service to our members would be even more restricted than at present. One example of this is that we heard from one retired individual in Lanark, Ontario, who is no longer able to drive the 120-odd kilometres to Ottawa or the 140-odd kilometres to Kingston to visit an audiologist to get a prescription for a new hearing aid to help him deal with a hearing loss he has suffered for the past 40 years. With the reduction of train and bus service, there is no readily available long-distance public transit in much of Ontario any more. This is by no means an isolated occurrence in this province.


The Ontario chapter of CHHA is most concerned that if the acquisition of a hearing aid in this province becomes a licensed act, the already lengthy waiting period to get an appointment to see an audiologist would become even longer, if one could even get an appointment in rural areas. One of the major problems we face at present in hearing aid delivery is the fact that so many persons needing an aid give up before they get it because of the already lengthy waits and numerous visits needed to meet the assistive devices program criteria.

What consumers in this province would prefer to see is audiologists who spent the majority of their time doing Ministry of Health-funded aural rehabilitation with their patients. We feel that this is what audiologists studied so hard for and received their master's degree so deservedly for. Ontario would no longer have the glaring gaps in service it presently has if this were the case.

In my own work as a teacher of deaf and hard of hearing students in Toronto, I have had the good fortune over the past couple of years to work closely with and consult with an excellent audiologist attached to our programs. Her work is key in helping me to develop listening skills training programs for my deaf and hard of hearing students. She never prescribes a hearing aid, but may occasionally prescribe an FM radio frequency hearing aid such as the ones Mr Ford and I are presently wearing. I put it to you, Madam Chairman and honourable members of this committee, that it is for precisely this kind of work that audiologists are most properly trained.

As consumers, we feel we have the most vested interest of anyone in seeing that a better hearing health care system is developed in Ontario. Much has been said by others over the past few years in this area, but very little has been asked of the consumer by way of input. We have met with many individuals and groups around the province in preparation for this presentation and feel we have the backing of most of the 400,000-odd hard-of-hearing citizens of Ontario.

We feel that the ministry has to start at the beginning, rather than by jumping into the middle of the fray, and, first, define the roles of all those who take part in the delivery of hearing health care. Then, with the assurance that all the bases have been covered, with accessible service we can move ahead into the future with the best possible delivery system for the needs of every hard of hearing citizen in our province. To this end, we have prepared a simple chart as an appendix to the report you have in front of you, showing the various service providers and the roles we, the receivers of this service, would like to see performed by those service providers. Thank you very much.

The Chair: Thank you very much for an excellent presentation. We appreciate your appearing before the committee today. If over the course of the hearings there is any additional information that you would like to present to the committee, please feel free to submit to us in writing.


The Chair: I would like to call next J. Serge LeClerc. You have 10 minutes for your presentation and we would ask if you would leave a few minutes at the end for questions from the committee, but that of course is your choice. You can begin your presentation now.

Mr LeClerc: This might be the most different presentation you have had in front of this committee. I appreciate being here as an individual to talk.

I have a certificate of study in social work. I am in my final year of an honours program at the University of Waterloo, with a double major. I am on the dean's honours list. I have helped establish an organization called Youth Working with Street Children. For the past year, I have been assistant executive director of a Christian organization with 10 ministries, two rehabilitation farms and four crisis pregnancy centres. I am a chapter director of Prison Fellowship of Canada, starting a pilot program of having Christian volunteers go into juvenile facilities. I lecture on the average of 12 times a year on university campuses. I speak throughout high schools and public schools throughout the province.

The reason why I do that is I was an eight-year-old street child. I was sentenced to St John's Training School at the age of eight. I was living full-time on the streets at the age of 12. I have spent 21 years in prison. I have spent 20 years as a drug addict. Five and a half years ago I had a grade 6 education.

I do not believe there is any doctorate in Canada who is more qualified than I am as a social worker with an honours degree to talk to street children, to talk to drug addicts and to talk to juvenile offenders. I take great offence that my protection as a social worker is not regulated, that I can talk to a 15-year-old girl in the counsellor's office after I do a school presentation, a girl who has suffered an abortion, where she has not been told the results of post-abortion syndrome, and I advise her to disclose and go get help, where I would be open to be sued by the parents because they felt I gave her wrong advice and would embarrass them in the town they are in.

The reality is that there is one diplomaed PhD in your regulated workers per 300 prisoners in the prison system. The waiting list to see a doctorate personnel is up to a year. The reality is that 90% of the children in juvenile custody have been sexually or physically abused. There are no PhDs in juvenile facilities unless they are sent to a treatment facility.

The reality is that the backbone of people services who are working with street children, with juvenile offenders, with drug addicts, are non-regulated workers, they are social workers. I do not see someone with a PhD as more qualified than I in what I do. I am on the dean's honours list and I certainly have a world of experience to go with my academic qualifications.

Volunteer organizations have not been addressed in your piece of legislation and neither have social workers. There are a lot of qualified social workers out there and because they do not have a PhD does not mean that they should not be regulated. They should be regulated for the protection of the consumer to meet qualifications that apply in whatever qualifications would be given.

You have removed the basket clause that this piece of legislation was originally presented with because you had trouble defining the words in it. The basket clause for non-regulated workers should be instilled so that if you do not want to deal with people such as qualified social workers with an MA or an honours degree they are protected from some irate parent or an irate spouse and they are not receiving a $25,000 fine or six months in prison.

You deal in section 23 with spiritual means according to the tenets of the denomination. It is very vague, the spiritual means. Can a Jehovah's Witness tell someone not to get a blood transfusion? Is that what you are saying? Is there a healing process within that? Can I tell a young boy that I became a Christian in the value system and the foundation of strength that I draw from? Is that offensive to a parent? Will a parent now say that I have tried to involve their young person in a cult? What about Christian counsellors? They are classified as unregulated workers. They are not covered.


What about the volunteers who go into 40 prisons with Prison Fellowship of Canada? What happens with them? You have left them wide open and they are the backbone, really, of the social profession. Without volunteer organizations, all your PhDs or lack of PhDs are not going to replace the work they are doing right now. Can some irate parent get angry at a volunteer in a crisis pregnancy centre because she feels that that volunteer has convinced her daughter that there are alternatives to abortion and the daughter keeps it and the parent does not want to deal with it?

I have saved the government millions of dollars by becoming rehabilitated. The reality is that there is an 83% recidivist rate in the prison system. The reality is that there is a 40% illiteracy rate and an 85% functional illiteracy rate.

My last arrest was for a $40-million conspiracy, a drug laboratory. We outgenerated Procter and Gamble in this country of $120 million a year. By the use of volunteers who came to share a world of wisdom with me, they were able to do something that the government had never been able to do, or all the qualified PhDs were ever capable of doing.

If this legislation goes through, you may disband that whole organization and network of volunteer organizations and you may affect the social workers who are being on the front line with lack of protection. You may also affect the Christian community, which is probably the largest number of volunteers, doing what the government cannot pay people to do for lack of money.

Once again, if you remove the basket clause for unregulated workers, in my opinion it is very silly. You should put it back in and look at the vagueness of section 26. As the man who spoke a little while ago said, put something separate for Christian counsellors in there and Christian volunteer organizations. Thank you.

Mr Owens: The question is around your problem with diagnosis. I have done work with terminally ill patients in "counselling and support." I am just wondering how you feel that by providing supportive counselling you would be violating the diagnosis clause you have referred to.

Mr LeClerc: I do not know about terminally ill patients. I do not deal with terminally ill patients; I deal with street children, I deal with juvenile offenders and I deal with drug and alcohol rehab. None of those programs have got PhDs to them. The Roof program, Oasis, a number of programs -- Evergreen, your best-known program here -- all the people who are involved are master's levels of social workers, and 90% of the people who are doing the work are volunteers. They are not covered in this piece of legislation. You have removed the basket clause for non-regulated workers and I advise that you put it back in so there is some protection for the non-regulated worker -- however you want to word that -- and also for the non-regulated worker in the Christian community.

As far as diagnosis goes, I believe I can work with a street child and within 10 minutes have a handle on what the problem is. I believe in crisis intervention. I do not believe in the MMPI or all the other diagnostic tools the psychologists use, nor do I believe in long-range therapy. When it applies to a street child at 13 years old who is sitting on the track of your town and doing crack cocaine every 15 minutes, they are not the people the PhDs are going to address. That clientele is going to be addressed by the non-regulated worker and by the volunteer organizations that are not covered in your piece of legislation. It is a very dangerous piece of legislation in terms that it may disband all that. I do not know if I have answered your question, but I have certainly restated my opinion again.

The Chair: Thank you very much. We appreciate you coming before the committee this morning.


The Chair: I would like to call Eugene F. H. Strauss. Please come forward. You have 10 minutes for your presentation. We would ask if you would leave a few minutes at the end to allow for questions from committee members. Please begin your presentation now.

Mr Strauss: I made a written submission a couple of months ago, not knowing that I would have the privilege of being here. Since then I have made a shorter statement to save some of your time and I hope that will be helpful. I think the clerk of your committee has --

The Chair: All the committee members have received a copy of your presentation.

Mr Strauss: Of the original one and of my statement?

The Chair: That is correct.

Mr Strauss: I have listened to a number of the other submissions this morning and I know of some of the others that were made on earlier occasions and I think I can state my concerns very briefly. I support the purpose of the legislation, which is to protect the public from unqualified or unscrupulous health practitioners. However, I am concerned about the perpetuation and indeed the intensification of unnecessary credentialism, specifically in the profession of psychology. I, like others before me, submit that a PhD in psychology, which can be earned through a thesis in industrial, experimental, developmental psychology or any other specialty in the field, is no better preparation for clinical practice than, say, a master's degree that has concentrated on psychological counselling or education.

The continuing role assigned under the new legislation to the Ontario Board of Examiners in Psychology threatens to perpetuate its past demand for a doctoral degree for eligibility for admission.

As an aside, I would add here that I was glad to hear earlier this morning that there had been a last-minute willingness to talk, but frankly I would rather the committee did something about the legislation, because the other is a little tenuous. This is the end of the aside.

I urge the prohibition of unwarranted credentialism in the legislation and that can then be tested in the courts. It does not define what it is, but it could be tested.

My second concern is the same as expressed to you by many others, and that is the so-called diagnosis clause, paragraph 26(2)1 in Bill 43, especially when it is read against the scope of practice for psychology and that is section 3 of Bill 63. The diagnosis clause is so all-embracing that it threatens to cut off much valuable and badly needed help offered by counsellors, ministers of religion and others who have specialized areas of social concern but who cannot qualify as psychologists, even under more reasonable criteria than those that have prevailed in the past.

Various ministers of health, I believe including yourself, Madam Chairman, and representatives of the ministry have maintained that it is not the purpose of the legislation to cut off such services. I accept that assurance but I urge that the legislation be written so as to reflect this. In this context I have included a suggested alternative text to paragraph 26(2)1 at the end of my written submission and I commend it to you for consideration. I would be glad to clarify anything I have said or written.

Mr Beer: I wonder if for the record you could tell us a little bit more about your suggested alternatives so that --

Mr Strauss: It is at the end and I have tried to stick as close as possible to the original text. All I have done is been a little more specific as to the kind of diagnosis -- and the word "diagnosis," of course, is not used -- which should be restricted to people more qualified than say, somebody like myself to do it. I have talked about a disease which is a physical or neurological disorder or another medical condition as the cause of physical or emotional distress and dysfunction. That, I think, is the change.

The rest of the wording is the same. The present wording, in my opinion, is so broad that if I inadvertently say to a client as a family counsellor, "Could it be that your insomnia is due to the fact that you're angry with your husband?" I am stating an opinion about the cause of a dysfunction and therefore would be breaking the law if I am not a member of the College of Psychologists of Ontario. I believe my wording is perhaps more specific and more to the point that, I think, was intended.

The Chair: I have a supplementary for Mr Cordiano on the same point.


Mr Cordiano: I just wanted to know, from your opinion, how that would not be considered an assessment as opposed to a diagnosis, which is what we are trying to grapple with -- the difference between the two?

Mr Strauss: Neither the word "assessment" nor "diagnosis" is presently defined. If it were, perhaps I would not have the concern. Nor have I defined it, of course. But I believe the more specific reference to medical disorders and other medical conditions emphasizes all that goes before is related to medicine and not social and interpersonal functioning. My concern is that the scope of practice for psychology is so broad -- it deals with interpersonal relations, with intellectual functioning, almost any comment might be deemed to be a health professional comment which might be inappropriate for somebody who is not a member of the college. I of course support, in my first point, the earlier statement that people do not need a PhD in order to be eligible to do the work and they should be regulated and controlled of course. Can I help?

Mr Cordiano: We do not have any further time to get to the bottom of this.

The Chair: If, over the course of these hearings, there is any additional information that you would like to present to the committee you may do so in writing to our clerk at any time.

The committee recessed at 1101.



The Chair: I would like to call Harald Dienes. You have 10 minutes for your presentation. We would ask you to leave a few minutes at the end for questions from committee members.

Mr Dienes: If I might just introduce myself. I practised Chinese medicine here in Toronto and I am also currently teaching Chinese medicine at two schools.

I would like to introduce you briefly to Chinese medicine and why I feel Chinese medicine should be regulated in Ontario. Chinese medicine is a medical system complete in itself and has been used for a very long time. It is based on different premises than western medicine and also the methods of treatment are quite different.

It is different, but it works. That naturally poses a challenge to conventional medical understanding. The fact of whether or not it works was disputed for a long time mainly due to fraud research that was undertaken in the early years. Chinese scientists did not have the proper training in the western research methods and western scientists did not have the proper training in Chinese medicine to conduct adequate research, but that has changed. In the last 10 years maybe, there is abundant scientific evidence in support of Chinese medicine. The problem is that this is not widely known yet even in the medical community.

I think it is important to understand that the two medical systems are not in direct competition with each other because they serve two distinct purposes. Western medicine, obviously, is very useful for acute care and Chinese medicine is useful for chronic conditions. It seems it would be good if the two systems could be integrated. I mean, Chinese medicine should be integrated into existing health care.

The benefits would be twofold. The benefits to the public: Patients would have access to treatment that works and that does not produce side effects and the benefit to the government would be that it has been demonstrated that Chinese medicine is cost-effective so there could be savings there. There have been some studies done in the United States that confirm that fact. Those studies are available.

If in fact there is benefit in Chinese medicine, it would make sense to make it more accessible. How could the public benefit from a regulation of Chinese medicine? It would benefit firstly because of the adoption of a standard of practice. Chinese medicine can be potentially harmful if it is performed by an unqualified practitioner. Also, it seems necessary to adopt a minimum standard of competence to assure a high quality of the service.

For instance, I am teaching at the naturopathy school and there the requirements for licensing are 200 hours. In the Acupuncture Foundation of Canada, which is the acupuncture group, the medical acupuncturists require about 100 hours for certification of their members.

On the other hand, look at California. California was kind of a model for many other countries in terms of the acupuncture legislation. They require 2,400 hours of theory and 800 clinical hours. So the public has to be made aware that there are different levels of competence in their practice. In Ontario, the Chinese Medicine and Acupuncture Association has adopted a standard of practice which is a four-year course requirement.

Beyond standards of practice, I think it is important to address the scope of practice. I had a meeting last year with Mr Burrows and the question came up: Who represents the profession? Because there are a number of other health professionals that use Chinese medicine as an adjunct to their practice, they all have some claim on the representation, it seems.

It seems to me because Chinese medicine is already a recognized profession in many other countries, the profession should speak for itself. Also, the consideration of the length of training requirement maybe should be considered. The last factor may be the question of international link. So, the Chinese Medicine and Acupuncture Association is affiliated with the World Federation of Acupuncture which is the governing body worldwide. I understand that the president of the association, Dr Cheung speaks to you on Thursday in London.

I want to point out that facts and scientific evidence in support of Chinese medicine are available, but it is not widely known. You may still be sceptical about what I say, but I would be happy to provide more information in terms of documentation or research articles or any further discussions.

Ms Haeck: This is more a question to counsel. Because of the acupuncture that may be used as part of the treatment, does that fall within the controlled acts?

Ms Bohnen: It would, except that the Minister of Health and her predecessors have said publicly that they intend there to be an exception to permit unregulated practitioners to continue to perform acupuncture.

Ms Haeck: Are they currently functioning under the Drugless Practitioners Act?

Ms Bohnen: No, they are currently functioning completely outside any legislation.


The Chair: I would now like to call the Church of Scientology of Toronto. Please come forward and introduce yourselves to the committee. You have 20 minutes for your presentation and we ask if you would leave a few minutes at the end in case any members of the committee have questions. Please begin your presentation now.

Mr Smith: I want to thank you very much for allowing us this opportunity to speak to you. My name is Rev Earl Smith. To my immediate right is Rev Janet Leveau and to her right is Rev Nicole Crellin.

There are many positive aspects to this proposed bill. In particular, we welcome the announcement of greater public representation on the advisory councils. We feel this will provide greater public input and increased confidence in the public that complaints will be dealt with fairly by the colleges, particularly after the revelations that the College of Physicians and Surgeons of Ontario was not disciplining or dealing fairly with complaints of sexual abuse by patients about their doctors.

We were pleased to see that the government has also reaffirmed its position that the so-called harm clause is unnecessary. We also felt it would be disastrous to the public to introduce such a clause.


It really leads us to what we think is the most contentious clause that concerns so many of us in the present proposed legislation with respect to subsection 26(2) of Bill 43. That is the diagnosis clause. It is the ambiguity of this clause which makes it so contentious and prevents the public from seeking help from unregulated practitioners who feel prevented from doing their jobs by the wording of this clause. The present wording of this section does not differentiate between an assessment made by a regulated or unregulated health care practitioner and prohibits the unregulated practitioner from "communicating...a conclusion identifying a disease, disorder or dysfunction as the cause of symptoms of the individual," etc.

Clergy, pastoral care workers, social workers, distress centre volunteers, psychotherapists, chaplains, crisis centre volunteers, drug education counsellors and thousands of others in the health care support field would be affected. None of these people, volunteer or paid, would want to place themselves in a position to be a test case in court. All of those listed above are called upon to give an assessment or diagnosis by those who look to them for assistance and direction.

For example, a person calls up a crisis centre for help. The person is having a bad drug experience. The volunteer indicates the person has an addiction problem and urges the person to come in. We would see that as identifying some sort of disorder or dysfunction.

Another example might occur where a woman calls a rape crisis centre. She does not want to speak to a doctor or other qualified professional, but wants to speak to someone who has undergone a similar experience. This is just a possible scenario. She tells the volunteer she feels guilty. The volunteer tells her it is a normal reaction in the circumstances and not to feel guilty. She is depressed because of being raped and she should get some professional help. A disorder or dysfunction has just been identified. In addition, what if the woman still does not want help from a regulated practitioner, but prefers to receive further help from an unregulated practitioner who has undergone perhaps a similar experience?

Such volunteers or unregulated practitioners might be very reluctant to assist in such a circumstance where they run the risk of making a diagnosis or assessment and subjecting themselves to prosecution for violation of a controlled act. The ambiguity of this clause in the proposed legislation threatens the choice of the individual to seek the type of care they want or feel comfortable with. For personal reasons, some people will choose to accept help from an unregulated practitioner as opposed to a regulated practitioner.

The present regulated health care workers cannot possibly address all the social or spiritual needs of the people in Ontario. I think that is why there are hundreds of volunteers and agencies providing help and assistance to a wide variety of people suffering from many disorders and dysfunctions prevalent in our society.

That made us look at cost as well. You have heard this from the coalition of churches and several others. We agree. The financial burdens and implications of this bill are frightening if this volunteer sector could not continue its present work or was uncertain that it could continue its work. The volunteer sector contributes much and saves the already overburdened taxpayer millions of dollars in voluntary services which would be lost or might be lost due to the present wording.

The court system is already overburdened and would also be affected by those people with a "Let's sue" mentality. There are thousands of unstable people presently being served by our voluntary networks. Those with a "Let's sue" mentality would only be too willing to use a new piece of legislation to get at those who tried to help them. In addition, those with their turf wars or ideological disputes may engage in litigation, further overburdening our courts.

The Ministry of Health continues to say the diagnosis clause will not cause problems for the unregulated and that the unregulated would be free to talk to the clients. We recognize the ministry did not intend to affect clergy and pastoral care workers. These intentions, while laudable and reputable, are inadequate for protection when one is in front of a court of law. It is the letter of the law that must clearly express the intention.

You have heard many submissions from a wide variety of groups which all agree that this clause in the legislation clearly presents a problem to the unregulated practitioner. Obviously, it is not worded well enough or clearly enough if so many are objecting. We, like many other groups, have received the response back from the Ministry of Health saying it is not the intention for the clause to be interpreted that way. But it is Parliament's job to bring in the legislation and it is the court's job to interpret the legislation. Obviously it is imperative that the wording clearly communicate the intent.

How can this problem be resolved? That was a difficult one. We could not really think of a wording. We figured the simplest solution would be to remove paragraph 26(2)1. Disorders and dysfunctions could be almost anything in life. It would be impossible to name them all. It would be equally impossible to legislate the communication of our opinions on these matters to others. Even the word "disease" causes us a problem in that certain conditions, such as alcoholism, are seen by some to be a physical disease and by others to be a spiritual or social problem. Other common examples that cross these lines are stress, depression, drug addiction, emotional and physical abuse of spouses and/or siblings, marital difficulties and the list goes on. Again, some would see many of these as physical diseases, disorders or dysfunctions while others would see them as spiritual or social disorders.

Those people who are not regulated are often called upon to give advice to those who need help and they consider such advice reliable and useful. It can include what is wrong with us and what our problems are. The present wording of this clause restricts the communication of the unregulated, and even the public they serve, by not allowing them to speak completely and freely about the problems they are trying to address. You will very often find people more willing to speak freely with a minister or counsellor in a more relaxed environment than to a doctor in his office. Sections 29, 30 and 31 of this act prohibit anyone from misrepresenting himself as a member of a regulated profession. This seems to us to be adequate protection for the public from anyone making false claims as to credentials or representing himself as a member of a regulated profession.

We have thought and consulted with many other groups over the problem presented by the wording of paragraph 26(2)1. We just cannot see any way to reword it without at the same time infringing on one or more of the various unregulated practitioners. So we urge the committee to remove this clause if an acceptable wording that does not restrict the unregulated practitioner from performing their duties, services and responsibilities to the public cannot be found. We think the present wording presents more problems than it solves and does not serve the greater good of the public at large. Sections 29, 30 and 31 clearly provide what we see as the desired protection to the general public.

Mr Owens: My question is actually to counsel, through the parliamentary assistant, and that is the issue of litigation against the "unregulated practitioner." It is my understanding that people can now sue. This will not change. Do you know of any cases that are on record where somebody has taken his minister or counsellor or whatever to court?

Mr Wessenger: I will ask counsel to refer to that question of what suits there might have been.

Ms Bohnen: First of all, to speak of lawsuits or litigation is a little inaccurate. The provisions in this legislation do not create new civil causes of action. They create provincial offences. In other words, you cannot sue somebody in civil court for a violation of any of the provisions of this legislation. All you could do, if you were so inclined as an individual, would be to lay a complaint and try to start the criminal or quasi-criminal process; in other words, try to start the process whereby provincial offences are prosecuted in criminal courts here. That is exactly the same as the legislation now, whereby it is a provincial offence to practise medicine without a licence, to contravene the Drugless Practitioners Act and so on.


The fact of the matter is that private prosecutions, which are what appear to be feared by many of the presenters you have heard from, are virtually non-existent. It is very difficult for an individual to start a prosecution. Police and crown attorneys prosecute in our system. Even if a private citizen is so motivated to pursue a private prosecution and bear all the expense of legal counsel and so forth, the crown attorney may exercise the discretion vested in the Attorney General to stay or discontinue prosecutions. But I think the bottom line is they are virtually non-existent in this country.

The Chair: Thank you very much for your presentation. We appreciate your appearing before the committee today. If at any time during the course of these hearings there is additional information you would like to present to the committee, please feel free to do so in writing to the clerk.


The Chair: I would now like to call Kim Scott. Welcome to the standing committee on social development. You have 10 minutes for your presentation and we ask if you would leave a few minutes for questions at the end of your presentation in case the committee members have any questions of you.

Ms Scott: I have come to speak about Bill 44, which requires that people with hearing impairment have a prescription in order to purchase a hearing aid. Before I express my feelings on this bill, I would like to tell you a little bit about myself. I am 26 years old. At the age of four I was diagnosed as having a congenital bilateral sensory-neural hearing loss. It is progressive, from the age of four where it was a mild loss to the point now where it is profound. I am to the stage now where I do not even know if I will have any hearing by the time I am 40.

My hearing loss has affected my lifestyle. I am trying to limit it as much as possible. As a child, it made it very difficult for me growing up. One of the biggest problems is the lack of understanding of people, especially educators, who did not understand the problems and how to cope with children with hearing impairment.

As I have gotten older, I have been fighting on my own. All my life I feel that I have been fighting to live as normal a life as possible. Right now I am on the road to achieving a dream. In one year my dream will be a reality, to work in a health care program. I want to be a respiratory therapist and I am going to be in one year. Unfortunately, I have had some barriers thrown up in front of me upon this. I have had people in the medical field who, unfortunately, are very ignorant. I expected them to be less ignorant than the normal public, but they were not.

I am going up to Sudbury to do a clinical rotation. Before I went I decided that I needed to have my hearing assessed. The little tell-tale signs were coming upon me: not being able to hear people, turning up everything very loud and having to turn down my hearing aids in order to hear satisfactorily and clearly.

I tried calling several audiologists throughout the city. I can speak for the three major hospitals in the downtown area -- Toronto Western, Toronto General and Mount Sinai -- because they all work together. All their audiology appointments were booked well into the month of September. This was three weeks ago. The only way I could get an appointment was if I got a cancellation and they were able to squeeze me in.

I have had this problem in the past where I needed new hearing aids, replacement hearing aids. To get an appointment with an audiologist is a real task. A few years ago I needed one new hearing aid of my two hearing aids. One of them broke and I required a replacement. I had to wait three months before I could get an appointment and that was with the Canadian Hearing Society on Spadina Avenue at Dupont Avenue.

Can you imagine what it is like being hard of hearing, where I am unable to cope with the use of one aid, waiting three months and living a day-to-day life that is extremely frustrating? My grades in school alone fell up to 20% in certain subjects. I am unable to work.

This was five years ago. Today my hearing loss has become even more profound and I now am to the point where I require hearing aids that are the strongest behind-the-ear hearing aids available on the market today. I cannot function with one hearing aid. I must have two, and since I am going to be working in the medical profession, it is even more essential. If I have to wait several months before I can get an appointment to see an audiologist, which is what this bill would mean, I will not be able to practise as a respiratory therapist, because nobody will tolerate me waiting three months. I cannot risk the wellbeing of my patients by working with only one hearing aid, which is exactly what I would be doing. I work in trauma, I work a great deal in the intensive care unit, and it is a big risk I would not be able to take.

I feel that in passing this bill you are taking away my opportunity to fulfil my dream. I have always wanted to practise in medicine, always, since I was a little girl, and I have been working very hard at this. To pass this bill will make it even harder for me to have appointments to see audiologists. There are only 150 or so practising audiologists for adults in the province of Ontario. Somebody has said to me, "Well, there are over 13,000 practising physicians." Of course that is true, but no physician will prescribe a hearing aid for me without an audiogram performed. I mean, he would be negligent. He would be guilty of negligence to do otherwise.

To pass this bill is reducing my accessibility to a hearing aid when I need it. To have to wait several months before I can get the care I need is taking away my entitlement to live like all of you have the privilege to live day to day. And that privilege is going to be taken away from me.

I ask myself the question, "Why would they pass such a bill?" I came up with two answers, because it is obvious there is no proof whatsoever to suggest that people getting a recommendation for a hearing aid without a physician's consent can be harmful to them. There has been no evidence of that.

The only other two things that I was able to think of were: an attempt to cut back costs by reducing the accessibility of the service. That may be true in some ways. By reducing the accessibility you will discourage people from abusing the system, which, as somebody in the medical field, I am well aware the public does abuse our medical facilities, but you cannot do that by sacrificing other people who do need the service, and I am one of them.

The other thing I could think about was that audiologists would like to have a more true definition of what their role in the health care field would be. As somebody in the respiratory therapy field, a field that is also searching to have its role more clearly defined, I understand that; but I have never supported anything that, in defining our role, is going to sacrifice the care of the patient in any way. I am opposed to it.

As far as I am concerned we are a team, everybody. I do not care what you are in the medical field. I do not look at one higher or lower than the other. We are all a team. To worry so much about such a thing just because you want your role defined is, to me, illogical especially when it is sacrificing the care of the people who need it, and I am one of them. Thank you.

The Chair: Thank you very much for your very thoughtful presentation. The committee has wanted to hear from consumers and I think you have made a very important presentation before the committee. I have two questioners. One minute, Mr Owens.

Mr Owens: As the Chairperson indicated, as a consumer I think you brought to the committee the kind of perspective we need.

Ms Scott: Excuse me, I am sorry. I am having a difficult time hearing you.

Mr Owens: As a consumer, you brought forward the kind of perspective that we need to hear. The issue of access is one that we are wrestling with and the hearing aid dispensers, I think, have articulated a very clear case that this legislation may restrict access. The audiologists come and say that is not true. So I am struggling with trying to find the middle ground of where is the reality here. Where do you see the reality?


Ms Scott: I see the reality as a shortage of audiologists in the province of Ontario. There is no question of that. If you think of the number of hearing aid sales that happen in one year compared to the number of audiologists prepared to prescribe them to the patients and recommend them to a patient, there is, obviously. The other reality is having the waiting list to get an appointment to see an audiologist, so that there is a shortage.

A few years ago I found a solution to my problem in London, Ontario. I was again stuck with the problem of trying to get an appointment to have my hearing assessed -- not necessarily to see an audiologist -- as long as I could get an accurate audiogram and have a new hearing aid recommended to me. One of the hospitals I called -- because they were telling me I would have to wait three to four months for an appointment in London, Ontario -- recommended I call a private practitioner, a hearing aid dispenser. I called. I got an appointment within the week to have my hearing assessed. They assessed my hearing very well; I have seen so many physicians and so many audiologists throughout my lifetime that I am able to judge very well.

If these practitioners are wiped out, if they no longer offer these courses in the colleges -- which would happen if you need a prescription to purchase a hearing aid -- and they are not able to perform audiograms, the waiting list is going to get even longer. This is not something recent. This has been going on for years, and my mother, who is sitting behind me, will also tell you the problems she had getting the appointments to have my hearing assessed when I was a child. It is a long, tedious process. If I can get it done within a week, I will.

The Chair: Thank you very much for your presentation before the committee, and I think I speak for all members here in wishing you good luck in achieving your goal.

The Chair: Our appointment with Stephen Griew is cancelled because of illness; however, there is a written presentation available for all committee members from Mr Griew.

Mr Hope: Can I ask a question of counsel?

The Chair: We have some time if anyone has questions they would like to direct to the parliamentary assistant. Now would be appropriate.

Mr Hope: The question I have for counsel deals with the person who just did a presentation to us and also with the question of reassessment to improve hearing aids or to do an evaluation of the hearing loss. My first question would be, in order for somebody to go see a dispenser, do they need to go see a physician or an audiologist to get that first initial test done and a fitting? If they went to --

The Chair: Let us take one question at a time, okay?

Mr Hope: Okay.

Mr Wessenger: Yes, I will have counsel answer that.

Ms Bohnen: The relevant provision in the act is that a hearing aid dispenser may not dispense a hearing aid without a prescription. The act does not address, deal with or otherwise restrict hearing aid evaluations, testing, administering audiograms by anybody. It simply says you have to have a prescription for a hearing aid to be dispensed to you and that prescription can be issued by either an audiologist or a physician.

Mr Hope: Okay, so in clear language, if I go to a doctor and the doctor says, "You are losing your hearing. Go see a dispenser or an audiologist, whoever you wish," and I wish to go see a dispenser, and it proves that I have a hearing loss, then he can say to the physician, "Yes, there is a hearing loss and this is the prescribed hearing aid that has to be inserted into this individual."

Ms Bohnen: Yes, and in the presentation this morning from the Canadian Hard of Hearing Association, you will see that in their appended chart, as they see the relevant roles to be played by each health care provider, they see the role of physician ought to be -- the general practitioner in particular -- to determine if there is a medical cause for the hearing loss, or it is such that a hearing aid is the appropriate intervention, and that is essentially what this legislation supports; that people ought to go to their physician or their audiologist to determine if a hearing aid is what is necessary, and after that every other aspect of the process can be performed by a hearing aid dispenser.

Mr Hope: My second part to the question leads to the issue that once I have a hearing aid I have been prescribed, I wear it constantly and I find there is difficulty -- as the young lady said she found difficulty -- would she still have the right to see the dispenser for an upgrading, or would she have to go back to her family physician to be reordered to a dispenser or an audiologist?

Ms Bohnen: I would say, just as the finer points of when you need to go back to your physician before your prescription needs to be renewed; the finer points of when you have to go back to an optometrist before an optician can adjust your glasses, give you a new pair of glasses and so forth, are dealt with through standards of practice and discussions through the players in the system, that is how the details of when you ought to go back to a physician or an audiologist before having your hearing aid adjusted, upgraded, altered, etc, will be worked out in the field by these providers.

Mr Hope: I hope you do not mind, Madam Chair -- so you mean to say that, for instance, in the young lady's case where it is identified that there will be a continuing loss of hearing, it could be the understanding of the physician, the audiologist and the dispenser that the prescription be on an ongoing basis?

Ms Bohnen: One would hope, and I am sure, the dispensers are also knowledgeable enough to send their customers or clients back to physicians and audiologists when they see there has been a change or a deterioration, or there has just been such a period of time since the person has been assessed, that they ought to refer them back.

Mr Hope: I bring these questions up because listening to the young lady and her comments, living in a society, that I can imagine myself just shutting off and not being able to be here for a couple of days. I imagine as you get to the receding part of the hearing during a day and not being able to address the issue right away. This is why I am posing the question, is it able to have an ongoing prescription with your physician and your dispenser that they have identified the disease, disorder, dysfunction, and then, instead of doing a lot of travelling back and forth, you can deal with the problem on a more level base to make sure you do not face the difficulties she did.

Ms Bohnen: The legislation does not define at all what the prescription has to consist of, so the providers are at some liberty to figure out the appropriate way of dealing with these situations. For what it is worth, difficulties that are being described are current difficulties and past, historical difficulties. They are not problems caused by this legislation which, as you well know, is not law yet. I do not believe this government or the previous government thinks this legislation is going to solve all the problems of access to hearing aid services or any other kinds of medical services, because it will not. Lots of other things have to take place for those problems to be addressed.

Mr Hope: What we may see the legislation doing is providing a mechanism so that the complications being faced by the consumer base are maybe more informationally addressed in the system?

Ms Bohnen: The hope and belief was that the legislation would protect the public without at the same time throwing up unnecessary obstacles to getting the service people need.

Mr Owens: Through the parliamentary assistant to counsel, do we have any sense of the average time a person spends on the waiting list to see an audiologist? The figures presented from speech pathologists in Thunder Bay indicated in that region there was essentially a month, but I do not know if that included audiologists as well.

Mr Wessenger: I will have counsel answer that.


Mr Burrows: The data, as we understand it, that were presented previously to the committee were obtained from the ministry's assistive devices program. In fact, Linda and I participated in some discussions on this topic earlier and the data were verified as coming from the program. As with all data, I suppose they are subject to interpretation, but the officials in the ministry associated with that program concluded that in their opinion there was not an access problem and they had not received any complaints from the public about access. But it did appear from the data, if you look at them, that there are areas of the province where there may be problems and there are other areas of the province where it is clear there are no problems. I do not know if any more current data are available so I do not know what current trends may or may not be.

Mr Owens: Would it be possible to see if some more up-to-date data are available? I guess I take Ms Bohnen's point to heart that this legislation will not solve all the access problems this health care system has. However, I think I get a little bit nervous about what appears -- and I say appears -- to be a restriction on the folks who are dispensing hearing aids, especially in regions that may be under service by audiologists, as in northern Ontario, because then you are looking at perhaps northern travel programs and things like that.

Ms Bohnen: The added factor I think you should bear in mind is that access to hearing aid services and the manner in which the service is provided is also a function of the rules established by the assistive devices program, which has been forced to develop its program during this very long hiatus of waiting for legislation to be passed, and that also very much affects things. As I think Mr Burrows stated earlier, that program is driven by policy rather than law and it may be that adjustments will be made or can be made to that program's policies to respond to concerns about access which really do not result directly from this legislation.

The Chair: Thank you very much. I would like to adjourn the committee hearings now.

The committee recessed at 1152.


The committee resumed at 1400.

The Chair: The standing committee on social development is now in session. I would like to welcome everyone.


The Chair: I am going to call first the Ontario Dental Association. I would ask that you begin your presentation by introducing yourselves to the members of the committee. We would appreciate it if you would leave a couple of minutes at the end of your presentation to allow for questions from committee members if you wish. You have in total 20 minutes for your presentation and questions. Thank you very much. Please begin now.

Dr Somer: My name is David Somer. I am president of the Ontario Dental Association. With me today are George Sweetnam, who is also a dentist and is the vice-president of the association, and John Gillies, who is our executive director. I want to thank you for the opportunity to explore our thoughts on the Regulated Health Professions Act proposals with your committee.

The Ontario Dental Association represents more than 5,000 dentists. That is almost 90% of all the dentists in Ontario. I think you know that our initial statement complements the goals of the health legislation review. We have a long history of public advocacy. We have worked with members of the review team in an effort to achieve our shared goals, and we assure you that Ontario dentists will continue to work with the ministry with a view towards strengthening the public protection measures in this legislation.

I would like to call on Dr Sweetnam, who has worked on this project for many, many years now, to outline some of our specific concerns and recommendations about how to resolve some of these problems.

Dr Sweetnam: Madam Chair, members of the committee, in the handouts that you have been provided with, you might like to follow the two-page handout here with "Problems and Solutions." It is a very brief summary, and highlights the remarks I am going to make for the next few minutes.

As Dr Somer has indicated, the ODA believes that the legislation does not go far enough in protecting the public. We will begin with Bill 49, the Dentistry Act.

There is an omission in the authorized activities granted to dentistry. The only profession that has been granted the authorized act to apply or order the application of a form of energy prescribed by the regulations under the RHPA is medicine.

It is apparent to anyone who has visited the dental office that dentists routinely use numerous forms of energy. Lasers, electrosurgical equipment and high-intensity light are included among the energy forms that dentists employ in their practice. Given the role of dentists in providing such services, we believe the legislation should reflect existing practice by recognizing our use of numerous forms of energy in the dental office. We understand the specific forms of energy will be regulated under the RHPA. We have provided initial information of energies used by dentists to the ministry, and we are complying with counsel's request to provide further details. However, we continue to believe that regardless of what specific forms of energy are stipulated in the regulations, dentistry should have this controlled act within its purview. We do not understand the distinction made between physicians and dentists.

The government already has prepared some amendments designed to ensure consistency throughout the acts governing the health professions. We were surprised that this omission was not resolved during that amendment-making process. Throughout the review process, we had been assured that no professional group would be denied the right to continue to perform services within its current scope of practice and educational training. To ensure that this legislation does not eliminate the ability of dentists to utilize necessary energy sources in their daily practice, we recommend that dentists be granted the authority to continue to perform this controlled activity.

Turning to the list of authorized acts for dentists, we find that the act, as it relates to the fitting or dispensing of dental prostheses, orthodontic appliances or devices, is incomplete. First, the RHPA proposals fail to recognize that the prosthetic appliances and devices involved should never be provided to a patient unless there is a diagnosed need for the specific appliance. A good prosthesis or other dental appliance will not benefit the patient if that is not the appropriate treatment option.

To ensure that patients have the benefit of a diagnosis prior to receiving such invasive treatment, we recommend that a prescription be required in order to fit or dispense dental prostheses, appliances or devices. This solution is consistent with other RHPA proposals dealing with appliances for both vision and hearing. We believe that the simple inclusion of the word "prescribing" will provide the important public protection measures which have been omitted.

To extend public protection to all identified areas of risk, the ODA recommends that the wording be revised. This section would then read: "Prescribing, fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect the teeth from abnormal functioning." We understand that the ministry staff agrees with the inclusion of the term "periodontal" and will not expand on this addition further.

Given the legislative model, this revised phrasing would be included in Bill 49, the Dentistry Act, and the omnibus act, Bill 43.

Moving on to the Denturism Act, we question the RHPA proposal to permit denturists the authority to fit and dispense partial dentures. This changes the current legislation. The technical skill involved in fabricating a partial denture is only one aspect of care for the patient who has some missing teeth. The central issue to successful treatment is the determination of oral health status and patient need.

A partial denture is only one of many different therapy options for patients with natural teeth. A diagnosis is absolutely essential to detect pathology in the oral cavity and to determine what treatment option is appropriate. Will the bone, gums and adjacent natural teeth support an artificial appliance? This requires clinical examination, including X-rays. Denturists do not possess the prerequisite skills and training to carry out this detailed examination. We agree that patients are entitled to a choice of where they obtain particular health services such as dentures, but only after it has been determined that this would be the appropriate course of treatment and that it could be provided in a manner which would do no harm to the patient.

Because partial dentures have a direct impact on a patient's natural teeth, a partial denture should only be fitted on the order or prescription of a dentist. This solution recognizes the skill and training of the denturist and at the same time ensures that the patient has received a comprehensive examination to determine the most appropriate treatment plan. Therefore, the ODA recommends Bill 50, the Denturism Act, be amended as follows:

"In the course of engaging in the practice of denturism, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to fit and dispense removable dentures for the edentulous and, on the order or prescription of a member of the Royal College of Dental Surgeons of Ontario, to fit and dispense partial dentures."

Dental hygiene: As we turn to Bill 47, the Dental Hygiene Act, we wish to recognize the valuable role of the dental hygienist in the delivery of oral health care. The dental hygienist is a vital member of the dental team. However, we believe that the broad scope-of-practice statement proposed for dental hygienists will lead to the fragmentation of the delivery of oral health care.

The elected officers of the Ontario Dental Hygienists' Association have stated repeatedly that hygienists do not support independent practice for dental hygienists. On this point, I will leave you with information to support this. However, this legislation proposes to grant dental hygienists the authority to provide preventive and therapeutic treatment services without the patient ever having been seen by a dentist.

The scope of practice of any profession should recognize the education and training of a profession. However, we must be careful not to confuse and equate technical skill with the corresponding ability to determine when to apply the skilled service. Seemingly simple procedures can lead to disastrous results for the patient when the service was not appropriate for the presenting patient.

We support an enhanced role for the dental hygienist and we anticipate that the hygienist will be required to work in more community settings providing care for the elderly in the future. We know that Ontario's population of older adults is increasing. This demographic trend impacts upon the delivery of oral health care services. More preventive and treatment services will be required for this population of older adults who are known to keep their natural teeth longer. However, the institutionalized elderly are an at-risk group. They often have an overwhelming number of medical problems. As a result, designing oral health treatment programs for the institutionalized frail elderly is a complex task. Diagnosis of the patient's oral health status and the consideration of related health conditions and ongoing treatment are essential.

Cost control measures must not eliminate this initial step to the delivery of oral health care. All patients, including the institutionalized elderly, are entitled to comprehensive dental care.

We believe that granting dental hygienists the ability to work on the order of a dentist, rather than the current requirement of direct supervision, would facilitate the delivery of full-scope dental services to patients in institutionalized settings in a cost-effective manner.

We believe our recommended change to the wording recognizes the full role of the dental hygienist and is in keeping with the intent of the review:

"The practice of dental hygiene is the assessment of teeth and adjacent tissues and, on the order of a member of the Royal College of Dental Surgeons of Ontario, treatment by preventive and therapeutic means including the provision of restorative and orthodontic procedures and services."


As we review Bill 48, the Dental Technology Act, again we ask the committee to consider public protection. In the absence of a controlled act, no guarantee exists that quality devices will be delivered. A dentist is not a metallurgist and cannot assess the quality of materials used before inserting the device in the patient's mouth. All that glitters is not gold. Only a registered dental technologist should be held responsible for delivering a dental prosthesis or appliance or device that has been ordered or prescribed by a dentist.

The ODA previously has recommended the inclusion of the following controlled act in the Dental Technology Act: "Dispensing fixed and removable prostheses and dental appliances and devices to a qualified practitioner pursuant to an order or prescription from a qualified practitioner." We recently learned that Ministry of Health staff are exploring an alternate amendment with the registered dental technicians, and we look forward to the opportunity to participate in that discussion. Without more details, we are not able to comment on that amendment at this time. We simply reiterate that our main concern is to resolve the situation in a manner consistent with the protection of the public from unnecessary risk of harm.

Finally, we wish to address one of the recent amendments to the RHPA. We understand that the ministry has proposed that the authorized act for nursing which permits nurses to administer a substance by injection or inhalation on the order of a qualified person has been changed to read: "Administering a substance by injection or inhalation on the order of a member of the College of Physicians and Surgeons of Ontario." This amendment was never discussed with dentists. Because dentists and registered nurses work together, this amendment will have a dramatic and unacceptable impact on the delivery of oral health services. We suggest that the committee revise this authorized act in the Nursing Act to ensure that current interprofessional working relationships are not impeded unnecessarily. If the ministry intends to change the phrase "on the order of a qualified person" to make it more specific, they will have to ensure that this act includes each of the professions involved in this activity; for example, dentists.

We have appreciated the opportunity to highlight some of our concerns with the RHPA proposals. We will be presenting you with a more detailed brief on these matters and other issues later this month. At this point, we would be pleased to answer questions from the committee.

Mr Jackson: I would like to thank the ODA for clearly and succinctly setting out their concerns, for the appended guide to the five bills in particular, and for your reference to the elderly, which we have not had much detailed response on to date. So thank you for that.

Perhaps, Madam Chair, I could ask the ministry on the last point, with respect to the Nursing Act, if we could get some clarification on whether that was an oversight or if there was a purpose in being specific to the College of Physicians and Surgeons and the rationale behind that?

Mr Wessenger: I will ask staff to reply to that.

Ms Bohnen: I do not know if I would describe it precisely as an oversight. One of the purposes of the minister circulating the proposed amendment so early in the process was to get feedback. That said, I do not believe there will be any difficulty in adding a reference to a member of the Royal College of Dental Surgeons, and for that matter, members of other colleges whose members may prescribe substances that are administered by injection and inhalation.

Mr Owens: This morning we heard testimony from the folks involved in psychology where they announced what essentially turns out to be a landmark agreement to sit down with the various associations and boards to work out their difficulties. I am just wondering if that approach has been tried with the denturists and the folks who are involved and why did it not work. Or has it not been attempted, and why has it not been attempted?

Dr Somer: There have been many meetings in the past, and the differences in their respective roles were so great that we really are very much at an impasse. I think that we need to rely on this act to make sure that the roles are very precisely defined.

The Chair: Question, Ms Haeck?

Ms Haeck: Yes, to the parliamentary assistant. I would like to ask about the query the association has raised on page 2 of its submission regarding forms of energy, the second complete paragraph, "We do not understand the distinction being made between physicians and dentists," around the use of specific forms of energy. Can you comment on that?

Mr Wessenger: I will refer that to counsel, though I understand it has to be dealt with under the regulations.

Ms Bohnen: The intention is to regulate under the controlled act that specifically refers to hazardous forms of energy. The intention is to regulate forms of energy which may be hazardous, although they do not involve cutting or other invasive procedures, because that aspect of practice is captured by some of the other controlled acts. So the intention is to list forms of energy which may be hazardous in some other fashion.

Indeed that controlled act is specifically authorized to physicians in the Medicine Act, because even on the most cursory review it is apparent that physicians will order and apply such forms of energy as electroconvulsive therapy. The list of forms of energy not having been prepared yet, it has not been so clear what other professions need to be specifically authorized to use those. Therefore, it seemed to be much more sensible to deal with the whole issue in the regulation under the RHPA and have it both list these forms of energy which must be restricted and identify at the same time those professions which must be authorized to order them or administer them, and all of the professions have been told that they will be consulted in the preparation of that regulation.

The Chair: Ms Haeck, the deputant would like to respond to your question if you would like to ask.

Ms Haeck: In fact I wanted to turn to you and raise the question of whether you have been working with the ministry on this issue and how you are feeling about this particular issue at this time.

Dr Gillies: Obviously we have had extensive discussions with ministry and ministry staff on this issue over recent times, but we still have two particular concerns. One is a technical one, and that is that if it is a controlled act for physicians, it is very difficult for our college to write regulations when there is no legislative authority for it to do so. The second is that in fact for dentistry, and this seems not to be well understood, application of forms of energy can be an extremely invasive procedure when you are using electrosurgical instruments and lasers which are cutting both hard and soft tissue. We really do not understand why there should be any differentiation between the surgical use of this type of energy by physicians and the surgical use of that type of energy by dentists. It just makes no sense to us.

Ms Haeck: I am very thankful for the association's remarks. I think I recently saw a picture which used the lasers. It does make it a lot clearer. Thank you.

Mr Owens: A quick question, through the PA to ministry staff. Again around the issue of denturists, I am wondering why the change came about. What was the rationale to allow denturists to do partials, as opposed to maintaining the dentist as I guess the access point to treatment, especially for partials?

Mr Wessenger: I will refer that to ministry staff.

Ms Bohnen: The Health Professions Legislation Review concluded, after considering, discussing and reviewing the submissions made by the provider groups, that denture therapists could safely and effectively dispense partial dentures without supervision. I would just add it is not the first time that a governmental commission had made such a recommendation in Ontario, but legislative change has not resulted from previous commissions' conclusions that denture therapists can indeed safely and effectively dispense partial dentures.

The Chair: I would like to thank you very much for your presentation. If there is anything further that you would like to make the committee aware of or you at any time feel that there is additional information that would be helpful, we would encourage you to submit it in writing. We want to thank you for your very thoughtful presentation today.



The Chair: I would like to call the Commercial Dental Laboratory Conference and ask you to come forward and introduce yourselves to the committee. You have 20 minutes for your presentation and if you will leave a few minutes for committee members, it would be appreciated. Please begin your presentation now. Welcome.

Mr Powe: Madam Chair, committee members, my name is Bob Powe, representing-spokesman for the Commercial Dental Laboratory Conference, better known as the CDLC. I am the past-president of the association and currently chairman of the legislative committee. With me are Jim Kerr, past-president and committee member, and Alberto De Luca, who is president and also executive director. In the gallery are Fred Bryan and our legal counsel, Stephen LeDrew. We definitely appreciate the opportunity to make a presentation and submission today. We will be brief, five or six minutes, I expect, so there will be ample time for questions.

The CDLC, or Commercial Dental Laboratory Conference, was formed 20 years ago, approximately. It is the only association in the province of Ontario which represents dental laboratories. The laboratory members include small laboratories and large laboratories: small laboratories being in the order of two to three persons; larger laboratories running up 30 to 50 people and even in a few instances greater than that.

The CDLC, in addition to representing the interests of dental laboratories in various matters, also carries out education with its members, including technical as well as managerial and overall business. We attempt to keep abreast of the technology, and it provides a forum for common problems for discussion of dental laboratories. That might give you a brief overview of the Commercial Dental Laboratory Conference.

The CDLC's involvement in the legislative review process has been one of very great involvement over many years. In fact, we have been submitting briefs for a 15-year period and more currently we have responded and submitted to the review committee. We have in addition met with other associations that are similarly affected.

The CDLC is not a profession in that sense. It is not a health profession. We are dental laboratories, and therefore the impact of the legislation certainly affects the commercial laboratory, because we have RDTs, registered dental technicians and technologists, involved.

Of all the interested associations submitting briefs over the period of the 15 years, we are probably unique in that our proposals and our position have been constant over the 15-year period. In essence, our approach to the legislation and our approach to carrying on business in a dental laboratory is that an RDT be in charge of the technical aspects of commercial dental laboratories. One could substitute other words or terms for "in charge," but essentially that an RDT be involved and have responsibility for the final product.

Supplementary to that is that the CDLC has provided strong support for the upgrading of RDTs to provide a greater overall competence, not only technical competence, which is important, and probably relative to the discussions that are coming from review of this legislation are supervisory human relations skills and managerial skills that are involved or being requested of the RDT.

Where are we now in making our presentation here today, that is, the CDLC? We understand that there is a possibility of amendment to the omnibus bill. From our understanding of that amendment, the possibility is that the principles and intent are ones which we can support, subject to the final wording. We would like to have input on that if that does come to pass. We have no difficulty in supporting such a proposed amendment in principle, because the amendment, as we understand it, is consistent with the position that we have had over a 15-year period. To repeat what is that position, the position is essentially that a registered dental technician be in charge of the technical operations of a commercial dental laboratory.

In closing, I would like to thank the committee for giving us the opportunity to appear. We express our willingness to provide other input and to participate in any other requirements in the days ahead. We will be willing to entertain questions at this point.

The Chair: I would like to thank you very much for your presentation before the committee. Mr Hope, a question?

Mr Hope: One question. You say you represent both the registered and non-registered, if I am reading this correctly.

Mr Powe: Yes.

Mr Hope: And you are saying you would like to have a registered overlooking the non-registered?

Mr Powe: Essentially, we represent the commercial dental laboratory and we therefore have an interest in the registered dental technician and also other technicians who are not registered who are performing operations and so on within the dental laboratory, so that is when we say non-registered. The commercial dental laboratories have an interest in both groups, those who have achieved the qualification of a registered dental technician and those other technicians who are working in a dental laboratory who are not registered.

Mr Hope: With both of those technicians working in that field -- and I am just trying to get a better understanding -- would a non-registered be able, on a type of apprenticeship program, to achieve his registration through that, through direct supervision?

Mr Powe: Much of the training of dental technicians is done on the job in the dental laboratory under more experienced technicians, including registered dental technicians.

Mr Hope: So for instance, if there were no more non-registered dental technicians entering the field, then eventually we would phase out the non-registered and we would just have all registered from now on. Just hypothetically thinking, we do not have the non entering the workforce any more, and through an apprenticeship training program where you are asking for direct supervision, we will no longer have the non-registered. Do you follow what I am saying?

Mr Powe: I am not sure if I am focusing correctly on the question. I would have to repeat that the commercial dental laboratories now take essentially untrained persons and, not through a formal apprenticeship program but through an on-the-job training program within the laboratory, actually train the individual in various phases of the technology, from very simple tasks and increasingly through more difficult tasks. That individual in due time has the opportunity to qualify as a registered dental technician through writing the exams of the Governing Board of Dental Technicians of Ontario as it currently is formed.

Mr Hope: Okay. Not being the knowledge of all, are there currently courses provided for registered? Where are we getting the non-registered?

Mr Powe: The registered dental technicians, as I have mentioned, can come up through the dental laboratory. It is not a formal apprenticeship program, but it can be a planned on-the-job training program, and after a period of time they can write an exam at the end through the Governing Board of Dental Technicians. Also providing registered dental technicians, or in some cases non-registered, is the three-year program at George Brown College in dental technology where those individuals can enrol, and there is a supply of graduates from George Brown College who are entering laboratories and being further trained. When they complete George Brown College in three years, they still are not eligible for registration. It would take at least another year in a laboratory, plus the writing of the governing board of dental technicians' examinations.


Mr Owens: In terms of some of the new treatment modalities that are coming on stream, it seems a couple of times a year you hear about a new process, whether it is new plastics for fillings or screwing teeth directly into the bone. How do your folks keep up with these developments? Is there mandatory education? Is it company-sponsored education? Do they go back to George Brown College? How does this work so that they can keep on top and perhaps ahead of what is happening?

Mr Powe: That is a considerable challenge in most areas of advance in technology. The manufacturers -- if we view possibly the implants as an example, the manufacturers of implants provide courses for persons in dental laboratories to qualify them to make prostheses in conjunction with particular implants that they manufacture. The training in some instances could be from George Brown as an additional, and many manufacturers and other professionals including dentists and registered dental technicians, have achieved the competence and skills to put on seminars and clinics. The commercial dental laboratory itself is very active in locating speakers and making available to its members and others that kind of an upgrade with this advance in technology.

Mr Owens: We had a presenter, I guess last week, a dental technologist who alluded to the fact that there were a number of illegal operations going on out there.

My question is, if we decide to make this a controlled act, how can we provide a good level of enforcement to ensure that these quote "illegal" labs are not still operating?

Mr Powe: My first statement would be, the first dental laboratory conference is not in favour of a controlled act of dental technologists. We feel that is not required. It is not geared to the responsibility that a registered dental technician should have and does not provide the dental technician, the RDT, with the scope that should be provided. We are definitely more in favour, we do support, the proposed amendment as we understand it. It would seem that coming out of that would be the requirements for enforcement in that legislation because I think there is a possibility that could be written so far as the laboratories are concerned and the operators of the laboratories. We do not support the controlled act. We think it is inappropriate for our operations.

The Chair: If, over the course of our deliberations, there is additional information that you think would be helpful, we would encourage you to send it in writing to our clerk.


The Chair: I call now the Ontario Psychological Association. Please begin your presentation by introducing yourselves to the committee. You have 20 minutes for your presentation, and if possible we would appreciate if you would leave a few minutes at the end for questions from the committee members.

Dr Stasiak: Thank you for the opportunity to present the Ontario Psychological Association's concerns with the Regulated Health Professions Act and the Psychology Act.

Let me introduce to you the members of our panel. Dr Iris Jackson-Whaley is a psychologist in private practice and the president-elect of the association; Dr Ruth Berman is the association's executive director, and Dr Pierre Ritchie, the executive director of the Canadian Psychological Association and two-time former president of the Ontario Psychological Association, has been the chair of our task force on the Health Professions Legislation Review for over eight years.

I would like to note for the record that the Ontario Psychological Association fully endorsed the final report of the Health Professions Legislation Review with respect to both the omnibus bill and the Psychology Act. We believe that two of the subsequent changes made during the drafting of the legislation substantially weakened the principles that underlie the intent of the review's proposal as well as the intent of the governments of all three political parties that shepherded the legislation to this stage. Primary among these principles is the enhanced protection of the public.

I would like to call upon Dr Ritchie to describe the problems we see in the Psychology Act, how these problems have the potential for violating the principles to which I referred, and some solutions to improve the legislation in this regard.

Dr Ritchie : Merci, Dr Stasiak. Madame la présidente, j'ai l'honneur de vous présenter la perspective de notre société professionnelle.

I should also like to note that Dr Stasiak and I got back about 2:30 this morning from our American colleagues' conference. Some of us when we are tired slow down; I am told that I tend to gallop. So if I start to gallop and it is not making sense, would you just signal me, because when we rehearsed this morning this is what I was told.

When the Health Professions Legislation Review began, we had our wish list like everybody else. Today we have not brought a shopping list. We are not looking to eke out a little more to see if we can improve our standing. Our comments are not about the protection of turf. The case we put today is compellingly focused, we believe, on the protection of the public.

The problems we want to address are readily correctable. The OPA identified two problems with subsection 15(1) of the proposed Psychology Act as presently drafted. One involves title protection; the other deals with the term "health care to individuals".

The Schwartz report recommended a clear holding-out clause that would apply to all restricted titles. This provision would prohibit persons to take or use any name, title or description implying or calculated to lead people to infer that the person is qualified or recognized by law as a member of a health profession unless the person is authorized to do so pursuant to an act governing a health profession or group of health professions.

The current Psychologists Registration Act, in force for the past 30 years, while not containing the broad language recommended by Mr Schwartz regulates the terms "psychology" and "psychological" as well as "psychologist." To our continuing astonishment, the proposed Bill 63 only limits the title "psychologist." In other words, the proposed wording of section 15 is less stringent than the current provisions of the Psychologists Registration Act. This significantly reduces consumer protection and contradicts the intent of the proposed act to enhance consumer protection.

Under the proposed wording of Section 15, anyone regardless of training could legally advertise himself or herself as a consultant in psychology or as one who offers psychological services. Such individuals would not be accountable to the proposed quality assurance system nor would their clients have recourse within the regulated health professions legal framework.

The proposed wording would force members of the public to distinguish between a psychologist, who is regulated and trained in the provision of psychological services, and a consultant in psychology or a provider of psychological services, both of whom would be unregulated and perhaps untrained.

The OPA commissioned a nationally recognized polling firm, Environics, to undertake an Ontario-wide survey conducted by telephone this past June. Based on little more than 1,000 completed interviews it confirms with a margin of error of plus or minus 3% that 96% of the public expect that psychologists, persons with a practice in psychology and those who offer psychological services should all be licensed. Yet under section 15, only the title "psychologist" would be restricted.

The OPA strongly urges that the wording of subsection 15(1) of the Psychology Act be amended to extend title restriction and thus consumer protection to include the terms "psychology" and "psychological" in line with the provisions which have proven very effective for over 30 years.

In the interest of time, I am not going to actually read the legislative text that we suggest, but you have it before you in bold print.

Alternatively, Bill 43 could be modified by returning to language originally proposed by the HPLR. This is a holding-out provision that would apply to the title restriction of all the regulated health professions. The proposed language for the amendment to section 30 of the Regulated Health Professions Act is again in bold print and again I will not read it.


It is important to underscore that we know of no one among the proposed regulated health professions, nor anyone currently practising as an unregulated counsellor, who would be impeded in any fashion by maintaining the same restriction for the terms "psychology," "psychological" and "psychologist" as has already been in force for 30 years. We also know of no one representing any regulated or unregulated group who asked for the weaker title protection currently in the Psychology Act you have before you. On the contrary, representatives of consumers and other groups, including Professor Evans, have supported maintaining the title protection found in the Psychologists Registration Act.

The proposed act also refers to the provision of health care to individuals. This phrase, inserted into the latest version of all proposed acts, creates enormous problems for consumers, psychologists and a number of other professions.

This is legislation to regulate practitioners, not health care or health facilities. By leaving the phrase "health care to individuals" undefined the proposed act would create a two-tier system and reduce protection of the public. In such a system, for example, the title "psychologist" would be restricted only when one is providing "health care to individuals." In any other area of practice anyone could use the title "psychologist." This leaves the public without the protection of the act because the service being provided may not be considered health care by a court of law, even though the practitioner in each case has the same title.

What we suggest is simply to replace this phrase with "services in Ontario," and in that way these problems can be resolved, so that the proposed act would read, at the end of the pertinent clause, "in the course of providing or offering to provide services in Ontario."

Once again, we suggest an alternative. We have tried to come up with different solutions so that there would be some choice. If it is imperative that the phrase "health care to individuals" be retained, then the term "health care" should be defined in the act as the aggregate of all scopes of practice of the regulated health professions, exactly as we have been repeatedly assured by ministry officials that this term is intended to mean.

There are two other matters on which we shall briefly comment before receiving your questions. We know the current language of the controlled act for diagnosis has been troublesome to many. OPA believes diagnosis should be a controlled act in the interests of public protection, but that an amendment to the wording of section 26 of the proposed act is needed to ensure all health care professionals may legitimately communicate their findings directly to their patients. OPA supports the sharing of diagnostic authority within defined scopes of practice and believes this controlled act should be extended to those professions able to demonstrate that diagnosis is appropriate to their scope of practice and who meet the criteria for inclusion as set out by Mr Schwartz.

We are aware a number of practitioners, both regulated and unregulated, have difficulty with the current wording of section 26. With other professions, we have tried to work throughout the review process to find the best language to express the principles Mr Schwartz espoused, while not inhibiting the legitimate work of other practitioners.

We remain receptive to the arguments of others to remedy their problems. When drafting an amendment or an exemption clause, we urge you to: retain diagnosis as a controlled act; retain the principle of independent authority for diagnosis within the scopes of practice of the professions that have already met and others who may meet the criteria for being afforded this controlled act; and retain Mr Schwartz's primary criterion of risk to the public as the determining factor for this controlled act.

It was this factor of risk to the public, as well as competence, which determined which professions were to be made more accountable for such health services. This is also why the solution of limiting this controlled act to medical diagnosis, a solution which we know has been presented to you, would in our view be so inappropriate. Such a solution fails to recognize the necessary development over the past several decades of additional autonomous professions which have highly specialized diagnostic skills. It is as inconceivable as it would be unjust to make physicians responsible for such diagnostic procedures since they are not trained to provide them. Even worse, the public risk would be significantly increased if only medical diagnosis were controlled. We again stress the importance of retaining the basic criteria adopted by Mr Schwartz. The control of psychological diagnosis as well as those other areas of diagnosis which present risk, must be retained as authorized acts to ensure the public interest.

The issue of the regulation of persons with a masters degree in psychology has been raised from time to time and continues to be raised with members of this committee, as it was this morning with the excellent presentation of our colleagues from the OACCPP. We would like to provide the following additional information to the committee.

Despite OPA's advocacy of either separate legislation for persons with a masters degree in psychology or a two-level act, the Health Professions Legislation Review concluded this was not appropriate, given what it wanted to try to do. OPA repeatedly has been told that this matter is not part of the current legislative package. At this stage we do agree with our colleagues from the OACCPP that trying to force an artificial solution into the Psychology Act at the last minute is not an appropriate way to proceed.

We are, however, heartened that the proposed legislation will provide us with a forum, the minister's advisory council, to which further actions can be directed. We remain hopeful about the process -- some of the positive results of which I think you have already heard this morning and you are hearing from us again this afternoon -- that was encouraged by you, Madam Chair, during your tenure as minister, that has now gone on between OPA, its associate members, the OACCPP and more recently with OBEP also part of it. As you know, OPA has just signed a letter of agreement with these two other groups setting out both terms of reference and procedures for a joint task force. It is our hope that a proposal will be made for the advisory council's consideration once the new council is established. We have fixed for ourselves approximately 18 months. It is there in the agreement. That seems to fit what we think we need to get the task done and probably what it may take to get the whole thing set up, in any event.

I would also like to note that one of the main goals of our master's-level colleagues has always been to have an appropriate title. You now know that we all hope to be able to resolve this matter through the joint task force just established and we hope you will support this process and not constrain constructive options by only protecting the title "psychologist." Adopting one of our two proposed solutions is essential to help us achieve a resolution on this other matter.

All our comments today are discussed more comprehensively in OPA's complete brief, which has been submitted to the committee. We would be pleased to answer your questions.

Ms Haeck: First and foremost, I thank you for your presentation. In speaking to members of the OACCPP this morning -- that is a nice way of putting it, rather than the long handle -- they definitely feel heartened by the discussions that have taken place in recent times around this whole issue of inclusion within their organization. I guess the one thing I have been hearing an awful lot of, in my riding office as well as here, is that there is this concern on the part of the unregulated, as well as the regulated, around the counselling function. I know you make mention of it, but this is definitely an area which is going to provide some discussions for some time. Any particular comments that you would like to make beyond what is on the printed page?

Dr Ritchie: Just as further background perhaps, I think we all appreciate there are two issues here which sometimes get blended but which, depending on how one is looking at it, need to be kept discrete. Master's-level persons in psychology often use the title "counsellor" when they are in a community because no other title is available to them. "Counsellor" is an unregulated title, and within all the acts that are coming forward now it will remain an unregulated title. There is nothing in the proposed Psychology Act, nor would I anticipate anything that will come forward from our three groups, that would try to restrict "counsellor" to this particular group because it involves a much larger number of people than just those with masters' degrees in psychology.

The challenge is going to be to find that which will be appropriate to our colleagues within the psychological community in a way that is not going to inhibit other persons. As I mentioned, there are pastoral counsellors, marital therapists and so forth and they are not part of the framework of this legislation. We certainly would not be looking in any fashion to inhibit or delegitimize what they do, through our work.


Mr Wessenger: Thank you very much for your presentation. I am very pleased about the progress you are making with respect to the establishment of this task force and compliment you on entering into the agreement with the other bodies. Just for my own information, and perhaps there are other members of the committee who might appreciate some elaboration, I wonder whether you could sort of explain in more detail what you mean by a "psychological diagnosis" and how that would differ from having, for instance, the unregulated body coming in and saying, "We say you have an alcoholic problem or you're feeling guilt," if you might sort of elaborate on that for the committee.

Dr Ritchie: I think perhaps the best way to do that is to draw your attention again, as I am sure other groups have done in their presentations, to the difference in our scope of practice, which is laid out in the Psychologists Registration Act, which is non-exclusive. It simply sets out the parameters of what psychologists do. But within the context of the scope of practice, "non-exclusive" does not preclude anybody else from doing those things and we authorize that, which is really just a very small segment of the total scope of practice. Even within psychological diagnosis, the wording is quite precise in the authorized act about that which is limited only to psychologists. I come back to that criterion Mr Schwartz used. Quite frankly, we would have preferred an authorized act that had much broader language, but in the end we were convinced that the logic he was using and the filter he was using was reasonable and that is, if you start with the perspective of what really could hurt the public, how could a patient be hurt if this kind of diagnosis is left open-ended?

In the case of psychological diagnosis, the language you find in the authorized act is that part which Mr Schwartz found to be the part of psychological diagnosis that really needed to be controlled, because letting other people do neuropsychological diagnosis, for example, really would present a risk to the public. I think it is important to underscore that distinction between the general scope of practice, which is non-exclusive, does not inhibit or preclude anybody else from doing what he or she does to the extent that it overlaps with that scope; and the authorized act, which is a very thin slice of the totality of what psychologists do, but that part which, we agree with Mr Schwartz, really does present danger if you let people who do not have very advanced training do that kind of work.

Ms Jackson-Whaley: Could I answer that question from a slightly more practical point of view and from a different angle?

Mr Wessenger: Yes.

Ms Jackson-Whaley: There is a difference between a symptom and a diagnosis. A diagnosis, as psychologists do it, requires standardized procedures and training and assessment procedures that lead to a definitive statement of what is wrong with the person and how that came to be. A lot of people will say, "Oh, but you're depressed," or, "You seem to have a drinking problem," and those are not diagnoses. When clinical psychologists say that a person is depressed, they are speaking to a very clearly defined set of symptoms and aetiology or what went into creating that problem for that individual. I think there is quite a big difference.

Mr Jackson: On page 7 you referenced this committee as having heard of other groups that are having difficulty with their diagnostic authority. You point to the Schwartz guideline as giving further guidance. Could you share with us those groups or activities which are currently restricted that you feel could be expanded to be included. You speak in general terms here, but you do not give us examples that your professional association deems would be more appropriate if we were to -- I do not want to say "liberalize" -- this clause; you know what I am trying to ask.

Dr Ritchie: Yes, I think I do.

Mr Jackson: Can you give us some examples of that which would not fall in and that which would, because we are getting everything from a faith community to school settings in variety?

Dr Ritchie: As long as we will accept that I am not trying to be comprehensive and trying to include everyone who might be appropriate and therefore not be seen as deliberately trying to favour somebody more than somebody else, probably my own experience, which has been hospital-based to a large degree, and there may be others' that would be appropriate too.

I will cite you one example. I think the speech and language folks have made a very good case throughout that an important subset of what they do in the diagnostic realm really requires their highly specialized skills in order to assess and diagnose -- just assess -- but diagnose in the way it is meant to be used in this legislation. I think you have to look at the consequence of error and we are quite sensitive about other people making determinations about psychological diagnosis when they may not have a very complete knowledge. Therefore we are wary, particularly in a public domain, although we appreciate that is ultimately your job and you have to ask us to help you and you have to define who would be appropriate. But we are not experts in speech and language pathology. I am simply saying, as a clinician, as a colleague, I have been impressed by the case they have put forward, and there may well be others that each of my colleagues would point to as the one they would suggest.

We recognize, however, that if you begin with the notion of consequence of error, the risk to the public, you should be able to come up with a reasonable set of parameters and in that regard I think the ones drawn by Mr Schwartz are probably about as tight as you could get them. I do not think there is anybody to whom he accorded it who should not be there. I think it is reasonable to think there may be a small number of others who could.

The Chair: Thank you very much for a very excellent presentation. We appreciate your coming before the committee today. I think you know that if there is anything further you would like to communicate with the committee, you are welcome to do so in writing at any time.


The Chair: I call the Ontario Board of Examiners in Psychology. Please begin your presentation by introducing yourselves for the committee members and for Hansard. You have 20 minutes for your presentation. I think you already know we would appreciate if you would leave a few minutes for questions at the end of your presentation. Please begin your presentation now.

Mr Phills: Thank you, Madam Chair, for inviting us and giving us the opportunity to talk about this issue. I am George Phills, chief psychologist, London Board of Education, and am also chairman of the Ontario Board of Examiners in Psychology.

With me are Huguette Boisvert, who is our public member on the board, Dr Barbara Wand, who is the past registrar of our board, and Dr Patrick Wesley, the new registrar of our board. I thank you for being able to appear and I also have no excuse like Dr Ritchie's. I just talk naturally fast and I will try my best to slow down. Part of the difficulty, I find, is that this area has been talked about so much and we get going and I find I get wrapped up in it, so I will try to slow down and see what is going on.

The Ontario Board of Examiners in Psychology was set up under the Psychologists Registration Act of 1960. It has been regulating the professional practice of psychology for the past 30 years. There are some 1,820 registered psychologists providing services in Ontario and a further 100 on the temporary register in the process of becoming fully registered. During the past 30 years the board has created explicit and extensive standards of professional conduct, set rigorous criteria for entrance into the profession, developed a series of guidelines on various practice topics and established a detailed and user-oriented procedure to deal with public complaints.

The number of registered psychologists in Ontario has grown to almost 2,000 during the past 30 years. The board has accumulated experience in assessing the training and competence of persons from many provinces, the states and from other countries. Through the investigation of several hundred public complaints and through discipline tribunals of the board, a large body of knowledge and experience in regulating professional practice in the public interest has been established.

The Ontario Board of Examiners in Psychology exists to serve and protect the public, thus OBEP recognized and agreed with the main purpose of the Health Professions Legislation Review. These were to protect the public from unqualified, incompetent and unfit health care providers, develop mechanisms to encourage the provision of high quality care and permit the public to exercise freedom of choice of health care providers within a range of safe options, while at the same time being able to distinguish between regulated and unregulated providers of care and promote evolution in the roles played by individual professions.

The legislative proposals now before the standing committee on social development reflect to a large degree the goals mentioned above. The new, uniform procedural code proposed in Bill 43 will make the disciplinary procedures of the professional body clearer, both for the members of the public and for the professionals. Additional powers to protect the public interest are given to the College of Psychologists of Ontario, as to all colleges in the procedural code.


For the profession, the scope of practice proposed in Bill 63 and the requirement for quality assurance and continuing competency process will strengthen the board's efforts to promote high quality and professional improvement.

The board has considerable difficulty with the provision of Bill 63 in respect to titles that can be used which would allow the public to know what practitioners are regulated and therefore meet standards of practice, conduct, education and training. Under the present Psychologists Registration Act, the public of Ontario has a clear idea because three terms have been established by statute: "psychologist," "psychology" and "psychological." Over the past 30 years, Ontarians have come to rely on these descriptions as indicators of type and quality of service. The proposed Bill 63 removes the specific use limitations of two of these terms and will, if enacted, cause considerable confusion and will result in a major reduction in public protection.

I wonder if just for a moment you could turn to table A, which is right after page 5 in your document, so we could take a look at that table which looks at the complaints against psychologists, the types of complaints and the working settings. This shows you the kind of thing that OBEP has been doing over the past 30 years. I want to highlight custody and access complaints, which you will notice take place by private psychologists. We have had over 34, which is one of the largest ones, and with the present legislation as now stated, many of these people would not be registered or would not have to be registered.

The proposed Bill 63 removes all restrictions on the use of the terms "psychology" and "psychological." Consequently anyone, regardless of training, would be able to advertise a practice in psychology or psychological services. Further, by restricting the jurisdiction of the new college of psychology and the title "psychologist" to those persons offering health services to individuals, Bill 63 may withdraw regulation from significant areas of psychological practice such as organizational psychology, forensic psychology, custody and access or school psychology and psychologists in training education. Individuals, regardless of training or experience, will be able to use the title "psychologist" if they are not providing health care. Legal opinion is offered in appendix A to support this argument.

I would like you to refer again to our document and look at the yellow pages. This is a little exercise we provided people to say this is what could happen where these various ads could suggest that these people are psychologists. The task is to ask which ones are psychologists and which ones are not. If in your spare time you take a chance to look at it, you will notice none of them have to be regulated.

The board believes that any amendments to Bill 63 should meet four criteria. First, the amendments should be within the spirit of RHPA legislation taken as a whole and consistent with the intent of the RHPA declared by the various ministers who have guided the proposals through to the present stage. Second, proposed amendments to Bill 63 should not affect members of any other profession covered by the legislative package, nor affect any professional providers of service not regulated under the RHPA. Third, public protection from harm should at least be maintained at its present level, if not enhanced. Fourth, the right of the public to exercise informed choice in the selection of service provided should be supported by any proposed amendments.

I would like you to turn to table J right after page 17. This outlines the proposals of OBEP. We are suggesting this as a proposal. We leave it with you for your consideration.

I want to now ask our public trustee to make a few comments on behalf of the public trustees of the board.

Ms Boisvert: Madame la présidente, distingués membres du conseil, my name is Huguette Boisvert and I am here as a private citizen and also as a public member of the Ontario Board of Examiners in Psychology since 1988. It is in that capacity that I wish to speak to you about the changes proposed in the legislation. The public members -- we are three public members on that board -- of the Ontario Board of Examiners in Psychology support the recommendations made to you by this board. We believe that informed choice in the selection of psychological services by the public and quality assurance in the provision of psychological services to the public are the two most important factors that must be addressed, protected and enhanced by any amendments to the legislation.

We believe also that the proposed wording does not protect the public's right regarding informed choice and quality assurance because under the proposed wording the terms "psychology" and "psychological" will no longer be restricted to psychologists registered by OBEP or by the new college. Therefore, we will have a multitude of individuals advertising themselves as providing psychological services, services in psychology or psychological assessments, to name only a few, who will not be registered, monitored or regulated by anyone with regard to the quality and appropriateness of the service they provide to the public. I am talking for the public, I am not a professional. You can see that.

I quote from a letter to a committee member from one of my public member colleagues on the board, Deborah Brooks of Sault Ste Marie:

"For over 10 years I was actively involved in special education in Sault Ste Marie. I am the past director of the chapter of the association for children with learning difficulties and a past member of the public school board special education advisory committee.

"In both capacities I came into contact with many parents and children who had been victimized by individuals who held themselves out to be qualified to practise psychology but who were not. Indeed, the task of ferreting out appropriate psychological care from the rank and file of counsellors, social workers, some therapies can be very difficult for many people. Nevertheless, mostly people do come to associate the terms `psychological' and `psychology' with the work performed by qualified, regulated practitioners and will seek care givers based on the scriptures of practice.

"In removing protection of the terms `psychological' and `psychology,' the RHPA will without doubt create an intolerable state of confusion. It will remove a vital element which enables the public to identify proper care givers and make informed choices."

The proposed wording also seems to exclude from accountability and regulation all psychological services that will fall outside the definition of health care, yet no definition is provided for the term "health care."

In closing, I would like to point out that as as a mother of two dyslexic children and as a former school trustee for over 15 years, I am of the opinion that the public's right to informed choice and access to quality psychological service must be guaranteed and enhanced. I hope you will make the necessary changes to the new legislation to ensure that is so. I thank you very much, all of you, for your good attention.


Mr J. Wilson: I almost got my question answered by reading the legal opinion, but I will try it. If we were to accept your proposals for section 15 and, I gather -- continuing the extension of title protection to the other two derivatives, and just to play devil's advocate -- if the negotiations you are now undertaking with the master's-level practitioners were to break down and we were to accept your proposal here for what I will call extended title protection, would that in any way impede the master's-level practitioners in their practice? Say they never make it to becoming full members of the College of Psychologists.

Mr Phills: I could start with just a general response and state that it has not impeded them at present and that is the present law; we are not asking for any change. All three terms are there now, so that is not an issue as such. I see that the master's level is another issue on top of that. It is a new kind of issue.

Mr J. Wilson: But I see in your ads those terms are used, are they not?

Mr Phills: Yes, they are.

Mr J. Wilson: So you have people out there supposedly practising who are not members of the College of Psychologists.

Mr Phills: Probably who are being supervised by psychologists. They can practise under supervision.

Mr J. Wilson: So I have missed the gist. What is the problem with the ads then? Sorry, I am a bit slow today. I think I was up all night.

Ms Boisvert: It is misinformation for the public. The public is looking at it and need services. I look at it and I see psychological services. Already, I know that right now, it is registered. The act is there for that, but after the act, if it goes the way that it is now --

Mr J. Wilson: I see. Your yellow pages are examples of what would happen if we do not continue the protection. I am sorry I just missed that point.

Ms Boisvert: That is right. That is not the case.

Ms Haeck: Yes, Ms Boisvert, I would like to ask a question as a member of the public on this board, whether the OPA -- and some of the members are still here as well as yourself -- how to make the public much more aware of the psychological services out there. We have had the Consumers' Association of Ontario here and one of their extremely good solutions was around the issue of public awareness, public education. It is something that obviously, as you have all pointed out in your discussions -- yes, there are unscrupulous people out there and we are all aware of that. But how do we really let the broad spectrum of the public know about the right service provider?

Ms Boisvert: It is such a hard question you are asking because in all the fields there is always a protection for the public. Yet we try; everybody tries their own way to arrive at that and it is hard, but one of the ideas anyway I can give you is to be seen, like having a workshop on information to people at large. Things like that have to be seen so that people will understand the differentials because the information is not the office of the rich psychologists, but it is not anywhere else except at the library. You have people there who will be able to have the right information, but very few have access to it.

Ms Haeck: I know the consumers' association is working with the Metro libraries and is coming up with a plan of making pamphlets and materials available for the public. Obviously, the more organizations that work with them, it will make this whole process much more valuable.

Mr Martin: As I sit here and listen to many of the deputants, I feel sometimes like I am standing on a tightrope with the protection of the public on one hand and the delivery of service on the other, particularly where it impacts on northern Ontario which is where I come from. Right now, we have a difficult time getting qualified psychologists and other professionals into the north to practice. I am wondering if you might comment on how -- and I noticed that the quote you used was from a woman from Sault Ste Marie -- the limiting of the term "psychology" and "psychological" to people of your college might in any way enhance or detract from what is already a problem re northern Ontario and getting access to those kinds of services.

Mr Phills: I would like to refer to table D, which gives us a spread of where our psychologists are. We feel we are making some headway in that area. So much of it depends upon the training facilities that offer training in the north, but at the same time I think we have made more headway in the last five years, I would say, than we have in the previous 10 years to provide service up there. Maybe I could ask Dr Wand if she would like to comment too because that has been a problem for quite a while.

Dr Wand: One thing to try to make clear is that when we are talking about enhancing title protection or limiting the use of terms, we are really trying to maintain the level of restriction on the use of these terms that presently exist under the existing legislation. I think it is important to make clear that we are not asking for any change from the present form of restriction on the use of these terms. We are concerned about the proposed Bill 63. The way psychological services are offered in the north would not be affected by our recommendation here. They would be retained. I understand there is a problem of attracting people to the north, but I think one of the important factors is that there are not too many jobs offered to psychologists in the north, so part of that is the availability of work for psychologists in the north.

The Chair: The deputation has asked for another few minutes to complete the presentation. We just have two minutes left. Do we yield the floor?

Mr Martin: Sure.

Mr Wesley: As a former faculty member, I just want to add that for 12 years in the north in the university, in psychology and in other experiences out there, the real key to this is not in terms of professional legislation at all; it is in terms of investment in the training facilities of northerners. I think that looking for changes in this legislation solves that kind of problem. It is really looking in the wrong place. The supply issue is not something that is controlled by legislation.

The Chair: I would like to thank you very much for your presentation. We appreciate your appearing before the committee today. If there is any additional information you think would be helpful, I know you will submit it to the clerk for the committee's consideration.

Mr Phills: We will.



The Chair: The Union of Ontario Indians, please come forward. Please begin by introducing yourself to the committee. You have 20 minutes for your presentation. We hope you will leave a few minutes at the end, if you would, in case any of the committee members have questions. Please be seated and begin your presentation now.

Mr Roy: My name is Alan Roy and I am director of the health program at the Union of Ontario Indians. With me is Ron Wakegijig, a traditional healer from Manitoulin Island, a former chief of Wikwemikong reserve, and generally considered a co-ordinator for a number of healers on Manitoulin Island and the north shore.

The Anishinabek Nation, represented by the Union of Ontario Indians, is a federation of 43 first nations located around the Great Lakes. They number about 25,000 and the members belong to the Chippewa, Ojibway, Odawa, Delaware, Pottawatomi and Algonquin people. Their homelands, represented by treaties such as the Robinson Huron and Robinson Superior treaties, involve the watersheds flowing into the Great Lakes from Thunder Bay to Ottawa, from Sudbury to Windsor.

Each first nation employs community health representatives, alcohol and drug abuse workers and some employ public health nurses and other professionals on part-time contracts to serve the communities. Some communities have always had traditional healers and traditional midwives to provide their services upon request from citizens of these nations.

Our elders believe that the aboriginal rights to govern ourselves have never been surrendered and, as nations, we have the ability to pass laws, regulations and policies that govern our people. That concept includes the design, implementation and evaluation of our health programs and the duties of our health workers. Ontario has acknowledged this aboriginal right of the Anishinabek nation to govern itself in the aboriginal self-government paper ratified by the Ontario cabinet in 1990. This paper attempts to facilitate negotiations between the province of Ontario and first nations of Ontario in defining government-to-government relationships on all matters impacting on the lives of aboriginal people.

As there are approximately 200 staff employed in health programs by first nations, and many traditional healers as well as midwives serving the communities, the Anishinabek must ensure that their work status is recognized, protected and enhanced in light of any regulatory legislation proposed by this government. We have noted that Bill 43 attempts to control the activities of all health professions and health providers within the Ontario boundaries through various colleges sponsored and endorsed by the government of Ontario, which would include the colleges of physicians and surgeons, dentists, pharmacists, etc.

The legislation also includes the health service activities, listed in paragraphs 1-13 of subsection 26(2), which are prohibited unless a college has authorized a licence to a specific health provider. Many of the activities listed in this section are presently performed to varying degrees by the Anishinabek health staff and traditional health providers. I think Ron Wakegijig can be more specific later on, during the question period, about the types of activities that are actually performed. I have listed a number of examples there and I go on.

We have also noted that section 28 deals with the concept of exemptions to the principle of regulated control and licensing by a college, but our health providers are not mentioned. Also, I will point out at this time that some committee members have pointed out to me that exemptions may be dealt with by regulation. When I originally wrote this brief, I was thinking in terms of a clause right in the legislation somewhere that would refer specifically to aboriginal people and health providers.

Community health workers, alcohol abuse workers and band-employed nurses have to diagnose patients on reserve in the absence of doctors. In some cases, emergency situations have to be handled by the health worker, and immediate decisions must be made to transport patients to a specialized facility. Many patients on reserve require the assistance with prescription drugs and injections of regularly prescribed medications.

In some cases, these health workers or nurses refer patients to traditional healers, or the patient will ask for advice on what services a traditional healer might provide. Many CHRs have delivered babies in emergency situations. These are front-line workers for public health on reserves, and they are expected to involve themselves in diagnosis, some treatment and assistive medical procedures at the demands of the first nation patients. The above list of activities in Bill 43 seems to threaten these health workers.

Traditional healers and midwives will be recognized, protected and evaluated by our first nations, and their duties performed by health staff in our communities will be monitored and work plans approved by the first nations' council. In order to avoid conflicts in jurisdiction and potential harassment by the medical establishment, we recommend the following amendments:

"That under subsection 26(4) or section 28e a specific amendment to the legislation include the exemption, recognition and protection of traditional healers, traditional midwives and health staff under the jurisdiction of first nations in Ontario;

"That Bill 56, section 2 include a definition of an `aboriginal traditional midwife';

"That within Bill 56, section 5, add the concept of an aboriginal first nations midwifery council, which will recognize, facilitate and support midwifery within our communities;

"That within Bill 56, sections 6 to 14, all colleges, councils, registration committees, complaints committees and discipline committees will not affect the jurisdiction of first nations councils for midwifery in our communities. Rather, the activities of midwives, traditional healers and health workers will be supported by an Indian advisory council set up by the first nations themselves; and

"That both Bills 56 and 43 have a clause to provide for and facilitate the development of a separate and distinct advisory council, which could facilitate, promote and support health services within the Anishinabek nation."

In summary, our understanding was that the purpose of the committee in its review, or the legislation, was to devise new structures for control or enhance the structures for control; to decide which providers should be controlled; and to settle outstanding issues involved in health service delivery.

What we saw was an absence of any reference to our communities or the systems we use to provide health care to our clients, and we are talking only about citizens within our communities, as far as delivery is concerned. It is true on occasion that healers do deal with the dominant society, but for the most part we are talking about delivery within our own communities and control institutions within our own communities.

In the absence of an Ontario native health policy, the absence of an Anishinabek-Ontario political accord and the presence of the Ontario cabinet paper for negotiation of first nation-specific amendments with the government of Ontario, an opportunity to address these concepts should not be lost. This proposed health legislation crosses the jurisdictional boundaries and could lead to serious conflict in future for Anishinabek health providers.

First nations are willing, able and indeed are community-directed to take responsibility for their community's institutions, which directly affect the lives of their citizens. First nations health providers historically have maintained an essential and culturally integrated service, and we cannot afford to have those services threatened or disrupted by the College of Physicians and Surgeons or any other control agencies within Ontario. It is therefore incumbent upon the standing committee for social development to consider that appropriate additional clauses be inserted in the legislation to recognize the concept of a separate and distinct development and facilitatory mechanism for the Anishinabek nation's health care.

Our policy development staff at the Union of Ontario Indians are available to work with ministry staff in drafting any such clauses to the legislation. I also tabled some questions, but I would like to make sure the members have a chance to question Ron Wakegijig on some of the health practices involved here. Maybe we could leave the questions to the end.

The Chair: Can I suggest that we have a few questions and then if there is time perhaps you can just state your questions for the record or, failing that, table them with the committee and the ministry will respond, and they can be part of the public record as well.

Mr Roy: Good suggestion.

The Chair: We have them on the appendix before us. There are five questions.

Mr Roy: Correct.

Mr Jackson: Gentlemen, thank you for your presentation. Let me ask you a question regarding the separate councils. Have you had any opportunity to speak to the new government about the recommendations, generally, about a separate advisory council or, in the case of midwifery, the separate council recognizing those services within first nations' activities in this province? Have you had any feedback from the government or any dialogue on these points?

Mr Roy: No. We have had some discussions with the task force on midwifery, but Ron Wakegijig has been trying to set up such a council in Ontario for traditional healers. I will let him comment on that.


Mr Wakegijig: Basically we work with the federal Department of Health and Welfare Canada through our community health centre on the reserve. What we have been trying to do is set up an advisory council of traditional healers that will legitimize certain practitioners as being bona fide traditional healers. We are quite concerned, as the government is, about quackery as you call it. Unfortunately, there are people like that in both societies, people that take advantage of the ill health of certain individuals. There is a price to be paid whether it be monetary or deteriorating health of the individuals that are subjected to this quackery. We are extremely concerned over it and we are in the process of doing something about it right now.

Mr Jackson: Madam Chair, perhaps I could request that, when we assemble as a committee on the 16th and maybe the 17th, we invite the ministry responsible for native affairs as well to respond to some of the questions the committee might have with respect to the points raised in this brief. I understand Health will respond to the questions. We appreciate that, and I am sure they will ensure that these questions are shared with the minister responsible for native affairs. But I for one would like to request, if there is agreement with the committee, that they also come forward to respond to some questions in this area.

The Chair: Your request is noted, Mr Jackson. Question, Mr Wessenger?

Mr Wessenger: Yes, thank you very much for your presentation. I was wondering if these recommendations have been discussed at all with other first nations.

Mr Roy: They have not. The other first nations were represented in front of the task force on midwifery, but I am representing the Anishinabek Nation here and just the federation that I have described in my brief. I am not sure why the other associations have not come in front of you, but I would say that I have heard similar concerns expressed in the other associations. I have been in this business for 20 years, and I know everybody else in the other associations, and I have been listening. So what I am proposing here is not out of line for all of Ontario, but I am speaking just for the Anishinabek Nation.

Ms Haeck: Thank you, also, very much. My question relates to your proposed amendments. You have, in the first one, said you would like to see an addition under section 28. I was wondering if you did not feel that section 28c gave the traditional healer the kind of empowerment needed to perform all those services.

Mr Roy: I understand what you are saying; however, we thought it was because this group is so distinct and because the Ontario government is trying to build specific relationships with aboriginal communities it warranted a separate clause distinct in its own manner. That is why I did not suggest along the lines of what you are suggesting.

Mr Hope: Just listening to the concerns that you bring forward -- and I want to get to the treatment aspect of things, but before I get into that -- on the consultation, this piece of legislation has been developed starting about 1982. What actual input have the Indian reserves and the first nations people had in this consultation process?

Mr Roy: As far as I know, this is the first opportunity we have had. The problem is the Ministry of Health never had an Indian health liaison unit within the ministry. There has never been an Indian health policy in Ontario. There has never been a preoccupation with the Ontario government dealing with the associations on matters like this, and I must say there has never been a preoccupation on the part of the treaty associations to deal with the province. We deal mainly with the federal government. But that has all changed in the last few years. Ontario right now is probably one of the leaders in Canada in developing relationships with aboriginal communities. So it is late, and I understand the problem that you are alluding to, but there we have it.

Mr Hope: So it would just be a major stepping-stone in achieving some --

Mr Roy: This would be a big step.

Mr Hope: Along with self-government aspects of this government's initiatives.

Mr Roy: It would be a very big step.

Mr Hope: If further time allows, I would ask in more depth about the treatment aspect, if you would not mind commenting on it.

Mr Wakegijig: Well, first of all, I will just briefly describe part of what I do in the community where I come from and various other communities on Manitoulin and what we call the north shore of Lake Huron.

One of my specialty areas, if you can call it that, is diabetes among native people. We started a program about five or six years ago and I worked very closely, by the way, with orthodox physicians who come to our clinic. One of the big problems we are faced with is in the older population. First of all, they are illiterate in so far as reading and writing the English language is concerned. In their own language and their own culture they are extremely literate, as far as that goes.

So it is very hard for an old person. Let's say a senior in his 70s. He is diagnosed as having diabetes. One of the primary treatments for the control of diabetes is diet. It is very crucial. So when the doctor prescribes a certain diet for his patient, they are either very reluctant to follow it or they do not follow it all. As a result, in years gone by we have had people suffering from complications, or amputations have had to take place. People have gone blind. Their kidneys have failed. So what I do is follow-up work after a physician has made an official diagnosis that the person is diabetic. That is where I come along from the traditional point of view to emphasize the importance of dietary measures, dietary control of the diabetes. So coming from a traditional practitioner like myself, they are more receptive to it, because they figure it is part of the traditional treatment.

Furthermore, what I recommended -- we had a lot of problems at the initial stages -- was providing each of these diabetics with glucose monitors. So as a result, they are able to monitor themselves on a daily basis. As soon as they know something is going wrong with their blood sugar levels, they are able to do something about it themselves by readjusting their diet or the form of exercise they are capable of doing during the course of a day. So that is one of the benefits of traditional practice.

I have been practising traditional medicine for 25 years now. It is the symbol of these bear claws that I wear. Every bear claw represents five years of experience or whatever you want to call it. But I deal with psychological problems. I work closely with the psychiatrists at Manser Mental Health Clinic. If I suspect a child of having extremely complicated medical problems, I refer them to the family doctor that is looking after the Millard Clinic, with the recommendation that immediate steps be taken to have them examined here at the Hospital for Sick Children, which is a specialized facility. We have been quite successful in that area. Instead of waiting for months to have a child brought down to the Hospital for Sick Children, it is only a matter of hours or a matter of days before we have him down here.

The Chair: I would like to thank you very, very much. Your presentation has been very helpful to the committee. Particularly the examples of the last few minutes I think have given the committee an insight into some of the challenges in the areas of provision of service for the native population of Ontario.

If, over the course of our hearings, there is additional information, I know you realize you can visit any of the members individually, but you can also submit in writing additional information to the committee that you think might be helpful.

We have officially received your questions. They are a matter of record, and I will refer them to the minister through the parliamentary assistant and ask the ministry to respond in writing for the committee during the course of our deliberations. Thank you very much for appearing today. We appreciate hearing from you.



The Chair: I would like to call now the Denturist Association of Ontario. Welcome to the standing committee on social development. Please introduce yourselves at the start of your presentation. You have 20 minutes. We would ask if you would leave a few minutes at the end for questions from the committee.

Mr Battell: Madam Chairperson, my name is Ken Battell and I am the president of the Denturist Association of Ontario. With me today are Cliff Muzylowsky, our vice-president, and Jurgen von Fielitz, the chairperson of our association's legislative committee. We are practising denture therapists.

We are delighted to appear here today to support the passage of Bill 50, an act governing denturism. For the members of our profession and for the consumers of Ontario, the Regulated Health Professions Act and Bill 50 represent a major victory over almost 20 years of arguments and studies about the fitting of partial dentures.

With the passage of this legislation -- as proposed by the Schwartz commission, approved by Liberal Health ministers Murray Elston and Elinor Caplan, and introduced by Health ministers Evelyn Gigantes and Frances Lankin -- consumers will finally have the legal right to have access to high-quality partial dentures at an affordable price.

This is a victory that is being loudly applauded by consumers and, in particular, senior citizens who tend to be the primary beneficiaries of the choice of which profession fits their partial dentures that this legislation provides.

In their submission to this committee, the United Senior Citizens of Ontario, which represents some 300,000 seniors through their 1,400 chapters across Ontario, has told you:

"We strongly support the proposed legislation granting denturists the right to fit partials without the supervision of a dentist because it will increase the access to good dental care at more affordable prices. We believe that this legislation is in the interests of consumers and will lead to an enhancement of the quality of life of thousands of seniors who cannot afford partial dentures under the existing legislation."

Another major consumer organization representing seniors, the Ontario Coalition of Senior Citizens Organizations, which represents 39 senior citizen organizations ranging from the Big Trout Lake Indian Band to the Older Women's Network, have stated that they too vigorously support the expanded scope of practice for denturists. In a letter to the Denturist Association of Ontario, the coalition stated:

"Research has shown that high costs often prevent seniors from obtaining the dental services they need. Since this legislation will allow denturists to provide quality partial dentures at lower cost, it certainly deserves our full support."

We are delighted to have such vigorous support from consumers. However, while we understand that both the Minister of Health and the members of this committee have said they want to use these hearings to listen to what consumers think, we fully appreciate that in the course of these proceedings you are going to hear primarily from witnesses who are opposed to this legislation.

What the members of this committee need to understand is that this is not the first time the denturist-consumer lobby has won this argument. We have won it before on the merits of the case and then lost it when powerful vested-interest groups combined and successfully convinced politicians to back down. If I may, Madam Chairperson, it might be useful if I took this committee through a brief history of the struggle over the provision of high quality, less expensive partials in Ontario.

In 1972, under pressure from the Ontario Dental Association and the Royal College of Dental Surgeons, the then Minister of Health, Dr Richard Potter, introduced legislation which prohibited denture therapists from performing intra-oral procedures of denture therapy except under the supervision of a dentist. By law, our profession was not allowed to do complete dentures, let alone partials.

While the ODA and the RCDS promised the government of the day that prices would remain low if they had exclusive rights in the area of dentures, the fact is that prices continued to skyrocket. As a result, the government moved some two years later with new legislation, the Denture Therapy Act, 1974, which enabled denturists to perform complete dentures, but not partials.

At that time, both the NDP and the Liberals voted against that legislation, arguing forcefully for the right of denturists to make and fit both full and partial dentures independent of dental supervision. Indeed, a private member's bill was introduced by NDP MPP Mel Swart which sought to extend the practice of denture therapy to the provision of partial dentures. While Mr Swart's bill was defeated, our profession unleashed an unrelenting lobby campaign to review the legislation.

Finally, in 1980 Health Minister Dennis Timbrell agreed to assign the issue to the Ontario Council of Health. Following an exhaustive study by Professor Bernard Dickens, the government released the Dickens report of 1981. This was our profession's first major victory.

The Dickens report recommended "that the Denture Therapy Act, 1974, be amended to permit a registered denture therapist to design, supply, adjust and repair partial dentures without supervision from a dental surgeon." However, while consumers and denturists were celebrating our victory, in response to an aggressive lobby by the ODA and RCDS, both the Council of Health and the government of Ontario backed down and refused to implement the recommendations of the Dickens report on the grounds of "public safety."

The health council stated, "Since the safety or otherwise of unsupervised practice of denture therapy has not been determined empirically, it may be desirable to design and carry out studies which would provide the empirical evidence needed for objective decision-making."

While the Governing Board of Denture Therapists, the Ontario Association of Denture Therapists and George Brown College each argued vehemently that there was no risk of harm, the ODA, the Association of Prosthodontists of Ontario, the RCDS and the faculties of dentistry at both Western and the University of Toronto argued that it it might be harmful to allow denturists to do partials.

In their presentation, the dental lobby displayed pictures of gross anatomical anomalies that shocked the decision-makers of the day. The question was posed: How could denturists possibly treat such unhealthy mouths? The answer, of course, is quite simple. We would not. Denturists are trained to recognize abnormalities through the courses in oral pathology, biology, microbiology, histology, etc. We automatically refer such patients to qualified practitioners.

We do not work on unhealthy mouths. That is within the scope of practice of dentists, not denturists. Indeed, if a patient were to come into the office of a denturist with his or her mouth in the condition depicted by some of the photographs you have been shown, he or she would automatically be referred to an oral surgeon.

As the members of this committee are aware, one of the major focuses of the HPLR process over the past nine years was to uncover evidence of harm by practitioners. One of the reasons why the review and the last four ministers of Health supported the legislation before this committee is that no one has been able to come forward with a single case of harm involving denturists.

Prior to becoming Canada's ambassador to the United Nations, Stephen Lewis, acting in a consulting capacity to our association, told the HPLR team: "It is apparent to anyone familiar with this field that over the years thousands of partial dentures have been made and fitted -- whether legal or illegal -- and there is utterly no evidence, in the aftermath, of patient risk.... All the hints and intimidations of the horror stories, all the lurid descriptions of what can go wrong, appear to be the stuff of sheer illusion."

As Mr Lewis stated, "Hyperbole is no substitute for fact." Indeed, it was on the basis of fact that Dickens recommended that denturists be permitted to fit partials. It has been on the basis of fact that the HPLR and a number of health ministers have recommended the passage of the legislation that is before you today. Nevertheless, over the course of these hearings this committee will no doubt be subjected to a great deal of hyperbole and explanations by vested interests as to why they continue to believe denturists might do harm if you pass this legislation.

Those opposed to denturists fitting partials argue that because partials involve working with natural teeth, they pose a greater risk of harm than full dentures. However, in many cases denturists are required and legally permitted to fit both upper or lower dentures opposing dentate or partially edentuous mouths without dental supervision. Clearly, it is an odd distinction that allows us to legally place dentures in opposition to natural teeth but not adjoining them.


It is important that the members of this committee understand that during the course of the past nine years of this process, the Ontario Dental Association has canvassed their membership time and again seeking real-life, specific examples of where denturists have done harm. None have been found.

While vested-interest groups might continue to produce pictures of unhealthy mouths and hint that this is what denturists could do if this act were passed, the fact is that there are no cases of demonstrated harm done by denturists. In fact, denturists have the enviable record of zero malpractice convictions in Ontario.

Indeed, there is evidence to indicate that quality of prostheses provided by denturists may in fact be superior to those provided by dentists. The July 1987 issue of Journal, published by the Canadian Dental Association, contains a study which we have provided at the back of this brief.

The evidence suggests that the quality of work performed by denturists is equal to or better than provided by the dental profession. This should not be surprising, given that denturists spend a great deal more time learning about the fabrication and fitting of dentures than dentists do.

Over the course of our three-year program of study, denturists spend 1,967 hours learning to manufacture prosthetics compared to a total of 331 hours spent by dentists. In our submission we have included a table that compares the removable prosthodontics curricula of dentists to denturists relating to prosthodontics.

In terms of price, the exhaustive study conducted by Dr Bernard Dickens for the Ontario Council of Health in 1981 found that "based on anecdotal evidence, numerous letters from the public, etc, the prices charged by denture therapists may be approximately half of those charged by dentists." Similarly, recent studies comparing the costs of dentures fitted by denturists versus dentists show that our prices remain considerably lower than dentists'.

I would remind members of this committee that since denture wearers are often seniors on fixed incomes, the issue of cost is critically important. Certainly that has been the historical concern of consumer groups.

Denturists have worked very closely with seniors and their organizations over the past 20 years to improve upon the dental care of the elderly. As you know, our profession, through Mr von Fielitz, was an active contributor to the Hicks Advisory Committee on Dental Care for Seniors in Need. Indeed, denturists are the only dental profession who regularly make house calls to seniors in their homes and to elderly persons in institutions.

At the heart of Bill 50 is improved access to service and reduced cost. With the passage of this legislation, denturists will be able to provide services to the individuals whose prosthetic needs are covered by government programs such as welfare, the Department of Veterans Affairs and the Workers' Compensation Board. We will also be able to provide subsidized services to seniors living in homes for the aged, to residents of psychiatric hospitals and in homes for special care, all at reduced costs to the taxpayer. What denturists offer are faster, less expensive, more accessible, high-quality services to the public.

In summary, this legislation provides for a system of dental care in which consumers will have greater choice, improved access to services, equal or better quality, and less expensive partials. That is why the Denturist Association of Ontario, the United Senior Citizens of Ontario and the Ontario Coalition of Senior Citizens' Organizations urge you to pass this legislation unamended.

I would like to conclude these remarks with a point that will not be obvious from either this presentation or from submissions you have heard from organized dentistry. That point is the importance of the co-operative relationship that actually exists between denturists and dentists.

I think it is important to recognize the distinction between official voices of our professions and the real world. The fact is, denturists and dentists often have excellent working relationships. Many, if not most, dentists recognize the expertise of denturists in the field of prosthetics. We often refer patients to each other, and in most cases we have developed good working relationships that benefit our patients.

What you are seeing played out before you are the last agonizing jabs between organized dentistry and organized denturism after 20 years of official strife, but these arguments do not in fact reflect how the oral health care system actually operates in today's environment. That is why it is so important that this legislation be passed and put behind us, once and for all. We recognize, as do our colleagues in dentistry, that we must continue to build on the very positive co-operative relationships that have developed in recent years to the benefit of our patients and, frankly, to our mutual benefit as well.

We would now be pleased to answer any questions.

Mr Muzylowsky: With your permission, I would like to give you a very brief demonstration that hopefully cuts through some of the rhetoric and gives you a better understanding of exactly what the problem is we are facing.

The Chair: By all means, the time is yours. Please proceed.

Mr Muzylowsky: I have prepared some models here. I will take the liberty of standing up. For instance, denturists are legally entitled to examine patients and construct full dentures. This is a model resulting from the impression of a complete denture. The model represents an impression of a complete denture. Often in the process of constructing complete dentures, uppers and lowers, we encounter situations where there is a partial dentureless lower opposing the upper. There are two teeth. This would represent, obviously, a partial to be made. We are legally entitled to take an impression of that mouth, examine it and make an assessment of the whole situation. We obviously have to do that.

We are entitled to make bite registrations, also for the lower. These two go together, the upper and the lower. This is all within the legal scope of our practice. We can then complete an upper denture. The moment we want to make a lower denture, the whole thing becomes illegal and we are facing a six-month suspension. Yet we can work legally on the dentureless and on the partially dentureless case. Where it comes to a process of designing, surveying and manufacturing the denture and putting it in the patient's mouth, we cannot do it. Here our expertise is far greater than the dentist's. As our accompanying appendix will show, prosthetics-wise we are trained far better than is being done at a dental college.

This shows how ludicrous the whole situation is.

Mr Owens: I was pleased to hear about the co-operative relationship you want to maintain with the dental profession. If I come into your office and I do not have the kind of gross pathology that you referred to in your presentation, do you have any kind of a requirement or a suggestion to me as a patient, because you would not know me if you fell over me on the street, that I see a dentist to ensure that there is no latent pathology before you start to work on the dentures?

Mr Muzylowsky: Yes, we do refer the patient to a dentist. We suggest to the patient that he or she will see a dentist prior to the fabrication of the partial to be entirely sure. I think this is just a reasonable thing to do. We will tell the patient, and then it is up to the patient of course to do that. A patient may say, "I'm sorry, but I have seen my dentist two, three, six months before already and my mouth is fine, and I refuse to go back."

Mr Owens: Would you then ask for records so that you have a reference point to start from?

Mr Muzylowsky: We, of course, have had difficulties in the past to get records. A record in this case would be a record from the dentist or the practitioner who looked after the patient and it often would be very difficult to obtain.

Mrs Marland: I will tell you right off the top so that you do not hear it when you leave the room: I am married to a dentist.

Mr Muzylowsky: Aha.

Mrs Marland: I am being very fair. I am also intrigued that your exhibits are in a candy box. I think that is great. If the people --

Mr Muzylowsky: It is a gift from a dentist.

Mrs Marland: If they ate what was in the candy, that is why they need the full dentures.

Very seriously and very respectfully, I would like to ask you, when you compare the number of hours in your training where you learned to manufacture prosthetics, in those 1,967 hours you refer to, how much training or instruction do you receive in the basic health sciences?

Mr von Fielitz: As a graduate of George Brown College, having taken the denture therapy program, I feel I can best answer that question.

A good deal of our curriculum is spent on areas of concern, not only basic science but also dental science. Requirements such as histology, anatomy of head and neck, orofacial anatomy, oropathology and general medicine are part of our curriculum.

I believe as part of the submission by the Governing Board of Denture Therapists they included a copy of the three-year denture therapy program objectives. Spelled out in the objectives are the number of hours that are actually spent in these areas of the basic and dental sciences.

Again, we receive a great deal of training which would allow us to recognize normal and abnormal situations. It is not our scope of practice to make a diagnosis but to recognize the situation and refer individuals to the appropriate practitioner.

The Chair: Thank you very much for an excellent presentation. Time has run out. I know that Mrs Marland can continue her questioning privately and individually. If there is additional information you think would be helpful to the committee, feel free to submit it in writing.

The committee adjourned at 1602.