The house resumed at 8 p.m.
ESTIMATES, MINISTRY OF HEALTH (CONTINUED)
On vote 2903:
Mr. Chairman: The hon. member for Cochrane South.
Mr. Ferrier: Yes Mr. Chairman, between supper hour and now we’ve been doing a bit of research.
Hon. F. S. Miller: Don’t admit any guilt.
Mr. Ferrier: We’ve been doing a bit of research and we’ve got more information than we had at 6 o’clock. We were talking about the conversion of beds at St. Mary’s Hospital in Timmins and mentioning that the people were pretty upset when they were told that 25 beds had to be converted for chronic care
Chronic patients are not people who lie in bed all the time; they are somewhat ambulatory and could use a common room or sun room for social activities and that type of thing, and would like to get up and eat their meals someplace other than in their bedroom. So there was quite a disturbance by the people at the hospital. They felt that if they just converted active treatment beds to chronic beds they would be just putting chronic patients in the hospital pretty well to vegetate and die. That wasn’t considered a very worthwhile way to treat them.
The mayor came down and spoke to the minister and the minister realized that he had made a mistake. The information that had come from his ministry to make this conversion didn’t seem to take into account the conversion to the psychiatric beds that St. Mary’s had agreed to take. So the minister agreed that the whole hospital bed situation in the Timmins area would be referred to the local health council for them to make an examination of the facts and bring back some recommendations.
That’s the way it should have been in the first place. The health council should have been involved and should have had the opportunity to look into the matter, to study the situation and to make recommendations. After all, that was the reason they wore appointed. I have to commend the minister. At least he realized that this course of action was open and he was prepared to take it. They will have some difficult decisions to make and I know there are tensions between the two hospitals in the community. But I hope they have the wisdom of Solomon and can make some recommendations that will be acceptable to both parties.
St. Mary’s is going to take over the psychiatric services that are being closed down at Northeastern. There are to be 20 beds for active psychiatric care in St. Mary’s hospital, or at Northeastern under the administration of St. Mary’s. I suppose the minister feels that because it’s being handled by St. Mary’s they can get the federal subsidy on the OHIP payment.
One thing that has not been mentioned very much in all these restraints that are being carried on in the provincial sector, the cutback in active treatment beds, is that for a number of years the federal government has agreed to fund active treatment beds. However when the province went into extended care coverage for nursing homes and the home care programme and the chronic programme, my understanding is that the federal government refused to operate on a share-cost basis.
The federal government’s cutback and restraints has, I think, put a significant degree of pressure on the provinces. It seems to me that the federal government, had they been responsible and co-operative in a fair and reasonable manner, would have been prepared to share these less costly health care forms and would have underwritten some of the costs, not only in Ontario but throughout the country. Had they done so, perhaps there wouldn’t have been the great pressure on the provincial health care budget there is today.
I think we shouldn’t let the federal Liberals off the hook too easily either, because --
Hon. F. S. Miller: We’re ad idem there.
Mr. Ferrier: Yes, but you haven’t said very much about that.
Ms. Gigantes: Who signed on?
Mr. Ferrier: I remember Tommy Douglas making a very informative presentation on Canada AM not too long ago, pointing out some of these things and expanding on what he was saying in the federal House. I haven’t heard that come from Queen’s Park. Perhaps you feel it would be too much of an excuse. I think that the federal government has been quite irresponsible on this matter and has been putting undue pressure upon the provinces. I feel that some of the actions we’re seeing in Ottawa now about a new Constitution -- they’re going to repatriate it perhaps without even referring it to the provinces -- is typical of the federal government’s arrogance and lack of concern for the provinces. They don’t seem to realize they are in a cooperative federalism. Prime Minister Trudeau has talked about participatory democracy, but he doesn’t even carry it out in a number of instances within the federal system under which we operate.
Anyway, the 20 beds in Timmins, as far as we’re concerned, is not enough. The minister proposes to carry out his programme in the Kapuskasing area with one social worker and one psychiatric nurse and with a psychiatrist visiting there periodically, and using the Sensenbrenner Hospital for acute patients. If these patients have to be hospitalized for any length of time they will be sent to North Bay.
He has suggested for the tri-town area that there be two social workers and two registered psychiatric nurses; again with a psychiatrist visiting there to consult. This could be under the public health programme in the tri-town area.
In the Timmins area there are to be, I understand, two psychologists. They have to be made available for Kapuskasing and the tri-town team.
There are to be two registered nurses to carry out the outpatient programme. There will be two or three social workers who will do the family visits in the community and that type of thing. There will be one rehab officer for all of northeastern Ontario, perhaps a child care worker as a resource person to the school board and a few extra nurses probably in connection with this 20- bed unit; and that is supposed to replace the Northeastern Hospital that has been serving all of northeastern Ontario for the last eight years.
If the minister feels he can adequately serve the area with modern psychiatric methods with a staff of 16 or 20 and 20 beds, then he is quite optimistic. Perhaps you can carry out your outpatients’ programme, I don’t know, but there have been over 400 patients who have been involved in that programme. If you feel that you can substitute this service with this number of people for the over 200 that you had, then you’ve either been ripping off the taxpayer in a tremendous way in the last eight years or else you are not going to really adequately serve them by this method. I suspect that it is more of the latter than of the former.
The hospital has had problems and growing pains over the years. Some of the medical directors you had there have not been as responsive to the needs of the community as the last medical director has been. He has suggested that the hospital’s programme should respond to the needs of the community rather than impose a pattern on the community. I know that previously there was a good deal of resentment when the programme was imposed on the community, because any person that was to be admitted to Northeastern had to be admitted first to the General Hospital and then transferred over there. On a weekend they just weren’t prepared to admit people.
I know the member for Cochrane North, (Mr. Brunelle), like myself, has had a number of people call complaining about that, that so and so is very disturbed and should be in the hospital and he can’t get them in.
Even doctors contacted me and we succeeded, sometimes, in getting patients admitted. That did cause problems in the community, but in the last year or so there was a reorientation of the whole treatment programme and I think it was working quite successfully.
The minister heard our brief and I think the minister has to admit the people in our area were very responsible, restrained and did not make inflammatory or derogatory remarks. In fact we presented a reasonable case, presented it well and were not involved in some of the insults or that type of thing that might have gone on in other places. We wanted a combination of psychiatric beds and chronic care beds and retarded beds. We were given to understand there would be reconsideration of our proposals.
Some of us came down to see the Premier (Mr. Davis) to present the case to him and he more or less said the same thing. The response that we finally got was that there would be these 20 beds at Northeastern.
The people are not really satisfied that it is quid pro quo, that you exchange one for the other and we are going to be adequately served. The alternative of making it a mentally retarded resource centre is falling into the same trap as the psychiatric hospital was, in that they are only talking about 50 in-patients at this point. It may be going up to a few more, but if you don’t utilize that facility to its capacity you will fall into the same trap. It will he under-utilized and a minister four or five years down the road will say: “We are not really getting the most for our dollars, we’re going to close it down again.” And who will get it next? Will Correctional Services take over the programme at Monteith or something like that? This is the worry that the people have.
There has been a real period of anxiety and upset in that community. It’s been a very traumatic period of time, particularly over the Christmas period. One wonders why it couldn’t have been left a little longer into the new year before you took your action. It didn’t make for a very pleasant Christmas for the employees, for the patients and for the families of the patients. It’s been a very upsetting time.
While you did promise us those 20 beds, and St. Mary’s Hospital is in the process of implementing the resolution that they passed -- not so much because they agreed with it as they realized that there had to be psychiatric services in the area -- you’ve transferred a number of patients down to North Bay. I know that one woman has had a fall down there and she has had quite a bad hip injury as a result. I know that it’s been a very traumatic experience for some of the people who have been transferred down there by car, ambulance and what have you. It has been a very upsetting experience.
It’s 225 miles or so to that hospital from our area, and it has been difficult for families to have to bring loved ones down there for a period of time. It means that they will not be visiting them nearly as often.
One of the sad things about these kinds of hospitals is that patients sometimes go in there in a chronic state, their family forgets about them and they’re left there until their dying days. It’s an unhappy situation.
The homes for special care programme that you do have at the nursing home is able to accommodate a few people, but not nearly enough. It means that while you might be saving some money, the people are going to have to pick it up in travelling down to North Bay. It’s a long trip down there and back in one day, so people are going to have to stay in motels and will have overnight expenses for motels and meals and all the rest of it if they really are concerned -- and a number are concerned about their loved ones who are patients there.
I know that in the riding of the member for Cochrane North, people from Kapuskasing, Smooth Rock, and probably Cochrane, all will have to go down there too. It’s not really the kind of solution we are happy about,
What about the employees? There were over 200 employees. The day the announcement was made about the closing, your ministry was to be presented with a proposal from the administrator of Northeastern to fully utilize the hospital there so that some greater economies would be available and you’d get better value for your dollars,
But that proposal wasn’t even considered. The decision had been made and was already in motion, and the minister had to be able to say what a tough line he was taking on his own institutions, Goderich and Northeastern, so he could justify to the hospital administrators and the chairmen that were sitting in the room over in the Macdonald Block, or wherever it was, that he meant business and was prepared to take tough decisions within his own ministry with his own institutions, so they had to be prepared to accept the tough decisions that he was going to take as far as they were concerned.
The thing is that the employees first heard it over the CBC at noon and it was a pretty traumatic experience, as I have said, for them.
There are going to be a number of jobs lost. If people are kept on in the new facility -- and some of them will be -- they will no longer be civil servants and they will lose some of the credits that they have had. There will be a number of them, at this early stage, who will not be carried over so there will be periods of unemployment.
One of the really good things about this kind of hospital is that people who are not able to do hard work -- the cleaning and this type of thing -- have an alternative form of employment they can go to. This was one of the reasons, I think, why Mr. Spooner, when he was the member for Cochrane South, pushed so hard to have the hospital built there. There was a lot of politicking involved in it; it was good for him -- bringing a hospital in and this type of thing -- but he did have in mind the alternative kind of jobs which would be available in a heavy industry community. I give him credit for that.
These kinds of jobs may not be available and unless they are prepared to move there may be very significant periods of unemployment. I doubt if the kind of people who have worked at the hospital will be employed by Texasgulf for some part of its expansion programme.
I don’t know how many of the employees are being placed in other parts of your ministry or at your institutions. I know your personnel people used some very questionable tactics and when you found out about it you were quite annoyed; I hope you followed through. They gave the people the option of changing to another institution or another part of the Health ministry’s operation, either being moved at their own expense or at government expense. It was a kind of blackmail. I hope you cleared that up.
Another problem I have brought to your attention -- I don’t know whether or not you are yet prepared to respond to it -- as far as the employees are concerned, is the question of whether the severance pay, the holiday pay and pension credit for those to whom it pertains can be made available on March 31 or as close as possible. That is a concern among a number of the employees there.
I think the situation has been very traumatic for the employees. I don’t know what the final resolution is going to be as far as St. Mary’s is concerned -- about the chronic beds and this kind of thing -- but Northern College did have a contract with Northeastern Hospital as far as education for psychiatric nursing was concerned. They will now have to be accommodated in North Bay, at some expense as far as travelling is concerned and as far as room and board is concerned.
I don’t know whether the regular nursing courses can be carried out at St. Mary’s if you cut back and change over to chronic beds. You will have to cut down as far as I can understand, on the number of nurses you are accepting there.
Judging by the employment opportunities for nurses in my area, and perhaps in the general hospital system throughout Ontario, maybe you are going to have to cut back on the number of admissions you make to the nursing schools. It is not very fair for a young lady or a young man to take a course in a field when they are not going to be able to have a job. It’s an important training but unless they can work in their field it’s not very wise.
There is extra expense now being experienced by the Ministry of Correctional Services because they have to send inmates who have psychiatric problems down to North Bay. It means a couple of custodial officers taking the inmate down and it’s at least a whole day’s trip. There are the wages of two people for a whole day and all the travelling expenses and that kind of thing. It has gone on with some degree of frequency and there are a number of extra expenses that you are going to have.
I don’t know what the proposals are for the ARF programme. The last I heard was that they were considering putting Addiction Research Foundation personnel in St. Mary’s Hospital in the old nurses’ wing, up on the third floor I think it is. Because they are in the central part of the city, a lot of the people who would be calling upon them would have easy access to them. Well if that is the case, I don’t know how the funding is going to be handled, but, I suggest it may cost as much to carry out the programme, or more, through that medium than if they had been at Northeastern.
I understand that the Monteith programme is going to be continued, but just where I don’t know. Perhaps in the early stages it will be continued at Northeastern and then transferred.
That was the kind of programme that really showed the government was concerned about rehabilitation. I think there have been some pretty significant, positive results from that programme; and I was very concerned that this programme might be seriously jeopardized if you did not make the commitment to go ahead with it. But the Minister of Correctional Services (Mr. J. R. Smith) and yourself, I understand, are prepared to stand firm and see that the programme continues.
I think that it was a pretty tough role that you perpetrated against northeastern Ontario. Perhaps Northeastern, as the leader of the Liberal Party intimated, was overbuilt in the first place. That’s not our fault; that’s poor planning within your ministry and your people back in those days. I think you should have, away back when, considered using that facility as a joint facility, as it was built for mentally retarded and for people requiring psychiatric care. Over the years we have pleaded with you, as a way of resolving this chronic care situation, to make chronic care beds available in Northeastern.
During the late stages of the election you led the Timmins city council to believe that this was in fact receiving very serious consideration by you and your officials. They were pretty upset when you came along and made your announcement.
Your plan to provide chronic care beds in the area is, of course, welcome; but they have to be provided in a facility that is appropriate for them and can offer the common room type of thing, where they can go and socialize, along with some suitable type of dining room facility. I have said all along, but perhaps you have never agreed to this, that if you made the 26 beds available at the Timmins nursing home and designated it specifically for chronic care, you could meet the crisis for the time being. Then when other long range plans were in place you could perhaps channel those over for extended care. You haven’t been prepared to accept those arguments.
Now there was one hopeful thing that the minister did say when he was in Timmins; that he is prepared to move forward to some extent the new district hospital he has said would be coming our way. I don’t know how much the restraint programme is going to have a bearing on that.
Also there is the fact that you are going to put about $1.6 million into St. Mary’s now to improve the emergency care, the radiology department, the urology department, the pathology department. That’s very good. But what you are prepared to do as far as the district hospital is concerned is a very serious concern. I hope the minister, when he told us that night in January he was going to seriously consider moving it up, will be prepared to do that.
You know, Mr. Minister, I think that overall it’s important to establish various parts of this province as regional or district medical centres where a fairly wide degree of service is made available for that region. I think our area, being a heavy industry area with mining and lumbering sectors, should have an orthopaedic surgeon at hand with the facilities he needs.
We’ve had two that have come there and they have gone, one to Stratford and the other one to Sudbury, because there were not sufficient beds available in the area for them to do the work that needed to be done. I think it would save money for the local people, it would be much more convenient and it might save money for the government, if you had facilities where an orthopaedic specialist could be there.
In our whole area of northeastern Ontario we should have a pediatrician. The nearest ones that I know of are in North Bay and Sudbury. It’s not just my area but it’s all up though the whole district of Cochrane. We serve all the way up to the coast of James Bay, the Moosonee area and all the native communities. We also serve Gogama and Foleyet. Those communities should be taken into account when you are applying your 4.5 per cent formula to decide on the number of beds.
I hope when you are planning that region or district hospital that you are prepared maybe to move up a little bit, that you will think of the possibilities of attracting some specialists into that area and providing them with the facilities and sufficient beds that they can really operate as a district or a regional hospital and serve the people in those areas.
Another area that I think is of major concern as far as hospital facilities go is the service that St. Mary’s provides to the francophone community. You have a committee looking into the needs of the francophone community of this Province of Ontario. I can tell you that there are not nearly enough francophone doctors serving the francophone community of this province. It’s very disconcerting for a number of unilingual francophone people of this province who have to go to doctors and try to communicate with and tell them their symptoms when they can’t communicate.
That’s a serious lack that is in existence as far as the francophone community is concerned. I think that the University of Ottawa has for the most part taken the students from the Province of Quebec into their medical school and they are not taking a number of people from northern Ontario into the school so that the francophones from northern Ontario will be induced to come back to the north an serve in those hospitals we have.
In a hospital like St. Mary’s we do have auxiliary health care personnel who are francophone and who can provide some of the significant services to the francophone population. But I want to tell the minister that his 4.5 beds should maybe be reconsidered as far as the francophone communities of this province are concerned. In those areas where there are inadequate facilities provided in the hospital sector for the francophone communities you should raise your ratio to a considerable extent.
When you are planning your district hospital, take that into account. When the district health council is making their recommendations to you, they better take that into account and see that the francophone community of my area, and indeed of the province, have sufficient professional health care people to serve them and to speak their own language; and your medical school at the University of Ottawa should give sufficient preference to francophone students from the Province of Ontario so that we’re graduating enough doctors who are prepared to come back to Ontario and serve our francophone community in Ontario rather than to go back to Quebec and serve there. They have their own medical schools there and Quebec can well afford to train their own doctors. We need francophone doctors in the worst way in our community.
So, I suppose I had better wind it up but I am --
Hon. F. S. Miller: Keep on, keep on.
Mr. Ferrier: Well I did a pretty good job of research over the supper hour. But I am telling you, Mr. Minister, we weren’t very happy with your announcement on Dec. 19 and we are still not satisfied with the response that you have given us.
A hon. member: There is no rationale.
Hon. F. S. Miller: There is though.
Mr. Ferrier: In fact, Mr. Minister you have got too many insensitive, cold, calculating bureaucrats down here at Queen’s Park. No, it is not you, it is your bureaucrats down here.
Mr. McClellan: It’s them, yes.
Mr. Ferrier: And some of them ought to know better.
Mr. Angus: Lots of luck, Frank.
Mr. Ferrier: Some of them ought to know better because they have --
Mr. Warner: It is your responsibility.
Mr. Deans: Frank Miller, they have been manipulating Ministers of Health ever since I came here.
Hon. F. S. Miller: I realize that; it’s probably the most plastic they ever had.
Mr. Deans: I am not going to tell you that.
Mr. Ferrier: I am telling you, Mr. Minister, northern Ontario has unique problems. They are problems of distance, they are problems of weather, they are problems of scattered population; but there are human needs, health care needs, that have to be dealt with in a unique way. The way the hatchet was used on Northeastern certainly didn’t indicate much sensitivity on behalf of this government. You didn’t win yourself very many friends in northern Ontario by that action.
Your compromise was the same thing we talked about in your office: that the general hospital would pick up 20 beds and you wouldn’t be prepared to put the restraint axe on them. I think your bureaucrats really didn’t do you much of a service when they said that they were there to axe St. Mary’s Hospital. I think that slipped through your hands without you really realizing it. Sometimes they do things that seriously embarrass you and I think that --
Hon. F. S. Miller: Yes, and they sent you information.
Mr. Ferrier: If they are really responsive to what is going on and they are concerned they will know that; and I believe there were some in your ministry who proposed that St. Mary’s pass that resolution and accept those 20 beds.
I know; I have a pipeline into the St. Mary’s Hospital board. I know it is all confidential and all the rest of it, but sometimes the better half lets the odd things slip.
Hon. F. S. Miller: Is she on the board?
Mr. Ferrier: She is on the board. You see the NDP are pretty active up in my area.
Hon. F. S. Miller: Yes, I have met your family.
Mr. Ferrier: In one way, Mr. Minister, some of us have to take extreme measures to pitch in.
Mr. Ferrier: But anyway, Mr. Minister, we feel it is typical of this arrogant, insensitive way that Queen’s Park deals with the north. The whole decision reinforced our sense of separation, our sense of not being taken into account, of you concentrating more and more power down here and not transferring power out to the areas in a certain kind of local autonomy that some of your ministers get up and argue about when a pertinent local decision is to be made by the local people. You have a health council and you didn’t take them into account; and you didn’t take any of the professionals into account; you didn’t even let your administrator of the hospital know.
I think you haven’t really done yourself much of a service in the decision that you took there. If you had done what we had pleaded with you and pleaded with the Premier to do -- and I hope that the Premier gets up and talks about the little conversation he and Bill Drysdale and I and Dr. Stewart had in his room. We were prepared to take a compromise, with the hospital as a resource centre for the retarded -- 75 or 100 beds or more -- to keep 75 or so beds for the mentally ill and to have adequate psychiatric services. We would have been satisfied.
The Association for the Mentally Retarded were not overly enthusiastic about taking that over, but now they have agreed and I think they’re pretty pleased they’ve got this large facility. They’re going to go ahead with it.
I think you made a mistake in not listening to us in our area. You might be able to justify it in dollars and cents, but you haven’t explained very well what you’re going to put there in its place. You may have explained it to a few of the professionals, but we had to wait a long time for the Minister of Community and Social Services (Mr. Taylor) to approve his news release. It must have been about three days we waited for that to come forth.
I still don’t know what you’re going to come forward with as far as the children’s programme is concerned, I hope you’ve got something in place to take over there, because if you haven’t that 5.5 per cent increase to which you’re limiting the Children’s Aid Societies is going to work real havoc upon the Children s Aid Society in my area and other places. You’ve got to give us something.
Perhaps you’re going to have an overall saving, 1 don’t know, but you’ve upset the people there very greatly and you’ve got to prove to us in some way that the alternatives you’ve put in place are going to work, I hope they do but I’m kind of dubious. If you can carry out a programme with 20 or 25 people where previous you had 200, one way or another you’ve really been misleading the people.
Mr. Laughren: Right on.
Mr. Ferrier: I say to my hon. friend from Nickel Belt I’m speaking up for his people, too, because there are the hospitals in Chapleau, Foleyet and Gogama; and also the member of Algoma (Mr. Wildman), we looked after some of his people. You know that now, and before you hammer that baton down I’ll sit down.
You’ve got one psychiatric hospital in North Bay serving all of northeastern Ontario from North Bay to Sault Ste. Marie to Wawa to Hornepayne to Hearst to Moosonee to Winisk to Ogaki to Fort Albany. I don’t know, that’s half the size of Europe and you’ve got one hospital. I know there are not too many people up in the northeast with problems but there is the odd one who does need some psychiatric care.
You’ve let us down and I’m pretty damned mad at you.
Hon. F. S. Miller: Mr. Chairman, we shared the same source of research across the dinner hour and that’s not all we shared. First of all, we have two other things in common. We’re both nice guys.
Mr. Warner: That is the only source.
Mr. McClellan: Half right.
Mr. Deans: Half right again.
Hon. F. S. Miller: The second thing is we both are members of the United Church.
Mr. Sweeney: He’s getting in deeper all the time,
Mr. Chairman: Order, please.
Hon. F. S. Miller: My friend on the far side is not only a member but a minister. Now that’s the closest he is ever going to be to being a minister in any other sense.
Mr. Chairman: Order, please.
Hon. F. S. Miller: I have to point out I now understand how he got elected, because any minister of any United Church that I ever attended who spoke more than 20 minutes was out. He has now spoken for 45.
Hon. F. S. Miller: That’s the trouble.
Mr. Laughren: Are you going to take the chiropractors out of OHIP?
Hon. F. S. Miller: I will have to if they continue to interfere with my debates in this way. It’s one of three secrets we have to keep between you and your congregation.
Mr. Warner: It’s a good thing you are not a minister of the church.
Hon. F. S. Miller: Yes.
Hon. F. S. Miller: I think I’ll go up there and start converting them to some other faith.
Mr. Chairman: Order, please. Could we have a little devotion to the estimates?
Mr. Warner: Watch him. He is going to close the churches.
Hon. F. S. Miller: That, I might say, is the only devotion the Chairman has shown since he got elected.
Mr. Chairman: Hear, hear.
Hon. F. S. Miller: Until I became Minister of Health, I never realized what a nasty guy I was.
Mr. Chairman: Hear, hear.
Mr. Deans: Hansard is recording you. Did Hansard get that? The Chairman said, “Hear, hear.”
Hon. F. S. Miller: Mr. Chairman, there is a time and a place for almost anything, but this is not it.
I’ve been called arrogant, as somebody reminded me from your benches, more often in the last three weeks than my wife has called me in 25 years of marriage.
Mr. Laughren: Is your wife at home a lot?
Hon. F. S. Miller: I’ve been called dictatorial; I’ve been called insensitive.
Mr. Makarchuk: You are.
Hon. F. S. Miller: I’ve been called many things. But one thing I’ve discovered, though, is the difference between me and you is I’m willing to make a decision without waiting until doomsday for enough facts to have all of the facts --
Mr. Chairman: Order, please.
Hon. F. S. Miller: Mr. Chairman, they’re trying to incite me into responding to interjections.
Mr. Chairman: Order, please. The minister will continue.
Mr. Deans: We’d like you to respond to the speech.
Hon. F. S. Miller: There was nothing to respond to, so I had to find something to say.
Mr. Deans: That is a bit insulting, I think. Would you like him to restate it?
Hon. F. S. Miller: If he can do it in one sentence, yes.
Mr. Chairman: Order, please.
Hon. F. S. Miller: The fact is, though, decision-making is always based on incomplete facts. One of the things I’ve learned about planners or experts, is that there is always something else they need to know, before they give you advice.
An hon. member: That won’t bother you.
Hon. F. S. Miller: They need another study. They need more information. They have to check more variables. The fact is that life goes on and decisions have to be made.
Mr. Warner: Without facts? That’s what happened with the hospitals, and you know it.
Hon. F. S. Miller: You were at the chiropractic dinner too. I sat near you.
Mr. Chairman: Order, please.
Mr. Gaunt: He didn’t smoke a cigar, though.
Hon. F. S. Miller: No, but I shared that with another member of this House who doesn’t share my sex.
Mr. Sweeney: Since when did you start sharing?
Hon. F. S. Miller: I’ll rephrase that.
Mr. Sweeney: When did you start sharing?
Mr. Gaunt: This is confession night.
Mr. Makarchuk: Are you advertising?
Ms. Warner: If you were the Minister of Transportation and Communications, you would close Highway 401.
Mr. Lawlor: Stop complaining, Frank.
Hon. F. S. Miller: I wish I were advertising; I would be caught on one of our bases for false advertising if I were.
If, in fact, I waited for all the facts nothing, would happen, because they are never in. One of the things I say in all seriousness is that I’ve never pretended to know that I made the right decision on any particular issue.
Mr. Warner: That’s obvious.
Hon. F. S. Miller: That’s fair enough. Yes, I admit it. That’s the great difference between you and me. I’m always aware I’m human and fallible.
Mr. Makarchuk: Stop it.
Mr. Shore: Stop pontificating, will you?
Hon. F. S. Miller: Pardon? No, no. If I were pontificating I would be infallible.
Mr. Shore: Oh, okay.
Mr. Sweeney: Bob, who is the minister?
Mr. Deans: I will have the member for Lake Nipigon (Mr. Stokes) fly in to deal with you if you don’t get to the point pretty soon.
Hon. F. S. Miller: I have to sit through till 10:30 under any circumstances.
Mr. Warner: You’re making up for yesterday.
Mr. Deans: When is the last time you did this?
Hon. F. S. Miller: And besides, until April 5 that’s as far as I can see. And what worries me is my pension. My pension isn’t in effect that day. That comes as a great shock. The Liberals, who today fell into their own trap --
Mr. Gaunt: We will worry about us; you will worry about you.
Mr. Chairman: Order, please.
Mr. Gaunt: The blame is yours.
Mr. Speaker: Order, please.
Mr. Gaunt: You worry about you, and we will worry about us.
Hon. F. S. Miller: The member for Huron-Bruce is safe anyway.
Mr. Gaunt: Thank you.
Mr. Laughren: One of 36.
Mr. Gaunt: Thank you; I hate to be alone.
Mr. Laughren: I think the member for Huron-Middlesex (Mr. Riddell) is all right.
Hon. F. S. Miller: I was trying to give you some meaty information.
Mr. Chairman: Order, please.
Hon. F. S. Miller: I would point out, though, that health councils are a newly-formed entity. In my 12 visits around the province on a number of occasions I was asked by people at my meetings in January and February whether or not I was referring the issue of closures and constrictions in budgets to the health councils. I said with one exception, no.
My reasons were simple. They had to be. That was, that in fact most health councils had just been constituted. To pass the buck to them to make some tough decisions in their early days would probably have alienated the communities they served against them and, in fact, made them subject to advice they got from us rather than advice they got from their communities. Thus, I chose to take the responsibility myself for the decisions I had to make in this year.
I don’t recall your council offered any objections to that suggestion when I was in Timmins. Later on, when there was an error -- and I happen to admit to errors -- in suggesting that 25 beds be transferred from active to chronic as well as taking the psych load at St. Mary’s, they wrote me a rather angry letter, and I don’t blame them, saying that they wanted to be involved in that decision. I quickly, immediately -- you know that -- without any reference to staff, accepted that recommendation. I revoked the decision and agreed that the assumption of the 20 beds by St. Mary’s was not a fact that some of my staff were aware of, who had prepared this information well in advance of St. Mary’s agreeing to take the beds, and asked the health council to give me their alternatives by June 1.
It is interesting that even where I have challenged the health council to solve my problems, they have asked out. They don’t want to solve them. They want to wait until they have had some more time establishing their liaison with their communities before they get a nasty job, such as the closure of beds.
You talked about federal government constraints. You and I see eye to eye on that. But you may well recall me standing up in this House last June and demanding a health minister’s conference of all of the provincial health ministers to object to a unilateral decision by the federal government to opt out of 50-50 cost sharing in the hospital and health field, without consultation with the provinces. That meeting took place on Aug. 18, 19 and 20.
It is interesting to me that a unanimous, non-political provincial agreement was reached decrying the decision of the federal government and asking them to revoke or stop Bill C-68, which right now today is before the federal Parliament -- and they are going to have to invoke closure to get it through.
Mr. Lewis: So?
Hon. F. S. Miller: No, I am just referring to the things your speaker mentioned in his speech.
Mr. Lewis: I heard.
Hon. F. S. Miller: I don’t think it is fair; it has nothing to do with today’s constraints, and I don’t want to try to pass the buck from me to them. But we were living within a set of rules they created and we did not feel they should opt out when, in fact, some provinces, led by Ontario, had been looking for lower-cost alternatives in 100-cent provincial dollars. Psychiatric care, as you mentioned, is not shared federally. Nursing homes aren’t shared federally. Home care isn’t shared federally. Ambulance services aren’t shared federally and drug plans aren’t shared federally. All of those things have been brought in by the Province of Ontario in the belief they were necessary for their people without federal assistance, even though the assistance would have been easy to take, had we opted for a continuation of the high-cost health care programmes they had financed. I think we all know that.
The delegations you referred to were, I thought, very orderly and very thoughtful. Whether we agree upon my willingness to listen or not, I believe we listened and took action on a number of the things they suggested, again, not on all the things they asked for but some.
You asked me about the need to contract the hospitals at all. Great changes have taken place in psychiatric care. I have 15 institutions, some of which like St. Thomas, if I recall figures, have 600 patients where a few years ago they had 1,800. One can only continue to contract the patient load of a given hospital for so long before sooner or later there’s a need for the closure of some.
Mr. Lewis: What about your rationalization study?
Hon. F. S. Miller: Which one?
Mr. Lewis: The one on psychiatric care.
Hon. F. S. Miller: I mustn’t answer those things. I’ve been told by your representative in the chair that I mustn’t answer interjections.
Mr. Lewis: You told me in question period the other day you’d get an answer to the letter you haven’t answered.
Hon. F. S. Miller: I’m looking seriously for that.
Mr. Lewis: You’re looking seriously at it, are you?
Hon. F. S. Miller: I must say you’ve kept me rather busy in here of late.
Mr. Lewis: Come now, you have a very large staff.
Mr. Chairman: Order, please. The hon. minister will continue.
Hon. F. S. Miller: Ah, but my civil servant doesn’t look after that aspect.
Mr. Lewis: Any civil servant who can disrupt a health system so artfully can answer a letter.
Mr. Chairman: Order, please.
Hon. F. S. Miller: Anyone who can send copies of my purchase orders to your party must be --
Mr. Warner: A dime a dozen.
Mr. Lewis: If your purchase orders for cars weren’t on stationery order sheets, they wouldn’t come to us. Where’s the rationalization study?
Hon. F. S. Miller: You referred to nursing courses. There will need to be a reduction in the admission numbers of nursing students. I’m sure the Ministry of Colleges and Universities has already taken these steps to tailor the number of graduates more closely to the demand.
Mr. Davison: Fifteen per cent.
Hon. F. S. Miller: Fifteen per cent. Let me say to you I don’t know that any educational course in this province has ever been offered solely on the assumption that taking it meant getting a job, has it?
Mr. Davison: But at least they had some possibility of getting a job. Not any more.
Mr. Warner: It is called planning.
Hon. F. S. Miller: We probably have as good manpower planning as any place in the world on that particular topic. Should I answer you on the francophone bit in French tonight or English?
Mr. Deans: Continue with what you’re doing.
Hon. F. S. Miller: The only thing I can tell you is if I answer you in French you’ll understand me without any problem at all.
Mr. Ferrier: Oui.
Hon. F. S. Miller: The trouble is I embarrass the Minister without Portfolio (Mr. Brunelle) when I speak French.
We’re concerned and we evidenced that concern by asking for a study.
Mr. Warner: Is this French or English?
Hon. F. S. Miller: What was that? Switch to English?
Mr. Warner: I didn’t know whether it was French or English.
Hon. F. S. Miller: Monsieur le président, il m’a dit que je dois changer à l’anglais, n’est-ce-pas?
Mr. Lewis: Well, you could have run for the federal leadership.
Hon. F. S. Miller: Oui, pas question! C’est mon avis, j’aurais été le choix du Parti Progressive Conservateur du Canada, n’est-ce pas?
Mr. Lewis: That’s the first time the member for Renfrew South (Mr. Yakabuski) has ever applauded for a French speaker.
Hon. F. S. Miller: That’s because he didn’t know what I was saying.
An hon. member: Is that the research you did over the dinner hour?
Mr. Yakabuski: Maybe we did and we know there is an opening in London for a new leader. Socialism has failed.
Mr. Lewis: Who are you anyway?
Mr. Yakabuski: He is frustrated.
Mr. Chairman: Order, please. Will the hon. minister return to his estimates?
Mr. Lewis: Do you belong here?
Mr. Chairman: Order, please.
Mr. Chairman: Order, please.
Hon. F. S. Miller: Mr. Chairman, I am sure there was much more I could have added that would add to the intellectual level of this debate tonight, but I think I should wait for some of the other 22 speakers who are continue.
Mr. Chairman: The hon. member for St. Andrew-St. Patrick.
Mr. Grossman: Thank you, Mr. Chairman.
Mr. Angus: Are you going to cross the floor?
Mr. Grossman: It had to be sooner or later.
Mr. Riddell: Lay the cards on the table.
Mr. Grossman: Well, Mr. Chairman, may I initially say that I don’t apologize one whit for the --
Mr. Warner: Point of order, Mr. Chairman.
Mr. Chairman: The hon. member has a point of order.
Mr. Warner: Should not the Liberal speaker be next in line as we left off with the member from the north of our party?
Mr. Chairman: No, the Chairman recognizes the hon. member for St. Andrew-St. Patrick.
Mr. Yakabuski: What about the question period?
Mr. Chairman: There hasn’t been a member from the right-hand of the Speaker’s seat for some time. Then we will recognize the member for Wentworth (Mr. Deans).
Mr. Grossman: And I will speak for some time, Mr. Chairman.
Mr. Gaunt: On a point of order, Mr. Chairman, you mentioned that after the member for St. Andrew-St. Patrick you would recognize the member for Wentworth. We have a number of speakers on this side and I thought we were going in rotation.
Mr. Chairman: The Chair will recognize them in order. There hadn’t been anybody from your party who had indicated he wanted to speak, but I will recognize them.
Mr. Gaunt: I thought you had a list, I am sorry.
Mr. Chairman: I have no list.
Mr. Lewis: Where did you have dinner, Mr. Chairman?
Mr. Chairman: Order, please. Mr. Chairman?
Mr. Grossman: How long are you going to be?
Mr. Chairman: The hon. Member will continue.
Mr. Gaunt: Fifteen minutes.
Mr. Ferrier: Come on.
Mr. Grossman: Let’s wait for Warner.
Mr. B. Newman: May I start, Mr. Chairman?
Mr. Ferrier: This is a conspiracy against the Conservative Party.
Mr. B. Newman: Mr. Chairman, if I may, the first thing that I want to bring to the minister’s attention, and he did make mention of it in his reply to other previous speakers, is the consultations, if the minister went through as much consultation as he has made mention that he does -- and I am not referring to my own community -- I would wonder why the following letter would have been sent to all of the members, or I assumed all of the members of the House, and that is from the president of the Ontario Medical Association. Through you, Mr. Chairman, I would like to bring it to the attention of the minister. This letter is dated today, and it is for immediate release.
The Ontario Medical Association today released the contents of a letter sent by its president to Premier Davis calling for consultation on the closing of hospitals.
Following is the letter:
Dear Mr. Premier,
I am writing to convey to you the grave concern of the physicians of Ontario over the manner in which your government has reduced the projected expenditures of the Ministry of Health. We are particularly anxious about the effects of unplanned closing of community hospitals on the health of the people served by the hospitals, on the employment of the highly skilled personnel working in the institutions, and on the future prospects of communities without hospitals attracting resident physicians.
The council of the Ontario Medical Association, with representation from across the province, has unanimously deplored the projected, abrupt closing of Doctors Hospital, and has been strongly critical of the arbitrary closings of other hospitals. The council recommends a reappraisal of revenues, expenditures and utilization within the health care delivery system.
It is the view of our profession that before a decision is made to close any hospital, the Ministry of Health ought to consult with the district health councils or hospital planning councils where they exist and with the medical profession and with other interested parties. Such discussions would evolve plans for alternative health care facilities for the people in the community and for relocation of hospital personnel.
The medical profession, through the OMA, has been most co-operative with your government in matters affecting the public and the profession. We believe your government has a responsibility to reciprocate through meaningful consultation on an issue which so seriously affects the public and the profession as does the closing of hospital facilities.
Donald C. MacNeill,
Ontario Medical Association.
I am surprised, Mr. Chairman, after listening for probably six to eight hours and the minister’s comments and replies to the various members, that such a letter would have been sent out by the Ontario Medical Association if all of that consultation that the minister speaks of actually took place.
In my own community, I will say there was consultation. I think that the minister did start in -- I wouldn’t necessarily say the right way -- but there was some consultation.
I would like at this time, Mr. Chairman, to centre my remarks essentially around the closing of one hospital in my community; and that is the Riverview Hospital for chronic patients.
Back in early April of last year, I raised three questions with the minister concerning that hospital. One dealt with the rationalization of the facilities and the services in the hospital. Another dealt with the manpower situation and the unemployment situation as a result of the rationalization of services. At that time the minister replied to me that no one would lose their employment as a result of rationalization of the services in the city of Windsor.
The minister can look into Hansard and see that he actually did say that. I think I made mention to him of that at one time in talking with him. I think I even mentioned it to him when he was in the city of Windsor and he met with various individuals who were going to be affected by the rationalizations of services in the community; the meeting held at the University of Windsor.
However, Mr. Minister, since my original asking of the question -- and I think it was April 15; it may have been some other day -- you have changed your mind and now you state that there is going to be substantial dislocation of personnel in the various hospitals in the community.
I am concerned about the loss of jobs as a remit of the minister’s projected rationalization and the closure of the chronic care facility of Riverview. My first concern is the health of the patients. Is the patient at Riverview going to be provided with that same high standard of hospital as he had received over the many years that the chronic care hospital has been in existence in the community? I hope that that same standard of care will be maintained.
The minister knows as a result of the discussions during his estimates back in May -- and I think May 5, 6 or 8 were the other two dates in which we had debated the estimates of the ministry all three members from the Windsor area took part in an attempt to point out to you at that time, Mr. Minister --
Hon. F. S. Miller: On a point of order, may I just ask for the reference you are speaking to in terms of dates. I would like to see Hansard on it, and I need to know it.
Mr. B. Newman: Right. I can’t give you the exact date, but I think it was April 15. If someone from your staff looks in the Hansard directory under Riverview Hospital, they can get those dates.
Hon. F. S. Miller: It is probably not printed.
Mr. B. Newman: It is printed, Mr. Minister.
Hon. F. S. Miller: In book form?
Mr. B. Newman: Yes.
Hon. F. S. Miller: Is it in response to a question, or in terms of estimates?
Mr. B. Newman: That was in response to a question, originally. I asked three questions before anyone was interested in hospital closures. Later, we got into the discussion of your estimates and the closing of Riverview Hospital at that time. I think it was early in May if I’m not mistaken -- May 5, 6, 7, 8, around that period of time -- in 1975. Your officials can look in Hansard and see exactly what you’ve said as far as the loss of jobs in the community was concerned.
However, I want to carry on. As I said earlier my prime concern is the delivery of services to the individuals who require these services at the Riverview Hospital. I am very much afraid that by dispersing the patients in Riverview you may be doing a real disservice: I hope you will not do any harm to them as individuals. I hope not. However, I look upon your fragmenting the various teams which provided these services to the patients.
You are going to break up these health delivery teams and as a result it is maybe going to be very difficult to provide the same level of care that the people received.
You’re aware of the whole situation in the Windsor area. You have debated it back and forth not only with me but with the other two Windsor members. I ask you to reconsider some of the decisions which you have made.
Remember there was the Essex County Health Council that met and made certain proposals but you sort of used the bullheaded approach -- “It has to be my way” -- rather than the general way as recommended by the health council in the community. I hope that you reconsider what plans you have had and keep that Riverview Hospital open until the time you or your ministry or your successor deliver to the community just what the ministry, your predecessor, had promised.
That was a chronic care facility stationed in or in conjunction with the IODE hospital so that we could move the patients en masse out of Riverview into the facility at lODE without disrupting the valuable health delivery teams which have been developed in the Riverview Hospital.
It was back in 1973 -- in fact I happen to have a letter dated Oct. 11, 1973, that says:
The Essex county council has passed a resolution to share in the cost of construction and the Essex County Hospital Planning Council has also approved the building of a new chronic care hospital.
This communication happens to be dated Oct. 11, 1973. I would assume that had been discussed at some date prior to Oct. 11.
I would think it was probably some time in September because on Oct. 3, 1973, the Windsor Star carried a headline, “Hospital Addition Reduced.” It was referring directly to the new chronic care facility which we thought, in good faith, was going to be built at the IODE or the Windsor Western Hospital site. That was in 1973; that’s 21/2 years ago now. Surely, when you make a commitment like that -- and this is for the betterment of the health services in the community -- we in the area would think you would fulfil that commitment.
I know you are going to say that you people didn’t approve of that; that this was only a recommendation of the Essex County Hospital Planning Council. I hope you don’t tell me that. I hope this was in your plans. If I am not mistaken since that date some $1 million has been expended in the planning of the new facility. Is that $1 million going to go down the drain today?
You are asking the community to save you $4 million in health costs. The $4 million of the $50 million that you are attempting to save through your rationalization in hospital closings is the equivalent of eight per cent of the moneys being asked to he saved in the community of Windsor alone. We have only four per cent of the population. You are asking us to make twice the contribution of the average in the Province of Ontario. That is not fair.
Our people pay the same OHIP premium as do people in all other parts of the province and we would like to have a fair share of the health dollar spent in the community or spent in the delivery of health services. We hope that you reconsider any decisions, that you come along and keep the Riverview Hospital at higher than the 120 figure that you or your officials are suggesting and that you do not delay until 1980 on the building of a chronic care facility. You have got to do it. You are going to save money by doing it because in your plan as you have it today -- and that is the redistribution of the patients from Riverview into thee acute care hospitals -- you are really only shifting costs from Riverview, in which the patients are accommodated at a substantially lower figure, to higher cost hospitals in the community. You certainly are.
Hon. F. S. Miller: Really and honestly, one must look into the arithmetic of chronic care before you make a comment like that. Unlike active care, we pay a per diem for chronic care and it is not the active treatment rate. Please check that.
Mr. B. Newman: The minister can use that argument; I will use my argument.
Hon. F. S. Miller: But you are wrong.
Mr. B. Newman: I don’t think I am wrong.
Mr. Deans: That has never stopped him before.
Mr. Warner: You have been wrong all day today.
Mr. Lewis: This has not been a good day for them.
Hon. F. S. Miller: It hasn’t been; they have been wrong all day.
Mr. Chairman: Order, please.
Mr. B. Newman: Then what you are saying is that, for the hospitals in the community now that do not have beds occupied the costs there are still at that higher figure than what they are at the Riverview Hospital.
Hon. F. S. Miller: No.
Mr. B. Newman: You say no?
Hon. F. S. Miller: You are wrong.
Mr. B. Newman: Well, you can reply to me a little later. I will continue with this. As I said, this promise was made by your government in 1973. No issue in my day in this House has disrupted the community to the extent that the closing of Riverview Hospital has done. It has absolutely got everyone in the community very much perturbed at the actions of this ministry and at the actions of the government. It has solidified the feeling and the concern of all of those who would like to see the facility operate at a reduced bed capacity -- but not reduced to the extent that you want to reduce it -- and to continue and at as early a time as possible to complete a new facility at the IODE centre.
I understand that you could go on one portion of it, and over a period of time really complete the whole hospital. I hope the minister does construct that new facility for the health of the many who require the services of Riverview Hospital. Your actions or your decisions to phase out or to close out Riverview Hospital have brought all kinds of protests. There have been protests from every level of society in the community -- from workers in plants, caretakers in the hospitals, housewives, the medical profession, both the students and the educators in the four levels of education -- everyone was completely upset.
In fact, there were even members from one of the union locals who picketed the hospital because of the decision of the government eventually to phase out Riverview Hospital.
Here are some newspaper headlines on Riverview. Sept. 24, 1975: “Pickets Protest Cut At Hospitals.” Nov. 4, 1975: “People Should Fight for Riverview Hospital.” November 1975: “Staff At Riverview Give Hope And Courage.” That was an individual writing that the staff were so concerned about the situation that they were the ones who were maintaining the morale of the patients in the hospital. November 1975: “Riverview Closing Spurs Loud Outcry.” November 1975: “Labour Group Goes to Bat for Riverview.” Nov. 18, 1975: “Aldermen Rally Behind Riverview.”
On November 17, 1975, city council passed a resolution at its meeting asking the minister to reconsider his decision regarding the closing before. of Riverview Hospital and that the: operation of these facilities be continued. On Dec. 2, 1975, the city of Windsor endorsed a resolution from the district labour council concerning Riverview Hospital. On Nov. 25, 1975, the town of Riverside passed a resolution concerning the keeping of the Riverview Hospital alive.
Mr. Chairman, listen to this letter from a patient in the hospital:
My name is Mary “So-and-So.” I have MS. My husband took care of me when I was in a wheelchair for five years until he had his heart attack. Then, I had to come to Riverview. It is not funny to know that I will never get better. I accept this, but it was hard for me to come to Riverview. Now I’m happy here because I have good care.
We have wonderful doctors and kind nurses who try to take care of us. The people in the therapy area are very kind and try very hard to help us. The whole people of Riverview make us feel not like patients, but like a family, from the youngest to the oldest, who is over 100.
We wish to stay in Riverview until we have a new building. Otherwise we are asking you to guarantee us the same kind of care we have in Riverview.
Here is the pleading from an individual who is afflicted with a type of ailment that none of us would like I to be bothered with.
The minister earlier in his comments made mention of an editorial in the Windsor paper that was sort of complimentary to him. But the minister never mentioned the editorials that made mention of false economies in hospital plans. The minister’s comment is concerning a Feb. 12, 1976, editorial: “Hospital Programme -- Tough but Needed.” But he does not mention a Nov. 13 editorial:
False Economies in Hospital Plan
The Ontario government’s proposal to rearrange Windsor hospital services in the interests of economy have a strange flavour of false economy.
I’m not going to read the rest of the editorial because if I’m not mistaken I read it into the record when we debated your estimates back in May, Mr. Minister, and I’m fairly certain that your officials have all of these editorials. If they don’t have them here they’ll show them to you at a later time.
But, Mr. Minister, you can see that practically everyone in the community is extremely concerned over your proposed closing of the hospital, or phasing it down to a point where you may -- and I hope not -- interfere with the health delivery to the many individuals who require the services provided in Riverview Hospital.
I do understand that the Windsor Western Hospital would like to build a new facility; that they do have sufficient funds to start it. I wonder why you wouldn’t come along and allow them to use these funds in an attempt to provide the type of chronic care facility that I know you want. You are essentially a kind and considerate individual but sitting to the right of you are individuals who are looking at only dollar signs, not at individuals --
Hon. F. S. Miller: They’re not even that good.
Mr. B. Newman: -- not at the needs, the health needs. It’s the same as with your officials back there. I think they are considerate. I don’t think they are as inhumane as some may say. They have simply been misled, and they are following what your colleagues are telling you you must tell them -- that is, to find some method of phasing out some of the hospitals that are providing an extremely high level of service to the patients in various communities throughout the province.
The phasing out of Riverview completely is going to have a harmful effect on the employment picture in the community. As I said earlier, my prime interest is in the health of the patient -- the health services provided to the patient -- but there is also another concern too and that is the fact that so many of the employees are not going to find employment. We have 10.3 per cent of our work force in the city of Windsor unemployed at this time. It’s many and many a year since we’ve had that high a figure and, surely, you aren’t going to add to that figure to increase it substantially. I hope you are not, in the interests of the delivery of health care to the many who require it in the Riverview Hospital.
You make mention that we’re going to take these people and put them into Metropolitan Hospital, into I ODE and into Grace. With three other hospitals in the community you’re going to take a certain category of patient out of Riverview and put them into these other hospitals. What you are doing, Mr. Minister, is putting them in a hospital that has to have renovations. Anyone I have ever consulted says you cannot have certain categories of chronic care patients in the ordinary type of hospital because of the changes needed -- washroom facilities, doors, elevators, everything of that sort.
So it’s really false economy when you think you are going to come along and provide that same type of health service when you’re going to put them into active treatment hospitals in the community. The cost of those alterations could be better put into the construction of that 1973-planned chronic care facility in the community.
I am also told that if you contacted any one of the hospitals today a person needing psychiatric treatment could not get a bed. What are we going to do with them? You’ve rationalized the services in the community -- or you have closed up some of them -- to the point where the individual needing psychiatric treatment -- has no place to go.
I hope, with the few comments I have made here, that you will reconsider the decision to reduce substantially the number of beds at the Riverview Hospital. We are willing to accept certain reductions. We are willing to rationalize the services. We are willing to play our part and to pay our share in the community but when you ask us to be responsible for eight per cent of your cutbacks when we have only four per cent of the population, you are asking for twice the sacrifice from the residents of the city of Windsor and the Essex county area than you are asking for from many of the other communities in the province.
Mr. Minister admit you made a mistake. Don’t worry about what your colleagues will say to you. It’s easy to be stubborn and bullheaded. You erred in the Windsor situation. Reconsider your decision.
Mr. Eakins: Reconsider.
Mr. B. Newman: Did you hear that? Thank you, Mr. Chairman.
Hon. F. S. Miller: The latter speaker’s last -- well, I don’t know what you would call them -- exhortations to me made me think of the old Irishman who was dying. The father came in to give him the last rites and said, “Do you renounce the devil?” And he said, “At a time like this, Father, I don’t want to alienate anybody.” I feel much the same way in responding to this. I have answered most of the detail you talked about earlier.
Mr. McClellan: What have you got against the Irish?
Hon. F. S. Miller: My mother was one.
Mr. Samis: What about the RCs?
Mr. Lewis: Why do you attack ethnic groups whenever you have the opportunity?
Hon. F. S. Miller: Do you I realize I married an immigrant?
Mr. Lewis: Most of us did.
Hon. F. S. Miller: Yes.
Mr. Samis: Most of us are.
Mr. Deans: So did my wife.
Hon. F. S. Miller: Yes, she told me the error of her ways. Interestingly enough, my wife and your wife’s husband came from the same country.
Mr. Deans: Is that right? It just shows you.
Mr. Davidson: Please respond. The hon. member is waiting to speak.
Hon. F. S. Miller: In a more serious vein, first of all, by the time the final suggestions made by your council were taken by us and accepted, the savings were considerably less than the’ $4 million we asked for. I mentioned that in responding to the member for Windsor-Sandwich.
Mr. B. Newman: It was $3.7 million.
Hon. F. S. Miller: No, they were down by their estimation to $3 million -- to $3.2 million. I hope you are right because, methodology being what it is, it might be a bit difficult, until the change was made, to give a final dollar figure on it. I would suspect that your population rate and the percentage of the savings effected in Windsor are not too far out of line. Be that as it may, it is recognized that 25 per cent of the population lives in the city of Toronto -- Metro Toronto -- and that is an area where the savings were taken in 1973 and were not there to be’ taken in any significant percentage. Again, it was a very high percentage. I keep repeating, 80 per cent of the total bed cuts or 80 per cent of the dollar savings that I took in this last round, were in the cities, I’m told. I’m sure you’ll find I may be out by a per cent or two, but it was in that range.
But what disturbs me most is the belief that you express -- and you’re a person I have respected, and I still respect, because of your long-term interest in preventive care, exercise and all those things that I believe in -- that more dollars and more hospital beds mean more health; they don’t.
Mr. B. Newman: I don’t necessarily believe that. I’m simply trying to point out, as you know, that the facility is antiquated. You know you’re eventually going to build a facility for them; in fact, you yourself say it will be in 1980. You can accelerate that.
Hon. F. S. Miller: Mr. Chairman, should one build beds today when surpluses exist and beds are sitting empty? In that city there will be beds empty even after these changes and without Riverview,
Mr. B. Newman: But whose fault is that?
Hon. F. S. Miller: It’s not a fault.
Mr. B. Newman: What do you mean, it isn’t a fault?
Hon. F. S. Miller: Let me point that out. It is not a fault.
Mr. B. Newman: Your government approved the construction of those other hospital beds.
Hon. F. S. Miller: Right. But I’ve also had letters from every member of this House, I think, asking me for more nursing home beds in the last few years. Have I not had a letter from almost every member, at least of the previous House?
Mr. B. Newman: I don’t think so
Hon. F. S. Miller: Well, there are not too many of you who were in the last House --
Mr. B. Newman: I don’t think I’ve ever written you a letter on that.
Hon. F. S. Miller: Well, you must be one of the exceptions. Certainly I’ve had them from Windsor. I’ve had them from the north. I’ve had them from almost every riding -- I won’t say every one.
Dr. Potter, in his wisdom, albeit sometimes criticized, pointed out that we couldn’t continue creating more and more expensive hospital beds and that the alternatives had to be provided. And contrary to the comments made by many critics, he and we provided them first and then cut back on the active beds. That’s what permitted a change in the overall provincial planning standards for active treatment beds. I’m reasonably sure they can be cut further without affecting the health of us in this province.
Chronic beds cost less than active beds, and they will cost less; I think the savings are greater than we compute in some ways. When we utilize the existing beds in existing hospitals -- rather than carry on with five institutions, we’ll have four -- we will still have spare capacity. To the best of my knowledge, although I stand to be corrected if my staff can tell me I’m wrong, we didn’t change the psychiatric bed setup in Windsor. We suggested changes, but who listened to the arguments of your hospital council and accepted their recommendations. Is that not so?
Mr. B. Newman: I don’t know.
Hon. F. S. Miller: It’s true. I read the letter into the record earlier and I think you’ll find we accepted their recommendations on psychiatric beds after due consideration. Therefore, the present three hospitals providing psychiatric care will continue providing it. Our staff and our psychiatric advisers suggested there were both good savings and good reasons for consolidation, but your hospitals and your council felt otherwise and we accepted that advice. We did ask them to look at paediatrics and obstetrics, and we gave them a year to give us an answer. And surely, again, that was fair. That was their suggestion and again we accepted it.
So really, in all seriousness, I think of all the places in the province that have had to face some of the tough decisions, Windsor has had a fair shake. Windsor has participated, Windsor has been listened to and, apart from some of the predictable public reactions, Windsor is reasonably satisfied,
Mr. B. Newman: I did make mention at the outset of my comments that you did consult in our communities and we appreciated the opportunity of having input. But consultation only goes up to where it meets your standard or your requirement and after that the heavy hand comes down.
You can recall that the suggestion from the health council was for 160 beds to be maintained at Riverview Hospital. You insisted on 120 beds. All I ask you is to guarantee the community that the individuals at Riverview will get the same kind of health care as a result of your rationalization and that you keep in mind that a new chronic-care hospital or transforming one of the hospitals into a chronic-care hospital is by far a better answer than distributing those requiring chronic care through four or, as you say, five facilities in the community.
Hon. F. S. Miller: Until the changes are effected I can only say I hope and trust the quality of care will be up to the standards that exist today. I took the time to look up the April 14, 1975, copy of Hansard, and unless we have researched the wrong copy, I don’t see --
Mr. B. Newman: Right at the bottom of the Hansard, in the right-hand column, the last couple of lines.
Hon. F. S. Miller: Well, I must have the wrong one then. So therefore rather than argue with me, you did pose the question but you did not get the answer that you claim I made. I would appreciate your making reference to it specifically if you can find it.
Mr. B. Newman: I will do that personally.
Mr. Grossman: Mr. Chairman, I hope you will allow me to speak with as much clarity and length as you did before you assumed the Chair. I also say that I have learned my lesson. The member for Windsor-Walkerville said he would be about 10 or 15 minutes, but it’s not the first miscalculation he has made today.
Mr. Warner: Take your time.
Mr. Sweeney: You are wasting time. Come on, there are 20 more of us over here.
Mr. Grossman: I don’t really have to repeat just for the sake of Hansard or the record a lot of those valid points that have been made with regard to Doctors Hospital by both opposition parties, and I won’t purport at length to so do. Suffice to say, before I cover some similar ground, lest my friends in Her Majesty’s loyal opposition took me the ether day to suggest that they ought not be supporting the fight against Doctors Hospital, let me assure them that I do quite understand that very many of their constituents are seriously affected by the closure, as are a great number of mine.
As one who has made clear that I would oppose the closing if I were aware of the facts, as I am, even if it were not in my riding, let me say that it ill-behooves me to suggest that the members opposite ought not do the same when they become equally aware of the facts, which is not, however, to say that I quite approve in any way whatsoever the way they conducted themselves or handled themselves at those meetings at which were assembled very many hundreds of threatened people who were trying to guess which way to move at the particular time.
Having said that may I assure them that any facts they brought out during the debate I am very happy to receive and I will attempt as a result not to get emotional unnecessarily, nor to get involved in too much rhetoric during my remarks about this hospital.
As the minister will attest, I have done my share both outside the Legislature, and inside this building outside of this assembly. I would like to begin by referring immediately to the statement issued by the ministry on, I think it was Monday, Feb. 2, when they discussed the oncoming hospital closures in Metro Toronto. At that time on page 3 of the release, the ministry stated under “Hospital Closures” the following:
We determine where closure is possible by looking at hospitals with an alternate facility within reasonable travelling distance and institutions where a building programme was essential for the continuation of its operation. In our review we also assured ourselves that the facilities nearest these institutions could accommodate the additional patient days. In many instances, the hospitals identified for closure have occupancy rates that are considerably lower than their peers. Virtually all hospitals identified for closure have an average length of stay higher than comparable facilities, a reflection of under-utilization.
Well, as has been the habit, I think 1 may deal with those in reverse order. That may cease, because the member for Sudbury East (Mr. Martel) was advising the minister at some length on how to handle question period tomorrow a little earlier.
Mr. Lewis: The minister works only in reverse.
Mr. Grossman: I understand.
Mr. Lewis: Therefore, he answers only in reverse order.
Hon. Mr. Miller: Even though I went to Mr. Transmission.
Mr. Lewis: That isn’t you. That’s your colleague in Community and Social Services.
Mr. Grossman: I think I will save my election rhetoric. I may need it shortly. In any event, “average length of stay higher than comparable facilities.” This is one of the criteria for closure. Well, not only is that not true about those hospitals there in the peer group of Doctors Hospital but it is even more untrue about the hospitals in the vicinity of Doctors Hospital. Let me quickly recite some comparable average length of stay periods.
For the peer group in Metro Toronto, the Doctors Hospital has an average length of stay of 7.5 days. The peer group: Etobicoke General, 7.8; Humber Memorial, 9; Northwestern General, 7.7; Queensway, 10.1; York-Finch, 7.8. Those are the peer groups.
Now let’s look at the downtown Toronto teaching hospitals -- St. Michael’s, 12.1 days; Toronto General, 10.8; Toronto Western, 12; Women’s College, 9.7; Wellesley, 11.6 and so on and so on. They are all, without exception, hospitals which have a longer average length of stay than Doctors Hospital.
So when the ministry says, “In many instances the hospitals identified for closure have an average length of stay higher than comparable facilities,” it is inapplicable to the Doctors Hospital. Secondly, the ministry goes on: “In many cases, the hospitals identified for closure have occupancy rates that are considerably lower than their peers.” Occupancy rates are supposed to be considerably lower than their peers if the hospital was closed. Well, the Doctors Hospital has 83.9 per cent occupancy. What about the peer group that wasn’t closed? Humber Memorial is busier, 92.7 per cent; Northwestern General, 78.4 per cent; Queensway about the same, 84.3 per cent; York-Finch, 83.6 per cent, about the same. Certainly Doctors Hospital has a percentage of occupancy which is equally sufficient and certainly not “considerably lower” than its peers.
Try another criterion. The ministry says: “We also assured ourselves that the facilities nearest these institutions could accommodate the additional patient-days.”
My friends and some others opposite have pointed out that the bed surplus, the ability to accommodate the patient-days, is clearly denied by the adjacent hospitals. It’s not there. Or there is some feeling that more patient-days could be squeezed into those beds. The institutions themselves have denied that they can accommodate all the additional patient-days. With regard to that surplus, with regard to that ability, the Henderson report, which was referred to earlier and quoted, has also indicated that there isn’t a bed surplus that is close enough or indeed existent at all in order to “accommodate the additional patient-days.”
Surely if it is a fact that the institutions nearest can accommodate those additional patient-days, it’s no great trick for the ministry to identify where that accommodation will occur, to what extent and how many patient-days will be picked up. But they can’t do it for the simple reason that the hospitals in the vicinity can’t do it; they can’t indicate their ability to pick up those additional patient-days at any cost -- and we’ll get into the cost later.
So the ministry has not assured itself, nor has it assured this member, this assembly or the institutions involved, that those institutions can accommodate the additional patient-days.
Mr. Nixon: Has he assured you there will be a saving in money?
Mr. Grossman: It hasn’t satisfied me as of yet.
Mr. Grande: Are you going to resign?
Mr. Nixon: He has got until tomorrow, I understand.
Mr. Grossman: Until the 5th.
Mr. Nixon: Oh well, lots of time.
Mr. Grossman: May I also say to my friends opposite, I appreciate their support. I know they find it shocking when a party does not exercise a strong whip on all of its members and permits one of its members to speak out on a matter about which he feels very strongly.
Mr. Samis: It is healthy.
Mr. Reid: You know that it is all a plot to get rid of you.
Mr. Nixon: But your hospital closing was just a political token, you know; you are just a show Tory.
Mr. Grossman: I was about to give you a compliment --
Mr. Speaker: Order, please.
Mr. Warner: They’ve saved your seat on the far right.
Mr. Grossman: No kidding.
Mr. Grossman: I was about to give you a compliment, Pat, but you blew it; now I’m not going to.
Mr. Grossman: That’s something that some of the more democratic parties in this country and in this Legislature can allow; it keeps them healthy and it is something I suggest should be commended. I appreciate your support anyway, even though your mouths are agape.
Mr. Grossman: Secondly, the ministry continues: “Institutions where a building programme was essential for the continuation of its operations.” Mr. Chairman, lest anyone still wonder whether or not the institution requires a building programme for the continuation of its operations, let me first reaffirm the ministry’s position. In the fact-sheet that was distributed with regard to the Doctors Hospital on the announcement of the closing, on page 2, under “Selection,” the ministry goes on to say:
The principal season that Doctors Hospital was selected for closure is simply that the hospital would have had in have been totally replaced within the next few years.
Mr. Grande: They know it is not true.
Mr. Grossman: I’ll tell you why it’s not true. Firstly, the ministry has seen to it that it’s not true by spending a heck of a lot of money on the building in the last five years. Let me just run through a few of them. These are works completed since 1971: Complete implementation of changes requested by the Ministry of Health to conform with updating of requirements of the Fire Marshal; reworking of the medical gas system; alteration of access to patient bedrooms; alteration of previously poorly utilized admitting and emergency suites; rearrangement of nurseries; replacement of eroded water supply; modernization of dishwashing facilities; addition of ventilation systems; redesign of main entrance; re-roofing of both the original hospital buildings; three new heating boilers; air- conditioning and humidity control for safety; addition of facilities to enable the electric wiring of all patient areas to be put on emergency standby power; elimination of waste incineration to suit the air management branch; addition of new small pathological waste incinerator; reworking of the waste chute; paving of the parking lot; redesign of a proper coronary care unit; general re-arrangements of the cafeteria; and a miscellaneous set of works to update the mechanical and the electrical installations. I could go on --
Mr. Chairman: There seem to be quite a few conversations going on in the House; I wonder if we could be a little more quiet and listen to the member.
Mr. Grossman: It will be quieter after the election, Mr. Chairman.
Hon. F. S. Miller: Please turn left.
Mr. Chairman: I would like a little bit of order, please.
Mr. Nixon: You are a very harsh chairman.
Mr. Chairman: Will the member continue?
Mr. Grossman: The hospital quite sensibly sought out and obtained an architect to give an independent assessment of the building. Let me quote just one portion of his report:
Certainly at this time, after all of the work done in improving its planning and fabric, your complex need not be replaced for any functional reason and not within a few years. The existing plant will survive without anything more than usual maintenance cost for as many years as the government may desire.
That’s the certified report of an architect who studied the building one month ago.
In any event, notwithstanding that, if it was felt that the building was one in which “a building programme was essential for the continuation of its operation,” and if it is evident that the building can continue for a few years and where the government acknowledges that the building and the operation is an efficient one, surely the government should make do with that older facility. After all, the name of the game is to save money -- not to close hospitals, not to close beds, but to save money.
Finally, the fifth criterion, or the first in their order, is an alternative facility within reasonable travelling distance. Well, I suppose we can’t deny that there are alternative facilities within reasonable travelling distance but whether those alternative facilities can accommodate the additional cases, whether all the doctors on staff get into those hospitals and, most importantly, whether the patients can and will travel and be welcome at those institutions is another matter. More to the point, there has been no analysis which shows that these alternative facilities within reasonable travelling distance can take on those cases and treat them as inexpensively as the Doctors Hospital has been treating those very same cases.
Mr. Chairman, I suppose I need not read into the record all of the evidence that shows that the Doctors Hospital was perhaps the second or third most efficient hospital, by all standards and including all hospitals of all sorts, in the province. I need not do that, because the minister in question period acknowledged the efficiency of the hospital and the fact that efficiency did not play a role.
Suffice it to say then that an analysis of hours of work per day, which is generally accepted as the most accurate standard of efficiency and the most crucial one in view of the fact that salaries comprise 80 per cent of the operating budget, shows that the Doctors Hospital substantially outstrips and outperforms all other hospitals. Most important --
Mr. Lawlor: You may perjure yourself on this one, and save a by-election.
Mr. Grossman: If I do, I’ll win it.
Mr. Martel: Don’t count on it.
Mr. Grossman: If I don’t my successor as nominee for this party will win it,
Mr. Martel: Who are you running for, the Liberals?
Mr. Grossman: Maybe my predecessor will come back.
Mr. Samis: That is nepotism.
Mr. Nixon: Lots of other good ridings.
Mr. Grossman: We’ve done it before.
Mr. Nixon: What are you getting out of them?
Mr. Grossman: That’s what I say -- mostly held by Her Majesty’s loyal opposition.
Hours of work per diem -- Doctors Hospital, 11.1.
Mr. Grande: How do you tolerate him?
Hon. F. S. Miller: We are a democratic party.
Mr. Grossman: That’s right. I say to the member for Oakwood I have explained that we do have a democratic party and my friends on this side of the House may not be happy tolerating it but accept it as part of the system. That’s the system over here.
Mr. Samis: Why be so defensive about it?
Mr. Grande: I want you to speak.
Mr. Grossman: I know it isn’t quite the same over there. I know you all believe in everything that happens over there.
Mr. Warner: Do you oppose it?
Mr. Chairman: Order, please.
Mr. Grossman: In any event, getting back to the Doctors Hospital, which is why I’m on my feet. The Doctors Hospital, 11.1 paid hours of work per day. Toronto General, 19.8. Toronto Western, 17.2. New Mount Sinai Hospital, 21.2.
Mr. Martel: That’s an exercise.
Mr. Grossman: Suffice it to I say I do not allege that these other hospitals are operating inefficiently. I do not say that they should be penalized. What I do say, is that when you’re saving money, how can you save it by closing down your efficient-running Ford and shifting everyone over into a Cadillac?
Hon. F. S. Miller: Mr. Chairman, I have to rise on a point of order.
Mr. Chairman: Order, please.
Mr. Warner: It is a fine time.
Hon. F. S. Miller: I don’t mind him criticizing me as Minister of Health but when he starts talking about efficient-running Fords to an ex-GM dealer, it’s just drawing the line a little too fine.
Mr. Martel: That is a point of distinction.
Mr. Chairman: The hon. member will continue .
Mr. Grossman: When the ministry wants to shift people out of Chevrolets which are running efficiently and into fancy Cadillacs which are well run but which by their very nature, cost more to run how are you going to save money? I would say that I can’t neglect the fact --
Mr. Martel: Resign.
Hon. Mr. Rhodes: The member for Sudbury East is an expert on Cadillacs and big houses.
Mr. Mattel: Inco gave me one.
Mr. Warner: Tell him about switching sides.
Mr. Chairman: Order, please.
Mr. Grossman: I wouldn’t call the member a Cadillac; perhaps a tank but not a Cadillac.
Moving from those five criteria -- the Doctors Hospital does not fall into any of them -- generally, when applying them to the closing, we must deal with how and why you’re going to save money.
I hate to say that private industry would do it better -- and I’m not saying that -- what I am saying is that if we were dealing with a situation in private enterprise -- of closing down one plant, to move that facility into another plant -- there would have been a very careful analysis of exactly --
Mr. Nixon: Doctors Hospital used to be a private industry until it was nationalized.
Mr. Grossman: Some days I wish it still were. There would be a careful analysis of exactly what is happening in the old plant -- exactly where the people who worked in the old plant were going to go; exactly where the input was going to be replaced and turned out; exactly where all that production was going to occur; and should have said where that saving would be effected and what the new product coming out of the new plant would cost.
I understand, certainly, it’s more difficult to do it in the health field. But I suggest, as well, that it’s not totally impossible to have a fairly good idea, with fairly good reasons and fairly good reasoning within some percentage of error, before you go about throwing 600 people out of work. You can’t just do it and guess that somehow we can squeeze the other institutions, because you may be wrong.
Mr. di Santo: You’re darn right he can. The minister is incompetent.
Mr. Grossman: It seems to me that in Metro Toronto the downtown Toronto hospital budget is somewhere just over $200 million. Taking the other hospitals in Metro, the total is somewhere around $430 million or $450 million. It’s inconceivable to me that this was the only way in which this saving could be effected.
Surely a general squeeze on the system would have put that additional pressure on those beds, wherever they be located, wherever those alleged vacancies occur, sufficiently to save $6.5 million. I quite agree with the minister when he says that if he can squeeze those $450 million down to save $8.5 million and close the Doctors Hospital or any other hospital, then he must consider saving money each and every place that he can. In other words, he may suggest it’s not an either/or situation. That’s fair enough. But we’re dealing with the same beds. We’re dealing with the same problem which, in essence, stems from the conclusion that there are about 400 surplus beds in Metro Toronto.
This House has discussed in some detail, as has the Henderson report -- and I won’t burden the House with hearing all that over again with all the arguments -- that there is, in fact, no surplus. I believe there is little or no surplus. The Henderson report is not usually one of my favourite documents. The special programme report, isn’t that what they call it? In any event, suffice it to say I don’t believe there is much of a surplus, if any, and if there is one, no one can quite identify it.
I think the feeling is that the surplus is in the availability of beds and in the minister’s acknowledgement that where there are beds they will be filled. So the name of the game, really, is to put pressure on beds; to have those beds turned over more quickly than they’re being turned over at the present time.
Let me comment that here is no hospital in Metro that turns over beds as quickly as the Doctors Hospital. I won’t bother you with all the figures. Trust me, the figures are here.
Mr. Singer: Why don’t you tell the minister about this, not the rest of us? The minister is the fellow.
Mr. Grossman: And if you want to get the other hospitals to somehow see if they can push through more patients --
Mr. Singer: But you are on the wrong side of the House to make that speech.
Mr. Grossman: -- in the same number of beds, that’s fine. Squeeze all over; squeeze on your $430 million, but don’t --
Mr. Singer: Larry, who are you preaching to?
Mr. Grossman: Unfortunately, I’m preaching to somebody who has already heard it.
Mr. Singer: In other words, the minister has turned his back on you. Who are you preaching to, Larry?
Mr. Grossman: But do not squeeze one portion. Squeeze all of them, including the staff portion, wherever they may be.
Mr. Singer: Preach to Miller. He won’t even listen to you. He turns his back on you.
Mr. Grossman: He’s listening. He’s heard it.
Mr. Singer: Listen to your own member. You are going to defeat him.
Mr. Chairman: Order, please. Order.
Mr. Grossman: The minister is tired. He spent a long time listening to your members.
Mr. Singer: Yes, he’s tired and sick.
Mr. Nixon: He’s about to retire.
Mr. Chairman: Order, please.
Mr. Grossman: He spent a long time listening to your members go on at length. It’s our turn over here.
Mr. Singer: Who closed your hospital?
Mr. Nixon: Yes, he is tired and sick. Who closed your hospital? Miller closed your hospital.
Mr. Chairman: Order, please.
Hon. F. S. Miller: Mr. Chairman, please ask them to refer to me as the Minister of Health.
Mr. Singer: No, Miller closed your hospital.
Mr. Chairman: The hon. member for St. Andrew-St. Patrick.
Hon. Mr. Rhodes: Mr. Chairman, if the interjections are going to come from the hon. member, why doesn’t he move to his proper seat? That’s what he is supposed to be doing.
Mr. Chairman: Order, please.
Mr. Singer: Come on, come on. It is your fault. You gave it to him.
Mr. Chairman: Order, please. The hon. member will continue.
Mr. Singer: You are punishing him for having been fired. Too bad.
Mr. Chairman: Order, please. Will the hon. member return to his seat if he wishes to address the Chair?
Mr. Grossman: I just want all the candidates from St. Andrew-St. Patrick to know what was happening in the House the evening that we were debating the Doctors Hospital as it applies to the party that inadvertently caused the election.
Mr. Martel: So you would resign?
Mr. Chairman: Order.
Mr. Grossman: At least the opposition and I were discussing the hospital.
Mr. Singer: Miller cancelled your hospital.
Mr. Grossman: Meanwhile back at the hospital.
Mr. Singer: Yes. Miller cancelled it.
Mr. Chairman: Order, please.
Mr. Singer: All the people who like doctors have to pick on Miller.
Mr. Chairman: Order, please. Will the hon. member for Wilson Heights kindly refrain from interrupting?
Mr. Singer: No, no. Kick me out.
Mr. Chairman: Will the hon. member return to his seat if he wishes to address the Chair?
Mr. Singer: I am sorry, Mr. Chairman. Miller cancelled the Doctors Hospital.
Mr. Chairman: Order please. The hon. member will return to his seat if he wishes to address the Chair.
Mr. Singer: I am not addressing you, I am just commenting.
Mr. Chairman: The hon. member will continue.
Mr. Grossman: The hon. Minister: of Health cancelled the hospital and Smith, the leader of the Liberal Party, said he thought a supportable case could be made out for the closure of the Doctors Hospital.
Mr. Singer: How are you going to find any work? Are you going to vote with the Minister of Health?
Mr. Grossman: That’s what he said. Of course, that was the morning of that day.
Mr. Singer: Tell us why it was justified.
Mr. Chairman: Order, please.
Mr. Grossman: Mr. Chairman, in analysing what is going to happen after the closure of the Doctors Hospital supported by the leader of the Liberal Party, some analysis ought to be made of the various and non-variable costs.
Mr. Singer: Who ordered it? Miller has gone.
Mr. Grossman: Let me say that when this matter was taken up with some of the officials in the ministry there was an indication made and admitted that not all of the patient-days would have to be picked up. When I asked how many of the patient days will not have to be picked up there was no answer. They didn’t quite know.
Mr. Singer: There was no hospital left.
Mr. Grossman: I pointed out that I am a fairly reasonable man, which I am, and that I would accept an indication of whether it would be closer to five per cent than 50 per cent.
Mr. Grossman: You may learn something, just settle down.
Mr. Singer: What do you take up if you haven’t a hospital left?
Mr. Grossman: There was no indication. They couldn’t say whether the loss in patient- days would be closer to five per cent than 50 per cent.
Mr. Singer: Very difficult if you haven’t got a hospital there to do it.
Mr. Grossman: Then we must look on to those costs that move with the patient. Some cost obviously have to move with the patient. You are still going to feed him. You are still going to take x-rays. You are still going to treat him with drugs.
Mr. Singer: Very difficult if you haven’t got a hospital there to do it in.
Mr. Grossman: You are still going to clean his sheets. There is still going to be some housekeeping service and there is still going to be some special services with regard to dietetics and general admission and medical records and libraries.
Mr. Singer: How do you do that if you haven’t got a building?
Mr. Grossman: Now, some of them can be separated out and applied onto, for example, general administration. So that when the ministry says, as they are quite entitled to do, “Obviously if you close an entire unit it is cheaper than closing down several beds in several units.” But it’s not quite so obvious when you take the next step and say: “Well, where are they going to go after yon close them?”
Obviously, in accordance with the fact sheet they’re going to go to the hospitals in the vicinity. And the hospitals in the vicinity are not only going to have to pick up a lot of the non-variable costs that must move with the patients, such as food, but they’re obviously going to be picking up a lot of other costs. And so far, because of their very special nature, they have been able to do so only at costs which are substantially greater than at the Doctors Hospital.
I’ve heard it said that obviously it’s comparing apples and oranges when you talk about community hospitals such as the Doctors Hospital, and teaching hospitals such as the ones on University Ave. That’s true, except if you’re saying to those patients, “Would you mind moving from the apples to the oranges and start using the oranges?” Then you’ve got a valid comparison. Then you’re entitled to compare those figures.
And, yes, I quite agree that obviously it’s more expensive to treat them at a teaching hospital. The question surely becomes, to use the vernacular: Is the incremental cost such that those additional cases can be handled more cheaply? In simple terms, without taking you through the calculations, let me say that it would require the teaching hospitals, which now treat patients at about $1,800 per case, to pick up the additional cases at about $240 per case -- from $1,800 to $240 as an incremental cost.
If that happens, if they can do that, then surely a calculation -- even if it hasn’t been made so far -- can he made tracing down how it is expected that it’s feasible that the incremental cost can be as low as $240. So there are a lot of questions remaining to be answered.
Mr. Singer: Tell us why he closed Doctors Hospital.
Mr. Grossman: One of them is the position of your party; but the other one is laboratories. For example, there is no hospital lab in the province -- and here are the figures -- that has a lower per-unit cost than the Doctors Hospital. Here it is, the lowest in the province. The average cost per 100 units of their special services in laboratories is lowest in the province. What’s going to happen to those costs? Can that be averaged down? Certainly not. Are the same number of tests, or whatever, done? How are they going to be done at the new hospitals and for how much?
I was in the House earlier when the member for Grey-Bruce (Mr. Sargent) was talking about the numbers of people who supported his position.
Mr. Singer: Do you object to that?
Mr. Grossman: No, I only feel obliged to point out to him that while his effort is, I’m sure, stupendous in that regard in terms of his community, the Doctors Hospital has pretty good support in Toronto. There are at the moment 80,000 people --
Mr. Singer: And that’s why you’re going to vote against your minister? Are you going to be brave?
Mr. Chairman: Order, please.
Mr. Grossman: I understand the leader of the Liberal Party has already decided on this issue.
Mr. Singer: Stand up; vote against him.
Mr. Grossman: The government is open to appeal on this issue; so this is for them. I know that your decision is made.
Mr. Singer: Come on. Tory poop.
Mr. Grossman: A total of 80,000 people in Metro have signed a petition -- 80,000 is the last count; it could be 84,000.
Mr. Singer: And the minister is very concerned. He’s walked out on you.
Mr. Grossman: I wonder what Wilson Height’s count is in view of the position of the Liberal Party.
Mr. Singer: He has walked out on you.
Mr. Chairman: Order, please.
Mr. Grossman: A while ago it was 1,421.
Mr. Singer: He walked out on you. Are you going to vote against the government on this?
Mr. Grossman: Anyway, let me finally say -- not shortly, just finally -- that I needn’t be- labour the facts and figures on the hospital. Not only do the ones we have covered speak for themselves with regard to the excellent operation being performed at the Doctors Hospital, but also it’s fairly obvious that if a shift must be made of those patient days, there must be some understanding and some anticipation of how many patient days are going to be picked up, where they are to be picked up, how they are going to be picked up and at what cost.
The ministry may be correct in saying they feel in their experience and wisdom that it can he picked up and that somehow in the general squeeze by their power of the purse, by their power not to allot any more money for the treatment of those patients, they can squeeze the savings so that the $6.5 million saving is effected. I just don’t see how it can be done at the present time.
Let me say clearly and go on record as saying that even if that $6.5-million saving can be effected, it ought not to be effected in this particular institution. I well understand that there are several hospitals -- nine others -- being affected in this province, and each of them has its own very special case. Some of them may prevail, some of them may be more special than the Doctors Hospital. and some may be less special. I don’t think myself that a more special case can be made out than that for Doctor’s Hospital.
Mr. Singer: Are you going to vote against it?
Mr. Grossman: I need not dwell at length on the importance of this hospital to a very special community. Let me say, however, that that community has developed a particular attachment to the hospital for some very good reasons. It is not enough to say there are 56 languages spoken at Toronto General Hospital, so everyone will be looked after. The languages spoken at the Doctors Hospital are spoken by the family practitioners, by the medical staff.
The languages are spoken by the very medical staff that at the Doctors Hospital work on a team basis. They can treat their patients right through, including the time during which they are operated on by the attending specialist up to the point at which they are discharged from the hospital. That is the way in which those persons who have a language difficulty, those persons who do not speak English, have a connection and an understanding about what has happened.
Anyone who has spent time in a hospital will understand that being perfectly fluent in English is not enough to prevent some feeling of paranoia, some feeling that I am locked in here, lost in a hospital, ill, and I need some help. It is bad enough being in a hospital without a language problem.
Mr. Singer: Having said all that are you going to support the government?
Mr. Grossman: This is a little too serious for heckling.
Mr. Chairman: Order, please.
Mr. Grossman: That’s why it’s different.
Mr. Singer: How can you support the minister after having said that?
Mr. Grossman: That’s why the number of languages spoken is not so important as who speaks the languages, and what privileges those persons who speak those languages have to treat their patients.
Mr. Singer: They are impressed with you; they tell me that.
Mr. Grossman: Let me tell you something about the doctors on staff. Let me read to you the countries of origin --
Mr. Singer: You make the speeches but you vote against them.
Mr. Grossman: -- and the places in which some of the staff, just some of the medical staff, got their degrees: Romania, Italy, Portugal, Bucharest -- Romania again -- South Africa, Portugal, Mexico, Philippines, Philippines, Hungary, Glasgow, Hungary, West Indies, Spain, Poland, Spain, West Indies, West Indies, Spain, Spain, Spain, Hungary, Turkey, Germany, Romania, Romania, Romania, Uruguay, South Africa, Yugoslavia, Spain, India --
Mr. Grande: Are you going to go on until 10:30?
Mr. Grossman: Yes. Yugoslavia, Taiwan, Taiwan again, West Germany, South Africa, Indonesia, Czechoslovakia; and so on.
Mr. Singer: You certainly have impressed the Minister of Health with all that. He is convinced.
Mr. Grossman: That is some example of the composition of the medical staff at Doctors Hospital.
Mr. Foulds: Are you going to cause a by- election?
Mr. Grossman: Let me also say that I was rather shocked to read that when the Grace Hospital was reprieved, for whatever reason, a spokesman was quoted as saying: “Few hospitals in this area have the warm relationship between it and the public that this hospital does.” I say that few hospitals may have as warm: a relationship, but certainly one of those few which does -- and has a warmer one -- is Doctors Hospital.
An hon. member: Will you run: as a progressive or as a Conservative.
Mr. Grossman: Let me say that we will fight the election when it comes, let’s talk about the Doctors Hospital.
Mr. Singer: I thought you were going to resign. You have given that up, eh?
Mr. Grossman: There are a lot of people at that hospital who require --
Mr. Singer: They don’t speak very highly of you.
Mr. Grossman: I wonder what they think of the party whose leader and member for Wilson Heights do not support the hospital’s continued existence?
Mr. Chairman: Order, please. Perhaps you will return to the estimates.
Mr. Grossman: Those persons --
Mr. Singer: How are you going to vote on this?
Mr. Grossman: If the member for Wilson Heights wants to stand up and give a lengthy defence of the hospital, then he will be entitled to ask the question on how certain people are going to vote when it comes to voting on the hospitals. I tell you --
Mr. Singer: The vote is much more important than the rhetoric.
Mr. Grossman: If that member is prepared to stand up and be counted --
Mr. Chairman: Order, please.
Mr. Grossman: -- it ill-behoves him to stand up and heckle. Now before 10:30, let me say that there a lot of people --
Mr. Chairman: Order.
Mr. Grossman: -- obviously affected in this area.
Hon. Mr. Rhodes: The other half of the Sargent-Singer combination. Throw him out.
Mr. Grossman: There are a lot of people in the affected area to whom the lack of a sufficiently detailed explanation is more than just an error, is more than just a misunderstanding; it is critical. Some of those people, who have been through concentration camps and have fled Europe and fled a lot of dictatorships, don’t understand when officials of the ministry say --
Mr. Singer: We don’t understand how you can speak one way and vote the other.
Mr. Grossman: -- they are going to come in with lead boots.
Mr. Singer: Some of us don’t understand it either.
Mr. Grossman: They are entitled to a little more than to be told that the time has come to apply the lead boots. Somehow they don’t understand that is just an indelicate way of explaining that we have to squeeze some hospital beds in Metro Toronto.
Mr. Singer: Are you voting for destruction of Doctors Hospital, having made that speech?
Mr. Grossman: Somehow it is just as important -- if the member for Wilson Heights won’t let me finish, I would be happy to finish tomorrow.
Mr. Grossman: Mr. Chairman, are you going to adjourn or shall I continue?
Mr. Singer: Explain it.
Mr. Chairman: Order, please. Perhaps, as it is close to 10:30, the hon. House leader will move the committee rise and report.
Hon. Mr. Taylor moved that the committee rise and report progress.
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. Taylor: Mr. Speaker, in the absence of the House leader, I would like to indicate tomorrow’s House business. The Premier (Mr. Davis) will be speaking in the Throne Speech debate following the question period, followed by consideration of supplementary estimates by the committee of supply. I understand the estimates will be those of the Ministry of Community and Social Services.
Hon. Mr. Taylor moved the adjournment of the House.
Motion agreed to.
The House adjourned at 10:30 p.m.