The House met at 10 a.m.
Hon. Mr. Snow: Mr. Speaker, I am sure the hon. members of the House would want to join me this morning in welcoming to the chamber Hon. James Morgan, Minister of Transportation and Communications in the province of Newfoundland.
Mr. Speaker: Statements by the ministry.
GRANTS TO CHILDREN’S AID SOCIETIES
Mr. Lewis: A question for the Minister of Community and Social Services: What exactly is real and what is fantasy about the grants that the ministry is giving to Children’s Aid Societies? Will the minister, for example, give to the Metropolitan Toronto Children’s Aid Society the 10 per cent to 12 per cent increase it needs rather than the 3.1 per cent increase he has offered within the grounds of his redefinition, whatever that is, of what the government is going to do?
Hon. Mr. Taylor: It may be difficult to distinguish reality from fantasy in the member’s mind.
Mr. MacDonald: You should deal with the questions and not go off on those political tangents.
Hon. Mr. Taylor: What I have been saying during the last two months has been consistent, namely, that no child or no person in this province in true need will do without because of the constraint programme.
I stated throughout my tour of this province that I was seeking additional funding to alleviate hardship in certain cases. I feel there are legitimate concerns in regard to some of the problems of the Children’s Aid Societies, especially where an additional burden for child care has been transferred to them.
I have merely reconfirmed in my earlier statement and acknowledged that I will ensure that no child is neglected. That applies to the Metropolitan Toronto Children’s Aid Society as it applies to the other 49 children’s Aid Societies in Ontario.
Mr. Lewis: Can the minister perhaps be more specific and tell us, now that he has been successful with the Ministry of Correctional Services, how much additional money exactly is he now able to make available to the societies by virtue of his negotiations over section 8? What is the amount we are talking about?
Hon. Mr. Taylor: There will be sufficient funds to alleviate the hardships that are imposed.
Mr. Lewis: What does that mean?
Mr. Deans: How do you budget on the basis of that?
Hon. Mr. Taylor: Simply this: I am not in a position today to give a finite figure.
Mr. Lewis: Give us an estimate.
Hon. Mr. Taylor: Just a minute. It’s not a matter of putting money on the table for grabs. It’s a matter of --
Mr. Lewis: How do you budget without knowing the amounts you have?
Mr. Speaker: Order, please.
Hon. Mr. Taylor: It is a matter of ensuring that the true needs are provided for. It is not a matter of throwing X dollars to be divided again arbitrarily right across the board.
Mr. Reid: Supplementary: Am I correct in my knowledge that your regulations and the legislation of the province require welfare boards and Children’s Aid Societies to take on as a case a person who is in need? If that is so, how can you tell Metro and others that they are not going to get any more funds if your legislation requires them to take these people on their caseloads?
Hon. Mr. Taylor: There are two areas. As you know, we have probably the most progressive Child Welfare Act in any jurisdiction in the world.
Mr. Lewis: Which you are now undermining.
Hon. Mr. Taylor: There are two areas of concern when we deal with Children’s Aid Societies. One, of course, is the active care of children. The other is in the area of preventive services. The area of preventive services -- that is the jurisdiction, the authority for Children’s Aid Societies to involve themselves in a whole spectrum of preventive services -- induces some societies to conclude that they must actively pursue that whole spectrum. I have found that throughout Ontario that is picked up to varying degrees in terms of implementation so that some societies will say it’s incumbent upon them under the Act to carry on these preventive programmes. Others feel that it’s not incumbent; it’s there. It depends on what society, really, you are dealing with as to what it feels its true legal obligations are. What I am ensuring is that the true hard-core services are maintained in terms of the accommodation of children in need.
Mr. Reid: And you will make up the difference in the budget in these cases?
Hon. Mr. Taylor: Yes, we will ensure that the --
Mr. Lewis: That’s just fatuous nonsense. Give us the figures.
Hon. Mr. Taylor: -- Children’s Aid Societies have sufficient funding to accommodate their needs so that they can --
Mr. Deans: How will they know that?
Hon. Mr. Taylor: -- look after the children under their care.
Mr. Speaker: The Leader of the Opposition. Order, please. This is becoming a debate now.
Mr. Lewis: We want the answers. Mr. Speaker, when one asks the minister how much money, one could at least expect an answer rather than a dissertation.
Mr. Speaker: The ministers answer the questions as they see fit. The hon. Leader of the Opposition.
Mr. McClellan: A supplementary, Mr. Speaker, on the minister’s answer.
Mr. Speaker: We will allow this supplementary.
Mr. McClellan: Since the minister said again that nobody in need will suffer hardship, could he explain to this House whether he intends to proceed with the recruitment of foster homes as alternatives to “the higher cost of residential care”? Could he explain that utterly preposterous proposal to this House? Does he not know the difference between --
Mr. Speaker: Order, please.
Mr. McClellan: -- foster care and residential treatment?
Mr. Speaker: I allowed the member a supplementary question on the first question. We are getting into a broader field. Does the Leader of the Opposition have further questions?
Mr. Lewis: A question for the Minister of Health: Now that the minister has indicated that five doctors may be charged by the College of Physicians and Surgeons for relationships with private labs or a lab, can he indicate to us the nature of the police information which he is getting and at what point he intends to expand the government’s approach to private labs to launch a full inquiry?
Hon. F. S. Miller: Mr. Speaker, first of all I understand that the charges are not being brought by the police against the doctors. They will be brought by the College of Physicians and Surgeons under its regulations -- under its disciplinary rules. The college has met with me in the last few days and said on the basis of its study of the relationships it has found, it feels it can take these people through its own action and, if necessary, to court over it.
Mr. Makarchuk: How come you charge the welfare people but don’t charge the doctors?
Mr. Speaker: Order.
Hon. F. S. Miller: I was satisfied and pleased that the college was very concerned about this kind of relationship.
Mr. Makarchuk: That is refreshing.
Mr. MacDonald: Who have you smoked out?
Hon. F. S. Miller: I have faith in some people. I even have faith in you people a lot of the time.
Mr. Speaker: Order, please.
Hon. F. S. Miller: I think there are many things we can do together and this is a good example of one of them. I don’t have to defend things I find wrong in my ministry. As members know from past experience, when good, valid points are brought up, I’m quite happy to have their assistance in resolving them, and this is one of those areas. I have nothing to defend. I have a problem that requires solution.
Mr. Lewis: Where is it?
Hon. F. S. Miller: Certainly many of the points members have discussed in the estimates debate the other day, for example, are worthy and are being followed up by our ministry. I’m sure members knew that, because they’ve seen some of the comments that were made by our staff in some of the studies.
The second part of the question was, what am I going to do about an inquiry? I don’t get the police information. I believe this is given to the Attorney General and I believe it’s kept confidentially with him during the preparation of charges. So it’s probably just as well kept there, knowing the confidentiality of information and what happens to it. I am determined to make a number of administrative changes within my ministry to eliminate some of the duplication in the present laboratory system of Ontario and to eliminate some of the incentives to hospitals that exist which allow them to send business out as a cost-saving measure internally, but a total increase to my budget.
Mr. MacDonald: They’re just following the established process. You do that in the whole government all the time.
Mr. Speaker: Order, please.
Hon. F. S. Miller: I believe there’s a place for a private lab. The idea that the private lab should not exist because one, two, three, four or 10 are found to have done something illicit doesn’t mean that there isn’t a place for a well-controlled private lab.
Mr. Lewis: You need an inquiry.
Hon. F. S. Miller: What I need to know is the dimension of the problem before we decide that an inquiry is required, and we are trying to find that out quite quickly. I am getting assistance from a number of areas and I’ll be getting advice from a number of areas. I’m sure the Premier (Mr. Davis) is as interested in this issue as I am. If the information indicates an inquiry from a judicial point of view is needed, I can assure the member it will go on.
Mr. MacDonald: Supplementary: Is the minister’s faith in the willingness and capacity of the doctors to police their own internal operations not shaken by the revelation of all that has been going on, and presumably going on for some time, when it was under their jurisdiction? If his faith is shaken a little in light of the facts, does he not think it is time that it should be subject to the normal rules that anybody else would be subject to outside in society?
Hon. F. S. Miller: I’m not going to argue with the experts like, I think, Justice McRuer who has said that the age of the self-governing college had passed.
Mr. Reid: Well, change it then.
Hon. F. S. Miller: I would say that there are real advantages to us all in the continuation of systems that I believe have worked admirably well compared to many other systems. The courts don’t catch all the thieves just because they’re run by government. The colleges don’t catch all the people who are professionally incompetent or not following the spirit of their regulations, and it’s not because they’re not under government that they don’t. Right now I would rather work with the existing system that has been acknowledged and enshrined by this Legislature in the Health Disciplines Act. I found absolutely no unwillingness on the part of the college to process as quickly as possible and to cooperate with us when charges were made or alleged. If I had found that resistance, I would have had cause to agree with the member.
Mr. Swart: Supplementary: Doesn’t the minister think the time for a public inquiry has arrived when his own deputy minister, almost a month ago, said that the abuse of OHIP by labs was felt to be widespread? Is that not reason for a full public inquiry?
Hon. F. S. Miller: This is in my estimates which are up today. Again I think this kind of thing needs to be explored in depth between us. I’m quite willing to accept the discussion, but I feel that using question period to answer that would really be taking time away from other ministers.
Mr. MacDonald: You are just bailing out the Minister of Community and Social Services (Mr. Taylor), and you know it.
Mr. Lewis: Another quick question for Minister of Health: Given the mounting evidence of the unnecessary number of various operations and surgical procedures performed in the hospitals of Ontario, and the enormous additional cost to the public purse, would the minister be willing to establish a provincial audit committee between his ministry and the College of Physicians and Surgeons to look initially at the operative procedures of hysterectomy, tonsillectomy and gall-bladders, in an effort to see how many millions of dollars might be saved in Ontario if there were some serious control exercised in this field?
Hon. F. S. Miller: Again, I share my friend’s interest in this from all points of view. I don’t think it’s a Canadian or Ontario phenomenon. It is a North American phenomenon.
Mr. MacDonald: Lead the world!
Mr. Reid: There’s hardly a gall-bladder left in Ontario.
Mr. Speaker: Order, please. The hon. minister is answering the question. We are wasting time here.
Mr. Reid: Lots of gall but no gall-bladders.
Mr. Speaker: Will the hon. minister ignore the interjections, please, and answer the question?
Hon. F. S. Miller: Mr. Speaker, I’d love to ignore the interjections. The issue is a very crucial one. When I first became minister, I was intrigued to try to find those aspects of the health care system that were subject to management. My friend is referring to one that is of course subject to management; that is, unnecessary surgery. One of the first things I did was to ask some members of my staff to start reviewing those potentially manageable aspects of health care.
Mr. Deans: That’s criminal.
Hon. F. S. Miller: It takes some time to amass the data, and I was referring to some of the data when we talked the other day. I can only tell the Leader of the Opposition that within a couple of months I hope to come out with some kind of a position on this that will allow us to discuss it further and act in that direction.
OHC LAND ACQUISITION
Mr. Lewis: I have a question for the Minister of Housing. What is the minister going to do about the judgement of His Honour Judge Addy in the Federal Court of Canada, trial division, on Karam and Karam and the National Capital Commission, when His Honour made very strong and condemnatory statements about the land acquisition policies of the Ontario Housing Corp.?
Hon. Mr. Rhodes: Mr. Speaker, I have looked into that particular matter since I became aware of it in the newspaper reports. I think I have satisfied myself as to what the situation was as it related to the acquisition of that land. I would be quite prepared to make a statement here in the House concerning it. I don’t propose to do so at this time and take up the time of the question period, but I would be prepared to make a statement early next week.
Mr. Lewis: By way of supplementary, would the minister be prepared to provide the information on which the land acquisition was based and to deal specifically with the very strong statements which Judge Addy makes?
Hon. Mr. Rhodes: Mr. Speaker, I would remind the hon. Leader of the Opposition that I believe, to the best of my knowledge, the details were tabled in the House by my predecessor as they related to the acquisition of the land, the cost per acre and the total price.
Mr. Lewis: Yes, but will the minister comment on the content?
Hon. Mr. Rhodes: Yes, indeed.
Mr. Singer: Supplementary: Would the minister not agree, Mr. Speaker, in view of what Judge Addy says, and in view of the charges that were made and proved in this House relating to South Milton and other land acquisitions, that the time is now here for a full-scale inquiry to be held by a royal commission into the affairs of Ontario Housing to determine why Ontario money is being wasted in this fashion?
Hon. Mr. Rhodes: Mr. Speaker, it is an opinion of the hon. member that money in fact is being wasted. I am quite prepared to present the information that I have as it relates to the acquisition of land. Figures have been tabled in this House and, in response to the question of whether or not I would request an inquiry, my answer is No.
Mr. Bullbrook: By way of one final supplementary, if I may, would the minister include the minutes of Ontario Housing Corp. in the documents that he makes available to us, please?
Hon. Mr. Rhodes: No, Mr. Speaker.
Mr. Singer: You could run 12 hospitals on what Ontario Housing has wasted.
Mr. Lewis: This is a time of restraint, you know.
WELFARE PAYMENTS TO METRO TORONTO
Mr. S. Smith: I have a question directed to the Minister of Community and Social Services. In view of the continuing concern -- and more recently expressed at Metro Toronto council -- could the minister please make it clear whether he will or he will not pay, as agreed, the 80 per cent of the mandatory welfare costs incurred under provincial legislation by Metropolitan Toronto? Could we be just absolutely clear whether he is going to pay the 80 per cent of the welfare cost which Metro Toronto has to pay and has no choice but to pay under provincial legislation?
Hon. Mr. Taylor: As I explained earlier, there is always some debate as to what is and what is not mandatory; so, for that reason --
Mr. S. Smith: Not at all.
Hon. Mr. Taylor: All right. There is a very broad spectrum of services that are offered by Children’s Aid Societies. For that very reason, we scrutinize their budgets very closely.
Mr. Lewis: We are not talking about Children’s Aid.
Mr. S. Smith: Welfare, not Children’s Aid.
Hon. Mr. Taylor: We do in fact pay 80 per cent of the approved budget. That has been done in the past and will be done in the future.
Mr. Lewis: Of course, you have to.
Mrs. Campbell: Could the minister not distinguish between Metro council and Metro Children’s Aid and would he answer the question as it applies to Metro council?
Mr. Shore: Yes or no?
Mr. McClellan: A simple question.
Hon. Mr. Taylor: In terms of Metro council, I presume the member is talking again about the broad spectrum of social services that are administered through that council. We have set guidelines in terms of the overall parameters of spending, and I expect the Metro council, like other councils within Ontario, to comply with the guidelines.
Mr. Lewis: If you are trying to be a Jimmy Auld, you will never pull it off.
Mr. S. Smith: I have a question for the Minister of Health. Is the minister aware of the viewpoint expressed by the chief of the Whitedog reserve in as much as it is the chief’s opinion that sport fishing ought to be banned in the polluted waters around that reserve, keeping in mind especially the very high degree of mercury contamination in the blood of those Indians who are involved in guiding and certain other aspects of sport fishing? Has he heard the opinion of the chief with regard to this?
Hon. F. S. Miller: Yes, I have.
Mr. S. Smith: By way of supplementary, can the Minister of Health offer us some excuse so that we can understand why his ministry has not moved swiftly to insist that the cabinet impose a ban on sport fishing in that area in accordance with the opinion of that particular chief?
Hon. F. S. Miller: It shocks me, Mr. Speaker, that a doctor would assume that one should take an action without getting medical advice first.
Mr. Reid: You have had five years.
Hon. F. S. Miller: I have been asking for advice and I have, as members know, sent a team of eminent people to Japan and to other parts of the world during the month of November. I was promised a report by Feb. 18. The editor of that report changed positions and I am told he is within days of giving me the report. I don’t want to prejudge it but I will be glad to make its contents available to the member and to the leader of the official opposition the moment it comes in because I want to do one of two things. I do not yet know what he will recommend to me but I want members to know and I want us to approach the problem in a sensible way. If he tells me we must close for the sake of health, I will be prepared to make that kind of recommendation. If he suggests other alternatives, I would hope the member would support me in my recommendation.
Mr. Foulds: Is the ministry in that investigation including the consideration of the report called the Great Lakes environmental contaminants survey which indicated, I believe about two weeks ago, that lake trout from Lake Superior should not be eaten more than once a week because of the high mercury content in those fish.
Hon. F. S. Miller: I haven’t seen that report, Mr. Speaker.
Mr. Speaker: One final supplementary.
Mr. Foulds: I asked the minister if his investigation would include the consideration of that report.
Hon. F. S. Miller: Mr. Speaker, I had a specific set of things the first report was working on. I think it wise, at this late date, not to complicate it. I think one could compare one set of findings with the other, because they will be highly related. It talks about the levels of mercury in fish and the effect on health, which is basically what the issue is.
Mr. Speaker: Are there any further questions?
Mr. S. Smith: By way of a supplementary question, in view of the fact that the same processes in the making of pulp and paper have been used in many other river systems in Ontario by many other companies, can the Minister of Health tell us what his ministry is doing to check on the fish in the other river systems, what figures he has, and will he agree to table any figures in the possession of his ministry in this regard?
Hon. F. S. Miller: Mr. Speaker, I suppose the member’s research department realizes that it is not the production of paper that causes the mercury contamination at all, but the production of caustic soda and chlorine.
Mr. Reid: Which is used in the process of pulp and paper; we understand that.
Mr. Lewis: They don’t have their $40,000 researcher yet.
Hon. F. S. Miller: Could the leader of the NDP just leak them some of his information?
Mr. S. Smith: Leak us an answer.
Mr. Speaker: Would the hon. minister please ignore the interjections; thank you.
Mr. S. Smith: He loves them, Mr. Speaker. It is his charming way of avoiding the questions.
Mr. Ruston: How true.
Hon. F. S. Miller: Yes. The fact remains that we have been looking at other systems, and this was isolated as the one that was the most critical. The member will recognize the original problem, I think, was sparked around Sarnia. The Dow Chemical case which, I know, was one of the --
Mr. Reid: We haven’t had that question for a while.
Mr. Singer: The legal fees are up to half a million: “The polluters will pay.”
Mr. Speaker: Order, please.
Hon. F. S. Miller: I don’t suppose they are, because I don’t think you’re one of the counsellors.
Mr. Speaker: Order, please. Will the hon. minister ignore the interjections.
Hon. F. S. Miller: Mr. Speaker, if I ignore the interjections in this House I’d respond to nothing.
Mr. Singer: He insulted you again, Mr. Speaker.
Hon. F. S. Miller: The fact is, yes, we have.
Mr. Ruston: No cameras today.
Mr. G. E. Smith: Mr. Speaker, I have a question of the Minister of Transportation and Communications. In view of the fact that PCV licensees are being replaced by R licences, limited to certain geographic areas of the province; and due to the fact that many truckers in Orillia and other parts of the province operate and reside at points close to the borders, will the minister allow previous holders of F licences to operate in more than one region?
Hon. Mr. Snow: Mr. Speaker, there is no easy answer to that particular question. As was explained during the debate on the amendment to the PCV Act last fall, the province is now divided up into five regions for the new B licence for dump truck operators. Each holder of an F licence, a former open F licence, will be automatically granted a new R licence for one of those five regions, the region of his choice. If an operator operates in two regions of the province, or more, he may then apply to the Ontario Highway Transport Board for authority to operate in the second, third, fourth or fifth region.
The chairman of the Highway Transport Board is now setting up places for hearings throughout the province. He will be announcing hearings where these applications will be heard -- not here in Toronto, but a different location throughout the province. They will be at as informal a place as possible so that these truckers, especially those ones that are located close to a boundary and have operated in both regions, will be able to get their permanent authority to operate in a second region. In the meantime, these truckers, if they have work in more than one region, immediately can apply to the chairman of the board and he will be able to grant them temporary authority to operate in the second region until such time as it can be formalized. This is being expedited as quickly as possible.
Mr. Eakins: Supplementary, Mr. Speaker: Would the minister consider south boundary adjustments, where there are obvious problems, where people live close to the boundary. I am thinking of the lower section of Haliburton where they are oriented to the south. Would the minister consider some boundary adjustments where there are obvious hardships, and if not, would he ensure that no one who has operated in the open F class for a number of years is going to lose his livelihood?
Hon. Mr. Snow: Mr. Speaker, the boundaries that we are using are the boundaries of the five regions established by our ministry. If there was some good reason to adjust a particular boundary for this purpose, if it would simplify matters, I wouldn’t be against doing so. But I am sure that if we moved a boundary over one township or one county, or whatever it may be, we would only then create the same situation at the next line, and I would far sooner deal with this particular problem. It’s not something new. It’s something that we knew was there when the legislation was passed. It was discussed here in the House. I gave assurances at that time and I am sure of we look in Hansard those assurances are still there.
I must say that perhaps the biggest problem is the misunderstanding or the lack of information regarding this particular matter. Any truckers I have talked to have been totally satisfied when I have explained the situation. With the schedule in the House, I can’t meet, unfortunately, with every dump truck operator in the Province of Ontario. We are attempting to get information out through the OTA to all the trucking industry. These people are normally the people who own one or two or three frocks and they are harder to contact through the association. It would be very hard and expensive to contact them through an advertising programme. So we have to find some way of explaining it to them. I think it will all be cleared up very shortly.
Mr. Speaker: This will be the final supplementary on this.
Mr. Moffatt: Since the operators now have licences, would it not make sense to the minister that the holders of open licences receive communication from this office directly to correct the problem they anticipate happening in the next month as the construction season approaches?
Hon. Mr. Snow: Yes, I already have that under way. I met with some of my staff last week on this, and it is either going to be done by way of a direct letter to everyone who has a licence or through their association; one or the other.
WORK ACTIVITY PROGRAMMES
Ms. Bryden: Mr. Speaker, my question is of the Minister of Community and Social Services. If he is really interested in getting people off welfare, may I ask whether he considers the cancellation of the work incentive programmes, the work activity programmes, a step in the opposite direction to this? Is he prepared to raise the allowable earnings which recipients of social assistance may keep if they do take part-time employment, or will they end up with no more money even if they go out to work? And what is he doing to provide jobs which will help people make enough to support their families and to get off welfare if he is going to insist that they work?
Hon. Mr. Taylor: I will attempt to answer those three questions, Mr. Speaker. I presume the member is referring to the work activity programmes of the municipality of Metropolitan Toronto. Is that correct? Work activity programmes are carried on by a number of municipalities throughout Ontario. Of course, it’s at the election of the municipalities whether or not they carry those on. We subsidize those to the extent of 80 per cent and of course we will continue to subsidize those programmes to the extent of 80 per cent of last year’s expenditures plus a further 5½ per cent. In fact, we’re increasing the moneys for work activity programmes. It is up to the local municipalities, in terms of their priorities, as to what they do in regard to carrying on their work activity programmes.
Ms. Bryden: May I clarify what I meant -- work activity was one, the other was the wage supplement to the working poor.
Hon. Mr. Taylor: Excuse me; that is a fourth matter then. In terms of the working poor there were three demonstration projects in Ontario that we entered into last fall. One was with Metropolitan Toronto; one was with Peterborough; and the other one was with Ottawa.
The Metropolitan Toronto one was financed to the extent of $1.2 million. The word that I’ve got as late as this week is that it has not been successful in that only 12 applicants have applied so far in regard to that programme, and the metropolitan corporation has now reduced its share of the moneys allocated for that programme.
The hon. member also mentioned the matter of employment opportunities for welfare recipients. May I reiterate that we feel more can be done to place welfare recipients through closer co-operation and liaison with Canada Manpower offices.
Mr. Deans: Canada Manpower is useless; absolutely useless.
Hon. Mr. Taylor: Traditionally, I think it only fair to say that Canada Manpower has not been effective in terms of placement of persons on welfare who are seeking jobs. Therefore, we have worked out with Canada Manpower the placement of welfare officers within the actual Canada Manpower offices in a number of centres -- which, I gather, is working well -- to assist in placements.
I believe there was another question that the member had as well?
Ms. Bryden: Yes; are you prepared to raise the allowable earnings?
Hon. Mr. Taylor: Yes, I’m sorry. In regard to the earnings of a person who may be on welfare, right now a person with dependents can keep the first $100 of his earnings plus 25 per cent of the additional money. There are no plans to vary those provisions.
KENT COUNTY SCHOOL TEACHERS’ STRIKE
Mr. Spence: Mr. Speaker, I have a question of the Minister of Education. Could the Minister of Education inform me if any progress is being made in settling the strike of the secondary school teachers and the lockout in the secondary schools in the county of Kent? The concern of the parents of the student who are attending these schools has been brought to my attention. What action is the minister taking to bring about a settlement of this strike?
Hon. Mr. Wells: Mr. Speaker, I can, of course, assure my friend that I appreciate him bringing this matter to my attention. It’s been brought to my attention daily, ever since the event occurred, by my colleague who sits on my right -- the Treasurer of Ontario (Mr. McKeough) -- who is as concerned as he is about this matter.
Mr. Shore: The Treasurer is down there now.
Hon. Mr. Wells: Indeed, he has had several meetings with the parties from time to time in an attempt to bring about some kind of resolution of the problem. At the present time, the Education Relations Commission has asked Dean Ianni of the law school in Windsor, who has been acting as a mediator, to go back. He is there now with another mediator attempting to bring the matter to a conclusion.
J. CLARK KEITH GENERATING PLANT
Mr. Burr: Mr. Speaker, a question of the Minister of Energy regarding the announced plan to close the J. Clark Keith generating plant in Windsor: In view of the Hydro chairman’s expressed fears that blackouts or brownouts may be expected in Ontario in the not too distant future, why does Hydro even contemplate taking out of commission this fully-paid-for station which is still in excellent condition?
Hon. Mr. Timbrell: First of all, I think the hon. member is not exactly properly quoting the chairman of Hydro or me for that matter. The indications that have come from Mr. Taylor and me in recent weeks are that unless the traditional growth and consumption of electricity is dampened over the next few years, by the early 1980s we could be facing brownouts and blackouts.
On the question of the J. Clark Keith plant, first of all the member will know -- and I believe members of his party have expressed concern about this over the years -- that that plant is the least efficient in terms of environmental standards of any in the entire Hydro system. I am told that it still does not meet the Ministry of the Environment’s pollution standards.
Secondly, in 1975 that plant was used to the enormous extent of 1.5 per cent of its capacity. It is used as a peaking plant because, as the member knows, it is fuelled by coal and is therefore one of the most expensive in the system in terms of operating expenses.
This plant will be closed for about 2½ years, during which time it will be decided whether it will reopen. And, if it does reopen, whether it would be a coal-fired plant or whether it would be a residual oil-fired plant, perhaps using oil from the Petrosar facility in Sarnia.
Mr. Burr: When the ministry, or Hydro, predicts the amount of money to be saved by such a closing does it take into account the amount that is going to be paid out in unemployment insurance by the federal government and the amount that may be paid out in welfare by the provincial government?
Hon. Mr. Timbrell: Mr. Speaker, the last time I checked Ontario Hydro ran neither the UIC nor the welfare department.
Mr. B. Newman: Mr. Speaker, a supplementary of the minister: Is the minister aware that many times the local plant was accused of polluting the environment when it wasn’t even operating?
Hon. Mr. Timbrell: I am aware, Mr. Speaker, that those accusations have been made in the past; on occasion, by members of the two parties opposite.
Mr. B. Newman: I am telling the minister that officials at the plant have received calls from the Minister of the Environment to turn down the plant; to shut off the plant, when it was not even operating. He can see that he can’t use that.
Mr. Speaker: Thank you; that is really not a supplementary question.
Mr. B. Newman: The question that I wanted to ask the minister is will he guarantee employment and placement to those who are going to lose their jobs as a result of the temporary shutdown of the plant?
Hon. Mr. Handleman: You cannot have it both ways.
Hon. Mr. Timbrell: Mr. Speaker, every possible effort is being put forth by Ontario Hydro to relocate as many as possible of the staff who want to relocate in other parts of the province. They are also discussing with some of the staff the potential for early retirement.
There is one problem, which I wasn’t aware of until a couple of days ago, which is being encountered and that is we are dealing with two unions. There is a different union at J. Clark Keith from other parts of the Hydro system, and the two unions don’t recognize one another.
PUBLIC TRANSPORTATION IN NIAGARA PENINSULA
Mr. G. I Miller: Mr. Speaker, I have a question for the Minister of Transportation and Communications. I noticed that he had a meeting with the city of Hamilton re bus service in the Niagara Peninsula and southwestern Ontario. The question I would like to ask is: Is any subsidy being provided for that service at the present time?
Hon. Mr. Snow: Mr. Speaker, I presume the hon. member is referring to the service of the Canada Coach Lines? If that is his question -- no, my ministry is not paying any subsidy for the operation of the Canada Coach Lines. We are, of course, paying subsidy to the city of Hamilton for the operation of the Hamilton Street Railway urban transit system.
Mr. G. I. Miller: A supplementary question: Is there any study being made to tie it in with the GO Transit system presently being provided from Hamilton to Toronto and other areas?
Hon. Mr. Snow: No, Mr. Speaker, there is no specific study being made as to extending the GO Transit to include Canada Coach. My officials are working out some studies with the officials of the Hamilton Street Railway to determine to what degree Canada Coach Lines is supplying an urban transit service within the urban transit area of the Hamilton-Wentworth region. We expect to have a report on that within the next two months, I believe, and that might make some rationale for an adjustment to the subsidy base for the city of Hamilton.
Mr. Speaker: Any further questions? The member for Oshawa.
Mr. Breaugh: Supplementary, Mr. Speaker: Would the minister consider extending the study outside the urban area of Hamilton?
Hon. Mr. Snow: Mr. Speaker, of course we are researching transportation needs and requirements continuously. It is not the government policy to subsidize the private carriers of passengers on bus systems throughout the province, other than the GO Transit system -- which, of course, I am sure the member is aware of. I mean it is not government policy to be involved in intercity passenger transportation -- in most cases carried by private carriers. In the case of the Canada Coach Lines, it is basically a private carrier which happens to be owned by the Hamilton Street Railway; the same as the Grey Coach Lines operates as a private carrier and is owned by the TTC.
Mr. Breaugh: Mr. Speaker, I have a question of the Solicitor General. Would the minister explain why the regulations were changed to allow police officers in Ontario to use flat-nose bullets? What’s the reason for that and what was the source of the request?
Hon. Mr. MacBeth: Mr. Speaker, there have been some changes in the regulations in connection with the weaponry that police forces in Ontario are allowed to use. There are technical reasons for it, but I am not sure of all of them. There have been rather extensive changes; but as far as this particular question is concerned, I will get some information for the members here.
Mr. Speaker: The oral question period has expired.
Hon. Mrs. Scrivener presented the report of the Provincial Auditor for the fiscal year ending March 31, 1975.
Mr. Speaker: Motions.
Introduction of bills.
SCHOOL BOARDS AND TEACHERS COLLECTIVE NEGOTIATIONS AMENDMENT ACT
Mr. Leluk moved first reading of bill intituled, An Act to amend the School Boards and Teachers Collective Negotiations Act, 1975.
Motion agreed to; first reading of the bill.
Mr. Leluk: Mr. Speaker, the purpose of the amendment is to require teachers to make up instructional days lost during a strike.
An hon. member: How about a cat-o’-nine-tails?
An hon. member: Presumably without pay.
Mr. Speaker: Orders of the day.
Clerk of the House: The 20th order, House in committee of supply.
SUPPLEMENTARY ESTIMATES, MINISTRY OF HEALTH (CONTINUED)
Mr. Chairman: Dealing specifically with vote 2903, item 1.
On vote 2903:
Mr. Ziemba: Mr. Chairman, in recent weeks the Ontario government has been reminding all of us of the need for constraint, restraint and holding the line on public spending. They say that we must bite the bullet and cut back, especially in the areas of health and social services.
Since Dec. 19 last, the Minister of Health has been touring the province telling the citizens of Goderich, South Porcupine, Clinton, Durham, Bobcaygeon, Kemptville, Copper Cliff and others that their hospitals must be closed with the resulting loss of employment for these communities. We had been told that 5,000 hospital workers would lose their jobs and that 3,000 hospital beds would be eliminated in the name of restraint. According to the Minister of Health (Mr. F. S. Miller), $50 million is going to be shaved from his $3.4-billion budget.
As the Health minister has made his rounds to these communities, he has become increasingly defensive about the cutbacks. He has begun to demand that members of the New Democratic Party say where they would cut back in the health system and achieve comparable savings without inflicting similar damage to the communities involved in the health care delivery system.
I want to respond to that challenge from the minister. I want to talk about one area of the health delivery system where an NDP government in this province would move without hesitation and without damaging the system one jot. As this debate continues, I’m confident that other members of this caucus will be talking specifically about the insensitivity and arbitrariness of the hospital closings. But I want to respond to the minister’s challenge by demonstrating where we would have saved significant amounts of money while protecting the jobs of hospital workers and further demonstrate how this particular ministry has its priorities all wrong.
Mr. Chairman, I’m going to relate to you a story, in many ways a very sordid story, a story that emerged piece by piece after many days of painstaking investigation by myself and one other person. Mr. Miller wants to save $50 million, a nice round figure.
Mr. Chairman: I would remind the member, first of all, that you must restrict your comments to the Ontario Health Insurance Plan; and when you refer to another member of the House you refer to him either by the ministry he heads or the riding he represents.
Mr. Ziemba: Thank you, Mr. Chairman, it is the Ontario Health Insurance Plan that I’m going to be dealing with. The Minister of Health wants to save $50 million, a nice round figure and one that jibes almost exactly with the amount of unnecessary laboratory testing that is being done in this province. OHIP payments for laboratory testing in private medical labs have risen from $20 million in 1972 to $88 million in this current year.
The minister is looking up, I see. The reason the pay-outs were so high last year, higher than even the ministry anticipated, was that apparently there was a leak from the ministry to foe private lab sector that the ministry would be pegging the private labs as to how much business they were doing over the period of one year and that quota, that ceiling, would be imposed as a budget for each individual lab. What these private lab operators did, of course, was to fall all over themselves to try to get their business up, and the last quarter is when the leak came out. The volume of business they did was astronomical. In fact, it’s going to be a surprise to this Legislature, I’m sure.
It was early in this debate that clever money investors began realizing that OHIP had left the public till unlocked. There was no control whatever by OHIP officials on whether medical tests were necessary or indeed even performed at all. When it became apparent that medical testing in private labs was a growth industry with an open-ended demand, the smart money simply moved in. A return on profit of 45 per cent of gross annual business was not in the slightest uncommon.
I have talked to a real estate agent who sells private labs. He sells them in much the same way as real estate agents sell Colonel Sanders franchises. He says they’re simply a licence to print money. He makes on the average of $10,000 every time he sells one of these. It’s one of the really profitable ventures.
I submit this proliferation of medical labs has been going on for some time. In a speech delivered two years ago this month Dr. R. A. Haggar, chairman of the district committee for laboratory medicine in Hamilton said:
“The failure of government to control the proliferation of commercial laboratories has probably been the greatest single factor in the excessive costs of laboratory tests. Ever since medical services became insured benefits hundreds of individuals have opened laboratories, and commercial enterprises have moved in to share this bonanza. In order to expand their operations, laboratory businessmen have launched aggressive campaigns to entice practising physicians to use their facilities. Some laboratories have advertised these services, personally solicited physicians and their employees, sent them gifts and have tried to convince government they can do lab tests cheaper than hospitals.”
The signals were there as Dr. Haggar clearly indicated -- here is a man who two years ago was clearly ahead of the times -- the ministry chose to ignore them.
Applying inflationary considerations to the $20 million worth of medical testing performed in 1972 we might today reasonably expect to be spending $30 or $35 million a year. But we’re not spending $35 million; we’re spending in the neighbourhood of $88 million on private medical testing.
The difference between what we might reasonably have expected to pay for this service and what we are paying is in excess of $50 million or almost exactly what the Minister of Health is hoping to cut back on by reducing the quality of hospital services and throwing hospital workers out of work. If the minister had seen to it that OHIP was doing its job properly the hospital beds, hospital jobs and hospitals which were closed -- all of them -- could have been saved.
With proper management OHIP could have kept the growth of medical costs in line with the ordinary growth in revenues which comes with the regular expansion of the economy but OHIP isn’t well managed. If the government doubts this it ought to ask the Ontario Provincial Police and the accountants who are investigating the laboratory testing scandal that I revealed last month, a month ago today.
After four weeks, OHIP has not yet been able to unsnarl its records to tell police investigators who was paid and how much for what. OHIP doesn’t even know where half the requisition cards are. If it doesn’t know what’s going on how can the ministry expect OHIP to control its own affairs?
But now for the story, including the evidence that I promised. This is a story of how OHIP was swindled; of how the government stood by ineptly while it all happened; and how the public paid the price.
The story begins inside Abko Laboratories, suite 201, 94 Cumberland St. in midtown Toronto. There, technologists who were paid as little as $130 to $140 a week became infuriated at the daily sight of OHIP billings being padded. Tests that were never performed were checked off for OHIP to pay. The doctors never complained and Abko employees knew why. They knew the reason because they had also seen cheques made out to doctors and bills which were being looked after for new office equipment in doctor offices and personal gifts.
Finally, the employees of the lab decided that they had to take action publicly. They took company records that documented these transactions and brought them to me. For my part, I have turned over most of this to the OPP but, before I did, I photostated the original documents and it is these photostats that I want to share with the Legislature today.
The first is what I am sure Abko would call the bit parade of doctors. This shows the names of doctors and the amount of business they generated for the lab in the year 1974, and in the first margin it shows the commissions and kickbacks that the doctors were getting.
Here is a cheque for $8,000, dated Feb. 4, 1974, and made out to Z. Nagy. It is signed by Valentin Abersok, a partner in Abko. On the reverse side of the cheque, Dr. Z. Nagy has endorsed it and included his address, 8 Wilket Rd., Willowdale.
Here is another cheque, for $2,000, made out to Ilone Nagy, Dr. Nagy’s daughter. On the bottom of this cheque, Abko has written, “Fixture and fixtures.”
Here is a cheque for $2,200, dated April 2, end made out to Ra-Za Services Ltd. It was not easy for me to locate Ra-Za Services but in time I found it to be a storefront medical clinic, complete with two labs down in the basement. The clinic is owned and operated by two doctors, a Dr. Khan and a Dr. Singh.
The basement is divided into a medical lab -- it’s really what they call a collector station or a bleeding station -- and the other half of the basement is a radiology lab where they do x-rays. Rents run a little over $500 for each side; that’s $1,000 plus a month. Abko paid over $2,200 for four months’ rent and they never moved in. The present lab, Flemington Labs, has taken over the lease and the operator of Flemington Labs is experiencing no difficulty in paying the $500-a-month rent to Dr. Khan and Dr. Singh. In addition to that, he pays the salary of a technologist, a young woman who takes the blood samples and sends them on to the head office. Apparently there is no difficulty in paying this rent, because Flemington Labs is being fed by the two doctors upstairs.
When I interviewed Ra-Za’s secretary, and I commented on how much money was being charged for the cellar, she explained it as a referral fee before correcting herself and saying it’s the rent. In any case it has to be the highest rent paid for any basement on Danforth Ave., compliments of OHIP and your taxes and mine, Mr. Chairman.
I’ll tell you another thing: Driving around this city and around this province, I couldn’t help but notice how many apartment building are being converted to medical centres, how many storefront medical clinics there are and how many medical centres are being built. They are all over the place -- medical centres for rent in a lot of these office buildings that couldn’t be rented for office purposes. So it seems they are just mushrooming and it’s all thanks to OHIP. It’s a real opportunity for them. They all follow the same pattern too. The doctors are upstairs and the pharmacy and the medical lab, as well as the radiology lab, are downstairs. We’ll get back to that later.
I also have here a receipt stamped “paid” from the T. Eaton Co. Ltd., documenting that repair services for Dr. Nagy’s television set were paid for by Abko. Nothing was too petty for these people. The obvious question to ask is, why was Abko Medical Laboratories on Cumberland St. being so generous to Dr. Nagy?
Indeed, in the records that I have obtained concerning Abko are detailed sheets indicating -- I showed you one of them -- the amount of business in dollar terms that each doctor did with this private laboratory. These sheets reveal that referrals to Abko by Dr. Nagy amounted to $17,825 in 1974 and $15,259 in 1975.
Let me say and let me be very precise about this, these figures indicate Dr. Nagy’s referrals in terms of actual revenue. They don’t indicate necessarily what Abko may have finally billed OHIP for; that was another matter. But Dr. Nagy should not be singled out for special treatment; he is by no means alone.
Let me deal next with the champion source of Abko revenue, a Dr. Marko Mihic. In one month alone, March, 1974, Dr. Mihic sent Abko $4,000 worth of testing work. Now that’s performance. Abko performs tests requested by Dr. Mihic and in return wealth is created -- wealth for Abko, wealth for Dr. Mihic and for Dr. Mihic’s family. Of course, every cent of this wealth was paid for by you and me and all the other residents and employers of Ontario who pay premiums and taxes to the Ontario Health Insurance Plan.
Because Dr. Mihic is the winner of the Abko cup, let me just take a moment to document for the Legislature the dollar amounts of testing he referred month-by-month through 1974 to Abko. In January, 1974, Dr. Mihic sent $2,331 worth of business to Abko; in February, $3,805; in March, as I have already mentioned, $4,087.
Mr. Makarchuk: That’s real growth.
Mr. MacDonald: It’s what you call reverse strength.
Mr. Ziemba: In April it was $2,259; in May, $3,054; in June, $2,474; and in July, $3,189. But what’s this, Mr. Chairman? In August it was $1,656; it dropped away down. Presumably, Dr. Mihic took an August vacation in 1974.
Mr. Mackenzie: One doctor, and one lab tested them all.
Mr. Ziemba: In September it was $2,818; in October, $2,501; in November, $2,427 and in December, $4,142.
Mr. Makarchuk: A fine Christmas present!
Mr. Ziemba: In one year, Mr. Chairman, Dr. Marko Mihic sent $34,743 worth of business Abko’s way. In return, the records show that such industry paid Dr. Mihic handsomely. Abko records indicate the company paid $3,500 in several instalments to Dr. Mihic -- at least one member of his family helped him on his T4 slip, I see.
I have here three cheques both made out to N. Mihic, Dr. Mihic’s son Nicki, one for $1,500 and two others for $1,000 each.
Mr. Makarchuk: There is real private enterprise.
Hon. F. S. Miller: That is not private enterprise, that’s theft.
Mr. Swart: Theft by whom? Will the minister say that outside the House?
Hon. Mr. Miller: I have got other people saying it for me. Will he say this outside the House?
An hon. member: Why?
Hon. Mr. Miller: Somebody just challenged me to say something outside the House.
Mr. MacDonald: This is what you are supposed to do with regard to the College’s inadequate supervision of the profession.
Mr. Ziemba: The cheque for $1,500 was cashed on Feb. 1, 1974, by Nicki Mihic and has his address on the reverse side -- 278 Oriole Parkway, Toronto, out.
I must not leave the Legislature with the impression that it was all dollars and cents with Abko; it wasn’t. I have here a bill from Simpson’s made out to A. Gergely at 2177 Danforth Ave. It’s for a dyed otter-muskrat coat. They have good taste, don’t they? The coat was purchased for or by a Dr. Anna Gergely at 2177 Danforth Ave., where she has both her medical office and her apartment, but the Simpson’s bill was paid for by an official of Abko.
I wonder if this is any consolation to the registered nurses that I’ve been reading about in the Globe and Mail earlier this week, who are thrown out of the hospitals and have to clerk in Woolworth’s. Dr. Gergely’s dyed otter fur coat.
In fact, I cannot contrast what this government has allowed to take place in the health care delivery system more starkly than that. It’s buccaneer, private enterprise run amok in its most ruthless and inhuman form. The families in this province who can least afford to be unemployed -- cleaning staff, ward attendants, nurses, orderlies, technicians, ordinary working people -- are losing their jobs while a doctor receives a fur coat, paid for by the taxpayers. Where is that minister who likes welfare bashing? He’s not here. I’m sorry he couldn’t hear this.
I have cancelled cheques here for $1,000 and another for $700 made out to Dr. Yat T. Tse, of 129 Dundas St., by Dr. Joseph Kohari, another Abko partner. In addition to his medical practice, Dr. Tse owns an apartment building, King’s Plaza Apartments, at 122 Dowling Ave. in Toronto. Last July, Abko kindly paid the apartment building’s fuel bills in the amount of $1,525.79. I’ve got that bill here, paid by Abko. The bill was paid to Star Fuels on Lawrence Ave. W. Also in July of last year, Dr. Tse had his life insurance premium with the Maritime Life Assurance Co. paid for by Abko in the amount of $376.29. In June of last year, Dr. Tse had a little landscaping done at his home at 301 Hillhurst Blvd. and the Express Landscaping and Gardening Co.’s bill for $76 was paid for by Abko. What a petty chiseler. I hope he’s one of the five you’ve reported, Mr. Minister.
A bill for $180 from Anca Laboratories in Whitby was made out to Dr. Tse, and once again it was picked up by Abko. I have it all documented here. It’s apparent that Dr. Tse preferred payments in goods and services instead of cash and Abko obliged, including a bill for $57.50 from Sands Pharmaceuticals. And if you think that Dr. Tse benefited a great deal from Abko, bear in mind that over the course of 1974, Dr. Tse sent more than $11,000 worth of business Abko’s way.
Next we come to Dr. Fred Nishikawa at 265 St. Clair Ave. E. Dr. Nishikawa is clearly a loyal family man. Abko’s cheque for $1,000 was made out to Fred’s wife, Mrs. Mollie Nishikawa, and she endorsed it when she cashed it on Aug. 10, 1973, at the Donwoods Plaza branch of the Toronto Dominion Bank. It’s right here, Mr. Chairman. There is another Abko entry showing a payment in the amount of $411.75, indicating Abko reciprocated in Dr. Nishikawa’s loyalty to them.
In 1971, Abko received $6,255 worth of business from Dr. Nishikawa’s referrals. A hustling private enterpriser, Dr. Nishikawa improved his productivity year by year -- $10,629 in 1973 and $10,993 in 1974.
Dr. C. T. Leung, who had just moved into new offices at 600 Sherbourne St. -- a kind of condominium office, very nice -- received a $299 examination table supplied by Abko -- and a personal favour. Abko hired Dr. Leung’s father at a weekly salary of $150. The senior Leung was one of Abko’s highest paid employees. And according to other employees at the medical laboratory, Mr. Leung did nothing for his weekly salary.
Now, this is a case of a double-cross and a triple-cross. Dr. Leung was sending business Abko’s way, but in the meantime the lab which was located in this posh new condominium was expecting business from other doctors. I learned that the delivery person had to sneak the samples past the lab downstairs, in and out of the doctor’s office.
Dr. Claude Hale of St. George St. is a member of the staff at Wellesley Hospital and had a $350 month subsidy from Abko towards his office rent. And there’s a cheque for $1,000 from Abko, endorsed when cashed by Dr. Hale, Jan. 20, 1973, on record in the Abko files.
Dr. A. E. Kadry of 29 Wellesley St. received a whopping Christmas present from Abko Medical Laboratories on Dec. 17, 1973. The cheque for $8,400 was cashed two days later. One cannot help but ask the Health minister --
Mr. Makarchuk: Does he believe in Santa Claus?
Mr. Ziemba: One cannot help but ask the Health minister: Are the jobs of some hospital workers in Ontario being eliminated because of Dr. Kadry’s 1973 Christmas present?
In 1973, Dr. Kadry sent $22,604 worth of referrals to Abko. Now three of his colleagues -- they all shared this Kadry clinic -- Dr. Gallimore, Dr. Padimore and a Dr. Roger, operating out of this location, sent a whopping $59,120 Abko’s way during 1974. Twenty-two thousand dollars that Dr. Kadry sent in is a lot of money, but a mere pittance compared with the amount of Dr. Anna Lauks, a gynecologist and obstetrician at Women’s College Hospital, sent Abko’s way that same year. Dr. Lauks sent the incredible but documented amount of $54,433 worth of referrals to Abko in 1973. According to Abko’s records -- it is right here -- Dr. Lauks received a cheque each month for $460 from Abko in return, to help pay her rent.
In 1973, Dr. Natalie Romanik, who occupies medical offices in the same premises as Abko, dispatched $49,213 worth of business to Abko. Dr. Romanik received monthly returns of $500 from Abko.
Yet another in-house source of business for Abko was Dr. Joseph Florence, at 94 Cumberland. In 1973 he sent Abko $6,237 and in 1974 $4,458. In return, Abko paid a bill from Eaton’s home furnishings for $508 -- and I have got it here -- and gave him cheques of $200 and $700.
Mr. Bullbrook: I am starting to understand why the minister needs supplementary estimates.
Mr. Ziemba: Dr. J. N. Vanek, who occupies the next office to Dr. Leung at 600 Sherbourne St., had a bill for goods shipped from the Arte Shoppe to Dr. Vanek’s home at 32 Chelford Rd. I have got the bill here. The bill was worth $949.75, and it was paid for by Abko.
One final note about Abko. Cobac Development is a company owned by the same men who own Abko Laboratories -- Dr. Kohari and Mr. Abersok. Cobac Developments is in the business of decorating, equipping and refurbishing doctors’ offices. At 94 Cumberland St., Dr. Hanincec, Dr. Vujnovic and Dr. Romanik, all had their offices done over.
In the west end and, I am sorry to say, in my riding, the two Dr. Gajics -- husband and wife -- and a Dr. Mihic --
Mr. Norton: Did that really happen in a socialist riding? I thought it was only in free enterprise --
Mr. Swart: Free enterprise still remains.
Mr. Warner: They are on the fringe.
Mr. Ziemba: -- had their offices outfitted at a cost of about $5,000 each; between $4,000 and $5,000. That’s approximately $30,000 worth of work done by Cobac, provided at no cost, right down to the last Q tip, and paid for by Abko.
Mr. Warner: Still only a police investigation?
Mr. Ziemba: So far I have only discussed one laboratory, Abko. But I don’t believe this story begins and ends with Abko. The OHIP payments for private medical labs did not leap from $17.8 million in 1971 to $88 million in 1975 because of one private medical laboratory. I think Abko is the tip of the iceberg.
Let me come back to Dr. Haggar and his speech in Hamilton in 1974:
“Physicians are the ones who order all the laboratory tests but have to answer to no one for their actions. Fortunately, the majority are reasonable men who do not abuse the system; only a minority over-utilize the laboratories. In some instances, however, practising physicians own or direct laboratories. It should go without saying that no physician should have any direct or indirect financial interest in a laboratory (or a pharmacy or optical supply house or any other medical enterprise) to which he might send his own patients. This is clearly a conflict of interest and can only result in accusations of unethical practice.”
What Abko has been engaged in isn’t just illegal because it is taking money unjustifiably from OHIP. It also breaks regulation 577 made under the Health Disciplines Act. Regulation 577 says that it is professional misconduct to have a conflict of interest.
For receiving fees from any person to whom a member -- of the College of Physicians and Surgeons -- has referred a patient or requesting or accepting a rebate or commission for the referral of a patient, the regulation stipulates, a doctor is open to disciplinary action.
In addition, so does conduct or action which would be considered disgraceful or dishonourable by members of the profession. It would appear that not only has the government been lax in its failure to prevent a rip-off of the medical system of the magnitude of an Abko, but the College of Physicians and Surgeons was lax as well.
These are the people you have so much faith in, Mr. Minister, through the chairman, who are going to clean up this mess -- the same people who were dealing with that crackpot doctor who was beating his patient with an iron bar and who gave the guy a fine.
Perhaps it’s no longer possible for the profession to police itself. Certainly the cost to the taxpayers makes answers to these kinds of questions extremely pertinent. The money that pays for OHIP and the remainder of Ontario’s health care delivery system is properly spread right across our society because we are interested in all members of our society being healthy. Accordingly, all society requires all of the facts in order to decide how its interests are served best.
It is for this reason that I am proposing that a select committee of this Legislature be set up to investigate OHIP generally, and real or potential conflicts of interest on the part of doctors in particular.
I have here a press clipping from the London Free Press, dated Feb. 13, 1976. “Davis Prepared to investigate Allegations involving Health Labs”. This is a month ago. This is the day I released the story to the Toronto Star.
“It says: Premier William Davis said today he is prepared to launch a full and public investigation into allegations of false billings, unnecessary testing and possible conflict of interest involving private health laboratories. ‘It is absolutely vital that the government move with dispatch to make public any wrong-doing, either by private testing laboratories or doctors so that the full nature of any alleged fraudulent activities may be fully understood and, where necessary, appropriate charges laid,’ the Premier said.”
That was Feb. 13 -- what was he doing, Mr. Chairman? He hasn’t moved yet and he’s got one of these -- I described it in a press conference last week; it’s one of these rip-off labs, ADS Laboratories -- which is right in his riding in Brampton.
Representation on that committee, Mr. Chairman, would happily -- as a result of this minority government situation -- include a majority from political parties which don’t have a vested interest in apologizing for what they have failed at. The committee I am proposing would have the power to subpoena witnesses and compile testimony under oath, with the right of cross-examination by all interested parties. I want a full and open inquiry to let the doctors, many of whom I have mentioned, prove the excuses that they have given to the police on the advice of their lawyers -- that the money paid out to them by Abko were not payments but loans, and therefore proper. Let them prove that.
Abko records that I have checked don’t show any agreements by these doctors. I don’t believe for one second that these were ever intended to be loans. This was a form of payola in order to get business for a private medical laboratory. It happened because the OHIP system was powerless to prevent it from happening. This is exactly the argument that I would use for not cutting back funding for hospital labs, Mr. Chairman. I have yet to come across a hospital lab that turns over any gifts, fur coats, or $8,000 cheques to doctors.
All my life, Mr. Chairman, I have believed that the practice of medicine is a decent, honourable profession. I still do. It’s a great profession. I hope my son, John, will become a doctor. He’s nine now. I believe strongly that the vast majority of doctors are scrupulous and honest in their chosen profession. The vast majority of doctors are not involved in the types of practices that I have outlined in this speech. And it’s these men and women who must be protected. This is another reason why this Legislature must order a public inquiry to ensure that the innocent are spared of any stigma associated with these revelations. Thank you, Mr. Chairman.
Mr. Chairman: The hon. member for Hamilton West.
Hon. F. S. Miller: Mr. Chairman, am I not allowed to reply?
Mr. S. Smith: If the minister would like. I can interject at any time.
Mr. Chairman: If you wish.
Hon. F. S. Miller: Mr. Chairman, the member for High Park-Swansea is, of course touching upon matters of great concern to me as well as the Legislature. I have been deeply concerned with the irregularities he alleges have occurred. The police, I understand, are investigating them now. I don’t know if charges have been laid or not. The College of Physicians and Surgeons has been involved in examining the relationship with every doctor whose name that they have.
Mr. Ziemba: No charges have yet been laid.
Hon. F. S. Miller: But if this member didn’t have a pre-1492 view of the world, he would not try to draw the conclusions he’s drawing. We have a vested interest in finding every person in every part of government dealing or private enterprise who, through any fraudulent means, breaks the law. That job will go on as long as human beings are in business in any form at all. What he can’t see is that the world isn’t flat; that because he has found one person --
Mr. McClellan: One?
Hon. F. S. Miller: I am talking about a business. I quite agree there are probably others. That, in fact, one should jump to the conclusion that it was private enterprise that was at fault. That’s where you and I disagree.
Mr. Swart: Your deputy minister said it was widespread.
Mr. Warner: This didn’t take place in a public place.
Hon. F. S. Miller: No, but what takes place in a public place is inefficiency in many ways. Your forms of government are able to tolerate total inefficiency by letting the state assume all responsibility. I would rather, any time at all --
Mr. Chairman: Order, please, the minister has the floor.
Hon. F. S. Miller: I would rather, at any time at all, have to deal in the normal, traditional way with the people who break the laws, by fining and prosecuting them, than damn the system that has made this country one of the best in the world. You would like to jump to conclusions and say --
Hon. F. S. Miller: May I ask you to be quiet? Did I not sit patiently through what I consider a very important speech?
Mr. MacDonald: Because that was wise.
Hon. F. S. Miller: May I not have the same kind of respect in return?
Mr. MacDonald: Your reaction to this is to defend free enterprise. It’s irrelevant.
Mr. Chairman: Order, please.
Hon. F. S. Miller: If you will let me finish, perhaps I will be able to draw some conclusions.
Mr. S. Smith: I’d like to talk today too.
Hon. F. S. Miller: It will be my duty to find inefficiencies in those things, such as hospitals, that are publicly financed. Admittedly, I am not likely to find people breaking the laws in public hospitals. It is not against the law to have too many people on staff or to provide extra services that may or may not be required, but it still costs the same kinds of tax dollars out of you and I. And to draw the comparison that I should not have cut out inefficiency in hospitals because I could have found inefficiencies in private labs is ridiculous, absolutely and totally ridiculous. I am working on them both. They are not mutually exclusive. I am going to get rid of any of the excesses.
The great growth in the private lab sector has not been because of the sweetheart deals, although I admit they exist. The great growth is partly my ministry’s fault, and I quite accept it, in terms of the funding mechanisms we have had for hospitals which have created it. And it is partly because the free enterprise system has always been able to offer ways of giving services that are legal, apart from the things you talked about.
Mr. Swart: It is not free enterprise; it’s private enterprise.
Hon. F. S. Miller: There is a great deal of competition among the 282 laboratories in this province that are licensed as private labs and, sadly enough, this kind of competition at times brings up the kinds of things you have raised. But let me say that I will endorse the police and the college in every action they take to eliminate the things which you have alleged today. Assuming they are correct -- and I don’t question that part of it; I don’t know whether they are or not, a court must make that decision -- you and I are on the same side in that argument, we can’t tolerate that kind of thing. I have been keenly aware of it and working on it. The very fact that it was brought up, as you may discover when we come to court, may have blown the case. That’s the thing we have to find out.
Mr. Renwick: No.
Hon. F. S. Miller: I said, “may have.”
Mr. MacDonald: Don’t raise that --
Hon. F. S. Miller: I am not bringing the issues that you were discussing with the Attorney General (Mr. McMurtry).
Mr. Renwick: Either the evidence is there or it is not there.
Hon. F. S. Miller: I hope it is but what I am saying, sir, is that in fact we believe evidence was destroyed that would have been useful to us.
Mr. Renwick: That’s why we have been calling for an overall judicial inquiry to prevent exactly that happening.
Hon. F. S. Miller: Right. I have never ruled that out, but there was --
Mr. Deans: You haven’t done it.
Hon. F. S. Miller: Yes, but again, sir, you are a lawyer. You realize that one could have judicial inquiries every day of the week when somebody pops up with an irregularity somewhere.
Mr. MacDonald: We’ve had them for less excuse than this.
Hon. F. S. Miller: I heard two called for today --
Mr. Renwick: We are concerned about the very thing you are, that evidence may possibly be destroyed.
Mr. Bullbrook: Let’s not get into this again. If he and Renwick want to talk, let them go outside and talk for a while. There was half an hour yesterday with McMurtry.
Hon. F. S. Miller: But, what I am trying to say is that I have a great deal of interest in cutting down two things: the ordering of unnecessary tests, which is perfectly legal and it is being done by doctors who don’t get one penny kickback in any sense at all, because it has become easy to do, because it’s good defensive medicine, because in many instances the forms and so on are designed in a way that allows a doctor to have a shopping list.
Mr. Dukszta: That is your responsibility. It is your ministry.
Hon. F. S. Miller: I am not arguing that.
Mr. Chairman: Order, please. Will the minister just respond to what has been said by the member and ignore the interjections?
Hon. F. S. Miller: I will try to. Please have a quiet chat later with the members of the organization who are making them.
We do have to work on those things. You assume all problems are resolvable at once. Well, look, one thing I have learned in my ministry is that I have many, many, many problems.
Mr. Deans: You sure do.
Hon. F. S. Miller: Sure I do, and you would if you won.
Mr. S. Smith: We all would if they won.
Hon. F. S. Miller: You wouldn’t. Fine, I almost have.
An hon. member: You must live right at times.
Mr. MacDonald: We know in advance.
Hon. F. S. Miller: You live in a dream world. Someday, I say, when --
Mr. Breithaupt: I almost wish they did.
Mr. Chairman: Order, please. The minister is no longer responding to the remarks of the member for High Park-Swansea. He is responding to the interjections. I will now recognize the member for Hamilton West.
Mr. S. Smith: Thank you, Mr. Chairman.
Mr. Norton: Restore some order among the people on the other side.
Hon. F. S. Miller: On a point of order, Mr. Chairman. I never interjected. I think I may have made one during the speech of the member for High Park-Swansea. I think I normally have a reasonably quiet stance while people are talking to me.
It is very difficult to ignore interjections and to blame the speaker for responding to them. Without taking some action to penalize those making them is not totally fair.
Mr. Chairman: I have asked them to refrain from interjecting and I hoped that you would have ignored them. It seems we are not making any progress at all. I will recognize the member for Hamilton West.
Mr. S. Smith: Thank you very much, Mr. Chairman. The minister, in fact, does not usually respond to interjections; generally speaking he responds to thoughts which come to him from random places, as I recall.
Hon. F. S. Miller: That’s an interjection I can’t afford to ignore.
Mr. Mackenzie: Holton says he is illegal.
Mr. S. Smith: I am pleased to stand up.
Mr. Renwick: That wasn’t an interjection, because you were on your feet.
Mr. S. Smith: In the estimates that we are discussing today it is perfectly obvious that the points brought up by the member for High Park-Swansea (Mr. Ziemba) are extremely important points, which I am very pleased that he has brought up in this House. I want to support him in his efforts in doing this particular type of investigative work.
I would also like to say that there are many other members, I suspect, who have information that they would like to bring forward -- and I am going to talk about some of this. They would very much like to have the inquiry that was already promised to the people of this province by the Premier (Mr. Davis) of this province. It would provide the proper forum for people to come forward with various types of evidence -- some of which would be hearsay -- but which would be extremely helpful to the people, and to the medical profession as a whole, so that they would be forewarned about the kinds of facilities and services and deals that happen to exist, It would be very helpful to the ministry as well.
For the life of me, I cannot understand why the Premier has not made good on a very reasonable promise, and one which I congratulated him for and which I was very pleased to see reported. He would have the support of all parties in the House for such an inquiry; and it could in no way reflect badly upon him or upon his government. As far as I am concerned, it is something that should have already gone ahead.
I want to say something about the private labs, and then something about the public labs that have been closed. With regard to the private labs, I think it is obvious and it is well known in the medical profession, and the ministry knows it very well, that far too much ordering of laboratory tests goes on all the time. I am speaking of honest people; ordering them at honest labs. I am not speaking only of those where there are some very questionable proceedings.
It seems very clear that the present system, which the ministry seems to be very enamoured of, really gives the doctor no incentive to be frugal or thrifty with public money.
The story is repeated over and over again -- because the same is true in hospital beds, the same is true in return visits, the same is true with surgery, and so on. The incentives are all to spend more and not to spend less. The ministry seems to have a strange inertia here. They seem unable to introduce a method of payment which would, in fact, encourage doctors to be more frugal; to have them police each other; to set standards for each other; to have publication in each region and in each area of the names of those doctors who are clearly over-ordering to ask the medical societies to really police themselves. And failing that, to introduce non-medical people into the policing function, so that the interests of the public could properly be served.
Of course, it is the doctor who has to decide which tests to order. But we well know from various medical auditing procedures that there are ways in which doctors can be brought to meet a certain standard. I bring to your attention the example of utilization committees which in some hospitals are very effective indeed and which publish for everyone the average number of days in hospital or the average number of tests or the types of tests which ought to be ordered and the frequency with which they ought to be ordered. Most doctors will try to keep within these standards but if there is no attention paid to this, if they are not published, if the committees don’t exist or are toothless, then I think a good many well-meaning doctors just take the easy way out.
This government threatens deterrent fees on the patients. They are saying if you penalize the patient, then he might scream loud enough so the doctor won’t misuse the system and won’t over-order the tests. And, of course, they are right in a way. They have a certain logic on their side in the sense that they could reduce fees and payments about seven per cent, according to the Saskatchewan experience, if they introduced a deterrent fee on the patient.
First of all, it seems to me grossly unjust that it’s the patient who should have to suffer financially because the doctors refuse to police themselves and the ministry refuses to help the doctors police themselves. It strikes me, furthermore, as unjust because the experience in Saskatchewan showed that the people who were deterred from seeking services were those people in large families and those people who were elderly.
There may not be an identity between the large families and the elderly, on the one hand, and the poor and the sick on the other, but it strikes me as sufficiently likely that they are the same people. This is the work of Dr. Beck in Saskatchewan. Our party cannot possibly support deterrent fees and we, therefore, would hope that the minister would stop blaming the patient for the sins of the doctor. As a physician, I have worked very hard with my fellow physicians and I find a vast majority of them very interested and very willing to adapt their practices in the public interest. But somebody has to sit down with them; the mechanism must be set up. And this ministry shows absolutely no energy for that type of a flexible approach.
With regard to the labs, the Ontario Association of Medical Laboratories, which I suspect has many members who are perfectly honest people trying to do a good job, has pointed out that between $3 million and $4 million a year could be saved by the simple expedient of preventing the ordering of profile testing. To explain this -- and the minister knows it very well -- when you want to test, let’s say somebody’s liver function, it could be done very well by ordering one teat or sometimes two or three, but many of the laboratory requisitions and so on make it mandatory pretty well to order a whole profile which consists of maybe 10, 11 or 12 tests and they are all done and they are billed individually to OHIP. The benefit to the patient is highly questionable and the association of labs has suggested that this be in some way curtailed and they have made very specific suggestions in a report to Mr. Backley on Jan. 27 of this year.
I know the minister has a lot of problems and he frequently reveals many of them here in the House, for that matter.
Mr. Reid: Nothing Freudian about that,
Hon. F. S. Miller: On a point of personal privilege, Mr. Chairman, I must ask for my diagnosis today because I understand the balance of your party has it and I would rather like to see it.
Mr. Reid: It is not good.
Mr. Breithaupt: We will give you a full profile.
Mr. S. Smith: The minister himself has put it very well, Mr. Chairman, when he said how difficult it is to give bad news to people. I can’t possibly answer his question.
Mr. Grossman: It is harder to receive it.
Mr. S. Smith: The recommendations have been made and they strike me as very modest and reasonable recommendations. I don’t understand why between the end of January and now he could not have taken some steps to implement them. For one thing, they recommend -- and it sounds like a simple mechanical thing -- that none of the laboratory requisitions should be allowed to be reprinted and reused without approval of a certain advisory committee and, to me, that should have been set up immediately. I don’t understand what the delay is about.
There are a number of other recommendations and I won’t burden the House with reading them all. They are in the report which is open to any member to read. But these recommendations should be implemented immediately.
Let me tell you the story that occurred in Hamilton. A very distinguished doctor there called me -- he actually called a friend of mine to say he wanted this message passed on to me. He was very disturbed that a particular laboratory company, a private lab, had approached him, as a representative of a group of doctors who own their own building and have their clinics there, to offer to provide a laboratory service for these doctors. The offer was a very strange one inasmuch as it consisted of an offer to rent premises in the doctor’s building at much higher than any rate of rent that would normally be charged for those particular buildings.
Furthermore, the company offered to hire for the doctors -- or to have the doctors hire and the company would pay the salary -- a person to do some of the blood-letting and the preparations for testing and so on. This particular person, who would work in the doctor’s office, would be paid at whatever the going rate was but the doctors would be compensated for a salary much higher than the going rate. They could spend whatever portion of that they thought would be necessary to hire the particular technician involved.
Furthermore, if that were not sufficient, there was an offer to form a pharmacy in that particular building and, again, to adjust the rents in such a way that, although it might not be legally a kickback, the amount, the volume, of prescriptions put through that pharmacy would, one way or another, be reflected in higher rents which would come back to the doctors’ group. In addition to that, if that were not enough, they were offered trips to Hawaii with their wives, if they so preferred.
I calculated that the total cost of this particular package to the laboratory company must surely come to somewhere between -- I don’t know -- maybe $23,000 to $32,000 a year. I am being fairly careful in that particular estimate.
Knowing what these doctors could possibly generate, even if they became lab crazy in the way of testing, that must mean that for every $30,000 of lab tests about $6,000, as far as I can make out -- $6,000 to $8,000 at least, minimum -- would come back in one form of kickback or another.
These people would have no thick with such individuals. These people were very honest. They simply threw them out of the office and got hold of my people immediately.
I was about to reveal this information when, strangely enough, two days later the Premier (Mr. Davis) of the province announced that there would be an inquiry. I said to them there was the proper place for us to give this information because a lot of it was hearsay; we had nothing in writing. I speak in the Legislature well aware of a certain immunity concerned in so doing.
I am terribly disappointed because I wonder how many other good people like my friend must exist, who would come forward if there were such an inquiry; who could be persuaded, through the local academies of medicine and medical societies, to come forward so as to protect the name of the medical profession and the laboratory profession.
With regard to the public health labs closed, I’ve had occasion to visit them now. I have not visited the one in St. Catharines but I’ve been to Kenora, Woodstock and North Bay. I am very disturbed because I ended up in each of these places spending an evening talking with people and trying to guess what the minister has in mind. It is a very disturbing thing, if any of you have done this, to meet with a bunch of people who are losing their jobs. I’m in favour of restraint and I was prepared to stand up and say, “I’m sorry but you may have to lose your jobs. That is just the way it is. If we are cutting back, jobs are lost.” Yet I couldn’t answer their questions which had to do with how many dollars would be saved; how many people would it take to do these tests in a neighbouring lab; and so on. It’s awfully tough.
We started guessing -- maybe, if he has in mind switching this type of test to this lab and this type of test to another, he could save this. It was a guessing game. I cannot understand why the same ministry that actually has courses in management -- the famous Ministry of Health management technique courses which tell you, if you are a civil servant in that ministry, that the proper way to manage is to consult with your employees; to consult with the people under you; to talk with them; to share the decision-making -- couldn’t do such a simple thing as that. The minister’s answer that if he were to do that he would just get a lot of flak and feedback and it would make his life difficult is an answer that I find really one of the worst he has ever given in his ministry since I’ve known him in my very short time here. I’m just amazed that he would come up with answers like that. When you can talk with people, when you ask their opinion, when you explain to them in a painstaking way the logic of what you’re doing and why you’re compelled to do it, of course that’s difficult. It’s complicated, it’s time-consuming; but good heavens, have we reached a point in 1976 that the government is so old and so tired that it has neither the patience nor the energy to consult with the very people involved. Are matters in such a hurry that it has come to this state of affairs?
Look at Kenora. Kenora is a lab which I have visited. It’s a very modern and a very nice lab. It has four people working there -- a chief technician, an assistant technician and then two people at the aid or secretarial level. To take the tests out of Kenora and switch them to Thunder Bay, they will probably have to hire at least a technician in Thunder Bay and possibly one more person. One of these people has built his own house with his own hands in Kenora, having been assured that the job would be a long-lasting one. Kenora being a disadvantaged area economically, he’s not going to get anything for that house when he sells it; so he’s in really bad difficulties there. He has to move to take another job with a lab service elsewhere.
They have to hire a courier service. Then there’s the problem that the roads are frequently impassable. I calculated that they are going to save probably the salary of one secretary and maybe two. In a place like Kenora -- where unemployment is so rampant and where the economy is so down compared to the rest of the Province of Ontario; where, probably at this moment as we sit here, I suspect there are 30 or 40 civil servants drawing a salary working out plans on how to increase employment in Kenora -- to save one or two salaries for a secretary and make the people of Kenora feel that they are being picked on in this way makes no sense at all. If he had gone np to look at that lab and spoken to the people there, then the minister would know that they’re going to have to break streamlines and gas-lines and take down a wall in order to get the equipment out of that place. It doesn’t appear to make sense. It was only built six or seven years ago. It doesn’t make sense at all.
I wish the minister would be less stubborn. He seems to feel that he’s going out on a limb on these closings, and he seems to feel that somehow or other he just has to stick with them, unless of course he’s advised by the minister sitting beside him from time to time that he has made a mistake in Milton and places like that. Once in a while he can be persuaded, apparently, by certain female hospital administrators, but apart from that particular penchant of the minister it seems to me that he ought not to be so stubborn.
It is senseless to close the Kenora lab, absolutely senseless. He ought to be willing to accept that maybe the advice he is given by his ministry has not always been brilliant advice and that maybe he should exercise some of his prerogatives as the Minister of Health and not just be the servant of the people who are under him in the ministry.
I want to say a word about dental services, because the minister has constantly said that with regard to OHIP no services would be endangered in his cutback and yet there persists the rumour that he intends to phase out dental services in hospitals for those people who go in, for instance to have a large number of teeth extracted and it is suggested that it be done in a hospital. He feels, we are told, that that should not be done under OHIP and personally I would like to hear whether that is his decision, because I like to be open with people. I personally disagree totally with that decision if it is his decision.
Let me talk about doctors’ fees and about OHIP, because obviously we will discuss hospitals under another vote. One of the problems that we keep hearing about with regard to OHIP is the administrative cost. There is a belief about, whether it be correct or not, that to administer that particular insurance programme is extremely costly and most insurance people toss around a figure which indicates that OHIP is much more costly to administer than, let’s say PSI was before it. I think it is very important that the true, complete costs of administering OHIP, not just the ones that the minister is fond of passing around from time to time, but every single cost of administration of OHIP, be published in a way that everybody can understand so that we know how much of the money goes for administration. I hear stories every day of the number of clerks who are sending out all kinds of duplicated material from OHIP and the amount of coffee drunk in the office and things of this kind, and I am very concerned. I don’t wish to slander anybody who is working there and working hard, but I think it is important that the minister give us the figures on administration in OHIP and that they better be totally accurate and complete figures.
I am concerned also, in OHIP, that you never seem to come to grips with this whole business of an OMA fee schedule and the whole question of the disparity in incomes between the various specialties in the practice of medicine. It is so obvious that there are various surgical specialties that are vastly overpaid in this province and it is so obvious that there are many hardworking, rural particularly, general practitioners who are in some ways, in some respects, underpaid for the amount of work and the hours they put in. That particular discrepancy is something which this government has failed to deal with over the years.
I would say that the minister would be very wise seriously to consider what has been recommended to him in a number of reports, that is to let the medical profession know that the total amount of money that they can have for fees in a given year is just a certain amount, whatever it happens to be, and let them figure out a way to divide it between themselves, because at the moment what you are doing is playing the old Windsor-Ottawa-Toronto game that happens in education.
As long as you have across-the-board increases, then that means the rich get richer and the poor get relatively poorer in this particular way. What happens is that they keep having their eyes set on the people who are at the high part of this profession and as they go up, as the leading surgeons go up in income, everybody else has to go up as well to keep pace.
I would say to you that in the long run the province would save money if it could get the medical profession to divide its own money and say: “This is the amount you have, you figure out how you are going to divide it. That is all that you are going to have for now”; because right now the fee for service and the fee for procedure makes very little sense. The people pay a great deal of money to support the procedure that any given surgeon does, and yet the surgeon collects a rather high fee.
I want to talk on the subject of unnecessary surgery. This is a topic I mentioned at a press conference some time ago and I wish to return to it at this time in the House. We are very disturbed by this. Of course, there is no clear definition of what constitutes appropriate surgery and so on. It is a rather difficult matter, but there have been various studies -- one very close to here by Eugene Vayda and others by Bunker -- that show that Canadian and United States surgical rates are much higher than those in England and Wales, yet death rates and incidence of illness from these various conditions for which the surgery is recommended are really no different in North America as opposed to England and Wales. It’s interesting that the only thing that seems to correlate with the incidence of surgery is the incidence of surgery. Every study that has been done has come to the conclusion that the one thing that guarantees that a lot of surgery will be performed is if you have a lot of surgeons. It doesn’t seem to matter as to what the illness incidence or the health care situation generally is, it is the method of payment. If you pay for procedure and the number of surgeries, that determines how much of the so-called discretionary surgery gets done. It is all paid under OHIP.
There are many operations that are questionable -- inguinal hernia, tonsillectomy, adenoidectomy, hysterectomy, cholecystectomy. Obviously there are times these operations need to be done and they are perfectly evident, but there is a large discretion in there. There is a large element of discretion where a choice can be made whether to do this surgery or not, and the thing that seems to encourage the balance to be shifted in favour of doing it seems to be whether there are surgeons around looking for work to do. It also seems to be the way in which you pay your surgeons.
I would like to bring to your attention some of the results from these studies. They’re in the public domain, of course, and anybody can find them.
The evidence, first: In 1972, the rate for 100,000 of the population, age corrected, for hysterectomy in England and Wales was 213; in Newfoundland it was 502, in Manitoba 522 and Ontario 630. That may not seem like a very large difference but even between the two closest, Ontario and Manitoba, the difference really is that you could have had 4.000 fewer hysterectomies -- that’s just one operation -- in one year in Ontario alone simply by applying the same criteria used in Manitoba. There is no evidence that in Ontario there is anything more in the way of illness that requires more hysterectomies.
I’m not even taking up the issue which many people have brought np of how unfair it is to patients because every time you do an operation there’s the risk, of course, of anaesthetic death and complications. I’m not even taking up here the issue of how unfair it is to women that hysterectomies are performed by male surgeons so frequently when they wouldn’t be quite so quick to perform an analogous operation on people of male gender.
The fact is that just looking at it from the point of view of dollars and cents the 4,000 operations -- I’ll get into how much that costs in a moment -- if you figure the hospital costs and the cost of the surgeon and so on, the 4,000 operations could have saved us $4.5 million. That’s just in one year.
If we look at tonsillectomy and adenoidectomy, the rate in 1972, for instance, in England and Wales -- where they have a lot of bronchial disease and so on -- is 497; Newfoundland 368, Manitoba 597 and Ontario 741.
Again, if we just take the next highest, Manitoba, and compare it with Ontario, we could have had 10,529 fewer tonsillectomies and adenoidectomies in Ontario with impunity. Not only were 10,000 children subjected to hospitalization and dangerous operations for nothing but, in fact, it cost the public a great deal of money. Considering that much shorter length of stay, of course, is involved in that particular operation, we calculate the savings to be $2,471,393.
Since 1972 there have been changes. Ontario’s rate has come down somewhat for hysterectomy and tonsillectomy but Manitoba’s has come down more and those in other provinces have also come down. If we were to use the standards of England and Wales, in point of fact, we’d be talking about reductions of $15 million and $16 million a year just for those two operations alone.
I’m not even going into the figures on hernia, on cholecystectomy, on certain aspects of mastectomy and on prostatectomy which are also costing the public in this province a tremendous fortune, even apart from the fact that the surgery should never be performed in the first place.
When the minister goes around this province and talks about the necessity for us all to show restraint -- he got me into a heck of a lot of difficulty because I had a press conference when he finally decided to cut the beds and to cut money from some of the larger city hospitals. When he finally decided to let a community like Hamilton make its own decision about it, I congratulated him. I actually stood up and said, “That’s really good. Finally, you’re cutting where it needs to be cut -- in the big hospitals and the big cities. Finally, you’re giving a place like Hamilton a chance to get together and make its own choice, its own decisions.”
Unfortunately, that was taken in some parts of the province to mean that I approved of the way he’s been going around doing all the cuts, and of course nothing could be farther from the truth.
The fact of the matter is that when you can see this money in unnecessary surgery, why do you always look for the cleaners you can throw out of work? Why do you always look for the nurses’ aides you can throw out of work? Why do you look for the small towns and the hospitals and the public health labs which you can kick out very easily? They don’t have much clout.
Why is it you won’t deal with the doctors who need to be funded into groups which will police each other properly, not with the present sort of self-policing which amounts to nothing in the way of medical audit and nothing in the way of saving the public’s money? There is no reward for frugality and thrift with the public’s money today. Why is it that you refuse to introduce standards committees and utilization committees? Why will you not confront the medical profession head on?
You would be doing the medical profession a favour there too. There are many of us in that profession, sense of whom are members of this House now, who have been fighting for years to get the ordinary doctor in practice to consider the public money and to consider the public interest, not just the private matter he happens to be dealing with. We would be delighted to assist the minister, I am sure, in this particular venture.
There are many doctors, I can tell you, who are perfectly public-spirited and who would like to be able to work to decrease unnecessary utilization of health facilities. I worked, in fact, as assistant chairman of the utilization committee at St. Joseph’s Hospital in Hamilton. I can tell you that there were 20 and 30 doctors volunteering for service on that committee who then formed what we called “patrolling functions,” in the sense that they spoke to their fellow doctors and brought to their attention excessive lengths of stay and things of this kind.
Why can you not introduce that sort of thing across this province? Why is it so much easier to sit in your office and simply dictate a note saying, “We have decided to save X million by closing this lab and $100,000 by closing that one,” when the savings are really out there to be made in a fundamental restructuring of the way you go about dealing with the medical profession. You can deal with them in a way which would be honourable, which would be acceptable to them and which wouldn’t be a slur on them in any way whatsoever.
It could be done if you had the energy and the enthusiasm and the willingness to take on the task. I am afraid you don’t at the moment. I am afraid that after running in this last direction and telling us all how we are somehow inaccurate in our figures; that we didn’t really need to save money; that there was no waste in government; there was no fat in government; suddenly you find yourself rushing about in a haphazard manner, trying to cut left and right. We are supposed to admire this. I am willing to accept a repentant sinner at some point but don’t expect me to admire you for doing it. I’ll accept it but I won’t admire it.
I think you are abrogating your responsibilities in terms of dealing with the medical profession.
Hon. F. S. Miller: It is difficult to carry the responses if I listen to a series of speakers because often the speaker has left. If I may try to answer each one in turn, I would appreciate it and I will try to be brief.
You started on the question of the laboratories and the publicity and the statement in which the Premier (Mr. Davis) said there might be an inquiry.
Mr. Warner: Might be?
Hon. F. S. Miller: Most certainly in the interval there has been a good deal of work done to prepare -- read it carefully; I will read it again without making unequivocal statements -- most certainly we are preparing the evidence to determine if an inquiry should be held. Most certainly feel there is nothing to be lost and much to be gained through any evidence which comes out through it. I don’t have any particularly protective stance in this or any other thing which uncovers areas which need to be improved in my ministry.
I am curious to think, though, that you don’t believe that we look at some of the practices of physicians today, whether it be in the ordering of laboratory tests which you first alluded to, or in the requirement for unnecessary surgery which you alluded to at the end. In either case, I know you are aware of the medical committees in many hospitals.
You must know that profiles on laboratory testing and tests ordered, and profiles on the billing practices of physicians are available, are scrutinized and are turned over to peers for review. It does take a doctor to review a doctor’s practice. I hope you will agree with that.
The differentiation, though, that I seem to feel in your comments is that somehow you would have the state telling the medical profession how many hysterectomies are permitted a year, etc.
Mr. S. Smith: I didn’t say that.
Hon. F. S. Miller: We have approached it another way.
Mr. S. Smith: It’s not what I said.
An hon. member: He didn’t say that.
Hon. F. S. Miller: I didn’t say he said it. Mr. Chairman, I was told not to listen to interjections, so I’m going to plug my ears and plod forward regardless.
Mr. S. Smith: You might at least listen to the address.
Hon. F. S. Miller: I simply point out that we are proceeding in that direction. The rate of surgery is too high. We chose to combat it though two means. One is to limit the number of specialists. I agree with your statement that surgery is proportional to surgeons. Psychiatry is proportional to psychiatrists. Perhaps one of the things we’ve been blessed with in this province is a shortage of psychiatrists. If in fact your comments upon all of us having our appendices out because there are a lot of surgeons around are correct, think how many people are mentally well because we don’t have psychiatrists in the province in the numbers we should have.
Mr. S. Smith: May I just say a word on that. I happen to agree with you about that. But one of the things you should do in this regard -- and I’m very serious about this, because it’s an enormous waste of money in psychiatry -- is you should look at the fact that at a place like Toronto on St. Clair Avenue you have all kinds of psychiatrists sitting there talking to people and being paid with no limit for any length or any number of visits for chats and discussions, and being paid at a very high rate by OHIP, while the mentally ill of this province are treated by a relatively small number of psychiatrists in rather poor conditions in the provincial hospitals. Your comment is absolutely correct. I wish that you’d take exactly what I said about surgery and apply it to psychiatry and every other specialty.
Hon. F. S. Miller: Mr. Chairman, as a matter of fact, it is interesting to note that the high rates that psychiatrists are paid in private practice are lower than they were in the universities. That is an interesting fact. I looked through the statistics the other day of the comparative salaries of the various specialists who teach and the various specialists who practice, and psychiatrists are, as you probably know, relatively low on both totem poles. They do not earn the kind of money other doctors do, perhaps because they are usually dealing on a one for one basis with patients. Perhaps it takes a considerable time to deal effectively with one patient.
Mr. S. Smith: Hourly rates versus fees for services.
Hon. F. S. Miller: Yes. So, in effect, the psychiatrist who does his job has certain problems. I guess one of the best reasons for group therapy was it got more people into a room at one time to be talked to and billed all at once.
Mr. Moffatt: That’s very good.
Hon. F. S. Miller: The OMA fee schedule is not set by the province. Let’s get that clear. The province determines the growth in the OMA fee schedule in a total per cent. It was settled at 8.1 per cent this year.
Again I agree with the member. There are many inequities in the individual fees in the schedule set by the physicians. If they give surgeons a 10 per cent increase on a particular procedure, and you’ve quoted the numbers of them, so many are done per year, that the computer says: “You’ve used up so much of the dollars we will give you.” If they say an office visit should go up five per cent, our computer says: “You’ve used so much of the dollars we will give you;” until in effect the individual changes in the fee schedule multiplied by the frequency of the procedures equal the amount we allow.
Surely, again that is better than the state being the decider of the relative values of physicians’ services. I truly believe that physicians will fight that out themselves and that I should control the costs of the system. It is an open-ended system in the sense that I have to pay for those necessary medical services rendered by the physicians of the province. These have increased; and the very reason we are here today is they increased last year 3.5 per cent more than predicted. Of the $18.5 million I’m asking for under this vote, I believe about $13.5 million was generated by an increase in the per-patient visits to physicians. It doesn’t mean I believe they should have.
I heard a doctor of the Ontario Medical Association stand up last year -- at least he was quoted as saying this; I didn’t hear him -- after the relatively unsatisfactory four per cent increase of 1975, and say: “Well, fellows, see your patients a little faster, a little more often and you’ll get more money.”
I decry that kind of approach. You do too. We have a job to work at it. But I’m not convinced yet that a global budget for the physicians’ component of the OHIP billing is the answer. Certainly it has been considered, certainly it’s been discussed and it has never been totally rejected. But it has implications that I think you will realize are not easy to administer.
One would have to predetermine the proration of the OMA schedule and adjust it pretty frequently until, all of a sudden, at the end of the year, you might be getting 30 per cent of the schedule for services you rendered. If we worked that route I think that could have a very harmful effect upon, for example a physician who comes into the business during the last quarter of the year; and also people who are coming in for necessary medical care at that time.
I got a little confused by your comments. You said I sat in my office and dispatched memos to people telling them to save money, and then I charged off in all directions, or words to that effect. Well, I certainly tried to go around and see most of the groups that were affected. I think it was a useful exercise, and I’m still talking to them. I must admit I’m hearing some very interesting suggestions coming from people. I think I’m trying to keep an open mind on those.
Let me go back for a second, though. I’m not blaming patients or MDs for the growth in the percentage of utilization. I blame the system. The system is designed by government and the system needs to be reviewed by government. I’ve talked about deterrent fees; they may not be the answer. Certainly the academics tell me you’re right. Certainly my stomach tells me you’re wrong.
Let me draw the analogy I’ve used a couple of times. The system right now has apparent free access. The patient comes and demands of the doctor, or the doctor demands of the patient to come. I think it’s true to say both happen -- and both happen unnecessarily at times, I think it’s true to say. But because the system has taken away personal responsibility and accountability on both sides, it’s easy to do, isn’t it? It’s easy to order people back; it’s easy to come. I think simply of the buffet luncheon: You pay your $3.50 at any Holiday Inn and take twice as much as you would normally ever eat for lunch.
Mr. Reid: Speak for yourself.
Hon. F. S. Miller: In your case, three times.
Mr. Reid: If you weren’t running every morning, you’d be a balloon.
Mr. S. Smith: That’s not an appropriate analogy.
Hon. F. S. Miller: All I can say to you is that people and doctors look at the system and say, “It is provided by the state, therefore we should utilize it to the fullest.” Okay? The fullest is often --
Mr. Reid: Come off it. It is the doctors who should be policing the system.
Hon. F. S. Miller: I mustn’t reply to any interjections. I mustn’t reply to any interjections.
Mr. S. Smith: Do you hear another voice behind you, Frank?
Hon. F. S. Miller: That’s the toughest stretch of my willpower I’ve had since I became minister.
I certainly agree I do not like profile testing. I can tell you the steps to rectify that in a regulatory sense are already in motion. Certainly the kinds of relationships that were alleged by the member for High Park-Swansea and by you to be occurring -- and I believe were occurring, whether they were low rental rates or high rental rates depending upon the lessee or the lessor -- are now going to be covered as conflicts of interest under section 27, I believe it is, of the regulations of the College of Physicians and Surgeons, on the assumption that their counsel approved the draft I see them working on at the present moment.
You know, I think they are taking very responsible action. I think they have been shocked by some of the things they have seen -- just as the labs have. The great bulk of the people are honest, and they really want to see the system made tight enough so that people bending the rules have something to lose -- their licence, a fine, court; whatever it may be. I think we would all agree that kind of approach should be taken.
But the way I would like to control unnecessary surgery, unnecessary cost, unnecessary tests, is in slightly other ways. First, it is proportional to the number of physicians; therefore control the number of physicians. At least for the last few years 50 per cent of the physicians being registered by the college came from outside of Ontario or outside of Canada in many instances. I am very encouraged that the steps we have taken in the last while has cut that down dramatically.
I think I have the figures here just for fun. During the latter half of 1975, the licensing of medical immigrants in Ontario was held to 49. Now that’s a dramatic change. That is not because we have not appreciated immigrant physicians when we needed them. It is because we now are refusing to let them go to a place unless they are needed -- to help the north, for example -- or come in unless their specialty is in short supply.
I feel that step one, taken almost a year ago now, is working well. It took until July, roughly, to get the federal government and ourselves clear of details that had to be worked out. It is a good example of federal-provincial co-operation in its best form, I think.
The second area, of course, was elective surgery, which is often the unnecessary surgery. It is most often performed if there is easy access to operating facilities and easy access to beds. Is that a fair statement? Well, I’ve got one doctor indicating yes and one doctor saying no.
Mr. S. Smith: That’s not entirely fair.
Hon. F. S. Miller: All right. I am sure, as a physician, you can tell me where I am wrong. But most certainly the ability to ignore your fellow doctors’ improper admission and improper procedural steps is easy if it isn’t hurting your practice of medicine with the people that you personally believe need admission and treatment. Now as long as you got yours in and he got twice as many in, you’ll grumble. The day you can’t get yours in when they need to get in and he’s still got his in, who shouldn’t be there, you’ll act. That’s where the kinds of committees you talk about are effective and will be encouraged; but they also require one real control upon them, the need to operate and act. They don’t act until we have tailored the number of active treatment beds to equate roughly to need. That was the basic reason behind the closures of beds in this province; to tailor them to the need of the people so that those in there wouldn’t be cholecystectomies that shouldn’t be in. When you read off that list I’ve only got about two to go, and one I am not eligible for.
Mr. S. Smith: Prostatectomy.
Mr. Moffatt: Tell us which one.
Mr. Breithaupt: Perhaps we can go back and have a second chance.
Mr. Warner: Ignore the interjections.
Hon. F. S. Miller: I guess I should point out -- and I did the other day when you were absent -- that 80 per cent of the savings made in this last round in dollars and in beds were not made in rural Ontario but in cities. I just want to point out that the inconsistencies you have accused me of sometimes pop up in the emanations from you. It says here:
“The Ontario Liberal leader Stuart Smith praised the provincial government Friday for ordering the closing of 1,218 hospital beds and the layoff of thousands of hospital workers. He said the $29.2 million in budget cuts, ‘will force the hospitals to operate more efficiently and more cost consciously. I congratulate the minister because it has taken a lot of courage. He certainly has my support in making these cost reductions.’”
I don’t know whether you said that --
Mr. S. Smith: I did.
Hon. F. S. Miller: -- but the Ottawa Citizen, dated Feb. 28, 1976, says you did. Later in the day, the Toronto Star, dated Feb. 28, 1976, quoted you at another time and another place as saying: “It was not only a pointless but a cruel exercise.” Then, just a little later, on March 9, on an open-line radio show on CFPL London, you said: “If you get us in this year, we would, in fact, reopen the hospitals.
Mr. S. Smith: On a point of privilege.
Mr. Chairman: Will the hon. member state his point of privilege.
Mr. S. Smith: That is exactly the point that seems to have been perhaps badly put so that people were not able to get the difference. I would have thought the difference is elementary, but it does seem as though there has been a problem.
Mr. S. Smith: This statement attributed to me I definitely did make. When I congratulated the minister it was on the subject of his phase two.
Mr. Lawlor: That’s merely an expression, not a point of privilege.
Mr. S. Smith: In point of fact, I did approve of the fact that he was cutting back beds, but I never approved the closing of hospitals. That is what is a pointless and cruel exercise. The closing of small rural hospitals was pointless and cruel. The cutting back of beds I approved of and I congratulated him for; his cutting of budgets in the large cities and the way he did it I congratulated him for.
Mr. Grossman: Like Doctors Hospital?
Mr. S. Smith: But certainly not the closing of the small rural hospitals. I definitely opposed him on the hospital closures, those which served rural or ethnic communities; my exact words.
Mr. Chairman: We seem to have strayed a little bit from this vote. I’m wondering if the hon. minister might return to the health insurance programme.
Hon. F. S. Miller: I’m not quite finished yet. I sat down to let him have his point of privilege. I will have a few more quotes to make from time to time, because I think they are appropriate. I do appreciate the ones when you support me.
Mr. S. Smith: You damn well should appreciate them, but I’m against the way you closed those town hospitals. You didn’t have to do that.
Mr. Chairman: Order please.
Hon. F. S. Miller: What did you say in Chesley?
Mr. S. Smith: I wasn’t in Chesley.
Hon. F. S. Miller: What did you say to Chesley then?
Mr. Chairman: Order please. I wonder if we could; return to health insurance, item 1.
Hon. F. S. Miller: We discussed the provincial health labs for a while and you questioned the saving in North Bay. I can appreciate both the lack of understanding and the unwillingness to understand how we saved $167,000 per year net in the closure of the North Bay lab. The figures are here. I don’t want to read them into the record. I’m quite happy to have you look at them if you will, but I am totally satisfied that the arithmetic is sound.
I only have to say to you, whether it is North Bay at $167,000 or Kenora at only $12,700 net, I have one basic question: When is a saving justified and when is it not? When should I or shouldn’t I do things?
For example, in North Bay, some reference was made to the kidney function testing going on in the community. It’s a great programme; it should continue. But you know, it doesn’t require the lab to be in North Bay; and if, in fact, the lab in Orillia can do it without extra staff -- and I understood they could -- and it takes one day extra for those samples to go back and forth at the very most, then I would suggest to you that no harm has been done to the patient who is being screened for a possible problem -- a person who, had there not been a programme at all, wouldn’t have been screened at all; a person who in almost any other community in Ontario isn’t being screened -- and that the delay is justified in terms of relative costs.
The kinds of things our provincial labs did are not of the staff type, you know that. There aren’t, in the main, doctors waiting for a decision to proceed with the diagnosis of a patient on an urgent basis. Those are usually done in the hospitals. One of the reasons that North Bay gradually could be replaced was that the hospitals had gained much more proficiency and capacity in the very tests that our lab in North Bay did at one time.
He then went on to say that I dashed off and was influenced by a female administrator. I almost stood up on a point of privilege then because I thought I was being slandered. Then I stopped and wondered what kind he was affected by.
As for dental services; yes, you are quite correct. We are cuffing out a number of the benefits under the OHIP plan for dental services. These have been discussed at considerable length with the Ontario Dental Association and, in fact, while I don’t know that I have their unqualified blessing, they feel that a number of the moves were justifiable in the interest of good dental decision-making.
We have tried to keep access open for those people who need a hospital on the basis of medical need. We are working on ways and means of making sure that the dentist, either before or after a procedure, depending upon its urgency, will have some right to point out that a particular patient, be it a retarded child, a very young child or a person injured in an accident, would have the right to have certain coverages through the OHIP plan -- not for the dental part of it but for the hospital part of the coverage while the procedures were being performed. I think you will find that the changes, once they are finally regularized, will be fair. That’s really all I have to say on that one, Mr. Chairman.
Mr. Swart: Mr. Chairman, I am going to try to finish my remarks by 1 o’clock. It may not be possible, but I will try. I think perhaps first of all --
Hon. F. S. Miller: Mr. Chairman, if I am absent for a second, there is no disrespect; I have to go out for a second. Okay?
Mr. Swart: We will carry on. Just before the leader of the third party leaves, I would just like to say very kindly to him if I could -- and he really should know this -- that he does not really need to make contradictory statements himself. He has got a caucus that will do it for him.
Mr. S. Smith: I shouldn’t have bothered showing you the respect of staying.
Mr. Swart: Mr. Chairman, I want to deal primarily with the matter of the closing of the health labs. I will try to confine myself to the vote we have before us, but I want to discuss the public lab closings within the parameters of the general cutbacks, whether they are hospitals, municipal social services or whatever they may be.
Up to the time of the revelations of my colleague the member for High Park-Swansea, the matter of public lab closings certainly was not as dramatic as hospitals, was not as serious to the public, I guess, as the social services and did not have as widespread an impact as the increase in taxes that is going to take place in the municipal field. But I say that the closing of the public health labs, and what is happening in the private health lab field, more than anything else gives us an insight into the irresponsibility of the ministry and, for that matter, the government of this province. It is irresponsible, what is happening. What is happening in the private health labs is their responsibility because they haven’t policed the system. It is fiscal irresponsibility on the part of the government, and I think it gives us an insight into the dominant motives of what the government is doing in the field of cutbacks.
I suggest there are two dominant motives in what is taking place. The first has been stated a number of times, I think, and it is the posturing the government is doing about restraints, primarily for political reasons, to appear tough before the public, to imply that they are going to watch their tax dollars,
The second motive, I suggest, is a real attempt to destroy efficient public institutions and to let the provision of services revert back to the private sector at a greater cost to the public.
Just two examples: The relationship of the closing of hospitals and the cutbacks to homes for the aged -- where many nursing services are provided -- to a decision to not make any cutbacks to private nursing homes, even though it can be documented all over this province that the private nursing homes too, to a very substantial degree, are ripping off the government and the taxpayer. It’s documented by the director of the homes for the aged in the Niagara Peninsula that the nursing patients who need heavy care are being refused by the private institutions and are going to the nursing care section of the homes for the aged. The private nursing homes can make more profit, of course, from those patients who don’t need heavy care.
The second example, of course, of the motive, is what is being done to the public health labs, where the government is shutting down the public health labs, or a substantial number of them. But in the period of time when the cost of the private labs has gone up from $20.5 million to $80 million or whatever the figure is -- probably $88 million -- the cost of the public labs has only gone up from $7.5 million to $12.5 million.
I say they are doing this simply to carry out the motives which I have mentioned and without any studies being done to substantiate closing these public labs.
The ministry simply doesn’t have any statistics, in spite of what was just said about North Bay, to prove there is going to be a financial saving with the closing of the public labs. I refer specifically now to the public lab in St. Catharines.
The regional council of Niagara asked for figures on Feb. 5 to justify the closing down of the public lab there; it has not yet got them. Figures were promised to the Niagara regional health unit, when it objected to the closing down of the public lab, to justify it. They have not been provided. The union, OPSEU, has been trying to get figures ever since the announcements were made on Dec. 18 and it has not been able to get the figures to justify the closing.
I sent a telegram to the minister on Feb. 13 asking for those detailed figures. I followed it up with a letter two days later and a further letter on Feb. 20. I have not yet received the figures to justify the closing down of that lab.
I say to you the very vague statistics they provided at the beginning and supplemented a little bit later are wrong. They are not accurate; they are full of inaccuracies and full of misstatements.
I have a letter here which I received in reply to my telegram; that’s the size of the letter. I asked for detailed figures and that’s the size of the letter I got back. That letter says that over 90 per cent of the St. Catharines’ laboratory workload is made up of serology tests and water and milk testing.
I also have here a printout from OHIP, from the Ministry of Health, which shows that the figure is 75.8 per cent, not over 90 per cent. If we look at that in reverse the minister is saying there is no clinical testing being done, or less than 10 per cent of clinical testing is being done by that lab. The printout showed that it’s 24 per cent, the other tests that are being done down there. That’s an error of 150 per cent. And do you know who that letter is signed by? It is signed by the man who is coming back to his seat now, the hon. Minister of Health. He has signed the letter which, by the ministry’s own figures, is out by 150 per cent.
Of course, the contradiction was in the letters that were sent to the Woodstock lab, where there are four different sets of statistical information for the varied numbers of people who were going to be affected. One letter and one memo was contradictory to the next one.
That letter I got from the minister said there was going to be a saving of something like 856,000 in closing down the St. Catharines public health lab, which of course serves the whole Niagara Peninsula. In fact, on Feb. 20, the Ministry of Health published a little further statement giving a few statistics on what would happen and the savings that would accrue from the closing down of that lab. I read this to you under the budget items:
“An estimated $56,000 saving would be realized by the laboratory closure. Staff salaries for five employees account for a saving of $55,000.”
They have seven employees there now.
“An additional saving of $11,000 will be realized from reduced rental payments. Courier service will cost an estimated $10,000, making a total saving of $56,000 annually.”
Let me tell you, the cost this year in the budget for that lab, or the amount to be spent, is $106,000; and they’re going to save $50,000 of that. Let me deal with some of these figures for just a minute. It says there will be an additional saving of $11,000 from reduced rental payments.
You know where the lab is located; it’s located in a part of the Shaver hospital. They pay a rent of something in excess of $10,000. But do you know where that rent goes? It goes to the Ministry of Health. So they’re going to save $11,000 because they don’t pay $11,000 to the Ministry of Health. Of course, it is no saving whatsoever in rent when you’re going to lose $11,000 income and pay out $11,000 less. I don’t look upon that as a saving.
He mentions the courier service will cost $10,000. I wonder if the minister knows that they have tried six different places, as of two days ago, to get a courier service to go to Hamilton, and that the cheapest offer they have got is $14,000; not $10,000 but $14,000. Perhaps that is because there was another mistake made in this memo. At the top it says the St. Catharines public health laboratory is 35 miles from Hamilton; actually it is 45 miles from the health laboratory in Hamilton. That is also an error of about 30 per cent in the statistics in this letter.
But that isn’t all, because the OPSEU has computed the cost of doing the tests which will be farmed out. This appears to be less than 10 per cent, and in fact is 24 per cent. The cost of those will be some $26,028 according to the fee paid by OHIP. That $26,000 isn’t going to be saved. It doesn’t mention that in the letter, they are going to pay for those costs. However, if you add up the $4,000, $11,000, $26,000, that’s over $40,000 of the $56,000 that isn’t going to be saved. By any yardstick it isn’t going to be saved, Mr. Minister.
And do you know what? That still leaves 75 per cent of all the tests to be done in Hamilton. How are you going to pay for those out of that other $16,000 saving?
It is just ludicrous, this report -- the savings are simply not there. There are, in fact, no savings in the closing of that lab; it is, in fact, going to be more costly. And, I am sure, Mr. Minister, that you have seen the figures put out by OPSEU at the Woodstock lab. I have not seen the cost of the tests there related to what OHIP pay refuted in any way.
In fact, the cost of the tests there is substantially cheaper than what you are paying for them from private labs. In fact, the total costs in the Woodstock lab for your chemistry tests, your microbiology tests, your haematology tests, are $212,389.76. That is what it is costing the public at the present time. If you farm them out the OHIP payments would be $313,295.72, or almost 50 per cent more, for making those tests in a private lab.
And, of course, the same sort of thing holds true in the St. Catharines’ area. Do you know that the Hamilton lab at the present time, according to DBS, has an output of something like 153.9 per cent of the normal output by BPS? St. Catharines is one of the highest producers in the province. It has an output of something over 160 per cent per employee compared with normal output. And yet we are going to close the St. Catharines lab down.
You may think, Mr. Minister, and your government may think, that because you are going to have somewhat bigger labs they may operate more cheaply. Whether it’s hospitals or anything else that seems to be a philosophy of your government. Those of us who have had some experience over the years with regional government know that the bigger they get doesn’t mean that it costs less to the taxpayer and I suggest the same is true in the field of public health labs.
I don’t need to document here the impossibility of policing the private labs. At least, it must be impossible because with the years your government has been in power and the obvious rip-offs that are taking place in certain areas with the private labs -- the increases in payments -- means that you must not be able to police them, or else you don’t care. I suppose there aren’t really many alternatives to come to but those.
I would like to quote, just to back up what the member for High Park-Swansea (Mr. Ziemba) has said, what the Ontario Association of Medical Laboratories said in a letter to your deputy minister on Jan. 27, expressing their concern about it. I think it’s fair to point out, Mr. Minister, that their concern is like your concern; it became a concern after Dec. 18. It wasn’t a concern of the association or of your ministry six months ago or a year ago. It became a concern when investigations started because you are going to close down the public labs and you were making comparisons between the public and the private labs. They say themselves -- and I think this is perhaps somewhat amusing -- that an advisory committee comprised of representation from the Ontario Medical Health Association, section of laboratory medicine, the Ministry of Health and the Ontario Association of Medical Laboratories should be formed immediately to recommend and assist the Ministry of Health with the implementation of policy. Those three groups are the three groups that are involved now. Those are the three groups that have permitted what is taking place to take place, and this is the way they want the policing.
But they make some admissions here too. They suggest that the advisory committee set up a mechanism whereby licensed independent laboratories are audited for billing procedures.
That’s a very admirable thing. It says: “Such audits should show that the tests billed are actually ordered and performed.” Do you think there is some suspicion with them, perhaps, by that time, that this wasn’t being done? It goes on:
“The Ontario Medical Association should be encouraged to advise physicians on the changing practice of laboratory medicine, including procedures that may now be redundant and the need to exercise care in ordering laboratory procedures. This should be timed to coincide with the elimination of profiles from laboratory requisition.”
Again I point out that they want this policing committee to be the same three groups that are involved in the situation that exists today.
It looks as though their concern and your concern, as I say, started after the investigation started. Your government surely must have had some reason to investigate the situation prior to this time, what with the increases taking place. I sat on a municipal council for many years and any rookie councillor who came onto that council, in the very first time he was going over the budget would have picked out something like this as a thing that needs to be investigated, when it is the single biggest increase in the expenditures of that department. You even had the legislation passed to police it, and I can give you quotes from the deputy minister and yourself when you were asked what happened in the area of lab ownership and the payment after the legislation was introduced back in 1972. “I am inclined to think nothing,” the Deputy Minister of Health said. And you are quoted as saying: “I can’t answer you, or guess or say this did or this did not happen.” Is that good enough for the government of this province, that they give that kind of an answer after legislation was passed three years before?
Yet it must have been perfectly obvious that increase in payments to the private health labs was excessive. We are talking here about savings, savings in an amount that should eliminate the need to cut the hospitals back; savings which could be made from the private labs. One of the most respected people in the Niagara area, the other night at the Ontario Mental Health Association -- and I am sure the Minister of Culture and Recreation (Mr. Welch) knows him, Dick Thornton, who is now the director of the health council -- made this statement. I wrote it down, almost word for word:
“We, the Health Council, have been examining the private health labs for six months and we are convinced that we should persuade the doctors to direct the tests back into the hospital labs and we’d get it done at half the cost.”
That is what a respected -- and I may not be using this term politically but I may also be using it politically -- conservative man who has been involved in the hospital field, and a man who is concerned about public expenditures, had to say publicly in Niagara Falls when my leader was there.
Let me also read to you some comments from Dr. J. N. Burkholder, who is the medical officer of health for the Niagara region. This is the point I was coming to -- and I think I will conclude by 1 o’clock -- and this was his analysis of closing down the lab:
“In essence, then, I think that the burden of proof is on the Ministry of Health to show that closing our laboratory will result in any substantial saving or, even more, saving of the entire cost of operation. I want to stress that we, in the health unit, have a high regard for the quality of work and reliability and communication provided by this laboratory. A few years ago, a proposal was made [and I could elaborate on this] to strengthen the work of this laboratory, but the proposal was not allowed to materialize. Meanwhile, as you may be aware the private enterprise laboratories have enjoyed a fantastic growth rate at the expense of the taxpayer.”
Again, from the medical officer of health in the Niagara region.
Mr. Warner: Right. Do something about it.
Mr. Swart: I say to you the responsibility for this mess lies squarely with you. I’m for an inquiry too, but I hope that inquiry doesn’t take the focus off the government, because they are the ones responsible for allowing this to get to the stage that it is.
You posture that you are trying to save money, as does the Treasurer (Mr. McKeough). You have the dramatic and highly visual road show put on by you and the Treasurer and the Minister of Community and Social Services (Mr. Taylor) going around saving all these huge sums of money. You posture as competent business people who are the only ones to be trusted to run this province.
Mr. Reid: Sounds like a set piece doesn’t it?
Mr. Swart: Right. But the real situation is that you’ve made cuts in the wrong places. You’ve made cuts without any meaningful investigation. The cursory facts you’ve produced are wrong; you haven’t even tried to implement even the minor safeguards that you thought were necessary when you passed the bill back in 1972. Any thorough study will show conclusively that the public labs should be left open and expanded, for economic reasons, if you want to save money for the public of this province.
In fact, I say your conduct of business, your government’s conduct of business in this regard, is deplorable. How you can posture as competent business people is beyond me. The $2 billion deficit this government had last year is --
Hon. F. S. Miller: Look at BC.
Mr. Swart: Yes. It’s greater per capita than BC.
Hon. F. S. Miller: We predicted ours.
Mr. Swart: That’s perhaps even worse, when you plan for it!
Hon. F. S. Miller: It isn’t.
Mr. Swart: It is the greatest deficit per capita than any province in this nation has ever had and you posture as competent business people.
Now on these so-called cutbacks: Either one of two things is the case -- and you must admit this. You’ve either allowed and promoted tremendous overspending and overbuilding and overstaffing in the hospitals up to this time; or you are wrong now. It has to be one or the other.
Mr. Chairman: I’m wondering if the hon. member could come to a point where he could conclude his debate.
Mr. Swart: I will be finished in three minutes if I may have that time.
Mr. Chairman: I think it is 1 o’clock now and normally the committee should rise and report.
Mr. Swart: Fine then, Mr. Chairman, I will conclude my remarks on Monday.
Hon. Mr. Welch moved the committee rise and report.
Motion agreed to.
The House resumed, Mr. Speaker in the chair.
Mr. Chairman: Mr. Speaker, the committee of supply begs to report progress and asks for leave to sit again.
Report agreed to.
Hon. Mr. Welch: Mr. Speaker, before moving the adjournment, may I indicate our programme for next week. We sit on Monday, Tuesday, Wednesday and Thursday next week; and of those four days, on three of them we sit in the evening -- Monday, Tuesday and Thursday.
On Monday we have the contribution of the Leader of the Official Opposition (Mr. Lewis) to the Throne Speech debate, followed by the consideration of supplementary estimates for the balance of that afternoon and Monday evening.
Tuesday, the leader of the Liberal Party will enter the Throne Speech debate, following which we will have supplementary estimates and we will adjourn at 6. Sorry, that’s Tuesday evening; on Tuesday evening we sit.
On Wednesday the Premier (Mr. Davis) will be involved in the Throne Speech debate and we will adjourn at 6.
On Thursday we will have supplementary estimates until 10:30 p.m. The hope is that we will complete the supplementary estimates both here and in the estimates committee by Thursday and also the motion for interim supply. We will rise on Thursday evening to take advantage of the mid-term break the following week.
Are there any questions about next week’s programme?
Mr. Renwick: Extremely lucid.
Hon. Mr. Welch moves the adjournment of the House.
Motion agreed to.
The House adjourned at 1 p.m.