Monday 7 October 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


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)

Wilson, Jim (Simcoe West PC)

Witmer, Elizabeth (Waterloo North PC)


Miclash, Frank (Kenora L) for Mrs McLeod

Sola, John (Mississauga East L) for Mr Beer

White, Drummond (Durham Centre NDP) for Mr Martin

Clerk: Mellor, Lynn

Staff: Spakowski, Mark, Legislative Counsel

The committee met at 1530 in room 151.


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 clerk has provided a list of all those sections that have been postponed and they are on the paper before you that says, "Bill 43, Regulated Health Professions Act, 1991, Postponed Items." As well, there is a package of proposed amendments to Bills 43, 44 and 45 and you will be receiving a package to add to that. At this time the clerk is distributing them.

We are going to begin today, with the consent of the committee, on the postponed items list at section 6 and deal with the clauses in numerical order. All agreed that we proceed in that way? That is the normal procedure for a committee.

Section/article 6:

Mr Wessenger: I would ask that the subsection 6(3) amendment be withdrawn. The purpose of withdrawing it is that we are not going to have a patient relations monitoring board. There is going to be another procedure to deal with the matter of monitoring the patient relations committee. It is going to be introduced at a later date.

The Chair: Shall section 6 stand as written in the bill?

Section 6 agreed to.

L'article 6 est adopté.

Mr Wessenger: I suggest that section 11 be reopened and heard with section 81.

The Chair: We have a request from the parliamentary assistant that consideration of section 11 be postponed until we have dealt with section 81.

Agreed to.

The Chair: Back to the agreed-upon agenda. We have now postponed section 11, carried all sections between the beginning of the bill and section 26, which we are now at. Is that your understanding?

Mr Wessenger: That is my understanding.

The Chair: The reason I want to be really clear on this is that when dealing with postponed items there is sometimes a little bit of, I would use the word "confusion" lightly, about exactly where we are. So for the record I want to be clear that everyone knows where we are and how we got there. Agreed. We are now beginning section 26, which was postponed.

Section/article 26:

The Chair: Mr Wessenger moves that paragraph 1 of subsection 26(2) of the bill be struck out and the following substituted:

"1. Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis."

Mr Wessenger: I think it is fair to say that the whole question of subsection 26(2), as set out in the bill, has been a matter of concern to many individuals. There have been certain perceptions with respect to the meaning of that clause as set out in the original bill, so this amendment is to make it clearer with respect to the intended intention that the unregulated groups would not be affected in their counselling role with respect to this clause.

The first aspect of the amendment is to substitute the word "diagnosis" for the word "conclusion." The purpose of this is because "diagnosis" is a much narrower and more precise term than "conclusion" and there was some concern expressed that the word "conclusion" could be an opinion given after an assessment or an observation made from an assessment. To clarify that, the word "conclusion" is being replaced by the word "diagnosis." We think this makes it much clearer that there is no restriction on communicating results of assessments.

The second aspect is to remove the word "dysfunction" from the definition. This narrows the restriction to diseases and disorders. This was done because dysfunctions are often identified by assessing patients. Therefore, it is doubly clearer that assessment results may be communicated.

Although it is not the subject matter of this particular amendment, there is a further amendment I would like to refer to which is related to subsection 26(2). That is the proposed subsection 28(2). Subsection 28(2), which we propose to introduce, makes it clear that, "Subsection 26(1) does not apply with respect to a communication made in the course of counselling about emotional, social, educational or spiritual matters as long as it is not a communication that a health profession act authorizes members to make." Again, this will help to clarify the situation with respect to the whole question of counselling. I think the amendment to subsection 26(2) has to be considered in connection with the amendment, subsection 28(2).

Mr J. Wilson: I just wonder if members would note, three pages following, that the PC amendment from my caucus only varies from the government's amendment to subsection 26(2) in that we have inserted the word "medical" in front of the word "diagnosis." I am wondering if that would be a friendly amendment to the parliamentary assistant, given that a number of the unregulated health professions, the coalition of churches and the Coalition of Unregulated Health Professionals really believe very strongly that we must make it clear in this legislation that we are referring to a prohibition on medical diagnosis.

We feel very strongly in our caucus that this would help, as the parliamentary assistant has just said, to strengthen the clause to ensure that anyone picking up a copy of the bill and reading it would understand we are referring to medical diagnosis. I wonder, Madam Chair, if that would be a friendly amendment.

The Chair: No, Mr Wilson, it would not. The notion of a friendly amendment is not parliamentary in this context. It is appropriate, if you wish, to move your amendment to the government amendment. It can then be discussed and voted on appropriately.


The Chair: Mr Wilson moves that paragraph 1 of subsection 26(2) of the bill be struck out and the following substituted:

"1. Communicating to the individual or his or her personal representative a medical diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis."

Mr Wessenger: If I might speak to that, the reason we do not consider it a friendly amendment is that it makes medicine the reference point, which is objectionable to other regulated professions and against the philosophy of the whole legislation, which is to recognize other professions in the delivery of health care, besides the whole question of medicine.

It would be difficult to apply to the authorized acts of chiropractic, chiropody, dentistry, optometry and psychology. Actually we did look at that whole question at an earlier stage in the manner of attempting to see if there would be some method of covering this aspect and defining each one of those diagnoses specifically, but the problems were too great to really proceed along that way. Therefore, I cannot support that amendment.

Mr J. Wilson: Speaking to it further, I agree it would be difficult, to some degree, to amend the other acts, but not impossible. It would make it clear, I think, that we are referring to medical diagnosis. A number of groups have asked for this. I do not think the legal hurdles are so great that we cannot get around them and adapt the other legislation to this amendment. It would seem to me that it is an appropriate amendment.

The government should be defining in the legislation what "diagnosis" means. You will admit, I think, parliamentary assistant, that many groups that appeared before this committee used the terms "assessment" and "diagnosis" interchangeably. Perhaps if you will not accept our amendment, which we feel strongly about, you will consider putting into the legislation a definition of what you are referring to as "diagnosis" so that it is clear to everyone who picks up this act what exactly the government's intention is here.

Mr White: I wonder if I could seek some clarification on this point from the parliamentary assistant, with the consultation available to him. As it presently stands, diagnosis is limited to this very specifically limited number of practitioners. Is that right?

Mr Wessenger: That is correct.

Mr White: Is the quality or the nature of their diagnosis profession-limited, ie, do optometrists have a specific area?

Mr Wessenger: Yes, they do. There are specific areas set out with respect to each profession.

Mr White: Along those lines, is it also true that no other of those professions may make a diagnosis in that area? Thus, a medical doctor could not make an optometrist's assessment and a medical doctor could not make a psychological assessment -- or diagnosis, excuse me. It is an important distinction, I understand.

Mr Wessenger: Yes. However, certainly the medical profession has a broad diagnostic power because of the various medical specialities.

Mr White: I understand that, but under the law, is it legal for a medical doctor to make a psychological diagnosis or assessment, whichever phrase you want to use?

Mr Wessenger: Yes, it would be.

Mr White: It would be illegal?

Mr Wessenger: No, it would be legal for a doctor to make a psychological assessment under the legislation.

Mr White: A medical doctor could make a psychological assessment.

Mr Wessenger: We might have counsel give some clarification here.

Ms Bohnen: In this legislation, physicians are authorized to diagnose all diseases and disorders. Professions like optometry, psychology and chiropody diagnose subsets of that, so there are certain kinds of diagnoses a physician can make, that a psychologist is authorized to make, or an optometrist is authorized to make. Certainly, psychologists do many things that physicians do not, but the only kind of thing you are talking about regulating at the moment is a certain kind of diagnosis.

Mr White: But within the context of this act, psychologists who are trained to use certain kinds of tools are the only people who are allowed to use those tools, right?

Ms Bohnen: No.

Mr White: Do you mean that under this act medical doctors who have absolutely no training whatsoever in using psychological tools are authorized to use them?

Ms Bohnen: I think you are talking about psychological testing. Psychological testing is not controlled by this legislation, but diagnosis is controlled.

Mr White: The diagnosis would derive from that testing, though.

Ms Bohnen: It may or it may not. For what psychologists are authorized to diagnose, perhaps I can just refer you to the proposed Psychology Act. For some of those things psychological tests would be a useful tool and for other things they would probably be quite useless. What psychologists will be authorized to diagnose, or at least to communicate diagnoses about, are neuropsychological disorders or psychologically based psychotic-neurotic or personality disorders. Physicians in this legislation are authorized also to communicate diagnoses about all of those things, but that says nothing about whether a physician is qualified to administer psychological tests. You are quite right that they do not administer psychological tests.

Mr White: But it is through psychological tests that psychologists can determine neuropsychological dysfunctions and learning disorders and a range of other difficulties. It is through those technologies. I guess what strikes me as unusual here is that you are saying they are allowed to use diagnoses that they are not trained to. I am sorry, go ahead.

Mr Owens: More to the point of Mr Wilson's comment around the issue of diagnosis and assessment in terms of the language usage, I think Mr Wilson hits on an interesting point when he says this terminology has been used interchangeably.

That is the crux of the problem, that the regulated professions that would be covered by the proposed government clause would be adequately protected. I do not think you can read this in isolation from the harm clause proposed and accepted by the official opposition that taken in its whole context, the unregulated professions are also protected through the harm clause with its various exemptions.

Mr J. Wilson: Just to come back to the comments by the parliamentary assistant, who said that perhaps our amendment inserting the word "medical" in front of the word "diagnosis" would somehow give supremacy back to physicians, I do not believe that to be the case, because you also note that my comments at the beginning of these clause-by-clause proceedings were that we would be giving the act of diagnosis within the scope of practice of audiology and speech-language pathology. So we are certainly not giving supremacy to physicians and I do not like the spin that has been put on that by the parliamentary assistant. I do not think it is a valid argument for not allowing the words "medical diagnosis" to be inserted in the legislation.

Mr Wessenger: Perhaps I might refer to counsel on this.


Ms Bohnen: I would like to get back to Mr White's point, because left the way it was it may be troubling to some members of the committee. It is the responsibility of the College of Physicians and Surgeons of Ontario to ensure that physicians only diagnose within their own individual competence. That competence in most cases, I would guess, does not include using the arsenal of psychological tests that psychologists use, but physicians diagnose in their way just as psychologists diagnose in their way.

What these bills are trying to do is to ensure that both groups are diagnosing the kinds of conditions they are competent to diagnose, but it does not suggest that physicians do what psychologists do, or that psychologists do it the same way physicians do it. Each profession is distinct and it is up to its regulatory body to ensure that the membership as a profession diagnoses in the ways they are competent to do so.

Mr Hope: Just listening to the conversation about inserting the word "medical," is it not true that some of the regulated professions concentrate on non-medical areas, so they would not have the ability to communicate that area?

Mr Wessenger: I think it is a fair reflection that in our opinion the insertion of the word "medical" would make it somewhat difficult for the other professions, yes.

Mr J. Wilson: I would be difficult but not impossible to amend, for example, the Audiology and Speech-Language Pathology Act to ensure that they are able to carry out the same medical diagnosis and give them that controlled act. I think the intent of the amendment is to ensure that all those unregulated professions understand that what we are trying to prohibit here is their communicating an actual medical diagnosis, and by inserting the word it makes that clear.

I go back to the many witnesses we had before this committee who used the word interchangeably and there is a lot of confusion out there. I have discussed this with the College of Physicians and Surgeons and they are comfortable with it as long as we take steps to make it clear which professions we also want to be carrying out a medical diagnosis. For instance, we proposed that speech-language pathologists be able to do that because it was clear in their testimony that they do conduct and are asked to conduct a medical diagnosis within their scope of practice.

Mr Hope: In response to what he is saying, and I guess to the parliamentary assistant, under subsection 28(2), dealing with the changes that will be made on educational and spiritual matters, would that not then alleviate the pressures put on about those able to communicate diagnosis? We are talking about educational. Educational may be education about a disorder or a dysfunction they may have through the communication process.

Mr Wessenger: It was felt that amendment would clarify the situation with respect to counselling in the educational and social areas. That certainly was the purpose of putting forward that amendment to add subsection 28(2), to combine it with this definition. We are of the opinion that this adequately protects the unregulated professions in carrying out their counselling functions.

Mr J. Wilson: In fact it was my colleague the member for Burlington South who suggested we put in the word "educational." We agree that is helpful, but we also think that inserting the word "medical," as has been asked by us, by many of the unregulated professions and by a coalition of churches, would also be very useful and work together as a package to ensure there is no confusion out there about what the intent of the legislation is.

Mr Owens: I guess I am hung up on the definition of "diagnosis" qua diagnosis because I do not believe that practitioners like speech-language pathologists actually diagnose in the strictest sense of the word. They clearly assess and then they communicate that assessment. The amendment or clause proposed by the parliamentary assistant clearly allows practitioners like speech-language pathologists to continue as they have done for years without any effect on their practice. Again, I refer back to the harm clause which covers the unregulated practitioners through the exemption process.

Mr J. Wilson: To that point, I think you would find speech-language pathologists disagree with you, Mr Owens. Take the case of chiropractors. The Workers' Compensation Board, clearly testifying before this committee, asked for diagnosis from -- and I asked them specifically, "Do you mean `diagnosis' in the way the College of Physicians and Surgeons would use the term?" They said, "Yes." To me that is a medical diagnosis. It is asked for and there are certain groups out there that do perform that.

Mr Owens: There is no argument.

Mr J. Wilson: It sounded like that was the argument about speech-language pathologists.

Mr White: I would like to speak on this. As I stated earlier, I obviously have some concerns about the whole nature of how "diagnosis" is defined, but limiting it to "medical diagnosis" is, I think, even more problematical because you have a number of professions that are or will be regulated, some of which will and do have specified scopes of practice that include diagnosis. They may not consider them to be medical diagnoses, though. I doubt whether a psychologist, for example, would consider himself to be a medical practitioner, nor, necessarily, a chiropractor or an optometrist, except when they testify before a committee such as this.

To all intents and purposes, when you specifically limit it to medical diagnoses, I think that further confuses people in terms of what diagnoses are covered by that term and it also confuses the professions involved. I hope that by leaving it as the government's parliamentary assistant has suggested, we would have the scope in the future to include other groups that have competencies to make assessments, diagnoses, whatever phrase one wants to use and be regulated by this same process. However, if it was to move to a medical diagnosis, it would by its nature refer only to one of those professions, that of the medical doctor. I think that is overly limiting.

Mr Cordiano: We have had a fair discussion on this and I move that we proceed with this matter and consideration and take a vote by putting the question before the committee.

The Chair: Thank you. I will entertain the motion you have made. I believe, however, before we vote on the amendment and the amendment to the amendment, your caucus has a motion you wish to withdraw on this particular aspect. Did you wish to do that at this time?

Mr Cordiano: We have a motion on section 26.

The Chair: To paragraph 26(2)1; how would you like to deal with that?

Mr Cordiano: We withdraw it.

The Chair: You wish to withdraw that. Do you want to speak to the withdrawal, Mr White?

Mr White: No, I want to speak to the closure motion.

The Chair: Just a moment, please.

Mr Cordiano: I also have another motion which I guess would follow after this.

The Chair: I will call that at the appropriate time. It is not at this moment. I have Mr Wilson. Is there discussion?

Mr J. Wilson: I will pass. I am fascinated with Mr White's insights on this legislation.

The Chair: I have been advised by the clerk that a motion to call the question is not debatable.

Mr White: My question is whether it is in order.

The Chair: According to the clerk it is in order. I now call the question on the amendment to the amendment which has been placed by Mr Wilson. All those in favour of Mr Wilson's amendment? Any opposed?

Motion negatived.

The Chair: I now call the government motion which is an amendment to paragraph 26(2)1. All those in favour of the government's amendment? Any opposed?.

Motion agreed to.


The Chair: Mr Wessenger moves that subparagraph ii of paragraph 6 of subsection 26(2) of the bill be struck out and the following substituted:

"ii. beyond the point in the nasal passages where they normally narrow."

Mr Wessenger: The purpose of this amendment is to clarify the language. The restriction is with respect to inserting instruments in the nasal passage.

Motion agreed to.

The Chair: Mr Wessenger moves that paragraph 11 of subsection 26(2) of the bill be amended by inserting after "orthodontic" in the second line "or periodontal."

Mr Wessenger: This amendment extends the controlled act to cover periodontal appliances.

Motion agreed to.

The Chair: Mr Cordiano moves that section 26 of the bill be amended by adding the following subsection:

"(4) Subsection (1) does not prevent an individual from communicating an opinion or result of an examination within the competence of the individual."

Mr Cordiano: As members would recall, we heard a great deal of concern by unregulated professionals with respect to the diagnosis clause referring back to the word "dysfunction" and rendering them incapable of communicating an assessment. This is an effort to clarify the difference between a "diagnosis" and an "assessment" being communicated by the mostly unregulated professionals.

Mr Wessenger: I would like to speak against the motion. We feel it is not necessary because the amended diagnosis clause makes it clear assessments may be communicated; that is, the control on communication relates to diagnosis only. It is clear that if an opinion is a diagnosis, it should not be communicated by unauthorized persons. Therefore, for that reason we would not support it.

Motion negatived.

The Chair: Mr J. Wilson moves that section 26 of the bill be amended by adding the following subsection:

"(4) Health care services in subsection (1) does not include an act done in the course of physically assisting a person with a disability with his or her routine activities of living if the act is done on the person's consent and the person, if able, would do the act for himself or herself."

Mr J. Wilson: The intent of the amendment is to make it very clear that attendant care is performed at the direction of the recipient of that care.

Mr Wessenger: I would like to speak against the amendment because it is more restrictive than the government amendment that is proposed in clause 28(e). It should be noted that the language in clause 28(e) has been approved by all the interested groups. I think it is appropriate that should be the clause that is passed, in view of the agreement by all interested groups. I think it is inappropriate to add the consent requirement here. I think it is presumed that all services require a valid consent of the recipient of the service or substitute decision-maker. That is a basic assumption of all the acts. It should not be set out here.

Mr J. Wilson: I do not understand why the government would be voting against this in that it actually strengthens the government's amendment to section 28 and makes it clear and concise. It is exactly what many of the groups asked us to do in the sense of making sure the recipient of the attendant care does direct that attendant care and gives consent to that care.

Motion negatived.

Section 26, as amended, agreed to.

L'article 26, modifié, est adopté.

Section/article 28:

The Chair: I believe section 28 is the next postponed section.

Mr Wessenger moves that section 28 of the bill be amended by adding the following clause:

"(e) Assisting a person with his or her routine activities of living and the act is a controlled act set out in paragraphs 5 or 6 of subsection 26(2)."

Mr J. Wilson: In light of my previous defeated amendment dealing with attendant care, I will certainly be supporting the government's amendment in this case.

Motion agreed to.

The Chair: Mr Wessenger moves that section 28 of the bill be amended by adding the following subsection:

"(2) Subsection 26(1) does not apply with respect to a communication made in the course of counselling about emotional, social, educational or spiritual matters, as long as it is not a communication that a health profession act authorizes members to make."

Mr Wessenger: I referred to this as being complementary to subsection 26(2), making it clear that it does not affect counselling in the areas of emotional, social, educational and spiritual matters.

Mr White: I am curious. We have a reference here to counselling and we have a distinction that the parliamentary assistant has made between assessment and diagnosis, something which, in the course of my career, I have never been quite clear on, and I am glad the act makes it clear. But it is "not a communication that a health professions Act authorizes members to make." In the case of someone who was employed by a health facility, such as a hospital or a clinic, how would there be a distinction made between a communication that a medical doctor makes, or a psychologist, or a social worker, or a nurse, about the psycho-social wherewithal of a client, patient, person or whatever the phrase is?

Mr Wessenger: There are, as you know, certain controlled acts set out, and each act that deals with a specific profession sets out the authorized acts that profession may do. Of course, all the authorized acts are set out for the medical profession. With respect to the psychologists, counsel has already indicated the area in which they can exercise a controlled act, and the controlled acts are set out, and will be set out, for the other professions.

There will be some amendments coming through with respect to these other acts and pertaining to other professions, but I do not think at this time it is appropriate to discuss the authorized act for each specific profession because it will be dealt with specifically as we reach that act.

Mr White: I would certainly agree with you on that point. However, at the moment there are many professions which are not regulated within the spirit or context of these acts, and inasmuch as numerous people are employed in Ministry of Health funded facilities, would it not be problematic for them to pursue their practice if they communicate anything to their clientele or patients?


Mr Wessenger: It is only a communication of a diagnosis. It is very clear in the act that we have the words "diagnosis" and "assessment," and it is very clear that a court would give different meanings to those words "diagnosis" and "assessment." There is nothing that restricts any regulated or unregulated person from communicating an assessment.

Mr J. Wilson: I have a question for the parliamentary assistant. When my colleague from Burlington South suggested the word "educational" be inserted in here, I thought there was some level of discomfort expressed by the government. I cannot quite recall for the life of me right now what exactly the discomfort was. Does the parliamentary assistant have any comments on the word "educational" at this point?

Mr Wessenger: The language is satisfactory, but I will ask counsel to explain how this bit differs from the prior amendment in the harm clause.

Ms Bohnen: When you first saw this language, it was an exception to the harm clause that was discussed last week. Instead of referring to counselling about emotional, social, educational or spiritual matters, it said "counselling of an emotional, social, educational or spiritual nature." The government's concern was that saying it was of a "nature" was not an accurate expression of what was meant.

For example, counselling of an emotional nature might be counselling in which people cried and people laughed and that was not what you intended. We did not even know what counselling of a social nature would be. Does that mean counselling with a gathering of people? The government members thought that what was really meant was emotional, social, educational or spiritual matters, and that is reflected in this language here. So it was not the word, per se; it was just the word "matters" instead of "nature."

Mr J. Wilson: Thank you, counsel. With the new wording and that explanation, we will be supporting this amendment.

Motion agreed to.

Section 28, as amended, agreed to.

L'article 28, modifié, est adopté.

Section/article 28.1:

The Chair: Mr Wessenger moves that subsection 28.1(4) of the bill, as added by the committee on September 30, 1991, be struck out and the following substituted:

"(4) Subsection (1) does not apply with respect to counselling about emotional, social, educational or spiritual matters."

Mr Wessenger: I think we need unanimous consent to consider this. This relates to the harm clause.

The Chair: We have no copies.

Mr J. Wilson: I guess in light of the clause just passed, this would be a housekeeping matter with regard to the harm clause.

Mr Wessenger: Yes, that is correct.

The Chair: Has it been read into the record in its entirety?

Mr Wessenger: Yes, I just read it in.

The Chair: It will be copied and distributed. Do you have a copy of it, Mr Wilson?

Mr J. Wilson: I have a copy and we have no objection.

Motion agreed to.

Section 28.1, as amended, agreed to.

L'article 28.1, modifié, est adopté.

The Chair: Mr Cordiano moves that the bill be amended by adding the following section:

"28.2. Sections 26 and 28.1 do not apply with respect to assistance with the activities of daily living rendered to a person with a disability under a contract with that person."

Mr Cordiano: The exception follows on what was discussed earlier with respect to disabled persons. It is an effort to ensure that we do not prevent what normally took place with respect to having that kind of service provided for a disabled person continuing to take place and that the disabled person would not be denied those services. This is an effort to ensure that it is followed and provides for the disabled person to have an ongoing relationship with the person who provides the service. We heard quite a bit about that from the disabled community and this attempts to clarify that position.

Mr Wessenger: I would like to speak against the motion. We have already passed clause 28(e), which was the clause that had been agreed to by all interest groups, and consequently I cannot support this motion. We feel it is more restrictive than the government's attendant care exception and therefore it is less acceptable to persons affected. Also, it requires a recipient of a service to have a disability and to enter into a contract. The evidence of the persons at committee, I understand, would make this unacceptable to them. There may be a contract, of course, between a social agency and an attendant or between an attendant and a recipient's family.

Mr J. Wilson: To follow up on the parliamentary assistant's comments, given that the committee defeated our attendant care motion and that we have agreed to pass the government amendment, I think Mr Cordiano would perhaps be in line to withdraw this amendment. It is redundant at this point.

Mr Cordiano: I think one could argue that there is clarity in what the government has proposed. I happen to feel that it is not clear enough and therefore put forward this amendment. I think we should take a vote on this, and that is my position.

The Chair: Any further discussion? I will call the question on the amendment. All those in favour of the amendment? Any opposed?

Motion negatived.

Mr. J. Wilson: I cannot believe I voted with you guys.

The Chair: Thank you very much, Mr Wilson. We move on now to proposed section 31.1. I believe there was agreement that this would be held down.

Mr Wessenger: Yes, held down.

The Chair: There was agreement that this would be held till the end. Okay, I think all the others are also --

Mr Wessenger: No.

The Chair: Which other one?

Mr Wessenger: Subsection 36(2).

Section/article 36:

The Chair: Subsection 36(2) can be dealt with today.

Mr Wessenger moves that subsection 36(2) of the bill be amended by inserting after "29" in the second line "29.1."

Mr Wessenger: This is just a housekeeping amendment that adds section 29.1 to the offence provision.

Motion agreed to.

Section 36, as amended, agreed to.

L'article 36, modifié, est adopté.

The Chair: Section 39 has been held down until the end. I believe now we are at schedule 2.

Schedule/annexe 2:

Section/article 1:

The Chair: Mr Wessenger moves that subsection 1(1) of schedule 2 of the bill be amended by adding the following definition:

"`patient relations program' means a program to enhance relations between members and patients."

Mr Wessenger: This is a definition section related to the new patient relations committee and program that is to be established.

Motion agreed to.


Section/article 9:

The Chair: I believe, Mr Wessenger, you have an amendment to section 9.

Mr Wessenger moves that section 9 of schedule 2 of the bill be amended by adding the following paragraph:

"7. Patient relations committee."

Mr Wessenger: This adds the patient relations committee to mandatory committees of each college.

Mr J. Wilson: This perhaps would have been appropriate on the previous amendment. This deals with the whole area of the CPSO sexual abuse task force recommendations and I thought -- correct me if I am wrong, Madam Chair -- we had agreed when we last met that we would stand down the whole discussion on a patient relations committee until much further in the process and that we would not be dealing with it today.

Mr Wessenger: It is my understanding that the only matter that was stood down until the end of all the bills was the matter related to native affairs. I believe this was to be stood down to be considered with the diagnosis.

Mr J. Wilson: No. Sexual abuse was also, or at least that is the agreement I agreed to. Otherwise, I would not have agreed. Perhaps you would like to check the transcript.

The Chair: I believe there was agreement by committee members that matters relating to sexual abuse would be stood down until after Bill 64.

Mr J. Wilson: That was my understanding, so perhaps the previous amendment, which we just did, also has to be stood down.

The Chair: Subsection 1(1), patient relations program.

Mr J. Wilson: It is a little different from the patient relations committee.

The Chair: That is correct.

Mr J. Wilson: So it is just this particular amendment.

Mr Wessenger: Could I just speak to this whole question? If the case is that we did agree to stand it down, I would ask that the committee might reconsider that aspect on the basis that we are not going to be in the position to have the final report with respect to the matter of sexual abuse by the time we finish these bills. Even if the report was finished, the consultation with all the groups would not be in at that stage. Certainly if it is the committee's wish to stand it down to the end, it can be, but I do not see any particular purpose in standing it down to the end of the other bills because we are going to be in no better position to consider the matter at that stage than we are at the present time.

The Chair: What I am hearing from Mr Wessenger is that we reconsider the decision regarding the timing related to issues around sexual assault. It is my understanding that the committee agreed to stand down everything that was related to the native band question and to sexual assault pending the completion of Bill 64. We have no idea what the timing is going to be regarding the completion of Bill 64. We have a request from the parliamentary assistant. I am going to ask for speakers on this matter and see how the committee feels about it before we proceed any further.

Mr J. Wilson: To be perfectly frank about it, we are not prepared to discuss the patient relations committee today because review of the transcript would clearly indicate that we agreed among committee members that this would be stood down until after Bill 64. I have a number of consultations and commitments coming up this week and next week around this very issue and cannot proceed today without hearing from people on how they feel about this.

My gut reaction on this is it just absolutely flies in the face of the logic the parliamentary assistant just presented to the committee. We are now setting up a huge bureaucracy in terms of a patient relations committee and he says, "Actually we are not really prepared to deal with the issue, but let's set up this bureaucracy anyway." Rather than getting me really angry and starting into this whole thing, it would be best for all committee members' good health that we stick to our original agreement and deal with this after Bill 64. We will have a little more time to consider it.

The Chair: In light of Mr Wilson's comments and the fact that there seems to be a number of people who want to speak on this, I would like to suggest that we adhere to the previous decision taken by the committee, that if there is a desire to discuss this further at another time, we can do so, but that we not deal with it today. Agreed?

Agreed to.

The Chair: Shall schedule 2, subsection 1(1), as amended, carry? That is the previous one, Mr Wilson. All in favour? Any opposed? That is carried.

We will stand down schedule 2, section 9.

Mr Wilson, I do not think your motion to schedule 2, section 24, relates to anything that has been stood down.

Mr White: Did we pass schedule 2, subsection 1(1)?

The Chair: Yes, we carried that.

Mr White: Are we then revoking that?

The Chair: No.

Mr J. Wilson: It relates to a different matter; similar name but a different matter.

Mr Hope: I would like a point of clarification for myself, under schedule 2, section 9, where it is dealing with the patient relations committee.

The Chair: That has been stood down. We are not dealing with that.

Mr Hope: That is what I wanted a little bit of clarification about. We are not creating a bigger bureaucracy; all we are doing is setting a committee in place. I am just wondering why we could not deal with this, because the content of the committee is then after, in detail later on.

The Chair: It is because it has been agreed by the committee on a previous occasion that it would be stood down pending the dealing with Bill 64. That agreement was unanimous by the committee. Mr Wilson has objected to dealing with the matter today, and I think it is a courtesy that we not go forward today.

Mr Hope: Okay.

Mr Wessenger: Madam Chairperson, I guess we could review the Hansard to confirm that there was that agreement on the record. I do not recall it, but it may be the case.

The Chair: Okay, we will get you a copy of Hansard, Mr Wessenger.

Section/article 24:

The Chair: Mr Wilson, do you want to move your amendment today on schedule 2, section 24?

Mr J. Wilson: Yes.

I move that subsection 24 of schedule 2 of the bill be amended by adding the following subsection:

"(4.1) Despite subsection (4), a panel shall be selected if the complainant has a disability and the complaint is recorded on a tape, film, disk or other medium."

This amendment had been presented earlier by myself. We were asked to do some rewording of it and we are bringing it back today reworded. I think I might have the wrong subsection. I have new wording on that -- sorry, Madam Chair -- that I should read in and retract the previous wording -- I got my pages mixed up here -- if that is permissible for the Chair. The wording I just read in is actually not the newest rewording.

The Vice-Chair: Mr Wilson moves that subsection 24(4) of schedule 2 to the bill be struck out and the following substituted:

"(4) A panel shall not be selected unless the complaint is in writing or is recorded on a tape, film, disk or other medium."

Mr J. Wilson: That is the new wording the committee had asked us to come back with.

Mr Wessenger: I would just like to confirm that the wording is satisfactory, so we will support the amendment.

Motion agreed to.

The Vice-Chair: Shall section 24, as amended, carry?

Section 24, schedule 2, as amended, agreed to.

L'article 24, modifié, est adopté.


The Vice-Chair: Just bear with me as we get caught up on where we are. The next section relates to sexual abuse, which we will also stand down.

Mr J. Wilson: Can I make a comment here with the indulgence of the committee? Dealing with the next matter that was stood down that is not dealing with sexual abuse, I believe it is schedule 2, section 46, and it was a Progressive Conservative motion. We have not received back wording on that, through no fault of legislative counsel. The question, when we last debated who would pay for the copies of transcripts, did arise and we were asked to come back with wording. I think there was some agreement that perhaps patients should bear the cost of the transcript. We do not have that wording available today so I would ask the indulgence of the committee to stand that down until we bring back from counsel --

The Chair: Agreed to stand down schedule 2, section 46, Mr Wilson's amendment? Agreed.

The next relates to the patient relations committee. We will hold that down. It is a government motion on section 81. I would point out that the government has withdrawn the original motion as proposed and substituted different wording. The moving of it was postponed, so we will hold that, or do you want that on the record, Mr Wessenger?

Mr Wessenger: I think it should be on the record that we are withdrawing schedule 2, sections 81.1 to 81.4, as originally moved, and we will be substituting a new amendment.

The Chair: Do you want to read it in?

Mr Wessenger: Why do we not just read it in?

The Chair: Mr Wessenger moves that schedule 2 of the bill be amended by adding, before the heading "Miscellaneous," the following sections:


"81.1(1) The council shall make regulations under paragraph 22.1 of subsection 91(1) prescribing a patient relations program.

"(2) The patient relations program must include measures for the prevention of professional misconduct of a sexual nature.

"81.2 The patient relations committee shall advise the council with respect to the patient relations program."

Is there agreement to stand that down until we deal with all matters relating to the patient relations committee and sexual assault issues in general? Agreed.

Mr Wilson, your amendment will also be stood down, the amendment to schedule 2, sections 81 to 81.4?

Mr J. Wilson: Agreed.

The Chair: You may want to have a look at that and make some changes in light of the government's amendment. The next one is also held down, subsections 85(3) and (4). Mr Wilson, that is held down.

Section/article 91:

The Chair: We now have a government motion that relates to the patient relations program. We have already dealt with one amendment relating to the program, as opposed to the committee. I think we can deal with this amendment today.

Mr Wessenger moves that subsection 91(1) of schedule 2 of the bill be amended by adding the following paragraph:

"22.1 prescribing a patient relations program;"

Mr Wessenger further moves that subsection 91(2) of schedule 2 of the bill be amended by inserting after 22 in the first line "or 22.1."

Motion agreed to.

The Chair: Shall schedule 2, subsection 91(1) and subsection 91(2), as amended, carry? All in favour? Any opposed? Carried.

Your motion to subsection 91(1), Mr Wilson, is stood down.

Mr J. Wilson: Yes.


The Chair: Just a minute. I should not have called for that subsection at this time. It was an error of the Chair. I ask for unanimous consent to reopen.

Agreed to.

The Chair: We will hold on the calling of that subsection until we have dealt with Mr Wilson's amendment to subsection 91(1), which will be held down. That concludes the items before us that we are able to deal with today on Bill 43.

Mr J. Wilson: May I make a suggestion? Through no fault of her own, the minister is sick today. Since originally we had thought we were going to be discussing a number of matters with her, perhaps we could adjourn at this time.

The Chair: Mr Wilson moves adjournment of the committee.

Mr J. Wilson: It is not debatable, but I would simply make the comment that going into Bill 44 at this time would not be appropriate, given that we need a little more time to prepare for it. I think I have the agreement of the Liberal caucus on that.

Mr Owens: Understanding that the motion to adjourn is not debatable, I have a copy of the Hansard of last week and if we could just adjourn for a break, I would like to be able to determine the agreement we had with respect to the issues of sexual abuse and patient relations, if that would be acceptable to the members.

Mr J. Wilson: I thought we solved that issue.

Mr Cordiano: I thought we settled it.

Mr J. Wilson: Notwithstanding the Hansard at this point, we have agreed to stand that down.

The Chair: Mr Wilson, the parliamentary assistant requested an opportunity to review the Hansard. We said we would make the Hansard available to him. I think it is perfectly appropriate for the committee to recess for five minutes and then discuss your motion to adjourn. We stand in recess for five minutes.

The committee recessed at 1637.


The Chair: Mr Wilson had made a motion to adjourn. I will now entertain a vote on that motion, which is not debatable.

Motion agreed to.

The committee adjourned at 1646.