Monday 23 September 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)

Silipo, Tony (Dovercourt NDP)

Wilson, Jim (Simcoe West PC)

Witmer, Elizabeth (Waterloo North PC)


Grandmaître, Bernard (Ottawa East L) for Mrs McLeod

Murdock, Sharon (Sudbury NDP) for Mr Martin

Wessenger, Paul (Simcoe Centre NDP) for Mr Silipo

Clerk: Mellor, Lynn


Drummond, Alison, Research Officer, Legislative Research Service

Spakowski, Mark, Legislative Counsel

The committee met at 1543 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: I would like to welcome everyone this afternoon. There are a couple of small housekeeping items. Alison, you wanted to make some comments regarding the package from legislative research.

Ms Drummond: All the committee members last week should have received the second interim version of a summary of recommendations by witnesses. This covers everything we heard in committee and a substantial chunk of the things that were received by mail, so the final version will include everything received by mail up to September 4. Ordinarily research does not attend clause-by-clause, but if any research questions come up, Lynn can always reach me by phone. So I will depart.

The Chair: Before she leaves, does anyone have any questions of Alison? On behalf of the committee I would like to comment on what an excellent compendium of recommendations we received. I know we will be looking forward to the final summary, but I would like to thank Alison and the research staff -- Bob Gardner was here as well -- and compliment them on an excellent piece of work.

Thank you very much, Alison. You will be hearing from us if there are any questions through clause-by-clause.

On the question of information received and questions asked, I think all committee members may be aware of a communication dated September 17 from the Association of Hearing Instrument Practitioners of Ontario, wherein a question was asked regarding Mr Schwartz's presentation. I took the liberty of asking Mr Schwartz to respond to the question that was raised. Mr Schwartz also agreed that if the committee has additional questions of him, he would be willing to respond in writing. I just mention that for the interest of committee members and any members of the public who are monitoring these hearings.

The committee can have Mr. Schwartz's input on any question which was not addressed during his presentation, which is on the record in Hansard. This further information from him can be received by all members of the committee. I will ensure that this happens if I receive anything from him. Similarly, if members have any requests that they would like Mr Schwartz to respond to, I would be pleased, through the clerk, to undertake to get that information for them and then distribute it to them. That was one piece of housekeeping.

The next thing I want to mention is that the clerk has advised me that a comprehensive package of all the proposed amendments will be ready for tomorrow. It will not be ready for today. That will enable all members to see what is being proposed from the different caucuses, and we will have that available for the public tomorrow as well.

Mr J. Wilson: I think you said the clerk will be presenting all amendments tomorrow. That is certainly not the case with the Ontario Progressive Conservative caucus.

The Chair: All amendments that have been received to date will be available tomorrow for distribution in a comprehensive package where everything has been collated according to section.

Mr J. Wilson: Thank you. I just mention that because Mr Hope was commenting earlier on how thin our package of amendments was. I just want him to know that it is in no way the final list.

The Chair: Just for the information of all members and for the public monitoring these hearings, amendments can be received throughout the course of clause-by-clause discussion. I will repeat it again tomorrow. At no time should anyone assume at any point during the hearings, until the bill has been fully debated and reported, that all amendments have been received. Amendments can continue to be received and tabled throughout the course of clause-by-clause debate.

It has been agreed that we will begin today's meeting with opening statements. I would like, first, to call on Mr Wessenger, the parliamentary assistant.

Mr Wessenger: Good afternoon, members of the social development committee. Public hearings have enabled you to hear from most of the groups who have been contributing their input to this legislative package over the course of the past eight years. It is hard to think of a legislative package that has had more input from interested groups than this one. You have heard the arguments and the recommendations. Now you must analyse the presentations and written submissions -- as the minister, myself and ministry staff have -- by applying one key test: How would their proposal or suggestion better serve the public interest? Alan Schwartz also brought the importance of this point home to us in his presentation.

We at the ministry are satisfied that the bills, with the amendments we will be discussing over the next few weeks, will well serve the public interest. We believe they will do so better than the existing legislation. We also believe there is no alternative legislative model that could better do that job of meeting the public need to have a louder voice in how the health care system operates and evolves, to have a greater say in the quality of care they receive, and to see women take a more equal role with men in the management of the system.

The government is proposing a number of amendments. These were delivered to the clerk of the committee on Friday. These are in addition to the ones we provided to the committee and publicly circulated before committee hearings began. Proposed amendments concerning health professions acts will be provided shortly. Amendments addressing the regulatory system in relation to aboriginal peoples will also be moved at a later date.

As to the amendments we are proposing now, I would like to outline the purpose of the most significant ones as a prelude to clause-by-clause discussion. The issue this committee has had the toughest time grappling with is the controlled act in paragraph 26(2)1 of the Regulated Health Professions Act, restricting to certain regulated professions the communication of conclusions about diseases, disorders and dysfunctions. It is the issue that has dominated the hearings.


The government has listened carefully to the fears expressed by clergy and others about the effect of this controlled act on their ability to function. We have also paid close attention to Alan Schwartz's compelling presentation about the paramount importance of protecting the public. We are introducing amendments to the controlled act which we believe will make it clear that the intent is to prevent harm that may result from the communication of diagnosis. The amendment makes it abundantly clear that communication of results of assessments by regulated and unregulated practitioners is not restricted. We also proposed to delete the word "dysfunction" from the controlled act but retain "disease" and "disorder." This amendment will result in consequential amendments to the authorized acts of a number of health professions.

I have an amendment creating a statutory exception so that individuals with disabilities can receive assistance with their routine activities of daily living. This government and the previous one were committed to such an exception from the beginning. However, the issue was whether it would be in the act or regulations. Thanks to interest groups and their efforts in meeting with us to discuss the issue, it is possible to propose a statutory exception which they have informed us meets their need of being able to continue to take part in community living with dignity.

On August 28, the Task Force on Sexual Abuse of Patients made a presentation to the committee. In her statement in the House on the occasion of second reading of these bills, the minister said that the Ministry of Health would have a zero-tolerance policy, as was also declared by the College of Physicians and Surgeons of Ontario. She said it was her goal "to enact a law that will deter sexual abuse, bring abusers to justice and treat victims with greater sensitivity and respect." The government is anxious to take all necessary action to eliminate sexual abuse. Indeed, as is evidenced by the advocacy and consent to treatment legislation, the government is determined to ensure that every individual, no matter how vulnerable or disadvantaged, is served by the Regulated Health Professions Act. We believe we can take some action immediately. I will outline that in a moment.

As to whether it will be necessary for further action that would be beneficial and appropriate, we believe we must await the final report of the task force and its presentation to the College of Physicians and Surgeons of Ontario. We say this even though the chair of the task force has told the committee that the concept of the preliminary recommendations will not be changed. It is necessary and appropriate to wait, because the task force was created by the college and we want to hear the college's response to the report. Moreover, we want to take action on all regulated health professions and we cannot do that without hearing from them. Furthermore, some of the preliminary recommendations raised contentious Charter of Rights and natural justice issues requiring full discussion with legal experts and the Ministry of the Attorney General.

So immediately upon release of the final report, now scheduled for late November, an interministerial working group will conduct a consultation with all interested professional groups and public interest groups. We hope a consensus will emerge from this consultation, though we recognize it may be necessary to make unpopular decisions and we are prepared to do so.

At this time, we are proposing amendments to the duties of the minister and the objectives of the colleges to reflect their responsibilities and to try to ensure that every individual can avail himself or herself of the rights and benefits of this legislation and that individuals are treated with sensitivity and respect.

We are proposing the creation of a new statutory committee, the patient relations committee. Within one year of proclamation of the bills, we will be requiring every college to institute a program aimed at preventing sexual misconduct The effectiveness of each college's program will be evaluated by a monitoring board composed of members of the public and representatives of the professions. The monitoring board will be required to make an annual report which must form part of the annual report of the college that is tabled in the Legislature.

RHPA and the procedural code currently include provisions that will improve complaints and discipline processes, such as increasing the number of public members on discipline panels, opening the record of the complaint investigation to the complainant who seeks a review of the decision and opening discipline hearings and protecting the privacy of witnesses testifying in relation to sexual misconduct in discipline hearings. In addition, we are proposing an amendment now to make it clear that a complainant in a discipline hearing may remain in the hearing room during the hearing, even if the general public is excluded, in order to protect the complainant's privacy.

As well, more action will be taken in regulations to be made under this legislation in the definition of sexual misconduct and in standards of practice. Mandatory reporting rules for members may also be addressed through regulation. In the interim, while we await the proclamation of this legislation, we will be formally requesting every governing body that currently exists under the legislation to develop a sexual abuse plan now, and to file it with the minister.

The colleges will be requested to consider what action can be taken immediately and what policies and procedures can be changed or put in place to start the task of eliminating sexual abuse. These plans may form the basis of the sexual misconduct programs to be required under the legislation. Our message is unequivocal: Sexual impropriety and abuse will not be tolerated.

The amendments being provided do not include amendments addressing issues raised by the Union of Ontario Indians, Equay-Wuk and other first nations. The issues that have been raised by aboriginal groups must be addressed in the context of the government's commitment to native self-government. There will be many health care issues to discuss as we move down the road towards self-government. We will be discussing these issues on a government-to-government basis and more agreements will emerge from these discussions.

The particular issue before the committee is how to address the effect of this legislation on native healers and midwives, in the knowledge that these bills are likely to become law before self-government is achieved. There is no pat answer to this question. Clearly, it must be found in consultation with native groups.

The Ministry of Health conducted a first round of discussions with native groups in July and funded initial consultations within their community. The message from every group is that further discussions are required, and we agree with this. At the same time, we are actively considering a range of statutory options, including an option suggested by the Chair of this committee. I know we all want to incorporate into this legislation provisions that will demonstrate respect for traditional healing and enhance the self-determination of native communities. The minister intends to come back to this matter later in the clause-by-clause process.

As I said earlier, we intend to propose amendments to the health professions acts, and they will be provided in the near future. They include adjustments to the scopes of practice and authorized acts of several professions; an amendment to make the performance of an authorized act without a necessary order or direction a disciplinary matter to be dealt with by the profession's college, but not a provincial offence; an amendment to the Nursing Act to reflect the fact that in many circumstances nurses provide care in accordance with their own judgement and not on the order of a physician -- similar amendments will be made to certain other health professions acts -- an amendment to all health professions acts expanding the range of the provisions restricting the use of professional titles. The restrictions will apply in all settings and will not be restricted to health care.

To sum up, we are now proposing a large number of substantive amendments. Unless there is a clear direction or consensus emerging from the committee, we hope that this legislation would adhere to the bills as tabled.

Issues that are not yet resolved the minister intends to refer to the future Health Professions Regulatory Advisory Council. One such issue is the question of whether registered nursing assistants should continue to be regulated together with registered nurses by the College of Nurses of Ontario or have a separate college. In that context, their scope of practice and authorized acts will also be discussed. We will be consulting with registered practical nurses and the Registered Nurses' Association of Ontario concerning the terms of reference of referral.

The scope of practice and authorized acts of naturopathy will of course be considered by the advisory council. The advisory council will also be providing advice on scope of practice and on the controlled acts, and on the professions not included in this package which we know will be seeking regulations. Other issues requiring referral may emerge during clause-by-clause.


I mentioned that regulations to be made by the college councils under this legislation will include definitions of sexual misconduct. We want to stress the importance of regulations. They are of no less importance than the statutory provisions themselves. We believe that the review of proposed regulations by the advisory council, which also provides a vehicle for public input, will ensure that regulations are in the public interest. For this reason we feel safe in using regulations, not acts, as a means of fleshing out what misconduct means.

In closing, I would like to take this opportunity to thank the members of all parties for their thoughtful questions and comments and their non-partisan approach to this committee process. I would especially like to thank the Chair for her very effective chairing. I am confident that the spirit of collaboration among committee members, which has been apparent to me throughout the hearings, will continue throughout clause-by-clause.

The Chair: Opening remarks, Mr Beer.

Mr Beer: Thank you very much, Madam Chair, and thank you to the parliamentary assistant for his comments. As was noted, we have just this afternoon received the amendments, so I am not going to comment on those. I think we are going to have to look carefully at those, as well as the ones presented by the other parties, to see how we will proceed with those amendments, but I would like to take this opportunity to make a few comments by way of beginning the discussions and, in some respects, to echo the comments that have been made.

I think all of us on the committee, as we have said, have learned about parts of the body we did not know existed and that there are people out there who do things to those parts of the body, and this has expanded our scope of knowledge.

Mr Owens: Our dinner conversations.

Mr Beer: There were a few times after lunch, when if I had to look at another audio-visual presentation, I may have had some difficulty. But I think the importance of these hearings was underlined by the fact that all of us on the committee, who really are a group of laypeople, found in virtually every presentation something new, or a new perspective on a particular issue or problem.

The first thing I want to do is thank very much all those groups and individuals who came before the committee. Even if in some cases we are not going to be able to deal with every single point that was raised, I think we now have the issues on public record. It has been said that we have, through this legislation, an ongoing mechanism to deal with many problems. I want to thank all those who spent so much time in putting together their presentations and making them.

I also think it is appropriate at this point to thank the staff from the ministry, our own research and people, the clerk. Again, in a committee such as this, the amount of material we had to receive and examine is really quite incredible. A number of people helped us to work our way through it, and now we really are ready to look at the legislation on a clause-by-clause basis, beginning with the omnibus act.

Clearly, the key issue and the one on which it was important that we spoke with Alan Schwartz at the end of our review, after having gone through many of the specific and particular issues, is that of the public interest. In a sense, as members of this committee, as laypeople, that is the measurement, if you like, we need to try to put on each question we are going to be examining and each amendment we will be looking at.

It has been noted many times in the course of the review, and in terms of what we are trying to accomplish, it is to protect the public interest and to provide for greater access to an ever-increasing number of health care services. I think that has been admirably done by the review and we will now be able to use the legislation in place to keep at it, if you like. I have stressed this with many people: It does not end with the proclamation of Bill 43 or any of the other bills, but in fact it has really set in motion a particular process that I think is going not only to enhance the health care that is available but also to ensure that it will be even better than it has been.

One of the things that struck me, particularly with those professions which for the first time will be receiving a college, was their own sense of wanting to ensure that they do what they do in an appropriate fashion and meet the scope of their area of practice. That is going to be very good protection for the public. Many have noted that during the course of the review, and particularly over the last couple of years, they have come together to meet with fellow practitioners in other areas. There have been some real benefits where people have perhaps sat down and discussed related areas of health care in a way they have never done before.

A lot of spinoffs have occurred as we have gone through this that are also going to make for a much better system of health care in this province. I am interested in looking carefully at the amendments that were noted, particularly around the diagnosis issue. Clearly, if we go back through all the hearings, the major concern was around this whole question of communicating. I think we as committee members all agreed and the ministry agreed that many things were being done that we did not want to stop being done, but we had to find a way to achieve that while at the same time protecting the public interest. It is in that vein that I think it is going to be necessary for us to still talk about the question of the harm clause and whether some wording is still required that will balance off changes we may come to make in the area of the diagnosis clause.

I was struck by Mr Schwartz's concern about particular changes that might come about and how still to make very clear the protection of the public. Perhaps as we go through, having these amendments proposed for the purposes of discussion, and certainly in terms of the ones we will be proposing, we want to get feedback, not looking at them as something written in stone, but always measuring the changes. That was one of the points we do not want to lose sight of, that we have a number of bills before us in addition to the omnibus bill and what we do in one has to relate to the basic concepts, the basic principles we are putting forward in that first one, Bill 43. I think that is a discussion we still feel is very important.

Again, we underline and recognize that by this legislation we are not trying to stop social workers from doing what they normally do. We are not trying to stop the clergy from doing what it does. There are a number of people who are concerned. I think we can deal with that while still ensuring that there is some clear indication in terms of what people can and cannot do. We have a responsibility to address that issue. I am very pleased that mention was made of one of the amendments around those with disabilities because I know we all were wrestling with that one. We should note the work that was done by the ministry, by several of the disabled organizations as well as health professionals in a number of areas, in themselves trying to work this out. If we can do that, it will be of tremendous help.

I think we are going to want to look carefully at the various issues raised around the area of sexual abuse, the proposed patient relations committee. Clearly that issue has to be front and centre and, as we move forward with this legislation, we must ensure that we reflect what is increasingly the determination of everyone, to see that we really deal with that specific issue.

Again, as was noted with respect to the native population, we have some proposals that we hope may be helpful in dealing with some of the issues native leaders have raised and we will be sharing those with everyone.

Finally, by way of opening remarks, I stress again one of the concepts we really did not have a lot of time to discuss -- and for a very good reason; it is a body that does not yet exist -- the advisory council. We should remind ourselves that it is there for a very good and specific purpose, which is to carry on the process we have begun in terms of some of the issues where frankly we as a committee may simply feel we cannot make a final judgement. We just do not feel comfortable. I think that is a perfectly valid argument to use in some instances. If we feel uncomfortable and believe it needs more review, that is one of the reasons that advisory council is there. After we have finished our work, it is to that body the minister of the day will be able to refer a variety of questions. If we look at how it is going to be constituted and the work it will be doing, I think it is not only going to provide protection for the public but, for the professions, a real place to go to see how this new system is functioning and, as problems arise, to help in resolving them.


We dealt with a bill which I think all ministers who have dealt with it have said is not by any means perfect. We have dealt with a bill that was proposed by a review team where the chair of that team said, "Look, it's not perfect, but we have reached a point where it is perhaps as close to that as we can get." With the amendments that we will discuss, I think we will be able to make it that much better, but undoubtedly there will still be questions which go beyond this committee. I think that, having done this work, the health care system in the province really will be the better for the work of everyone, and we want to keep that front and centre and focus on the public interest as we go through Bill 43 and the other acts that will follow.

So with that by way of opening comment, we will wait for a review of the actual amendments.

The Chair: Opening statement, Mr Wilson.

Mr J. Wilson: Perhaps it is appropriate to begin by thanking you for having put up with us over the summer and chairing our committee meetings.

The Chair: All in favour?

Mr J. Wilson: A raise is in order, I am sure. You have done an excellent job. You have not only provided guidance to the committee but you have provided tremendous insight in informal settings outside the committee. That has been very helpful to me personally and, I know, to other members of the committee, so I thank you.

I would also like to thank legislative counsel. Although we have not always agreed on some of the interpretations and intentions of the wording in the legislation, I am very grateful for their help and to the various ministries that have helped.

On a very personal note, I also thank the PC caucus's sole researcher in this area, Louise Verity, who is with us today. Louise has done a tremendous amount of work. We do not have 108,000 civil servants to help us out. We have one, and she is not even a civil servant, so I am grateful to her for all the work she has done in following the committee and helping the legislators to bring forward amendments.

On a sour note, I am gravely disappointed that the government would not allow us to see its amendments prior to today. I think it was not in the public interest to hold back the amendments. Certainly tradition around here is that the government brings forward amendments first. It has all the legal eagles on staff and it has the larger staff to deal with amendments and to deal with suggestions brought forward by the public, and I am disappointed that we are only now being given the amendments. It would have made for a more fruitful discussion today and certainly for even more fruitful opening remarks by myself had I been able to see the amendments earlier.

We were here on the weekend actually and we had hoped to have the amendments and be able to go over them. That was not the case, and I warned the government that in the future, whether intentional or not, that tends to politicize the legislative and committee process. I just warned the government that it is not good. We went through, in good faith, some four weeks of committee hearings in the summer in a non-partisan fashion, and to find out on Friday afternoon, after meeting with the minister Friday morning, that we were unable to see the government's amendments was disappointing and, I think, set us back a few days.

In fact at the end of my remarks today I will be asking the committee that we adjourn for the day so that we will have some time to look at the government amendments. First, we too have a responsibility, as all committee members do, but particularly in our caucus, to consult with our caucus. We do not tell our caucus what to do. We consult with our colleagues. Second, we have a number of interest groups and people who have appeared before the committee with whom we need an opportunity to discuss the government's amendments and more of our own amendments.

I am still concerned, having had a cursory view of the government's proposal to deal with the diagnosis clause, that we are not making clear the intent of the legislation, which is that in no way is the legislation to interfere with the normal duties of unregulated practitioners such as mental health workers -- the clergy in particular -- and social workers. We will be introducing further wording to ensure that it is clear to anyone who picks up the piece of legislation that it is not intended to inhibit the good work that those unregulated professionals do.

I think it is important in this day and age, when we create legislation, that normal, average people do not need a team of lawyers to interpret it for them, that the wording be very clear in the Queen's English that people feel comfortable with legislation when they read it -- they should be able to buy it in the Ontario government bookstore and understand the legislation -- and that we do not leave a great deal of interpretation up to the courts, which up to this point seemed to be the government's preference.

We have a very legalistic society. The newspapers and media are full every day of stories of the lawsuits that are going on among individuals, between government and groups and government and individuals. It reminds me very much of the California mentality that we used to refer to. It is a legalistic society and it is our responsibility as legislators to have legislation that is as clear, as easily readable and as understandable as possible to the public. We will be doing our best there; in fact, we will be suggesting that there be a preamble in the legislation that clearly states that in no way is this legislation intended to prohibit the good work done by the clergy and other unregulated professions.

Also, the diagnosis clause itself -- I did not hear the parliamentary assistant address this; excuse me if perhaps he did and I missed it -- there are a number of groups that I think presented compelling evidence before this committee that they should be able to diagnose and communicate within their scope of practice. We will be bringing forward amendments to deal with specific groups where we felt the evidence certainly weighed in on their side, on the contention that they are now diagnosing certain diseases and disorders and they are now communicating the results of those diagnoses not only to their patients but to the Workers' Compensation Board and to other health care practitioners. As I said, we will be introducing some amendments in that area.

Also, I do not think the parliamentary assistant dealt with the area of the powers of the minister. Certainly we had many groups appear before this committee that were very much worried about new powers that the minister is etching out for herself, in this case, which could very well cut into the principle and the intention of this legislation, which is to maintain the principle of self-regulation.

We will also be looking at what we see as further erosion of the principle of self-regulation, and that is the government's announcement, outside the committee, I may add, to increase the number of public members to just under 50%. I think we can come to a slight rearrangement there that will not erode or provide discomfort for professions. I say to the government that you either believe in self-regulation and you trust these people to be self-regulated or you do not, and you have to come clean with the public on that. I will be looking for a very clear statement from the government on its true belief there because I get the feeling from the government members from time to time that they are suspicious of professionals. I do not want to see that suspicion, which I think is unfounded, rooted in legislation, at least not during my term in office.

We will be looking on behalf of nurses. We are still not satisfied with the fact that the legislation, perhaps unintentionally, has moved to narrow the scope of practice of nurses. We certainly had testimony before this committee that nurses are capable of doing some 60% of what doctors do, and we will be introducing amendments in that area to ensure that the scope of practice for nurses does not inhibit what they are doing now and is flexible enough to provide for any advances that may be made in the nursing profession in the future.

Disabled persons: I commend the government and I am very pleased to hear from the parliamentary assistant that agreement has been found on an amendment that looks after the concerns that were brought before this committee by attendant care providers and recipients of that service.


Sexual abuse: I am very pleased to hear -- and in fact when we met with the minister last Friday, we made it very clear that it was one of our very strong beliefs that the government should come out very clearly in support of the interim report by the sexual abuse task force of the College of Physicians and Surgeons. It is very important that we send out a clear message from all three caucuses, and particularly from this committee, that zero tolerance is the law.

I say to the parliamentary assistant, and to the minister through him, that there are some things we can do at this time which I do not think would prejudge the final report of the task force in any way and would indicate our very serious commitment from all three caucuses in the area of sexual abuse and zero tolerance. In fact, in addition to what the parliamentary assistant has said, our caucus is certainly willing and will put forward the concept that was introduced to the committee by the task force chairman, and that is a survivors compensation fund, which colleges would be required to establish. Very often we saw, in the case of physicians in the testimony before the task force on sexual abuse, that physicians had profited from years of sexually abusing patients. I think this committee must send out a very clear signal that this is not acceptable. I do not think we are pre-empting anything that the committee itself will not recommend. The chair appeared before us and gave us a very clear indication of what recommendations will come forward from the final report of the committee.

Just a couple more, I guess. The title "doctor": We have the very strong opinion that since in this legislation we are moving to give the title "doctor" to chiropractors and psychologists, we also have a responsibility to the academic community to ensure that those health care professionals who have achieved the distinction and the degree of PhD should also be allowed to use the term "doctor" within a health care setting. It is my understanding from having spoken with a number of physicians that there is no confusion now in the hospital setting. The term "doctor" is often referred to by physicians themselves when referring to their PhD colleagues, and I think it is only right and it is a degree of justice that those people who have earned the highest degree possible in academia be allowed to use that title. I do not believe and do not support Mr Schwartz's contention that it will add mass confusion in the health care setting. I give the public more credit for understanding the difference between PhDs and medical doctors than perhaps the review committee did.

Title protection: Certain professions came before the committee to tell us that the legislation is serving to wipe out common usage of their titles, and we will be introducing amendments to ensure that the usage that is out there now that both consumers and health care professions use to refer to the profession is allowed to continue.

The parliamentary assistant mentioned registered nurses and the registered nursing assistants. We will be moving an amendment to establish a separate college for registered nursing assistants, but we are open, of course, to debate on that matter. It is a debate that I think will be fruitful here because there are a number of issues around that. Almost all other provinces have moved towards that now and I think the time is perhaps right in Ontario. It may not have been right some four years ago when Mr Schwartz last looked at this issue, but I think perhaps it is right now, and it is up to committee members to bring ourselves up to speed on the fact that RNAs are ready to have their own college.

I think that is about it. On native issues, we will be bringing forward some amendments for discussion. Again, there may be some areas we can move forward in that would not interfere with or preclude further discussions with natives, but I think it is up to all of us to bring forward a very strong message on behalf of natives that there is an understanding of their plight here at Queen's Park to help them advance their agenda, in fact.

In light of the Premier's commitment to native self-government, I think it is incumbent upon the government to come to this committee and to bring forward amendments that help clarify that for the public. My party has long said that we are not sure what native self-government means. The Premier has yet to define that. We had representations from a native group before this committee. They certainly made it very clear to me that this legislation may very well be their test legislation. It is the first major piece of legislation that has come forward since the Premier made his commitment to native self-government, and I think it is incumbent upon all legislators to have a further discussion of that and perhaps introduce amendments to this legislation which may advance that agenda. We would have no objection to that from our party, as long as it is fully explained to the public. We want to make sure we understand what the terminology is that we are using when we talk about native self-government. This legislation could very well be the test case, and both in private and public discussions with native groups, that certainly seems to be an intention out there.

Once again, thank you, Madam Chair, for your patience over these hearings and for the indulgence of all members. If I may, I would move that we adjourn the committee. We will have a subcommittee meeting to discuss the process and where we go in the next few days. Certainly we need time on the phones this afternoon and meeting time tonight to discuss the government amendments, some of our amendments and the Liberal amendments with interested parties.

The Chair: That concludes opening statements. I heard a motion to adjourn the committee at this time. All in favour of adjournment? Opposed? The committee stands adjourned until tomorrow following question period.

The committee adjourned at 1626.