Hansard Transcript 1988-Nov-28 | Legislative Assembly of Ontario

Mr. Farnan: On May 2, 1986, four-year-old Joey Kocher was struck by a car, which resulted in severe brain damage for Joey. He will be for ever confined to a wheelchair.

Joey was maintained in chronic care facilities from 1986 until his release in August 1988. Richard and Brenda Kocher were informed that Joey would be able to attend school as of January 1989. The chief of paediatrics, Dr. Biggar, at the Hugh MacMillan Medical Centre in Toronto recommended that Joey attend school in an integrated classroom environment, and the Waterloo County Board of Education is willing to accept him.

However, neither the Ministry of Community and Social Services nor the Ministry of Health will provide the funds to make this possible. Cutbacks in home care programs of the Ministry of Health are affecting education integration for Joey Kocher and many other boys and girls who require these services.

Failure to adequately fund these home care programs gives the lie to memorandum 81 and Bill 82, which guarantee every child in the province the right to an education suitable to his or her needs. Over the last four years, the home/school care program in the region of Waterloo has experienced a growth of over 300 per cent and restrictions are now being placed on the provision of services to children like Joey. In effect, it denies Joey the opportunity of reaching his full functional and cognitive potential.

LOVESICK LAKE NATIVE WOMEN’S ASSOCIATION

Mr. Pollock: On Saturday evening, I was privileged to attend a wild-meat dinner held in Buckhorn and sponsored by the Lovesick Lake Native Women’s Association. Not only was this a very interesting and delicious dinner, but it also served as a fund-raising event for this hardworking group of ladies.

This current project is to construct their camp, situated on 247 acres of land in Peterborough county. The camp program to be offered will allow children, both native and non-native, to learn about and experience native heritage and culture. Their dream is becoming a reality, as they soon will be in operation.

The Lovesick Lake Native Women’s Association has published a cookbook, known as The Gathering, which has become a Canadian bestseller. At this time, I should like to compliment and congratulate the association for its contribution to the culture and heritage of Ontario.

DIAPERS

Mr. Adams: Conventional disposable diapers are a symbol of the strengths and weaknesses of our society. A boon to millions, including the Koning-Keenan quads of Peterborough, they are convenient and efficient for their immediate use. But disposal creates problems, also typical for our society. The plastic in them is not degradable; it persists in dumps for ever. The contents of used diapers are deposited in places not designed to receive them, producing dangerous chemical reactions. Given the will, there are many partial and complete solutions to disposable-diaper problems, most of them economical.

We could keep disposable diapers, using degradable plastic, and regulate disposal of contents. We could encourage the use of reusable diapers, either plastic or cloth. Laundering these includes appropriate disposal of contents. Since Bruce Knapp and Peterborough city council attracted attention to this problem, I have received sample reusable plastic diapers from Contact Sales of Quebec and heard of others from Ontario and Quebec. I have heard from diaper laundering services, including a new one established in Peterborough which acquired 18 customers within a few hours.

These illustrate the job creation potential of reuse and recycling. Disposable diapers are symbolic of general problems facing society, in that they are creating problems for the very people they are designed to serve -- in this case, babies.

EMPLOYMENT ADJUSTMENT

Mr. Hampton: In the runup to the negotiation of a trade deal with the United States, one of the first things we bargained away was control over our softwood lumber and softwood lumber exports. It was the softwood lumber export tax. The province said that it would use the proceeds from the softwood lumber tax to assist northern Ontario communities that were hurt by the imposition of the 15 per cent export tax.

A stud mill is closed in Kenora, putting some 125 people out of work. A sawmill in Hudson has had several layoffs. Longlac has been hit; Timiskaming has been hit. What assistance has the province provided to these communities in the way of retraining allowances or relocation assistance? Little, if anything.

Last week, we had further examples of the economic and employment dislocations that will result from our new trade relationship with our neighbour to the south. Yet what is the government’s response to this? These dislocations, these losses of jobs are somehow not the responsibility of the province and the province should not respond or this province need not respond. Communities all across Ontario, northern Ontario and southern Ontario, are being hurt and it is time for the government to live up to its obligations under the softwood lumber tax issue and also other obligations to meet the needs of some of the employees who have been dislocated.

AUTOMOBILE INSURANCE

Mr. Runciman: Last Thursday, the Ontario Automobile Insurance Board established a maximum 12.5 per cent profit level for companies providing auto insurance in this province. The announcement was not well received, but that should not be a surprise to this government, a government that forged ahead with a massive and costly intervention in the private auto insurance sector, apparently for ideological reasons. The Progressive Conservative Party has said from the outset that establishment of the auto insurance board would not make anyone happy.

Our party predicted that it would not reduce auto insurance rates; that it would drive companies out of the business, limiting consumer choice; that it would establish a large and costly bureaucracy that consumers, one way or the other, would pay for, and that it would ultimately, much to the glee of the New Democratic Party and its soulmate, the Attorney General (Mr. Scott), lead us into the quagmire of government-run auto insurance.

Interjections.

Mr. Speaker: Order.

Mr. Runciman: If this government were serious about reducing auto insurance rates, it would have taken steps to reduce the cost of settling claims. Currently, the cost of settling the average bodily injury claim is over $20,000, but this government, now in office for over three years, has done nothing to deal with claims settlement. Why is tort reform not on the front burner?

Perhaps the bias of the Attorney General towards a government-run system is the answer, for without tort reform and with the automobile insurance board forcing more and more insurers out of the auto insurance business, pressures to institute a government-run system will surely grow. Consumers’ only hope is the election of a Conservative government in 1991.

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BRAMPTON SPORTS HALL OF FAME

Mr. Callahan: I think every member of the House is proud of the riding he comes from and the particular home town that spins that riding. I would like to rise today to recognize three people who were honoured in my community at the eighth annual Sports Hall of Fame dinner.

One of them is Julie White, who is a competitor in track and field. In fact, she competed in the pentathlon in the Olympics as well as in the high jump.

We also have Ralph Adsetts, who was very much involved in tennis in our community and, in fact, was a builder of the tennis activities in our community, providing us with a good number of very significant competitors.

In addition to that, we have Bill Graham, who is a successful contractor in our community. In addition to having played in the Canadian Football League, he is also today a very successful horse breeder and racer.

I salute those people and I would encourage other members of the House, if they do not have this already, to take steps to find appropriate people in their communities to recognize the significant Canadians who live in their own ridings.

STATEMENT BY THE MINISTRY

SCHOOL DRINKING WATER

Hon. Mr. Ward: Last Friday, my ministry became aware of the existence of a series of drinking water tests undertaken by an independent laboratory on behalf of CBLT news which suggested the presence of soluble lead at levels higher than permitted by federal standards. The drinking water was taken from water fountains in elementary schools constructed between 1983 and 1988 in the regions of Durham, York, Peel and Halton.

Information supplied on Friday by the Durham Board of Education indicated that the tests had been conducted on samples taken from five elementary schools within that board. Early Sunday morning, a team from the Ministry of the Environment conducted verification testing at those schools.

The results of the initial round of verification tests conducted on Sunday have confirmed that, in a number of instances, the presence of soluble lead in the samples does exceed the federal limit of 50 parts per billion.

Both the independent tests and the Ministry of the Environment’s tests indicate that the lead levels are elevated when the taps are first turned on after several hours or days of nonuse. The ministry’s tests indicate further that when the drinking fountains are permitted to run for two minutes following the first test, lead levels are consistently below the recommended limit.

The verification tests, which began this morning, involve the taking of an initial sample without running the water, a second sample after running the water for two minutes and a third sample after running the water for five minutes.

Water resources officials in the Ministry of the Environment advise me that the source of the lead detected in all the samples is not believed to be the municipal water supplies. Recent testing of water supplies in 42 Ontario municipalities revealed no instance of lead levels exceeding federal standards for drinking water.

The Ministry of the Environment further advises me that the presence of lead in these samples is believed to be related to the use of lead solder in copper pipes used in the water circulation systems within new schools. The situation is accentuated because the schools are not used on weekends and drinking water sits in the pipes, permitting lead to be leached out of solder residue into noncirculating water. As a result, the water flowing through drinking fountains and taps during the first few minutes of use on a Monday morning may be more likely to contain an elevated level of soluble lead.

After discussing this possibility in consultation with officials of various ministries, we have determined that a series of steps is appropriate. I am taking the following precautionary measures to assure parents that no children will be permitted to consume drinking water at school if there is possibility that water may contain a higher-than-acceptable level of soluble lead.

First, we are conducting verification testing in elementary schools in the regions of Durham, York, Peel and Halton, with results expected tomorrow.

Second, all schools are being advised to run their drinking water for a minimum of five minutes before permitting students to consume it.

Third, drinking water in all Ontario elementary schools will be tested on a priority basis beginning with new schools and older schools that may have lead pipes.

I am assured by the chief medical officer of health that the situation I have described is not health-threatening. A recent study of blood-lead levels in schoolchildren has revealed that elevated lead levels in water do not result in health-threatening lead levels in the blood of those children.

We believe, however, that the current situation requires an immediate, thorough and reasonable response conducted in a careful and orderly fashion based on our fundamental commitment to protect the health of our children.

As an additional precautionary measure, the chief medical officer of health is prepared to proceed immediately to test the blood levels of students in situations he deems appropriate.

RESPONSES

SCHOOL DRINKING WATER

Mrs. Grier: I am reassured by the statement of the Minister of Education (Mr. Ward) that elevated lead levels in water do not result in health-threatening lead levels in the blood of children. I hope that those tests are in fact going to be carried on very widely because the situation as described by the minister today is extremely worrying.

It is obvious from the causes of the problem that the minister has explained that this is a problem not necessarily confined to schools. There are many other institutions, both private and public, which probably have the same kinds of pipes, the same kinds of lead soldering and probably the same kinds of lead levels.

I think this House ought to have from the Minister of the Environment (Mr. Bradley) a very comprehensive statement about the condition of water in this province where we know there are pipes that could be contributing to lead in water supplies. What we also ought to have from the Minister of the Environment are legislated standards for drinking water.

We do not have them in this province and it is interesting that the Minister of Education refers to the exceedance of the federal levels and the federal guidelines. What we have in this province are only guidelines or objectives. We do not have legislated standards for drinking water. We do not have an opportunity for parents or the public, who think that perhaps their health is being threatened by the existence of lead from sources over which they have no control, to initiate action in order to get some recompense. We do not have an opportunity for public discussion and involvement as to what the levels of lead that are acceptable are.

If we had a safe drinking water act, we would then have that opportunity and there is on the Orders and Notices of this Legislature a private member’s bill standing in my name that would do just that. It would provide a safe drinking water act for the people of this province.

I think that the statement we have had today from the Minister of Education proves that such legislation is long overdue and I hope this incident will perhaps be a spur to the government which, before it was a government, said we needed a safe drinking water act to finally move to put in place legislated drinking water standards for the province as a whole.

Mrs. Marland: We are concerned in our caucus about the quality of drinking water in older areas. It is very interesting to note that one of the four regions that are listed in the minister’s statement today is the region of Peel. I introduced a private bill in this Legislature two years ago dealing with the problem of rusty water in the southern part of the region of Peel.

At that time, we were told that it was the responsibility of the federal government to cost the replacement of infrastructure in older areas in this province. Given the fact that we have this problem addressed today dealing with lead, it might be quite interesting -- I know that the Minister of Education has referred to lead soldering in new pipes; it is probably equally true that the lead levels that have been detected come from old pipes and old installations which are long overdue for replacement.

Since this is the government with the $1.3-billion tax grab in 1988, and we are in the affluent end of the 1980s, it would be great if these programs that are now putting people’s health at risk could be addressed with some real money from the Treasurer (Mr. R. F. Nixon) to the local municipalities to help cost-share the replacement of rusty and outdated lead pipe installations.

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Certainly, the testing of these children is only one area of concern. This morning, I was speaking at an elementary school in Mississauga where the children were asking me whether the government expected them to drink rusty water. I told these children that the water from the lake comes into those pipes from the water treatment plants and that when it goes through that system the water is actually safe to drink.

It is a pretty sad commentary that when it gets into the local water lines to the homes and to the schools and institutions, all the millions of dollars we spend on purifying Lake Ontario water suddenly is confronted with the kind of pollution referred to in the minister’s statement today.

When the Minister of Education is sitting around the cabinet table in the cabinet sweepstakes, I hope he is able to lobby for some money for infrastructure replacement in this province. This is an ageing province and the cost of infrastructure replacement has to be borne, not only by the federal government but by the provincial government as well. I am sure that is what the Minister of Education is asking for, to address the need for a solution to these lead pipes to which his statement was addressed today.

ORAL QUESTIONS

EMPLOYMENT ADJUSTMENT

Mr. B. Rae: I have some questions for the Premier about this epidemic of plant closures we have seen in this province in the last week. I want to ask the Premier whether he is finally prepared to admit that when it comes to our employment standards law, when it comes to our labour relations law and when it comes to our private pension legislation, it is indeed the province that is responsible. I wonder if he is finally going to stand up in this House and take some jurisdictional responsibility for what is going on in the province.

Hon. Mr. Peterson: The honourable member is quite right. A number of those acts are under our responsibility.

Mr. B. Rae: With that admission from the Premier, I wonder if he can tell us when the province intends to comply with the recommendations, even of the majority on the standing committee on resources development, in its Report on Plant Closures and Community and Employee Adjustment which came out in March 1987. It made some very specific recommendations on changes that are required in our employment standards law, in our pension legislation, in our labour relations legislation and on new community adjustment funds that will be established which will provide a distinct benefit for those workers who are being affected by change.

I wonder if the Premier can tell us, when is he going to do something which even his own members told him should be done in March 1987?

Hon. Mr. Peterson: My honourable friend has asked me a number of questions there pertaining to a number of pieces of legislation. I could start one by one. If we look at the severance questions here, the members will be aware that Ontario, in many ways, leads North America on the question of severance and notice.

Mr. Mackenzie: That does not say much.

Hon. Mr. Peterson: My honourable friend says it does not say much, but I can say that this government has been moving progressively on these issues for a number of years. We can look at the question of community adjustment; I think there are programs that can be done. We have instituted those in northern Ontario as my honourable friend knows, with the northern Ontario heritage fund.

My honourable friend will also be aware that the Macdonald commission, when it recommended the so-called free trade business, also recommended massive funds, some $4 billion, for community adjustment. We have not seen that forthcoming from the federal government.

We have been spending with quite dramatic increases in job training. Our budget is up some 98 per cent in the province over the last couple of years, and I think that we have been making a number of progressive moves in that regard.

With respect to the question of the wage guarantees and the Brown report that my honourable friend, if he has not referred to will refer to in the future, the Minister of Labour (Mr. Sorbara) has been negotiating with the federal government because Mr. Brown, as I recall, said that the federal government has the primary responsibility of looking after bankruptcy.

I say to my honourable friend in conclusion, because I am sure the Speaker is going to criticize me for speaking too long, that these are a great source of concern to me and to this government. As I said, by almost any standard, we have the most progressive legislation in North America today. It is constantly under a state of review and if we can improve it to keep jobs here, we will obviously do so. But the question all members of the Legislature want to put their minds to is, will new legislation in this province keep this province more competitive? Will it create new jobs? Those are the contexts in which all these matters have to be reviewed.

Mrs. Grier: I hope the Premier is going to find some company that attributes its closure to free trade, and therefore he can pin the blame on the federal government. The responsibility for dealing with plant closures lies in the jurisdiction of this province. I want to say to the Premier that when Goodyear Canada closed down in Etobicoke-Lakeshore, as PPG Canada is doing, there was a lot of concern expressed by the Premier and by members of his government. There was a lot of discussion. There were a number of meetings. In fact, the Premier said he hoped Goodyear would open its books and justify the closure.

Can the Premier tell the House how he can explain to the workers at PPG Canada that despite all of that concern and all of that discussion, there has been nothing done by this provincial government to make the situation any different for the workers at PPG today than it was for the workers at Goodyear? There has been no legislative change to demand justification, to give communities --

Mr. Speaker: Order; the question has been asked.

Hon. Mr. Peterson: I say to my honourable friend that those matters are obviously a great source of concern to this government. The question the honourable member would want to ask herself is, would a piece of legislation protect those jobs in perpetuity? Would it protect the workers in perpetuity or would it be giving them false hopes in that regard? The Goodyear plant was a different situation. As the member knows, it moved to Napanee and now has a world-class facility that will be competitive.

Interjection.

Hon. Mr. Peterson: The member disagrees with our helping that factory, and that is fair enough. There were a number of people dislocated in that situation.

My honourable friend is aware that there are a number of job dislocations going on constantly, irrespective of the free trade agreement. I think the member and I have exactly the same view on how the free trade agreement will accelerate a number of these problems, but then the question for the government and this Legislature is, do we want to bring in punitive legislation or do we want to bring in other kinds of legislation? What kind of legislation would really assist in helping these workers in these jobs?

We believe we have a real responsibility to help the workers to relocate and readjust. We have been increasing massively our expenditures in job training. Members have seen, at the same time, very serious cutbacks from the federal government. It has been cut back some 32 per cent in this province over the last four years.

What we believe is that we need now a massive community adjustment and worker relocation program on a federal basis. I can tell my honourable friend that if she looks at the record of this government, I think she will find it pretty impressive. What we need now is a massive national program. I have called upon the Prime Minister and the federal ministers to put this number one on the federal policy agenda so that we can respond to the real problem that real human beings are going to have, not just in Ontario but right across this country.

Mr. Speaker: New question, the Leader of the Opposition.

Mr. B. Rae: The Premier is showing himself to be the best flunky the chamber of commerce ever had in this province.

WORKERS’ COMPENSATION

Mr. B. Rae: I have a question for the Minister of Labour. On Friday, the minister will no doubt know, Norm Smyth and Peter Finn, both of whom have worked at McDonnell Douglas aircraft company, described their situation for the Ontario public. Mr. Smyth had worked at McDonnell Douglas for 20 years. Unbeknown to him, he was working on asbestos for many, many years and he now suffers from asbestosis, for which he has had an operation.

Since this information was made available to him last week and I am sure he has been able to look into it, I wonder if the minister can explain why it is the Workers’ Compensation Board is not prepared to give Mr. Smyth the pension, when he has been off work for over one year, has had to sell his home and up till this time has received no pension whatsoever from the Workers’ Compensation Board.

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Hon. Mr. Sorbara: Just in relation to information on the situation at McDonnell Douglas, when Mr. Smyth and others attended a news conference sponsored by the New Democratic Party -- indeed, the Leader of the Opposition was there -- he regrettably, I think, announced to the public that there were no standards for aluminum in the workplaces of Ontario. I think it is important to correct that little bit of misinformation in this House. There are standards in Ontario. Indeed, they are some of the most stringent standards in the world, equal to those of Sweden, and Sweden is often cited as a jurisdiction with very high standards.

The standards in this province, as I said, are among the highest in the world and our obligation in the Ministry of Labour is to ensure that those standards are complied with. The information I am given by officials from the Ministry of Labour is that those standards are now being complied with at McDonnell Douglas.

Mr. B. Rae: It is funny, Mr. Speaker; I must have some problem. I asked a question of the minister about a particular worker and his claim for asbestosis. If the minister now wants me to ask a question about a worker who has a claim for aluminum, I will be glad to do so.

Three hundred workers out of 1,200 workers who have been tested at McDonnell Douglas have aluminum levels that are medically too high, in some cases, four, five and six times higher than that which is medically normal, and 30 workers out of 60 workers at de Havilland Aircraft of Canada who have been similarly tested also show high aluminum levels.

Since the minister is so proud of the levels that have been established by his Ministry of Labour, I wonder if he can explain why no workers, including Peter Finn -- his doctor has said Mr. Finn should stay off work and should not go back to an aluminum contaminated area, and has said that in the presence of what he calls “an early cognitive deficit,” with the combination of this with aluminum he is very concerned that these two could be related.

I wonder if the minister could explain why the Workers’ Compensation Board, contrary to what the minister has just said, has not established any workable standard for aluminum overdose or for aluminum poisoning, and has not recognized any brain problems or bone marrow problems or other problems that in the view of many neurologists are connected to aluminum? What is he going to do about the fact that there are literally hundreds of workers in the aircraft industry today, 2,100 of whom have sent the minister letters -- I would like to send these letters over to the minister, if I may --

Mr. Speaker: Thank you.

Mr. B. Rae: None of these workers are receiving a nickel in claims from the Workers’ Compensation Board, not a cent --

Mr. Speaker: Order; the question has been well put.

Hon. Mr. Sorbara: In the case of Mr. Smyth and some of the other people whom the Leader of the Opposition mentioned, he should know full well that the Workers’ Compensation Board and the tribunals within the Workers’ Compensation Board are the appropriate forum to make those determinations. It would be capricious in the extreme for me to stand up in this House and say how those determinations should be made or what decision the Workers’ Compensation Appeals Tribunal should make.

The larger questions as to the risks associated with aluminum are serious questions. Those questions are being and will be referred to the Industrial Disease Standards Panel so that we can try and come to grips with them. I tell the Leader of the Opposition that the scientific evidence available to the Workers’ Compensation Board, and to the world in general, right now is inconclusive in the extreme. There is no evidence to associate, from what I am told by the scientific community, those sorts of diseases with those sorts of exposures.

If he wants me to stand up in this House and say that I will make the conclusion notwithstanding what the scientific data suggest, he has the wrong minister and the wrong forum.

Mr. B. Rae: That is what his predecessors in the Progressive Conservative Party said about asbestos. That is what his predecessors said about gold mining. That is what his predecessors said about radiation. What do we have to do, pile the bodies up on the floor of this Legislature before he is going to understand there is a problem? That is what it comes down to.

I would like to ask the minister what his advice is to the workers who now have blood levels that are three and four times as high as they should be under medical conditions. Is his advice to those workers that they have no problem and should be carrying on as if there is no difficulty and no question with respect to their health? Is that what he is telling those workers? I would love to take what he says and be able to wrap it around his neck in a few months’ time when we find out precisely how much is going on in these plants and what problems --

Mr. Speaker: Order.

Hon. Mr. Sorbara: The Leader of the Opposition certainly is resorting to some rather fancy rhetoric today in this House. Let me, as calmly as I can, try to explain to him that the matter of levels of acceptable exposure limits in facilities like McDonnell Douglas and others will be reviewed by the Joint Steering Committee on Hazardous Substances in the Workplace at its upcoming meeting, that the question of exposure to these substances will be dealt with on an urgent basis by the Industrial Disease Standards Panel and that the appropriate forum to determine whether or not a claim should succeed before the Workers’ Compensation Board ought not to be the Ministry of Labour, but the Workers’ Compensation Appeals Tribunal.

I plead with the Leader of the Opposition not to create the misimpression in this province that somehow we have an arbitrary system where ministers of labour intervene and adjudicate based on political pressure from that party or any other individual in this province.

EMPLOYMENT ADJUSTMENT

Mr. Harris: My question is to the Premier. In the report of the Premier’s Council entitled Competing in the New Global Economy, numerous recommendations are given, one of which, recommendation 3, deals with labour market adjustments. It states, “The Premier’s Council should examine the labour adjustment issues of restructuring in Ontario’s core industries and work with the government to develop a comprehensive approach to meeting the adjustment needs of workers in these industries.”

The Premier’s own council goes on and says, “Specific issues which the council believes will need to be examined include:...the subsequent economic fortunes of workers displaced during industry restructurings, including their eventual employment situation and income levels.”

Can the Premier tell us what measures have been taken to act upon this recommendation, with regard specifically to older workers in the 55-to-64 age group who are virtually untrainable for other jobs?

Hon. Mr. Peterson: I can tell my honourable friend that is exactly what the council is applying its mind to at the present time in the so-called second phase of the council’s work. I will be happy to report back when the council reports in the not-too-distant future.

Mr. Harris: Perhaps the Premier can explain why the province of Ontario is one of only three provinces that has yet to participate in the federal program for older worker adjustments. It is a program that has been under review by this government and the federal government since 1986, a cost-sharing assistance program designed for older workers aged 55 to 64 who have no prospects for re-employment following major permanent layoffs.

Given the fact that this program complements and in fact answers a specific recommendation that is made in the Premier’s Council report, how can the Premier justify Ontario’s being one of only three provinces not to participate?

Hon. Mr. Peterson: I am glad my honourable friend raised that question. As my honourable friend will know, the federal government historically has picked up 100 per cent of that program under the Unemployment Insurance Act and the provisions thereof. Now the federal government is trying to get rid of that responsibility and put it on to the provinces. My honourable friend will be aware there is a serious program of offloading to the provinces. Just as they have capped our funding for apprenticeship when we desperately need it in this world, just as they have cut close to $1 billion out of job training, they are trying to do the same thing with this program as well.

I can tell the member discussions are ongoing, but very clearly the federal government has brought in this new act, the free trade act, and has a very serious responsibility to exactly those people. He may want to talk to his close friends in Ottawa to get them off the puck and doing something serious about these problems.

Mr. Harris: The Treasurer (Mr. R. F. Nixon), in prompting the Premier, forgot to mention that yes, unemployment insurance is the responsibility of the federal government for the first year. After unemployment insurance runs out, it becomes 100 per cent the responsibility of the province. So there is a case and there is a program, and seven other provinces have agreed that there is a need for a federal-provincial program to take place in an area that would be total provincial jurisdiction. The feds have offered to pay 70 per cent of it, and yet Ontario has chosen to leave these workers out on their own for the sake of not picking up their 30 per cent.

This is a long-term program, not just the unemployment insurance part of it, and I would ask the Premier again: His own council says the province should be doing something about it, the feds have come up with a program worked out with seven other provinces, why has he totally abandoned the older workers in that age category in not joining in that program?

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Hon. Mr. Peterson: Let me tell my honourable friend that we have our own programs in that regard, the Transitions program. Discussions are ongoing with the federal government, but it goes back to something I said to my honourable friend a little earlier. The federal government is trying to get out of its responsibility in that regard, and what we are saying is that --

Mr. Harris: No, they are not. They are moving into a totally provincial area and offering 70 per cent of the money.

Hon. Mr. Peterson: I can say to my honourable friend that that, in my view, does not conform to the facts as they have developed over the constitutional history of this country. We are there, ready to take our responsibility, but when you see these cutbacks in every single area and you see the aggrieved results as a result of the free trade agreement, then the member opposite is going to have to ask himself whose responsibility it is.

PROPOSED HOSPITAL MERGER

Mr. Eves: I have a question for the Minister of Health. Can she explain to the members of the Legislature the role of district health councils and how important that role is in planning our health care resources in the province?

Interjections.

Mr. Speaker: Order. Perhaps the Attorney General (Mr. Scott) and the Leader of the Opposition (Mr. B. Rae) could relax. Order.

Hon. Mrs. Caplan: For the information of the critic for the third party, the district health council program was started in the province almost 15 years ago. Over the past year, I have visited every region of the province and met with every district health council. I have expressed my support for the program, which brings together representation from consumers, providers and government to do planning in the area of health care.

The role of the district health councils is presently under review, and I want to assure the member opposite that we are discussing with members of district health councils to ensure that that role is appropriate for the future.

Mr. Eves: Given how important the minister thinks district health councils are in Ontario, could she please tell this House what role the Metropolitan Toronto Health District Health Council has played in the proposed Wellesley Hospital-Sunnybrook Medical Centre merger?

Hon. Mrs. Caplan: In fact, I have just recently met with representatives from both Wellesley Hospital and Sunnybrook Medical Centre to discuss their proposal. Representatives were there from the university sector as well. I know that the proposal is of some interest to the community, and I am looking forward to having an opportunity to have ministry officials review this.

Mr. Eves: The minister, to my understanding, has had the report on the proposed merger since November 2. I find it very unusual that the Metropolitan Toronto District Health Council has had absolutely no involvement in this major proposal. As of last Friday, they do not even have a copy of the report, yet her ministry promised them an independent review of the report. A spokesperson at the district health council said on Friday that this deal was done in the back room, behind closed doors. There was no district health council involvement.

Why has the minister not involved the Metropolitan Toronto District Health Council in this very important merger proposal, and why has she not delivered on her commitment for their independent review? Does she not find that somewhat unusual?

Hon. Mrs. Caplan: In fact, the member opposite is wrong, as usual. I have just received a copy of this report, and I know that the proponents would be pleased to share it with the district health council. I am assuming. This is not my report; this is a recommendation from the two hospitals and the University of Toronto that is presently under review by the ministry.

INTERVAL AND TRANSITION HOUSES

Mr. Allen: I have a question for the Minister of Community and Social Services on the battered women who are being turned away from the interval and transition houses because of lack of space in this province. Last week the minister disputed, he may remember, my colleague’s claim regarding the number of people on waiting lists, but this morning the minister, like ourselves who met with the Ontario Association of Interval and Transition Houses, will have been very graphically shown the numbers. The names were written on the walls, on the ceilings, on the floors, on the tables and on the chairs. We were surrounded by them. You could not get away from them. There were 7,500 in number, or one woman rejected for every woman accepted.

The minister will also have learned from this morning that these children, with their mothers, would in all likelihood have had to go back to the homes from whence they came and be beaten once again. Will the minister tell us what he plans to do in future to ensure the equality of access for all battered women to the shelter, counselling, support and assistance that the transition and interval houses provide for them in Ontario?

Hon. Mr. Sweeney: When I became minister, the total budget in the province of Ontario for interval and transition houses and support programs within my ministry alone for family violence was $6.9 million; as of today, it is $32.6 million. The total amount of money going directly to shelters just for their basis support in 1985 was $5.9 million; today it is $19.6 million. The total amount of money for community counselling from this ministry and from this government in 1985 was zero; as of today, it is $5.7 million. The total amount of money for emergency transportation in this province was zero; as of today, it is $565,000. The total amount of money for child support services within the shelters was zero; as of today, it is $2.3 million. In the last three years we have opened up 22 new shelters for a total of 282 new beds.

Mr. Allen: The minister always gives us his dollar figures in Technicolor; the reality is in black and white in the experience of the women who have to access beds and space in these houses. He will know that there are only 1,289 beds that, in fact, are open or under development in the interval and transition houses at the moment. That is an increase of only 109 since 1985, or nine percent over that particular year. That is hardly the kind of increase that is anything to write home about, let alone a figure that meets the needs of the women in question.

He also knows that these women and their boards who run these houses still have to do public fund-raising. The system is not run as a public service, and it depends upon the exploitation of underpaid women who have to go out into the community to raise money to meet the balance.

What efforts is the minister going to make to ensure that services for battered women in fact are provided as fully funded, basic public services, and what will he do to ensure full and realistic staffing and living wages for the interval and transition house staffs?

Hon. Mr. Sweeney: When I first met with the representatives of OAITH shortly after I was made minister, they indicated to me that they had two critical concerns. The first one was to stabilize the funding for the existing transition and interval houses, because at that point in time they did not know from one week to the next, never mind one month to the next, whether they were going to be able to stay open at all, whether they were going to be able to have any staff at all, whether they were going to be able to provide service for anyone at all. So their very first request to me was to stabilize their funding. That we have done.

As a matter of fact, we are negotiating right at the present time that, in addition to their basic per diems, which they receive through the municipalities and for which the provincial government pays 80 per cent, we will cover all of their additional approved costs for between 80 per cent and 100 per cent. The distinction between the 80 per cent and the 100 per cent is for those houses that have other sources of raising revenue. If they have no other sources of raising revenue, we will pay 100 per cent of that difference. That is exactly what they asked us to do.

The second thing they asked us to do was to provide child support workers. We now have child support workers in all of these houses.

The third thing that they asked us to do, and what we are negotiating with them right at this present time --

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Mr. Speaker: Thank you. Order. New question, the member for Burlington South.

Mr. Jackson: My question is to the minister responsible for women’s issues. This month the government has spent $250,000 on TV ads designed to tell the public, “Wife assault -- it is a crime.” At the same time, the interval and transition houses, which provide emergency front-line services to victims of domestic violence, last year turned away 7,600 battered women at risk in their communities. Here are some of the names, which all parties were shown today at our meeting with the transition homes’ staff. I would like the minister to keep a copy in his office, as I have, to remind him of the emergency nature of this request and the nonpartisan manner in which we should be dealing with this tragedy.

if we were to add the names of the children who are affected as well as the women, there would not be enough room on the walls of this chamber to hold all the names of those victims in this province. Is it not time the minister spent more time on services than sound bites on television and decided to fund properly the transition and interval houses --

Mr. Speaker: Thank you. The minister.

Hon. Mr. Sorbara: I want to tell the member for Burlington South that I, too, was at the lobby session with the Ontario Association of Interval and Transition Houses. I want to tell him that during the summertime I visited a number of those houses. We all know that they operate under very serious and constrained circumstances.

I point out to him, as I point out to the other members of this House, that just prior to the launching of the public education campaign, we increased the budget for direct services in shelters by some 33 per cent, one of the most significant increases in a provision of service of anything that the Minister of Community and Social Services (Mr. Sweeney) in his ministry is doing. We have made a dramatic difference year over year for the past three years.

The member opposite talks about the public education campaign, and I just want to remind him that on this question of family violence and assault against spouses, for the first time in this province, the government of Ontario over the past three years has taken an approach that goes beyond simply discrete initiatives in each ministry but involves now some 18 ministries in a wide variety of programs. I want to tell him that the business of educating the public, of telling every person in this province that wife assault and domestic violence are a crime and are not to be tolerated, is something I consider to be very important. I would never want to say that public education in that kind of agenda is not important, and I am sorry that my friend the member for Burlington South thinks so.

Mr. Jackson: I am sorry that the minister did not find it in his heart to support a private member’s resolution that would have led to some badly needed court reforms for the victims of family violence in this province. I am disappointed that he did not have the courage and conviction at that point to come forward.

The workers in transition houses in Ontario are concerned about the current problems and the current waiting lists. That is what we are here to talk about today. He did not listen in June, when the Ontario Coalition of Rape Crisis Centres warned him that his summer campaign would increase demand. The centres were right; the demand was unprecedented. And the minister is not listening now, when these centres try to advise him about how he is spending these dollars. When one gets headlines like this: “Women Angered by $750,000 Spent to Reduce Wife Assault;” “Shelters for Women Oppose Ads;” “$750,000 Ad Campaign Draws Fire” --

Mr. Speaker: I am listening.

Interjections.

Mr. Speaker: Order. I am listening for a question.

Mr. Jackson: Thousands of women and countless thousands of children are being turned away today. When is the minister going to stop advertising his concern and start acting on his concern?

Hon. Mr. Sorbara: I want to tell the member for Burlington South that the government’s initiatives in this area are threefold: first, to provide services; second, to enhance criminalization; and third, to educate the public about the criminal nature of domestic violence -- a threefold program.

The public education aspect of that campaign has not only been supported by but encouraged by OAITH and all its member organizations. I want to tell him that when I was at the shelter in Atikokan and when I was at the shelter in Sault Ste. Marie and when I was at the shelter in Thunder Bay and when I was at the shelter in Kingston, each one of them confirmed that they wanted the government to continue --

Interjection.

Mr. Speaker: Order. The member for Burlington South does not want to listen.

CITY OF OTTAWA

Mr Chiarelli: My question is to the Minister of Tourism and Recreation and it relates to the superb job done by Mayor Jim Durrell and the people of Ottawa in creating one of the best Grey Cup classics in history. Given the fact that virtually every Grey Cup event last week was a tremendous success, will the minister acknowledge that the city of Ottawa should be considered a major player for future tourism and recreational events?

Hon. Mr. O’Neil: I would certainly like to thank the member for Ottawa West for his question. I would also like to congratulate the member, the mayor of Ottawa and all those who participated in making the 76th Grey Cup game such a great success.

Hon. Mr. Kerrio: Won by the east.

Hon. Mr. O’Neil: And won by the east, yes.

I do not think I have ever seen carried out a more successful game and all the celebrations that surround it. I can assure the member that we see the city of Ottawa and the surrounding area as being one of the top destination areas in Ontario and will continue to support it in every way we possibly can.

Interjections.

Mr. Speaker: Order. I am looking at all members.

Mr. Sterling: On a point of privilege, Mr. Speaker: Now that the member for Ottawa West has raised the Grey Cup in Ottawa, there was a luncheon hosted by the --

Mr. Speaker: Order. With respect, points of privilege usually are brought up at times other than question period. Points of order are within order. Please allow the member to put his question.

AUTOMOBILE INSURANCE

Mr. Kormos: I have a question for the Minister of Financial Institutions. There really should not have been any doubt, but just prior to the general election in 1987, the Premier (Mr. Peterson) announced to the province that he had a very specific plan to lower auto insurance rates in the province. If the minister has indeed been made privy to that plan, would he please tell us what that plan is?

Hon. Mr. Elston: I want to welcome a question from the member for Welland-Thorold. The honourable gentleman has not been in this House as long as his predecessor was, a man for whom we all had a great deal of admiration and respect because of his ability to put questions in proper context and otherwise.

I can tell the honourable gentleman that we have done a number of things which will help take some of the mystery out of the auto insurance industry for most of the consumers. In fact, most people have been quite pleased by the industry-wide hearings that have been going on under the auspices of the chairman of the Ontario Automobile Insurance Board. We are now starting to see that some of the parts are falling in place as they continue to put together a structure under which to consider rates for auto insurance in Ontario.

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The member was at the lockup that was held last Thursday and had the opportunity to speak to Mr. Kruger and others who were dealing with the questions addressed in the most recent report. I can tell the honourable gentleman that he, like all, is fully welcome to participate and continue to participate in the rate-setting exercise.

If the member has specific problems or concerns about the manner in which the hearings are being held to determine what rates are going to be set, I think he should bring them clearly and forcefully to the attention of Mr. Kruger and the members of the board who have been working quite hard to set the rate system in place for us. That will happen, as the member knows, next January.

Following along with those initiatives and the considerations for other reforms which are needed in the system, this government has acted in concert with the Premier --

Mr. Speaker: That seems like a fairly complete answer.

Mr. Kormos: The government’s auto insurance board has guaranteed an increase in profits for the auto insurers. That is a rate reduction plan that the drivers in this province are going to pay for through the nose. The government is guaranteeing profits. Will the government at least guarantee service? Will the government require that insurers provide coverage to all drivers in the province at the board-approved rate?

Hon. Mr. Elston: The honourable gentleman is not characterizing the announcement, I think, which was made last Thursday in its proper context. The 12.5 per cent return on equity figure is set there for the purpose only of establishing a benchmark upon which to consider a structure of rates. That particular setting does not guarantee anybody a profit, or anything, because the requirements of the marketplace are such that they still must write and sell insurance.

They still must have efficiencies in programming their businesses to carry out the activities which insurance companies must carry out, that is payments on losses, payment for marketing, payment for the overhead, payment of a number of expenses.

I can tell the honourable gentleman that there are no guarantees built into that announcement which was made last Thursday. He should understand that.

AMBULANCE SERVICES

Mrs. Marland: My question is to the Minister of Health. Last week in response to a question from my colleague, the member for Parry Sound (Mr. Eves) about the Halton-Mississauga ambulance strike, she said: “The situation is being monitored by the ministry. Where we have any information about specific cases, I am pleased to look into those because I want to ensure that emergency services are being maintained.

“I want to assure the member that a contingency plan is in effect and that there has been assistance provided from surrounding area ambulance services to assist in this situation.”

I would like to know if the minister feels that the monitoring by her staff of this strike -- which incidentally is affecting six Liberal members of this House who have chosen not to ask any questions on behalf of their constituents -- is adequate in light of the fact that it took 23 hours to transfer a patient last week?

Hon. Mrs. Caplan: On numerous occasions we have had the opportunity to discuss health issues in this House. I have said on those occasions that we in government and our party do not believe that health is a partisan issue. We have acknowledged that we all have the same goal, which is providing and responding to the needs, as identified, of the people of this province in as equitable a manner as possible.

Regarding the specific matter that the member raises, I have stated on a number of occasions that, in fact, emergency services are being maintained. The ministry is monitoring to ensure that is the case and that there is no risk to the public.

Mrs. Marland: Obviously the minister does not wish to answer my question about a 23-hour delay in transferring a patient. There is one thing I do agree with -- she says this is a nonpartisan issue. I just wish that the Liberal government would share in the concern that our caucus has on this issue.

The minister has said that there are numerous occasions for us to discuss this issue and other related health issues. She also replied last week that she had been assured that, in fact, emergency services are being maintained and there is no risk to the public; the minister might like to know that last week there was call for an ambulance from Oakville-Trafalgar Memorial Hospital at noon, and that call was replaced and monitored all afternoon for six hours. At six o’clock --

Mr. Speaker: Do you have a question?

Mrs. Marland: The minister has to have this background, Mr. Speaker, to answer the question. At six o’clock --

Mr. Speaker: Order. Our standing orders do allow, if they are lengthy questions or lengthy responses, that you can put them on the Orders and Notices, but if you prefer to place your supplementary briefly, that would be fine.

Mrs. Marland: I would be happy to, Mr. Speaker. Can the minister explain why, when at six o’clock the doctor found that the call, in fact, had been cancelled by the dispatcher who had called the hospital, a dispatcher who is not a medical person, who had established that the patient was in stable condition in hospital environment and the dispatcher cancelled that call and, through a lie, told the hospital that a doctor had cancelled it and he finally admitted to the doctor that he had cancelled it without --

Mr. Speaker: Order. Would the member take her seat? Minister.

Hon. Mrs. Caplan: I have said to the member that I would be pleased to investigate any specific complaints or situations which she would like to bring to my attention. It is my understanding, from the information that I have, that this was an issue of conflicting medical judgement. I would be pleased, if she has additional information, to investigate further.

Mrs. Marland: That is a lie.

Mr. Speaker: The member for Mississauga South (Mrs. Marland), really.

Interjections.

Mr. Speaker: Order. New question.

STUDENT NEWSPAPER

Ms. Poole: I have a question for the Minister of Colleges and Universities. Last week engineering students at the University of Toronto voted to keep their student newspaper, the Toike Oike, as is with no changes. Over the years this paper has offended and insulted not only its fellow students but also various minorities, and particularly women. It has made what it calls jokes about feminists, acquired immune deficiency syndrome, incest and rape, and its latest edition contained an ad for a machine to remove women’s breasts. I would ask the minister: Does she consider it appropriate that this kind of degrading material is being subsidized by the taxpayers to the extent that the Toike Oike is provided an office and facilities at the university campus at taxpayers’ expense?

Hon. Mrs. McLeod: I do think it is important, first of all, to clarify the fact that the ministry does not provide funds to support the operating cost of student newspapers. Those are covered through student activity fees. I suppose it is true to say that indirectly, through our transfer payments, in the sense that the student newspaper may be operating within the university’s physical space, there is some indirect subsidy. As with all transfer costs, of course, the management of those funds is through the university administration, and the ministry does not have jurisdiction to intervene directly in this particular issue.

Having said that, I think it is fair to state that from a very personal perspective, I neither appreciate nor in any way condone the kind of material that appears in the University of Toronto engineering newspaper.

Ms. Poole: I thank the minister for those words, and I would be the last to try to interfere with the university’s autonomy in its right to manage its own affairs. However, I do believe this is an issue on which our government should provide leadership. Would the minister undertake to make the following request of the president of the University of Toronto, who has been quite vocal himself in his condemnation of the Toike Oike: that the school begin immediately to charge the engineering society market rents for the public space they are using to promote this distorted brand of journalism.

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Hon. Mrs. McLeod: Again, I would have to suggest that it simply would not be appropriate for me to intervene with such a directive given the fact that this is within the jurisdiction of the university administration.

I do think it is extremely appropriate that the president of the university, Dr. Connell, has expressed his very strong concerns on this issue. It is also appropriate that their university affairs committee is going to continue to pursue the issue.

It is my understanding that in fact they are considering a regulation that all campus media would be required to conform to a code of ethics in order to receive further university support.

SOCIAL ASSISTANCE

Mr. Allen: To the Minister of Community and Social Services. It is now almost three months since Judge Thomson tabled his report of the Social Assistance Review Committee on providing the minister with a blueprint to tackle poverty in Ontario.

This morning, a network of some 40 persons representing almost as many groups who formally advised Judge Thomson with respect to that report, met to express their dismay that despite the finding of the report that many of the system’s present worst failures should be acted upon with a genuine sense of urgency, the government has yet to bring forward one proposed action in response to Thomson’s proposals. He said at the time that within two months, any self-respecting government that had the political will would find many things to act upon.

The minister said in September that he would be making a statement of his intentions in October when the House convened. To date, no statement has been forthcoming.

There is really only one question we have and the poor of Ontario have, and that is: In God’s name, how long do we have to wait?

Hon. Mr. Sweeney: As a matter of fact, we preceded Judge Thomson’s report by one initiative and that is the $20 million for utility costs. That is in the report. We had announced that even before the report itself was announced.

Second, I indicated very clearly when the report was released that I would be making an announcement in this session of the Legislature. I do not believe I said in October. If I did, it was incorrect.

I am as interested as the honourable member is in getting some initiative started on this. However, the member will realize that the first stage alone, as costed by Judge Thomson, is $400 million. There are not any initiatives in there that do not have a price tag attached to them, and I have to find within my ministry’s budget and within the budget of the total government, the resources to implement some of these. As soon as I can put that package together, I will be making a public announcement first of all in this House before any place else.

Mr. Allen: The first stage was easily separable into the major cost factor which was the increase in the rates and all the other suggestions, which were very many, and which could have been done at very modest cost in relationship to the total bill for the first stage.

I think the one judgement as to whether he is really serious about implementing Thomson at any early stage would come with the implementation of recommendation 273 which reads: “The provincial government should provide funding for a council of consumers of social assistance, with a mandate to provide ongoing advice on the design and development of the social assistance system.”

If the minister is serious, that is not a big cost. May I ask the minister: Is he going to do this? When is he going to do it? How will he do it? And when is he going to, through this means or any other, give assistance immediately to the poor of Ontario who are waiting desperately on his very words?

Hon. Mr. Sweeney: My recollection is that the report recommended with respect to the rates themselves, whether they be general welfare or family benefits, that there be a separation of shelter cost and all other costs and that -- I think the expression was market basket. The group my friend refers to would in fact advise the government as to what the makeup of that market basket should be.

When I was first approached after the report was released to indicate if there were any recommendations with which I had concern, that was one of the ones I referred to. As a matter of fact, I think it was one of only about two or three about which I made any expression of concern. It is precisely because that would take out of the responsibility of government a very significant cost item.

We have not ruled it out as we have not ruled on any of the major recommendations, but I want to tell the honourable member that particular recommendation does cause me some concern because it would literally put in the hands of a nongovernmental body a recommendation for a very significant amount of money.

As the member knows, our total budget for social assistance this year is $2.3 billion; that is a lot of money.

FRENCH-LANGUAGE SERVICES

Mr. Runciman: I have a question for the Minister of Health. The St. Lawrence Valley Personnel Association recently contacted me expressing concerns about an advertisement that appeared in Ontario papers. I have just supplied the minister with a copy of the ad. The ad calls for candidates for a personnel officer at the Brockville Psychiatric Hospital and it is asking candidates to have “excellent English and superior oral and written French-language skills.”

Can the minister tell me why, in an area not designated under Bill 8, she is requiring two languages and why the candidates are required to have better French-language skills than English?

Hon. Mrs. Caplan: For the information of the member, the ministry is committed to the implementation of Bill 8 and the provision of French-language services for the people of this province who require them. I want to tell him that we are particularly concerned that access to our psychiatric hospitals be made available to those people who require this. It is my understanding that the Brockville hospital also serves the Ottawa area, which is a designated area.

Mr. Runciman: The administrative staff at the hospital think this is ridiculous. I want to say there are 14 patients at the hospital whose mother tongue is French.

There have been some very vocal concerns in eastern Ontario about the implications of Bill 8 and the possible job losses to unilingual anglophones. I think this is a completely new wrinkle. We are talking about a community with less than one per cent mother-tongue French and the minister is doing nothing to alleviate those very valid concerns.

I am wondering if the minister is prepared to support the request of my colleague the member for Stormont, Dundas and Glengarry (Mr. Villeneuve) and the member for Sudbury East (Miss Martel) to hold public hearings on the way Bill 8 is being implemented across this province.

Hon. Mrs. Caplan: I am very proud of the progress the Ministry of Health has made in implementing the provisions of Bill 8 in a sensitive and responsible manner. I invite the member to join with us in support of this very important piece of legislation.

SCHOOL OPENING EXERCISES

Mrs. Fawcett: My question is for the Minister of Education. There seems to be a lot of confusion in my riding of Northumberland concerning the saying of the Lord’s Prayer in the public school system. Letters that are coming into my office daily indicate that the board is not allowing prayers of any faith to be said since the original letter was sent from the ministry in September.

My question to the minister is, are public schools presently allowed to say the Lord’s Prayer during opening and closing exercises as long as prayers of other cultures are also used and no one prayer takes an order of importance over the other?

Hon. Mr. Ward: The member is referring, of course, to a recent decision of the Ontario Court of Appeal dealing with a component of the regulations under the Education Act relating to religious exercises as part of opening exercises for each and every school day. I want to stress to the member that the court’s decision did not rule out a spiritual component of those opening exercises, nor did it ban the use of the Lord’s Prayer as part of those opening exercises. It merely stressed and urged boards which wished to have a religious or spiritual component as part of their opening exercises to recognize and have due regard to the multifaith traditions that exist in Ontario today and that no one religion be given a position of primacy.

That decision of the court was followed up by a letter that was sent to each and every board in this province, reminding them to have due regard for that court’s decision.

At some point in the very near future, I hope to be coming forward with some recommendations for new regulations to help clarify the situation, but I do want to stress that although many boards are choosing to exercise the option of not having religious exercises to open the school day, they are not doing so as a result of any directive from my ministry or the decision of the court.

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Mrs. Fawcett: I thank the minister very much. I think that does clear up quite a few questions from schools in my area. I am just wondering if there is any indication from the ministry exactly when the boards of education will be given official notice of the types of prayers that can be used.

Hon. Mr. Ward: When I wrote to the boards following the court’s decision, the judge in his decision made reference to some of the different programs that are used by various jurisdictions throughout this province that, in fact, in his judgement were deemed to be appropriate. I suggest to any parents who are concerned over this issue that they may want to look carefully to that as some recourse in discussions with their board as the board deliberates on this particular issue.

I expect in the near future -- I hope some time early in the new year -- to come forward with some suggestions and possibly new regulations dealing with the issue of opening exercises that will provide further clarification and indeed be consistent with the decision of the Court of Appeal.

PENSION BENEFITS

Mr. D. S. Cooke: I have a question to the Minister of Financial Institutions regarding pensions. It is a very simple question that perhaps the minister can answer today. The Friedland report was tabled many months ago. Workers all across this province want to know what the response from the government is going to be with regard to pension indexation. When is the minister going to be responding and when are we going to be dealing with legislation to index pensions in this province?

Hon. Mr. Elston: I want to thank the honourable gentleman for his question. As he knows, the indexing issue is one that is quite complex. We have been working on the Friedland report, along with the report that was also raised by his colleague the member for Etobicoke-Rexdale (Mr. Philip) last week and others which are dealing with the entire world of pensions.

We have a number of people who are providing us with valuable input with respect to that issue. We expect in due course to be drafting some material for further comment by those people from union, management and labour who have been providing us information.

I can tell the honourable gentleman that the issues are extremely complex and we are dealing with them issue by issue. As the items come up, we will be addressing them and we will be bringing forward our suggestions in due course to the Legislative Assembly.

Mr. Speaker: The member for Carleton with a point of privilege.

GREY CUP LUNCHEON

Mr. Sterling: On a point of privilege, Mr. Speaker: During question period, I raised the point with regard to this government’s treatment of members of the Legislature. Last Friday, the Premier (Mr. Peterson) held a luncheon in Ottawa for the Grey Cup. Every MPP in the Ottawa-Carleton area was invited to this luncheon, save one. That one happened to be a member of the opposition.

Interjections.

Mr. Speaker: Order. I am listening to a point of something here.

Mr. Sterling: My point is this: If the government of Ontario is going to spend taxpayers’ money to hold celebrations, which are important, I understand, then it should treat each MPP in an equal-handed manner.

It appears that this luncheon was held for the Liberal Party and not for the government of Ontario. If they are going to restrict their invitations to members of the Liberal Party, people who have donated to their party, MPPs who are Liberals in the area, then the Liberal Party of Ontario should pay for that. I would like you to investigate this particular matter as to who paid for that luncheon, whether the Liberal Party of Ontario or the government of Ontario paid for it and whether the actions of this particular government are proper.

Hon. Mr. Conway: On the same point, Mr. Speaker: I would be happy, on behalf of the government, to investigate the honourable member’s concern and complaint, keeping in mind that this government has shown genuine sensitivity for the wellbeing of the member for Carleton (Mr. Sterling).

I can remember an occasion not that long ago when, I think at the insistence of the leader of the government, the honourable member from Manotick was sent to Lausanne, Switzerland to participate in some deliberations that were important to the people of Ontario.

I repeat that we are always anxious and keen to involve the honourable member. I do not know what happened in this case but, on behalf of the government, to alleviate you of any burden, Mr. Speaker, I will certainly examine the situation and report back. I cannot imagine that having sent the honourable member to Switzerland, we would be unwilling to send him to Lansdowne Park.

Mr. Speaker: I have listened very carefully to the two members. I just cannot, in my own mind, make the decision that it is a bona fide point of privilege. However, I did note that the government House leader will take it into consideration and I think that is probably what the member was hoping for.

Petitions? Committee reports? Motions?

Mr. Harris: What happened to petitions? Did you call for petitions?

Mr. Speaker: Yes, I did. Would it be all right if we revert to petitions? Because of the activity in the chamber, we might just wait a moment. I believe the member for Nipissing has a petition.

PETITIONS

EXTENDED CARE

Mr. Harris: I have a petition; in fact, I have two. The first one is:

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“We believe that all residents of extended care facilities, whether it be a nursing home or a municipal home for the aged, are entitled to equal care and services according to the specific care requirements of each individual.

“Nursing home residents should benefit from the same amount of funding and kinds of services as residents of municipal homes for the aged.

“We urge the Ontario government to reform the extended care system so that it is uniform, fair and equitable with regard to funding and regulation and so that seniors in all extended care facilities receive the same quality of care they deserve.

“Further, we support Mrs. Mary Snelgrove, Mrs. Ena Symons and the Ontario Nursing Home Association in their legal challenge and their efforts to gain fair and equal treatment for nursing home residents.”

It is signed by, at first blush I would say about 98 residents of the Leisure World nursing home in North Bay, and by myself.

RETAIL STORE HOURS

Mr. Harris: I also have a second petition, a tad shorter. This one says:

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“We urge Premier Peterson not to proceed with the legislation he has announced, but instead to strengthen protection for all workers who do not want to work on Sundays; to not pass the responsibility back to local governments, and to maintain a common pause day for working people and working families in Ontario.”

This one is signed by a whole raft, a full page-load of residents of North Bay; in fact, by some outside North Bay in the Nipissing area, I notice here. I too have affixed my signature thereon.

Mr. Speaker: I am just a little curious about the first one. Did you sign as a member or as a resident?

Mr. Harris: Both.

Mr. Speaker: Both. Good.

Mr. Harris: As a resident of the riding and a future resident perhaps.

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INTRODUCTION OF BILL

MUNICIPAL STATUTE LAW AMENDMENT ACT

Hon. Mr. Eakins moved first reading of Bill 192, An Act to amend the Municipal Act and certain other Acts related to Municipalities.

Motion agreed to.

Hon. Mr. Eakins: This legislation addresses a number of issues in the Municipal Act and the acts for the restructured two-tier municipalities that will, for example, permit the city of Toronto to make a loan to Toronto Artscape, a nonprofit corporation which is establishing a small business incubator for professional artists and crafts-persons.

The legislation will also give municipalities a general power to participate in programs established by provincial ministries, eliminating the need for specific amendments in the future, as new programs are developed. In addition, it will provide greater flexibility in the provisions relating to uniform, county-wide assessment updates, and provides that separated municipalities will only be included in such updates if they request them.

ORDERS OF THE DAY

House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

Mr. Chairman: Comments or questions? The member for Simcoe West.

Mr. McCague: I apologize for rising ahead of the minister, but I sat here last week for quite a few hours and it seemed that when the minister got going she had quite a bit to tell us, so I thought maybe I could get in with a few questions prior to that.

The minister will know that she has agreed to see the people from the Collingwood General and Marine Hospital in a week’s time. I would just say to her, without divulging what it is they want to talk to her about -- not that she does not know, but not divulging publicly what they want to talk to her about -- that I hope she will see her way clear to being sympathetic to the requests that they have.

The minister will also know that, about 15 months ago, the Collingwood people started a local campaign to raise funds for various needs at the hospital, and were in fact successful in raising about $4.1 million. Although it is true that neither the minister nor her predecessors at any time said to the Collingwood hospital, “You may proceed,” there were indications there that they would be allowed to proceed in due course, which at that time was considered to be a couple of years.

They are a little disappointed, but I am sure that the minister will hear what they have to say sympathetically. I am sure that the people from the hospital are quite well aware of the kinds of pressures that the minister is under for funding, but there are some things there that I think must be done in the not-too-distant future.

We did talk in question period a little about the assistive devices program and, in particular, about its effect on the hearing-impaired. The minister said one thing which she might like to correct. In response to my question, she said:

“I am very aware of this particular issue. I know there are a number of people who have been giving information. Anyone who is specifically interested in the plans and proposals should communicate directly with the ministry.”

I think that it is a little inhibiting to us as MPPs, when it is suggested to my constituents that they not bother me with the complaint that they might have but that they go directly to the minister. I know the minister is shaking her head. In fairness, I did say at the start that she might want to clarify that comment, because it does not really look the best in Hansard.

You can understand the frustrations that people with hearing problems have when, according to a statement or a promise or whatever you might call it that the Premier (Mr. Peterson) made, the program was to be in place by the end of 1988. I did ask the minister if this would be in place by the end of 1988 and I got an answer which seemed to me to indicate that she really was not going to be able to get around to the program by the end of 1988 and that it might be some time longer.

On behalf of the people whom the ministry and the minister are talking to, people who have hearing aid centres and people who need that service, I think the association -- the name escapes me here for the moment -- of practitioners in the hearing aid business, according to its letters, has done a tremendous amount of work on adopting specific bylaws and a strict code of ethics to govern the conduct of its members.

I think the minister would want to acknowledge that, but I hope she can understand the frustration they have, having done what they were asked to do and having been directed and redirected about three or four times over the period of time since the Premier made his announcement in August 1987. I would just like to have the minister’s comments on the work which has been done by these people, and maybe she can give us something a little more specific as to the timing of the introduction of the program.

I know the minister is interested in the differential in the rates for homes for the aged and the nursing homes. The minister has the benefit, if you want to put it that way, of being on the right side of this issue. Her homes for the aged are funded more appropriately than are the nursing homes. She can certainly lay claim to her side of the equation being more appropriate.

My colleague the critic, the member for Parry Sound (Mr. Eves), raised this issue in his opening remarks. There have been a lot of people trying to get some kind of meeting of the ways of the Ministry of Community and Social Services and the Ministry of Health as it applies to the care of the elderly and seniors in homes for the aged and nursing homes.

That is a problem which was there when this government took over and which I know we tried to solve when we were government. The government came in with a resolve to do it very quickly but it is running into the same kind of roadblocks we had when we were trying to do it. I would like the minister to comment a little on how she is making out on getting the homes for the aged and the nursing homes under one ministry. I know she will be happy to do that. Great progress, no doubt.

A problem arose during this past summer which may, in fairness, be a problem of Ma Bell’s rather than the minister’s. In Collingwood, the Bell system or the emergency ambulance phone lines seemed to get into great difficulty: sometimes no answer, sometimes three times with no answer. I would just like to raise with her that people in Collingwood are told the system they are using is outdated to get to central dispatch. That is hard to understand, because it is just a brand-new installation, but it may be that the lines are slightly out of whack. The minister may look into it and report to me on that one some time in the future.

I would like to reserve the opportunity to have a second word with the minister after she answers, but I promise that I will not prolong the debate.

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Hon. Mrs. Caplan: I spoke to the critic for the third party at the beginning of this session. He mentioned that there were several members from his caucus who would like to place their questions on the agenda. If they would like to do so at this time, I believe there will be time during the rest of this session to respond to some of them. For those for which there is not time today, we will have another day for estimates.

Mr. McCague: I anticipated that answer. Although the minister has not been in this portfolio very long, she has learned very quickly that you can get your estimates time in fairly quickly if you have a good, lengthy statement and then you reserve all the questions until some time at the last. I congratulate her for all that and look forward to her answers.

Mrs. Marland: I would like to ask the Minister of Health some questions and I would like the answers today, because it is an issue of extreme urgency. It is the question that I raised with the minister in question period earlier this afternoon. She has promised from the beginning to monitor the Halton-Mississauga ambulance strike, and that matter has been raised some half-dozen times in this House. I wrote to her the week the strike began. That strike is now in its 117th day.

As I mentioned earlier this afternoon, it seems to be an ambulance strike that is of concern only to the two Conservative members of the Legislature who represent the constituents in Halton and Mississauga. There are six other members of this Legislature who represent Halton and Mississauga. They are all members of the Liberal government. Perhaps they are getting their answers in their caucus meetings or through some other route, but whatever the answers they are receiving, we do not see anyone moving to end this ambulance strike.

When we are looking at 117 days that an ambulance strike has been going on and there has been one meeting with the mediator, I have to wonder if the minister’s staff is keeping her fully informed. I would think that where people’s lives are at risk -- and this is no exaggeration -- she would insist that the mediator force the two parties to the table day after day until either they carve out an agreement to this labour dispute or they are then referred to arbitration.

I cannot see how, as the minister responsible for the health of the people of this province and, in this particular case, the people of Halton and Mississauga -- and we are talking about over 800,000 people -- she can sit back and say, as she said last week in answer to my colleague the member for Parry Sound when he asked her about a particular incident -- every week we have incidents to report to her and every week she says that she is happy to investigate the particular incidents: “The workings of our health care system rely on people who do go that extra mile to help those who are in need of critical and urgent care and I would like to acknowledge the physician in this case who did persevere to make sure that this patient received the care that he needed.”

I want to know whether the minister expects every physician to spend two or three hours on the phone in an evening trying to get help for his patients, because she goes on further to say, “I am pleased to look into” specific cases and “I want to ensure that emergency services are being maintained.”

I want to tell the minister that she is not therein the evenings, her staff are not there in the evenings and this surgeon could not reach anyone. As I tried to say, but it was hard to hear this afternoon with the interjections in question period, this call for an ambulance went to the hospital at 12 noon. The hospital staff monitored all afternoon with the ambulance dispatcher -- “When is the ambulance coming?” -- and the ambulance dispatcher said: “We have that call. It is coming, it is coming.”

Finally, at six o’clock, six hours later, when the nurse called again, the dispatcher said: “Oh, that call’s been cancelled.” The nurse said, “By whom?” and the dispatcher said, “Oh, that call was cancelled by a doctor at the hospital.”

So the nurse got on the telephone to the doctor in case something had changed, and it may in fact have been true. The doctor had not cancelled the call. The doctor got on the phone with the dispatcher, and the dispatcher admitted to the surgeon that he had lied. He said, “I did tell the staff that the doctor had cancelled the call, but I have to admit, Dr. So-And-So, that I cancelled the call.” When the surgeon asked the dispatcher why he had cancelled the call, the dispatcher said, “I phoned the hospital and I established that the patient was in a stable condition in a hospital environment.”

You can imagine what that surgeon felt. Here was a nonmedical person who did not even have the courtesy to phone the doctor who was responsible for that patient and his condition, making a decision arbitrarily to cancel a call for an ambulance. When that doctor then asked if he could speak to the dispatcher’s supervisor, the answer from the dispatcher was: “Yes, you can speak to my supervisor in business hours. He will be in at 8:30 in the morning.”

So when the minister -- very sincerely on her part, and I believe her -- says she will investigate individual situations, in this case she is not there and her staff are not there and that doctor could not reach anyone overnight. It was overnight that the patient almost died. That is not an exaggeration. I am not saying something that is not factual to be dramatic or to emphasize a point. I am simply saying to the minister that we are fortunate that patient is alive today.

When I said that in the House in question period today, I heard some of the Liberal backbenchers making comments about the fact that they did not believe that. The minister would only have to speak personally to the physician to find out that when that patient vomited during the night and aspirated, it was very, very touch-and-go for about 25 minutes about whether he was going to survive. That entire situation would have been avoided had the patient been able to be transferred to the Toronto General Hospital, where the surgeon at the Toronto General was waiting to do his surgery. He had to have the surgery in order to have his life sustained.

At 8:30 in the morning, when this same surgeon gets on the telephone again and says, “When can I have an ambulance?” -- and of course now he has to have an ambulance with a team on board in case they have to intubate that patient en route in the transfer between the hospitals, so now we need an ambulance with a doctor and a nurse on board -- the reply was: “If we happen to have an ambulance coming out from Metro westbound, then we’ll put your patient on to go eastbound into Metro.” The doctor said, “How long is that going to take?” and the answer was, “Well, it could take two or three days.” At that time, the doctor finally got on the phone to my office, and my office got on the phone to the minister’s office. The ambulance came at 11:40, 23 hours and 40 minutes after the original call.

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I am happy to tell the minister that the patient had the surgery that day and is in stable condition, but it is far more by good luck than by anything else that that patient has survived.

I know the minister is not waiting for us to stand in this House and give her chronologies of people whose lives have expired in order to get the sensitivity of this situation into focus. “The sensitivity of this situation into focus” means that instead of looking just at the lives, we must look at the quality of life of the hundreds of patients whose response times have been delayed.

It may well be that in the majority of cases where there is an emergency and an ambulance is called, if the response time is reduced -- I know my colleague the member for Burlington South (Mr. Jackson) has given examples where we have 20-minute, 25-minute, 35-minute response times -- there is no way the minister can tell me that the future health of that patient is not going to be at risk in terms of recovery, more so than if the response had been reduced.

I think the bottom line of this whole question about this ambulance strike is that if her staff are monitoring response times and are satisfied with 20-minute, 40-minute, one-hour and four-hour response times, all of which we have given the minister examples of, if her staff are happy with that, then that raises the question, why do we plan to have ambulance service with the kind of response times we have? Are we throwing money out? Are we saying that normally we can get by with the kind of response times our community has had in the last 117 days? Or is what we are saying that we face the responsibility, that we know a seven-minute response time in an urban area for an ambulance is what is needed, because it is needed to sustain the quality of recovery those patients can have by having an emergency situation looked at very quickly?

In the case of the Halton-Mississauga ambulance strike, the minister says, “I have been assured that in fact emergency services are being maintained and there is no risk to the public.” If that is what she thinks, perhaps she could tell me what is considered a risk to the public.

Hon. Mrs. Caplan: In fact, we did discuss this issue this afternoon during question period. I think it is very important when we discuss the issue of emergency health services and ambulance services specifically to recognize that, in fact, we are talking about transfers between hospitals as well as emergency situations.

I think it is important for the member to know that we recognize that many of the calls the ambulances respond to are for interhospital transfers. In fact, they talk about what is called a tiered response, which designates the difference between an emergency and a transfer between hospitals. During the differentiation, it is very important to know that it is the hospital and the medical judgement of the attending physicians that determine when an emergency response is required or whether a transfer is what is required.

I think it is important as we talk about emergency health services to recognize that there are 131 hospital-based and private services in the province, of which approximately half we know are unionized. The negotiations regarding wages and benefits in these services are conducted between the employers and the employees. The Ministry of Health is not party to those negotiations.

We are attempting within the ministry, with the appointment of an emergency health services co-ordinator, to look at all the aspects of the provision of ambulance services’ tiered response. In the many regions of the province there are numerous ways that we do respond. We know there are land ambulances and air ambulances. In fact, when I have travelled through the province, I have had an opportunity to see at first hand many of the different emergency services as they are provided across the province.

I want to tell the member opposite, as I mentioned in the House on a number of occasions, that people come from across Canada and from around the world to see how we provide what we do in this province. The fact is that we have, and should be very proud of the fact that we have, one of the very best emergency health systems, I would say, certainly in North America and probably in the world. We should be very proud of that.

I also say that the reason it is as good as it is is that we are always trying to make it better. That is why, as I said, we have recently appointed an emergency health services co-ordinator, recognizing that this is a provincial program that will respond to the different needs of the province, recognizing that there are no two regions that are absolutely identical.

I think it is important that we recognize this. For example, we have first-response teams. They are organized by groups of volunteer first-aiders who respond to medical emergencies and assist in stabilizing patients until the ambulance arrives. I met with one of these first-response teams when I travelled not far outside Kenora, as a matter of fact, this summer. I know they are very proud of the work they do. We are very proud of them. The ministry provides training and equipment to help out in those regions. I believe that is a very appropriate response in some of those regions.

We are currently conducting a review of first-response teams in Ontario so that we will be able to establish a policy statement, because we believe that, as part of our delivery of emergency health services, it is very important that we look at this from an overall perspective and that we have policies set in place.

I mentioned tiered response. We know these issues are also under review because we think it is very important that the Provincial Emergency Health Advisory Committee be permitted to advise us. I would tell the member that if she has any advice at any time, I am always happy not only to hear her concerns but to seek her advice as well.

We know that mutual assistance between public safety agencies such as fire departments, police departments and ambulance services has existed informally for sometime. That is why the term “tiered response” was used. I think it is important that we recognize that there are a number of ways in which emergency services are provided and that they work together cooperatively and responsibly around the province.

As I have said in the House, I am always -- perhaps “happy” is not the right word -- I am certainly interested in looking at any specific cases where the member feels that the system has not responded in a manner that she considers appropriate. I have said that, on any occasion, I am pleased to investigate and determine what the facts of the matter are. I want her to know that emergency and ambulance dispatch rely on information that comes from the hospitals and that the ability of communities to respond to assist one another is there because our dispatch is centralized.

I hope this answers some of the questions for the member opposite. I want to assure her of my concern as well as my commitment to make sure, as we look at overall provincial policies, that we recognize the important role that our ambulance services, our air ambulance services, our first-response teams, our fire departments and our police departments all play in responding to the emergency health needs of the people of this province.

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Mrs Marland: I am sorry to tell the minister that she did not answer my questions, and I do not really need a lecture on what the ambulance services are. I know what they are. I am disappointed to have her reading from her notes instead of answering this question. I want to stay on this question, because I have to have an answer for these physicians and surgeons and, most of all, for their patients, my constituents.

I know, of course, there are different ambulance services, I know there are intrahospital transfers and I know we have air ambulances. The interesting situation in this case that she said she would be happy to look into is that, first of all, an air ambulance would not work because it is not large enough to have the medical team on board in case this particular patient needed intubating en route. That is why they could not use the air ambulance.

She talks about the intrahospital transfers being based on the medical judgement of attending physicians. That is the whole point of this question of mine to her today. At the time, this patient’s life was not in the hands of the attending physician; it was in the hands of the dispatcher. I want to know what she thinks about the fact that a dispatcher cancelled the call for this ambulance. It was not the medical judgement of the attending physician. The medical judgement of the attending physicians in this case was to ask for this ambulance and they had been asking for it for six hours. It was not their choice to have the call cancelled and it was not just an intrahospital transfer. It was not something that could be done in one hospital but it was more convenient to do it in another. There was no alternative for this patient. The patient had to be at the Toronto General Hospital.

When she talks about the fact that we have this excellent health care system, of course we do and of course I stand here as proud as anyone else in this House about the health care service and the health care system that we have in this province because of tremendous dedication and commitment, like that of the two doctors who were attending this particular patient. What does she expect them to do when we have a crisis such as these two doctors faced on behalf of their patient last week?

When she says she is willing to investigate it, she has had it for a week. Apparently, she has not investigated it or she would have the answer today. I want to know how she is going to feel when it is an investigation after the fact. She is a family person. She has relatives and children, the same as the rest of us do.

As it turned out -- I have to tell the minister this because it is rather ironic -- at the time that all this was going on, I did not know the name of the patient. I have since learned that it does happen to be someone I do know in the community. I have to know how close it has to come to the minister or to her staff or to the members of her Liberal government before she says that the kind of response times we are looking at in Halton and Mississauga are simply not good enough.

I know we are into a labour dispute. I know that the Minister of Labour (Mr. Sorbara) is saying, “I suppose, Mrs. Marland, you want us to legislate them back to work and you want it deemed an essential service.” As a matter of fact, I would like to see the ambulance service deemed an essential service. An ambulance service is just as essential as fire and police because it deals with lives.

In this case, when we look at 117 days with one meeting with the mediator, and that meeting was back on September 8, I have to say to her, three months later and the mediator has not made these two groups sit down together, it looks as though nobody cares that the ambulance drivers are on strike in Halton and Mississauga.

When are we going to care and when is the minister going to answer the question about response time? It is not good enough to say, “I am monitoring the response time.” Maybe she has a big list in her office. Maybe her staff have a big board where they clock and register all the response times.

Maybe an hour or four hours -- an hour for the case of the four-year-old boy who had swallowed rubbing alcohol and was taken to hospital in a fire truck after the firemen decided they should not wait any longer for the ambulance -- maybe those times are long enough for her. I do not doubt, as I say, her expressed commitment to investigate particular instances, but how many instances does she need? When she investigates them after the fact, God knows she is fortunate those patients she is investigating are still alive.

When she says, “These decisions are made on the medical judgement of attending physicians,” her own words this afternoon, will she please tell me how she can sit there and say it is acceptable to have had an ambulance dispatcher cancel this call last week, after telling the hospital for six hours that the ambulance was coming, and then have the ambulance come 23 hours and 40 minutes later? I want to know her answer to that question.

Hon. Mrs. Caplan: I think it is very important for the member to understand that in fact it would not be the dispatcher who would use his or her own judgement. I have available for the member, if she would like to review it, the dispatch priority card index. The protocols are very clear for determining what is an emergency. In this particular case, the dispatcher spoke to the hospital and it was not the dispatcher’s own judgement that made the determination as to the status of the patient. I understand that what occurred was a difference in medical judgement at the hospital that resulted in the call being cancelled at the time, and it was reinstated at the request of the attending physician.

Mrs. Marland: I do not know where the minister is getting her information from. I realize she is dependent on what she is being told and I respect the fact that she is strapped from that point of view. I want to tell her there were two physicians involved. One was the general practitioner, the referring physician to the surgeon. The second one, the surgeon, was the surgeon in charge of this patient in the hospital, who had phoned his colleague at the Toronto General Hospital because it was a medical emergency and because his colleague at the Toronto General was the only person who could do that particular operation on that patient.

The dispatcher himself -- I am not going to read his name into the record, just as I am protecting the names of the doctor and the patient, because the confidentiality of that has to remain but I will be happy to give the minister the names in person -- told the doctor himself that he, the dispatcher, had made the decision to cancel the call. He told the doctor he had not spoken to anybody at the hospital.

Hon. Mrs. Caplan: That is not true.

Mrs. Marland: That is what he told the doctor. He said, “I have established, based on my information, that the patient is in a stable condition.” He did not speak to the doctor who was responsible for that patient.

As far as I am concerned, I hope that dispatcher -- obviously, it is somebody in management in that ambulance service -- has on his conscience what he risked for that family in leaving that patient to spend another 14 hours overnight in that hospital. It is something I do not seem to be able to convey to the minister with all the passion in my heart about this particular situation. I can see that patient, who happens to be a face and a body I know. It is just the same as if it were one of her children or one of the relatives of anybody -- as soon as she recognizes we are not talking about a number or a case; we are talking about an individual here.

That dispatcher, I understand, is still working at dispatching ambulances in Halton-Mississauga during the strike, and he had the unmitigated gall to cancel a call made by a surgeon for his patient without even having the doctor re-evaluate the patient six hours later. He did not even tell the doctor; the doctor was not involved. The doctor would not have known, had the nurse not found out that the call had been cancelled. He did not even have the gumption to say, “We have cancelled the call.” All afternoon he kept saying: “Oh, it’s coming. The ambulance is coming.” In the meantime, that patient was going downhill.

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If the minister has the information that the dispatcher established the condition of the patient, I want to tell her that dispatcher established that condition on his own, without speaking to the attending physician. I think that is terribly serious and terribly critical. I would like to know what the minister plans to do about that particular incident so that I can assure those two doctors, who were working 23 hours to maintain the life of this individual, that this will not happen again during this strike.

Hon. Mrs. Caplan: I think it is important to note in this case that the patient was transferred and I understand is in satisfactory and stable condition. I think it is important that we all restate that. I have said to the member, as I did today in question period, that in light of the new and additional information that she has provided, I will ask ministry officials to determine factually what occurred. It is my understanding that the dispatcher spoke to someone at the hospital who informed the dispatcher that the status of the patient had changed, that it was stable and was not considered an emergency. If that is not the fact, I will be pleased to request that the ministry investigate this matter further.

Mrs. Marland: I will look forward to the response after the minister’s staff investigates the question of who, by names, the dispatcher was supposed to have spoken to to establish the stability of that patient.

Perhaps the minister could tell me, in the case of a physician or a surgeon in a crisis situation, as these two physicians were during the evening hours when they could not reach the dispatcher’s supervisor -- the supervisor works business hours and they were told they could call him at 8:30 a.m. -- who else is it then that the physician who is fighting for the ambulance service for his patient in an emergency situation can turn to? We have a strike situation here, which is abnormal. What kinds of provisions for off-hours have the ministry staff made for these physicians who need to have an ambulance for their patients?

Hon. Mrs. Caplan: The central dispatch is a 24-hour service and anyone requiring emergency services can call that number, and not only the hospitals know that. In most regions where there is 911, that is one route to access, but I say to the member that it is a 24-hour service and it is available for anyone in emergency situations.

As I have said to the member before, the ministry is monitoring to ensure that the public is not at risk. We recognize there is a difference in status between emergency and nonemergency and hospital transfer. That is why I think it is important we differentiate between accessing a call based on what is a clear emergency according to the medical judgement in a hospital situation, and that which is not an emergency.

Mrs. Marland: Is the minister then going to be able to give us some kind of report as to what she considers to be an adequate response time for emergency calls for ambulance service? The minister is saying it is a 24-hour service. I am telling the minister that these two doctors, who also know it is a 24-hour service, by the way, were told that since the dispatcher had made the decision that that patient did not need to be transferred, there was no one else for those doctors to turn to. There was no one else for them to access about a 24-hour service until after 8:30 the next morning, and at this point it is 6:45 in the evening. So there was no alternative for those physicians. There was no one else for them to call.

When the minister says the ministry is monitoring the response times, I wonder if she could tell us, during the strike in Halton and Mississauga, how it is doing that. How is the ministry establishing that a response time has been what it needed to have been in the case of those patients? Is it following every call for an ambulance in an emergency situation? I am not talking about transfers. I am not talking about ambulances transporting people for treatment. I am talking about emergency response time only.

Are they following every single case? The minister can appreciate that because we are in a strike situation, we do not have access to the records of when the calls come in and when the patient is picked up. We do have examples where an ambulance has been on its way to one emergency and had to stop and pick up somebody else on the way because it was nearer. In one case, we had a situation where the first patient died while the ambulance picked up somebody on the way.

It may well be that that patient might have died in any case, but all I want to know is how the minister is going to be in a position to stand in this House and defend those response times, even when the strike is over. How is her staff addressing its analysis of response times and also where the patient is once the patient is transported out of the emergency situation? The patient may have stopped breathing for a certain period of time. Is her staff following up to find out whether, if the patient had been treated earlier, he would have had minimal brain damage, or would have had more recovery of his general health? What kind of analysis to response time is the minister’s staff doing?

Hon. Mrs. Caplan: As I have said to the member, the situation is being monitored to ensure that there is no risk to the public. There is a contingency plan in place. In fact, we know that services for nonemergency situations have been reduced to some degree so they can provide coverage for real emergencies. I think it is important that we emphasize in this House that I am assured that emergencies are being responded to appropriately.

Mrs. Marland: Does the minister think two ambulances for 600,000 people is sufficient?

Hon. Mrs. Caplan: I will repeat again that the situation is being monitored to ensure that there is no risk to the public, that contingency plans are in place and that the ministry is monitoring.

Mrs. Marland: I guess there is no point in pursuing these questions, because the minister is either not willing or not in a position to answer some of the questions.

I must say it makes me feel very uncomfortable. It makes me feel very unhappy to think that it seems to be all right that the strike continue without any intervention on the part of the Liberal government.

I think that when the Liberal government found it necessary to legislate teachers back to school to teach after a two-month strike, it is beyond me that it is not necessary to legislate ambulance driver attendants back to work after in excess of a three-month strike. If the minister is happy that the response times are being monitored, and as she keeps saying, if she is assured nobody is at risk, then I think what needs to be analysed is the risk that particular patient I happen to know of, a constituent of mine, was put in last week.

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When this minister knows the facts behind the case of my constituent last week, I do not think there is any way she could say that patient was not at risk. That was a trauma patient. That patient was at risk every moment until he was able to get to the hospital he had to get to to receive the surgery he needed. If we are saying a patient in that situation, waiting to be transported by an ambulance that never came for 23 hours and 40 minutes, is not at risk, then I guess I have to wonder what the ministry staff considers risk to be.

Maybe the ministry staff considers it a risk if we start having a loss of life, but God knows, we would be a pretty regressive Legislature if we felt we measured risk in terms of fatalities. We do not have to measure risk in terms of fatalities; we have to measure risk in true terms. When a patient is in a hospital for that number of hours waiting for life-sustaining surgery, then I think it takes fairly basic common sense to recognize that patient has been at risk.

If we can manage with two ambulances for 600,000 people, then I guess we have to ask why we have more ambulances normally. The answer is not that we have more ambulances normally because we have a lot of ambulances involved in transportation for intrahospital treatment and transfer; it is because an ambulance service is also an emergency service. If you have an emergency service, it is because you need it.

These answers we have had today and last week and the week before last make about as much sense as saying: “Well, we don’t very often need more than two fire engines and we could reduce the number of fire reels we have in a particular geographic area. We could reduce the number of firefighters we have. The public is not at risk because we don’t need them all the time. When we need them, we’ll call them in from surrounding areas.”

The truth of the matter is that where we are talking about life-threatening situations, whether it is fire protection or emergency ambulance service, there simply is not the time to call them in from surrounding areas. It is the time I am talking about. It is the time I have been talking about from the very beginning of this strike 117 days ago.

If this ministry’s staff under this Liberal Minister of Health is advising her that the response times are adequate and that there is no risk to the public, to use her own words, then I think we have a very sad situation indeed, because we obviously have a ministry staff that does not see its responsibilities fully.

There has to be risk when there is not a response time that is within the normal range. The normal range in urban areas for emergency response with ambulances, I understand, is seven minutes. Having lost a friend in September where the ambulance response time was 14 minutes, I know from personal experience that it is a matter of life and death. It is not being dramatic to say that. It is demonstrating a lack of responsibility, unfortunately, on the part of staff that has been asked to monitor this situation in Mississauga and Halton. I suppose I am astounded that I am the only person, along with my colleague the member for Burlington South, who is standing in this House asking these questions.

We have had calls from people who are apprehensive about the fact that if there is an emergency, they do not know what is going to happen. One area that seems to have been missed completely by this ministry is a major emergency. A major emergency on a large scale could be at Lester B. Pearson International Airport, which falls totally within the city of Mississauga. I want to tell the minister that when we had the last air traffic accident at Mississauga, it took 180 ambulances immediately to transport the people who survived that accident and needed medical attention.

We just do not have that number of ambulances at our service now because the management who are driving the reduced number of vehicles in Halton and Mississauga simply cannot cover it, even with support from Metropolitan Toronto and surrounding areas. That air-fatality accident called in ambulances from all the Metro areas, and that was when everybody was driving.

Last week, we saw something like 85 or 90 ambulance driver attendants sitting in this Legislature. The Minister of Health welcomed them. At that time, I said I would be far happier not to see those drivers in our public galleries, that I would be far happier to see them on call driving those ambulances.

I have a question to the minister on one other subject related to ambulance service. It is on the subject of who gets what equipment, because I understand that the government-operated ambulance services -- by the way, I should say at this point that I think all ambulance services should be government operated. I do not believe in private ambulance services if there is a differential in the level of service for patients around this province. I understand there is a differential in the level of equipment in those ambulances and in the condition of the ambulances themselves. I understand new vehicles and new equipment go to government-run ambulance services.

I am wondering if the minister could confirm whether it is true or false that private ambulance services do not get new vehicles and new equipment, but get vehicles passed down from government-operated services?

Hon. Mrs. Caplan: As I mentioned to the member earlier, in fact we now have a coordinator for emergency health services in the ministry. Requests from across the province are considered both on a provincial and on a regional basis. They are distributed based on the priority attached to them.

For the information of the member, when it comes to emergency planning, I have some information that perhaps I could share with her. The existing operator has five ambulances that are fully staffed. At most times, there are no more than would be available to handle emergencies before the strike, since the other six vehicles available at peak periods are normally engaged in routine transfers from hospital to hospital. Although the vehicles and the crews are moved around to provide maximum coverage, two operate primarily out of the services station in Mississauga, and one each out of Oakville, Burlington and Milton stations.

The ministry’s central ambulance communications centre in Mississauga is responsible for dispatching the nearest ambulance in response to an emergency call. I think it is really important the member should know, in response to her specific question, that the answer is that it is false, that all vehicles are rotated to all services, that emergency coverage in the area she refers to specifically is being maintained using vehicles and crews from services in the surrounding area, as required, and that extra support for the Mississauga area is being provided by other private ambulance services, particularly in Streetsville, as required.

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As I have mentioned, we are also monitoring the provision of ambulance services in this area to ensure there is no risk to the public during this strike situation. There are likely to be some delays in nonemergency situations and hospitals may and are using alternative means of transportation in nonemergency situations.

I think it is important we acknowledge this is a difficult time. However, it is inappropriate for the ministry to comment on negotiations that are ongoing between the employer and the employees.

I think that when we talk about the ambulance services, it is most important, not only in ambulance services specifically but also in emergency health services across the province, to acknowledge that what we have in place is a very fine service and to recognize that resources are allocated based on our setting priorities based on a rational planning process.

Mrs. Marland: I think the record should note that the minister obviously was just handed some material from her staff and that what she has just read into the record is from her staff. I am not laying blame on her for the content, but I think it is singularly significant when her staff tells her that it is inappropriate to comment on ongoing negotiations in this labour dispute, because what I am telling her is that there has been one meeting in three months, so she cannot talk about ongoing negotiations. I would not even feel so badly if the negotiations were ongoing, but one meeting three months ago is not ongoing negotiations to resolve this labour dispute.

Since the minister has just read beautifully the ambulance coverage in Halton and Mississauga and is told by her staff that they are monitoring the response times, I just have one final question for her: Is she satisfied with the ambulance coverage in Halton and Mississauga for emergency calls?

Hon. Mrs. Caplan: I have been assured that the public is not at risk and that emergency service is being maintained. I share and I hear from the member her concern and her frustration. I want her to know that frustration is shared, of course, by everyone, regardless of where they sit in this Legislature, but I want her to know that I have been assured the public is not at risk.

The Deputy Chairman: Has the member for Mississauga South now completed her questions?

Mrs. Marland: I yield.

The Deputy Chairman: We have first on my list the member for Mississauga West.

Mr. Mahoney: I would just like to ask a couple of questions and make a very brief comment in response to some of the comments from the previous questioner.

I can assure the minister that --

The Deputy Chairman: Just a minute.

Mr. Mahoney: I have a question to the minister.

The Deputy Chairman: The member for Mississauga West is recognized for the purpose of asking questions related to the topics raised by the member for Mississauga South. We have further supplementary questions on the same subject from the member for Windsor-Riverside (Mr. D. S. Cooke).

Mr. Mahoney: That is fine. I have questions on that issue. It is just that it was suggested no other member from the Mississauga area had asked any questions and I wanted to ask the minister a couple of questions.

I recently met with representatives from the union, as did other members of the Liberal caucus. A number of questions were raised with regard to the Shapiro report, particularly with regard to recommendation 3 in the Shapiro report, which recommends that a pilot project be established in a region. I wonder if the minister could tell me if she has had an opportunity to consider that recommendation and to consider possibly using the region of Peel as the region for the pilot project?

Hon. Mrs. Caplan: The member has raised this matter with me and I am familiar with the recommendations in the Shapiro report. As he knows, I met with Mr. Shapiro, although briefly, to discuss his report and some of his recommendations. I am aware ministry officials are presently reviewing that report and are discussing, with those regions that might be interested, his suggestion regarding a pilot project.

Mr. Mahoney: One further question to the minister would have to do with the numbers she recently read into the record and the levels of service. There have been conflicting reports with regard to the numbers, both from the union and from some staff, on which my office has attempted to get clarification. Exactly how many ambulances were available prior to the strike on a 24-hour basis and how many crews would be available over that 24-hour period, specifically in the Mississauga area, although it may be necessary to broaden that scope to include Mississauga and Halton?

I wonder if the minister would be able to clarify the actual numbers today, or if not, to bring a report back so that I could then tell my constituents, who have also expressed concern over the length of this strike, what the actual numbers are in relation to the ability of the services to respond to emergencies on an ongoing basis.

Hon. Mrs. Caplan: As I have said to the member, and to any member in this House on that kind of specific and detailed question, I would be very pleased to provide the member, in writing, with the details in response to the question he has asked today.

Mr. D. S. Cooke: We have obviously had these types of disputes in Ontario before and we get the same type of answer from this minister and previous ministers that we have had all along.

Regarding private ambulance services in this province, as I understand it, the ambulances are owned by the Ministry of Health, the uniforms the drivers and attendants wear are owned by the Ministry of Health, and the budgets are submitted and approved by the Ministry of Health. Really, the only involvement of the private operators is that they provide the administration for these services. The purse-strings are entirely and totally controlled by the ministry.

I would like to ask the minister what role she feels she has at the bargaining table, as the real power person behind whether there is going to be a settlement in this dispute or any other dispute that occurs in ambulance services across the province?

Hon. Mrs. Caplan: As I have said on numerous occasions, the negotiations are ongoing between the employer and the employees. The Ministry of Health is not at the table.

Mr. D. S. Cooke: The minister cannot just slough it off in that way. She cannot say a private operator exists; she owns the ambulances, she controls the purse-strings and she has to approve the budgets, yet she says she has absolutely no responsibility.

While she might not be sitting at the bargaining table, the fact of the matter is, she is there. She could settle the strike. She could become directly involved as Minister of Health because she controls the purse-strings. The minister knows she has that power. She knows she has the responsibility as Minister of Health. What role does she feel she should be playing as Minister of Health when these negotiations are taking place, not just in this particular instance but in others?

Hon. Mrs. Caplan: In response to the member, it might be helpful for him if I told him that there are a number of different types of services around the province. There are 65 private, 66 that are run by hospitals, 29 that are volunteer-based, four that are municipal, three that are run on a contract basis and nine that are run directly by the ministry. As I mentioned before, there is a total of 131 hospital-based and private ambulance services in the province. The member is also aware that we have received a report from Mr. Shapiro regarding --

Mr. D. S. Cooke: Mr. Chairman, this is not the question I asked. I watched the Minister of Health last week when specific questions were asked of her during these estimates, and she just wandered on by reading notes. I do not want to have her notes; I do not want to have her statistics. I was Health critic for this party for a number of years and I have heard all those statistics before.

What I want to ask the minister is, what responsibility does she feel she has when disputes like this occur where people’s health is put at risk and where she sits back and says, “I am not at the bargaining table. It is a private operator. It is up to the union and the private operator,” when in fact she controls the budget? When is she going to accept the responsibility and understand that she is a real partner in finding a solution to this dispute? When is she going to get involved?

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Hon. Mrs. Caplan: The reason that I appreciate the opportunity through estimates to give responses to the questions from members of the House is so that I can clarify in some detail those questions that perhaps during question period do not lend themselves to a fuller and longer response.

In fact, the member, as a previous Health critic for his party, would know that when it comes to mediation, it is the Ministry of Labour that would be involved in an attempt at mediation between a private employer and employees, and their union specifically, and that the Ministry of Health is not involved in mediation; nor are we involved in negotiations, particularly in services or in transfer payment agencies.

Mr. D. S. Cooke: If the minister refuses to accept any responsibility for the health care of people in this province, and that is exactly what she is doing -- I mean, when it comes to hospitals in the province, she throws up her hands when there are complaints and she says, “There is nothing I can do; there is a private board.” When it comes to ambulance services in the province, even though she carries the entire financial responsibility for that service, she throws up her hands and says it is not her responsibility -- I do not know what her motive is in becoming Minister of Health.

I would have thought that a person like her would want to get in and become Minister of Health because she would want to make some change to improve the system. Instead, what she has developed into is a very good note-reader in the Legislature, a reporter and a defuser of issues in the Legislature, but nothing in terms of fundamental change in the Ministry of Health. I think this dispute in the ambulance service is a good example.

I want to ask her something that has been raised at the Ministry of Health estimates on ambulance services year after year after year, and that is the fact that we do have a mixture of services. We have municipal; we have for-profit private operators; then we have the ones that are run directly by the Minister of Health; and then we have some that are volunteer agencies. The issue has been studied to death and recommendations have been made time and time and time again about rationalizing ambulance services in this province. When is the minister going to be prepared to not accept the status quo and to bring in some fundamental changes so that there is a rationale and not a hodgepodge of services all across this province?

Former governments recognized the problem. Every year in estimates her predecessor, the member for Bruce (Mr. Elston), used to say: “We are studying it. We are studying it. We are studying it.” I think the taxpayers of this province are sick and tired of hearing from her and her predecessor that they are studying the issue. When is she going to introduce some change to the system to rationalize ambulance services in this province?

Hon. Mrs. Caplan: In fact, I have some concern because the member for Windsor-Riverside, in standing in this House, I think suggests that one of the strengths of our system of delivery of health services is unacceptable to him. I would say that I do not agree with his hypothesis that the boards of our hospitals, who are transfer payment agencies, are not fulfilling a very important role. In fact, transfer payment agencies, whether they be hospitals, community-based organizations, are the ones that accept a level of accountability for the services which are funded by the ministry. In the same way --

Mr. D. S. Cooke: This is not the way that we can proceed in estimates if the minister wants to attempt to distort what other members have said. That is not what I said at all.

Hospital boards will in fact accept their responsibility. What I want her to do is to accept her responsibility. She is the Minister of Health; she is the one who funds these agencies, and when there are problems, she has to accept responsibility.

We are specifically talking about ambulance services, and my question was, when is she going to stop studying the irrational method of delivering ambulance services across this province and when is she going to follow recommendations that her own ministry personnel have made on many occasions to bring in reform, eliminate the hodgepodge system we have now and bring in something that is uniform across the province?

Hon. Mrs. Caplan: I would have to say that if we check the record in Hansard, the member opposite referred to the transfer payment agencies, of which hospitals and community-based organizations are two of many that provide the services. In fact, the Ministry of Health funds those services.

One of the things I have said repeatedly in numerous speeches across the province is, in fact, that over the years, the Ministry of Health was established as an insurance company, where the services were expected to be provided. One of the things that I have said repeatedly in this House is that I believe it is important for us to have a level of accountability and quality assurance for those services that we fund.

The member would be interested to know that at the present time, following the appointment of an emergency health services co-ordinator, we are considering a new legislative framework that would be for emergency health services across the province. I am hopeful that we will have an opportunity at some point in the future to discuss that new legislation, which I think even he might approve of.

Mr. D. S. Cooke: Just to finish, let the record show that we are now in the third year, going on the fourth year, of a Liberal government, and in the first year that it took office, the former Minister of Health said that the method used to deliver ambulance services across this province is irrational and that they were going to study it and make changes.

Now, what the minister has said is that she is continuing to study it, and some time in the future there will be changes. That just is not good enough; that is not good enough at all. Emergency health services are not provided adequately and equally across this province. If she does not bring in change, then she is the only one who can be held responsible when people do not get the proper type of care, as in the instance in the Peel area.

Instead of learning all of her cues and her lines in the Legislature, maybe what the minister should attempt to do is to make some fundamental change in the system, which just simply is not working. She is doing nothing to change it to make it work better for the patients of this province.

Hon. Mrs. Caplan: I disagree with the member opposite. In fact, we have made progress in a number of very important areas across the province. We can spend some time enumerating where I believe we have acted most appropriately to bring change, and fundamental change. In fact, he sees before this Legislature a new piece of legislation to expand community-based services across this province. I can tell him that, in fact, our commitment is to respond to what I have referred to in this House on a number of occasions as the three irresistible and compelling forces for change: the economic realities, the changing demographics and the impacts of technology.

I do not think there is any place where we see greater opportunities in technology than in the provision of emergency health services. We are beginning to see the kind of computerization and sharing of information through our central dispatch bed registries, which I think are responding to a tremendous challenge of geographic diversity.

I am not sure that we will ever have the situation in this province where we determine that what is right for northern Ontario, where they rely on air ambulance services extensively, is exactly the same as in an urban area in southern Ontario. That is what makes Ontario so unique. We have the ability and the flexibility to respond appropriately and to make the most rational and effective use of our resources as we respond to the very different needs of the people of this province.

Mr. Hampton: It is with a great deal of pleasure that I take part in this estimates discussion, because I have a number of questions that I would like to address to the Minister of Health and a number of matters that I want to put before the Minister of Health, not that they have not been put before her before -- in fact, they have -- but it seems that you have to hit the same nail five or six times before you get some attention on it.

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It is not unusual that we on the opposition side of the House come to the House and hear the minister say over and over again that Ontario has a world-class health care system second to none and that it is wonderfully managed, it is a rational health care system with rational management. But what we see in northern Ontario is anything hut a rationally planned health care system, it is anything but a world-class health care system, it is anything but a second-to-none health care system. In fact, in many situations it is becoming a very sad and serious health care system.

Just to emphasize that point, I want to refer to some comments made by a couple of northern Ontario physicians, physicians who are well respected both by their peers and by the communities they serve in. I want to refer first to a Dr. Denton of Kirkland Lake and then to a Dr. Moulton of my community, Fort Frances, who have spent a great deal of time advising the minister and the government as to how they might better promote health care in northern Ontario communities.

One of the comments that Dr. Denton makes -- and this is, by the way, an article that appeared in Ontario Medicine last fall, October 1987, entitled Problems in Training Doctors for the North -- is basically:

“The situation in some northern communities could become desperate. Doctors in the north are doing the best they can, but they can only do it for so long. In some instances, people who need specialists can be referred away from their towns. But in other cases, such as family doctors wanting the backup of obstetricians in the event of complications, it is just a matter of time before a major disaster happens. In my books, obstetrics is unsafe in my community of Kirkland Lake at the moment, because we do not have the backup.”

“The manpower problem in northern Ontario is not new, but,” according to Dr. Denton, “is getting worse.” He says that when he first moved to Kirkland Lake 10 years ago, there were two obstetricians; now there are none. There were two general surgeons; now there is one. And the town’s only ophthalmologist has left. Like many other northern communities, his community also suffers from a lack of psychiatrists. He points out: “Now the government plans to cut back on residency positions over the next five years, there is a worry that the north will face a further shortage of family doctors able to do anaesthesia.”

That is one doctor pointing out the seriousness of the situation. The list is much longer and much more serious than just the problem of doctors. The minister refers over and over again to the fact that the northern health travel grant program is a wonderful solution to many of the problems we have and that the northern health travel grant program has done so much to alleviate some of the pressing health care needs in northern Ontario.

Over the past 12 months, I have sent to the Minister of Health numbers of northern health travel grant applications that have been turned down by her bureaucracy, and turned down for a number of reasons that most of us in northwestern Ontario -- and I think we probably can speak for the rest of northern Ontario -- but most of us in northwestern Ontario, in any case, cannot understand.

To give the minister an example, if you live in communities like Kenora or Red Lake or Dryden or Sioux Lookout or Fort Frances or Rainy River, any of these communities in the far northwest corner of the province, your family doctor, if he needs to refer you to a specialist, will likely refer you to Winnipeg, for a number of reasons: first, because transportation to Winnipeg is easier than it is to Thunder Bay or to Toronto; and second, because most often there is better or more specialist care or a greater variety of specialist care available in Winnipeg than there is in Thunder Bay.

They make these referrals in the knowledge, quite often, of whom they are referring their patient to. They are acquainted with the specialist in Winnipeg. They know what kind of work the specialist does, so they know what kind of service is going to be provided when the patient is referred.

The patient goes to Winnipeg, sees a specialist or sometimes sees someone who is practising as a specialist although he or she does not have all of the documentation that a specialist might ordinarily have. The patient gets back to his or her community, whether it be Kenora, Dryden, Red Lake, Ear Falls or Sioux Lookout. The patient finds that he or she has been rejected for a northern health travel grant. Why? Not because the specialist did not provide the patient with good medicine; not because the person referred to in Winnipeg did not look after the patient; not because he or she did not incur all kinds of costs in going there -- none of those reasons.

The patient is refused a northern health travel grant because the person who was practising as a specialist in Winnipeg or the person referred to in Winnipeg who acted as a specialist lacked some particular piece of paper that is required in Ontario. Because that person lacked the particular piece of paper that is required in Ontario, the northern health travel grant is not provided.

If ever there was a case where bureaucratic nonsense gets in the way of good medicine, this is it. Yet the Ministry of Health refuses to do anything. The Ministry of Health simply says: “Those are the rules. That is the way it is.”

I want to ask the Minister of Health today, and I would like an answer to this: When this is the least-cost alternative, when good medicine is available, when it is far cheaper to send someone merely three hours or two hours away to Winnipeg than to ship the person all the way to Toronto, which is at least a day’s travel involving expensive air flights, why can the Ministry of Health not accommodate people of northwestern Ontario and change the northern health travel grant system so that this simple kind of justice is provided? Why can the bureaucracy not be changed?

That is one example. We have all kinds of other examples. In most small communities in northern Ontario, you will find that dentists do not do a lot of dental surgery. The reason they do not do a lot of dental surgery is first and foremost that they may not do it often enough. If they do not do it often enough, they do not feel entirely secure in doing a particular type of dental surgery three or four times a year. They do not feel secure in doing it. They are not certain that their patients will be getting the best medicine or the best treatment available. Finally, they are a little bit concerned about their liability. Naturally, they refer their patients to places like Thunder Bay, Winnipeg, Sault Ste. Marie or Sudbury for the more serious types of dental surgery.

When a person is referred from a town such as Longlac, Terrace Bay, Gogama, Hearst, Dryden or Red Lake to one of these larger communities for serious dental surgery, another unbelievable bureaucratic complication takes place. If the dental surgery takes place or is conducted in a hospital, then the patient qualifies for a northern health travel grant. But if the same surgery is not done in a hospital, if it is done in the dental specialist’s office, the patient does not qualify for a northern health travel grant.

I ask the minister to explain that one to people who have to travel 300, 400 or 500 miles to obtain serious dental surgery that, if not obtained, would surely mean the person would have to go in hospital, at the very least costing the province $400 a day for time in hospital. I want the minister to explain why it is that if the surgery is conducted in a hospital, the person qualifies for a northern health travel grant, but if it is not conducted in a hospital, the person does not qualify for a northern health travel grant.

In either case, it is medical treatment that eventually will save the province some money, because if the person does not go to see the specialist, we both know that he or she is going to wind up in the hospital and is going to cost the province more money. This is preventive medicine at its best. Yet because the province gets into these silly bureaucratic mixups, people are denied the care, and their physical and health situation deteriorates even further. I would like an explanation of that.

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As the minister knows, I and many of my colleagues conducted a tour of northwestern Ontario last spring and a tour of northeastern Ontario this fall. We talked at first hand to many of the people in the communities. One of the absolutely appalling things is that there are people who are so ill, who are handicapped, who are aged, who are young children and are referred elsewhere to see a specialist and have to have someone accompany them in their visit to the specialist. This often means that someone has to take time off work.

The guardian or the person who travels with the patient has to take time off work or has to incur significant travel expenses. Yet, time and time again, the Ministry of Health has referred the applications for a travel grant. We have situations across the north where people are being denied needed specialist medical treatment, because the person who might be guardian for them is denied the opportunity and travel grant moneys to enable him to travel with the patient.

We have examples of blind people, handicapped people, people who are aged, all these examples. Yet the minister’s bureaucracy continually turns the applications down as if the people in need should somehow try to shuffle the papers again, as if that might help them somehow to get the care they need.

The northern health travel grant program is a good program. These are serious and valid questions that need to be answered. These are problems with the program that need to be addressed. I know somewhere within the Ministry of Health there is the myth that if one deals with these problems, the northern health travel grant program will become so loose that it will be abused.

I have been told that by doctors who are very close to the Ministry of Health and by doctors who are very active in the Ontario Medical Association. Yet those same doctors tell us that the instances of abuse of the northern health travel grant program are so minute and so few that the myth that the program is going to be abused has no basis whatsoever.

I cannot understand, and people all across northern Ontario cannot understand, why the Ministry of Health has not acted to take care of some of the documented problems with the northern health travel grant program so that the people who need it and have to have it get some sort of justice from it; a justice that is well deserved. But let me leave the northern health travel grant program for a minute, because it is, though one of the most serious, certainly not the only problem we face.

I spoke earlier and I quoted Dr. Denton’s comments in Ontario Medicine. I want to go back to that, because as the minister knows, one of the most serious problems we have across northern Ontario is the lack of doctors, physiotherapists, occupational therapists, speech pathologists -- the list goes on. The minister has told us time and time again that the government’s underserviced area program is the answer to all of these woes; that it takes care of northern Ontario’s problems with the lack of health care professionals.

I want to refer to the article in Ontario Medicine again, because it sums it up. Dr. Denton, from Kirkland Lake, says that in his view of the underserviced area program: “I would like to see the underserviced area program do a better job. I would like to see more attention paid to it. The fact of the matter is that it is not meeting the needs”.

He says he has found a number of doctors go north for the three or four years in which they get a grant. As soon as their three or four years of grant are used up, they head back south. That is his estimation, and, as I said, he is a well-respected professional. He is a well-respected physician in northern Ontario and he is well respected by his colleagues at the Ontario Medical Association.

But he is not alone. One of the things we did in a follow-up to our tour is that we wrote to many of the municipalities and we asked them: What is your estimation? This is from the corporation of the Township of Ear Falls, a community that has enough difficulties without having a further difficulty of not being able to find enough doctors. This is the clerk-treasurer of the town responding. He says:

“I have given some thought to your request for my views on the underserviced area program in recruitment and retaining medical professionals in the north.

“Ear Falls has participated in the under-serviced area program tour since its inception” -- and they have been able to find some doctors. “The incentive grants definitely do induce a few doctors to come north. It does seem, however, that the number of professionals in the program is in no way keeping pace with the demand.

“As more communities obtain underserviced status, because more and more communities need the underserviced status, the problem only gets worse. Our past experience with doctors and dentists has been that, once the incentive grant has expired, it is time for them to move on, this in spite of the fact that their incomes here are very high.

“We are in the situation where we have to provide below-market-cost housing; we have to provide below-market-cost office space, and we have to provide below-market-cost equipment, all these things in addition to the grants, in order to get the needed medical care professionals.” His conclusion is that the underserviced area program is, at best, a Band-Aid solution. You get doctors for three years, and then they move on.

But let me go further. Let me give you an example of Dr. John O’Sullivan, someone who has practised medicine in the community of Emo for 24 years. His comment is simply this: In his 24 years, he has seen 21 doctors move through the community on the underserviced area program. They come out of medical schools, they get their first couple of years of grants and they say: “Goodbye. Thank you very much.”

To me, these things suggest that the underserviced area program is not doing the job that is necessary; it is not meeting the needs. If the minister needs any greater illustration, all she needs to do is look at the list of areas designated as underserviced for general practitioners in December 1987 and see the list of communities: Armstrong, Blind River, Cochrane, Dryden, Dubreuilville, Elliot Lake, Emo, Englehart, Fort Frances, Geraldton, Hearst, Hornepayne, Ignace, Iroquois Falls, Kapuskasing, Kirkland Lake, Manitouwadge, Marathon, Matheson, Moose Factory, North Bay.

She should look at it in 1987 and then look at it again in 1988: Armstrong, Cochrane, Chapleau, Dryden, Dubreuilville, Elliot Lake, Emo, Fort Frances, Geraldton, Hearst, Hornepayne, Ignace, Iroquois Falls, Kapuskasing, Kirkland Lake, Marathon, Mattawa, Matheson, Moose Factory, North Bay, Rainy River, Pickle Lake and so on.

Six months later, she will see the same communities. I could read for her today the November report or the October report of this year and she would see the same communities. The shame of it is that in the interim, in the 12 months that have passed since December 1987, what has happened in some of these communities is that they have got a doctor, but the doctor may have stayed six months or nine months, taken some of the grant money and moved on.

The underserviced area program records that as a success. It records that as a placement. That shows up in the minister’s statistics as a doctor placed, a community satisfied. Yet only eight or nine months later, the community is again looking for a doctor. How much more evidence do we need that this program is a Band-Aid solution that does not work? How much more do we need?

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Let me give the minister the example of one community, however, and I think she knows the community I am going to use because I have raised it so many times in the past: the community of Rainy River. The people of Rainy River is so fed up with the underserviced area program that they hope it goes somewhere and gets lost. They have found that the underserviced area program has not helped; it has hindered.

They have gone through all the recruiting tours. They have wined and dined medical school students at Hamilton, at Kingston, here in Toronto, at London, in Ottawa, and they have been told: “Well, if you can’t get one simply by going on the tour, why don’t you offer them free housing? Why don’t you offer them a free office? Why don’t you offer them a free car?”

This is a community that has a higher than 20 per cent unemployment rate, and 67 per cent of the people who live in the community are senior citizens on fixed incomes. They are supposed to delve into their pockets to help the underserviced area program bribe somebody to come and do the job. How much more evidence do we need?

Finally, when the town of Rainy River became totally upset with the underserviced area program and decided it had to go outside the country to find a doctor, it found a doctor in the United States who was fully licensed, had 12 years of practice behind her, who in fact had special ability in terms of obstetrics and was willing to practise obstetrics, was willing to come to the town of Rainy River, was willing to work in the town of Rainy River.

But do you know what the town of Rainy River found when it tried to get Dr. Batman from Philadelphia into the country? It found the underserviced area program did not help it get through the hoops of the College of Physicians and Surgeons of Ontario, did not help it get through the hoops of the Ministry of Health and did not help it get through the hoops of the Ontario Medical Association. The underserviced area program was actually a hindrance. The underserviced area program did not help at all. In fact, if anything, it placed more roadblocks in the way of the community.

I want to ask the Minister of Health if she really believes, with this kind of evidence, that the underserviced area program is doing the job. Does she really believe it is doing a satisfactory job? Is it not time that the government sat down and very seriously looked at alternatives to the underserviced area program? Something that provides more than a Band-Aid solution, something that does not say to communities which are already on their economic backside: “You have to come up with more money out of your public treasury if you want a doctor. You have to come up with more grants and more bribes if you want a doctor.”

What is amazing in all of this is that in fact there are alternatives. Alternatives have been suggested by different health care organizations and different health care advocacy groups. I want to refer to some of those alternatives which have been suggested, because to not refer to them I think is to give only half the picture.

In March 1988, the Ontario Medical Association’s special committee on northern affairs issued its report, in which it made several recommendations. One of the things they said is, “In the interim, the underserviced area program must continue to be an integral part of any northern Ontario health care strategy.” They said it has to be there for a while. But then they go on to the really key suggestions.

They said: “Appropriate residency training is necessary to meet the particular demands of medical care in the north and to encourage graduates to practise in the north. The Ontario Medical Association wants to discuss various approaches to this problem.” In other words, if the minister wants to do something about the serious problem in northern Ontario, there is a need for more residency positions in northern Ontario, not less. Yet the Ministry of Health has cut residency positions and is in the process of cutting them.

They said that “The feasibility of establishing chairs in multidisciplinary departments of northern health studies must be explored.” In other words, the minister has to do more in the education process.

They said, “An allowance should be established to subsidize northern physicians for continuing medical education.” Again, if the minister wants people to practise in northern Ontario, it is not enough just to have the underserviced area program; she has to do more ongoing medical education in northern Ontario.

These suggestions go on. What has the ministry done to respond to any of these recommendations? It is now seven months. The need is critical. What has the ministry done to respond to any of the recommendations made by the Ontario Medical Association’s special committee on northern affairs?

They are not the only people who have come forward with recommendations. The minister knows that, because she received a copy of a report entitled The Expansion of Family Medicine Training in Ontario. It is a report issued by the chairpersons of family medicine in the five Ontario medical schools: the University of Ottawa, Queen’s University, the University of Toronto, McMaster University and the University of Western Ontario.

The educators have advised the minister on what needs to be done. The educators have said there are some realistic, specific things she can do to ensure that a better quality of medicine is practised across northern Ontario. Let me just read some of these recommendations, because they hit the point right on.

Recommendation 5: An Ontario-wide three-year residency called the northern and rural program in family medicine, which should accommodate 24 trainees in each year of training in northern and rural family medicine, is recommended.

Recommendation 6: A proposed northern and rural program would begin operation in year one of expansion and take three years to reach maturity, after which time it would take an annual output of 25 positions. This program will be a three-year course with additional skills being taught, additional skills that are needed in northern Ontario communities.

Recommendation 7: These family physicians should be capable of carefully defined specialty substitution skills in such areas as anaesthesia, operative obstetrics, intensive care and emergency medicine, geriatrics and paediatrics.

Recommendation 9: Such a program will be the joint academic responsibility of the five medicine departments and will be centred, believe it or not, in northern Ontario.

In other words, even the medical educators are saying you cannot do all the education of doctors in southern Ontario and then ship them north and expect them to know how to handle the situation. A realistic training program has to be centred in northern Ontario.

Finally they say, where certain special areas of concentrated experience and supervision are required, the trainees may be seconded to southern teaching hospitals or family medicine teaching units, but the geographic home base of those accepted into the northern and rural program in family medicine will be understood to be in the north.

They go on to cite no less than 24 recommendations as to how better medicine, better training of doctors for northern Ontario can be provided.

I want to ask the minister, given that the chairpersons of family medicine in the five Ontario medical schools have told her what is needed, what has her ministry done to address this report? How has she responded? What concrete steps has she taken to meet this serious need and to address these very worthwhile recommendations which have been put to her by the chairpersons of the five medical schools?

Just dealing with the underserviced area program and the better training of physicians for northern Ontario does not cover the map either. The minister has said we have a rational health care system, that there is rational planning going on in the health care system. I have a number of questions about that. Permit me to refer to my own home community because I know it best. Let me give the minister an example.

There is a very dedicated physician in Fort Frances, and the minister knows him because his name appears in many of the reports that come to her desk: Dr. Moulton. He sent to the ministry a proposal to set up a day hospital program in the hospital, a program that would facilitate elderly people, chronically ill people who do not need to be in the hospital, who can be at home and with some assistance from home care can reside at home, coming to a special clinic where they could receive attention not only for their medical needs but also for their mental health, emotional and social needs.

It would be a very inexpensive program to fund and it would save the Ministry of Health literally hundreds of thousands of dollars because it would be a preventive program. It would be aimed at keeping those elderly, chronically infirm people out of the hospital, keeping them in their homes; and yet her ministry turned down the proposal. It seems that her ministry would rather see these people in the hospital in acute care beds at $400 a day than provide this very inexpensive, well-planned program, which, I might add, has been tested and shown to work. Her ministry would rather see these people in the hospital than see them out of the hospital receiving inexpensive preventive care.

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Why the ministry turns down these proposals I will never know. Why the minister insists on spending more money in acute care beds, why she insists on spending more money on the most expensive elements of hospital care and not on better preventive care I do not understand.

That is only one example. Let me give the minister the example of home care, and we have given it to her before. Across Ontario, but specifically across northern Ontario, she has thousands of dedicated home care workers who are providing the kind of home care that allows someone to remain in his home and, again, permits us to not put him in the hospital. Yet her ministry, through the decentralized system of contracts that it has, pays these people, maximum, all of $6.02 an hour. I have examples of people who have worked in home care for 18 years. For 18 years they have given dedicated service in this program and, after 18 years, her ministry provides them with no benefits whatsoever other than Canada pension and it pays them the grand total of $6.02 an hour.

The other tragedy of this is that most of these people are women. This is another ghetto for underemployed and underpaid women, and yet her ministry continues to sanction it. It continues to say, “We have no more money for it.” Yet she knows very well that the work these people do in home care keeps many people out of the hospital. As I say, acute care beds in the hospital cost $400 a day, at the very least. Again, I would like an explanation as to why this is so, why her ministry continues to do this when it makes neither financial sense nor health care sense.

Let’s step, just for a moment, into the question of community mental health. Again, I will use the examples from the north because I think they are the most extreme. We have the Lakehead Psychiatric Hospital in Thunder Bay, the one psychiatric institution in northwestern Ontario. It is a very expensive place to send people, because we start talking about bills of $500, $600 a day, not just $400, and because the community mental health service in so many smaller communities across northern Ontario is so inadequate that we end up having to send people who have mental health problems time and time again to Lakehead Psychiatric Hospital at $500 and $600 a day when they could be cared for in their own community much less expensively and, I would argue, given much better care. Yet the ministry refuses to fund some of the most necessary community mental health programs.

Again, I can give an example from any community across northwestern Ontario, because we talked to the community mental health directors in almost every one of those communities and they all said: “Give us one more psychiatric nurse, give us one more social worker and we will be able to save the Ministry of Health hundreds of thousands of dollars, because we will be able to provide the necessary treatment that so many members of these communities require. We will save them from having to be sent to the Lakehead Psychiatric Hospital, where the care is indeed very expensive.”

Again, I will give the minister a concrete example. The community mental health program at Fort Frances is an excellent program. It provides counselling in alcohol abuse; it provides family counselling and counselling in terms of family violence. What it wanted last year was one more clinical specialist to make the mental health program complete. I believe what it asked for was $50,000. It was ranked number one by the district health council in terms of priority, and yet her ministry turned it down. Why, when she can save money? When she can increase the efficiency and the effectiveness of the community mental health process, why does she turn these programs down?

Let me take it one step further. Everyone we spoke to in the area of community mental health has said to us: “If you want an effective community mental health program, get it out of the hospitals. Put it on the main street. Put it in the places where many of the emotionally ill and many of the people who have emotional problems will feel comfortable and somewhat easier about approaching the facility or approaching the service. Do not bury them in the basement of the hospital. Do not put them behind four corridors of doors in the hospital. Put them on the main street.”

We want to see some action on that. In all of those communities across northern Ontario that have some very serious community mental health problems, we have yet to see her ministry move the community mental health programs out of the hospitals and on to the main street, where they are so needed.

Does the minister know what? I bet the rent would be cheaper; the rent would probably be cheaper in the downtowns. I will tell her why. Ear Falls, Kenora, Rainy River, Atikokan, Ignace, Longlac: Look at how many of the communities across northern Ontario where economy is not booming. There is available space downtown that she can rent for many of these facilities. She can save her ministry some money. Again, why has she not moved?

Finally, I want to deal briefly with the question of native health care. When we did conduct our tour of northwestern and northeastern Ontario, it was very sad indeed to see the situations in so many of the communities. I only invite the minister to look at the infant mortality rates of many of our native communities; I invite her to look at the life expectancy statistics of many of the native people who reside across northern Ontario and see how much shorter it is than the white population’s. She should look at the morbidity rates. She should look at them all. If she is not shocked and saddened by what she sees, then I myself will be a very surprised individual. The fact of the matter is that we do not provide anywhere near the quality of care for our native people that is needed. Yet her ministry and the federal Department of National Health and Welfare keep bouncing native people back and forth like ping-pong balls, as if their needs somehow can wait for a later date.

The really sad thing about this is that, again, dealing with so many of the problems that native people face would not cost a great deal of money. I want to give the minister just one example that her ministry and the federal government have kicked around as a ping-pong ball that could save the government in general, I would argue, a lot of money, and provide all kinds of efficient and effective health care. I am talking about the native nursing program at Lakehead University in Thunder Bay.

The federal government has provided some basic purse-string funding for the native nursing program, and it has worked. I will tell the minister why it has worked. In the past, the federal government would go out on a recruiting program every year. It would go to England, the United States and several other countries, and it would spend hundreds of thousands of dollars recruiting nurses to work and live on remote native reserves. After one year, those nurses would leave. The federal government would go out again and spend all kinds of money recruiting, and again, after one year, those nurses would leave.

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The native nursing program has said: “No; let’s get the horse before the cart. Let’s take native people. Let’s take them to Lakehead University, let’s train them in nursing and then let them go back to their native communities, where they want to work.” The program has been successful. It has saved money. Yet the Ministry of Health, the Ministry of the Attorney General and the federal Department of National Health and Welfare have kicked this program around as though it is a ping-pong ball and somehow it can wait until doomsday before it gets adequate funding.

I want to ask the minister, why can her ministry not take the lead role? It is our estimation that it would cost $300,000 a year. It should take the lead role. If she has to, the minister should embarrass the federal government. It would be money incredibly well spent. But she should not treat the health of the native people like a ping-pong ball the way it has been treated and is continuing to be treated.

Last of all, let me give the minister another example of what is irrational about our health care system, totally irrational. It is not just in Toronto that we face tragic waiting lists for needed surgery. We have people across the north who are awaiting heart transplants, who are awaiting surgery for the replacement of joints who have waited a year and, after waiting a year, are being told by the doctors who have referred them, “You’re going to have to wait even longer.”

It has got to the point where we have people from northwestern Ontario who are going to Calgary to receive the needed surgery because they cannot wait any longer, because the tension of waiting, the nervous anxiety of waiting for the heart transplant or the pain of waiting for a joint transplant is totally beyond what they can bear in the future. So they mortgage the farm or they sell the car or they sell the truck, whatever they have, and they pay their own expenses out to Calgary to get the needed surgery. How can this be a rational health care planning system? How can it be?

Mr. Haggerty: We have doctors from Alberta coming to Ontario.

Mr. Hampton: Not any more. We are not going to have it because the Minister of Health has said -- and I want to refer to the question, because I almost forgot about this -- that she is going to restrict doctors who want to move here from other provinces and other countries. She may be thinking of the impact of that on southern Ontario, but has she thought of the impact of that on northern Ontario communities, where we cannot get enough doctors as it is? Has she honestly thought of the impact of that? What may save costs in southern Ontario may mean lives in northern Ontario. That is what it boils down to. Again, if the minister wants me to, I will quote for her the comments made by Dr. Denton and Dr. Moulton, because that is what they are saying. They are saying we are just waiting for a disaster to happen in some of these places.

Just a last reference to the rational planning of our health care system: I do not think it is a rational system. I think that in some cases it has been subjected to the most irrational and desperate kinds of political abuse. I want to refer again to my own home community. As the minister knows, the hospital in my community, La Verendrye General Hospital, has been desperately seeking to operate a larger intensive care unit because it is needed. We have a number of senior citizens, we have a number of people who suffer from industrial accidents. To get the intensive care unit, they need some provincial funding.

The minister says it is a rational system, but I wonder how it is that I can write to the former Minister of Health and he can write back and say: “No, the consideration of funding will take at least a year. t will have to go through all of the rational steps before it can be addressed.” It was a year ago in the summer, June 1987, that I wrote to the former Minister of Health. He said, “It will take at least a year before we can determine if funding will be available for the intensive care unit and how much will be available.”

Then, lo and behold, on Labour Day, September 1987, three days before election day, the Liberal candidate in my riding goes to a Labour Day rally and says, “I have just learned that funds are available for La Verendrye hospital’s intensive care unit beginning in April 1988.”

Mr. Villeneuve: Playing politics with health.

Mr. Hampton: Playing politics with health, exactly.

In northern Ontario we are used to the former Tory government promising a highway to get elected. We are used to that. In fact, we used to say with the former Tory government that you could plan on the highway being reannounced three times. Every highway had to last three elections.

Mr. Villeneuve: But it got built.

Mr. Hampton: All right, but no one before this has ever tried to use the health care system. No one has used the promise of a hospital or the promise of hospital facilities in northern Ontario as a cheap attempt to get elected. This is the first time we have ever seen it, and what is so sad about it is that in so many of those northern Ontario communities, better health care facilities are desperately needed.

On the one hand, we have the Minister of Health saying, “The rational health care process will take at least a year to deal with this system.” Yet three days before the election, the Liberal candidate stands up and says: “The funds are available. The intensive care unit will go ahead. Everything has been approved.” But then after the election, what happens? Her ministry says: “Sorry, the funds are not available. It has not been approved.”

Now, does that sound like a rational health care system to members? Does that sound like a health care system that is trying to meet the needs of Ontarians on a rational basis? It does not. It sounds as though health care is being used as a political football. If that is what it needs to get elected, then that is what this government will use it as, and I say shame on the minister and shame on her government.

Do not try to tell me this was not known by the Liberal Party, because I see those people who were running the campaign in my community walking up and down the halls here at Queen’s Park every day. Do not tell me that political people from Queen’s Park were dispatched to Rainy River to run the campaign and yet no one down here knew that this kind of promise was being made. That just will not sell.

I ask the minister again, that does not sound to me like a rational health care system. It does not sound to me like a compassionate health care system. It sounds to me like a health care system that is being used, unfortunately, in a very political way. I am very sad to see that happen, very sad.

I have put a number of questions to the minister. I hope she will take the time to answer them. I will put her on notice now. If she does not answer them today, those questions will be asked again and again, because the problems are not going away. They are getting worse and they are getting seriously worse. If the minister wants, I can bring letters from more town clerks and more clinic administrators from all across northern Ontario to tell her how bad it is getting, so I hope the minister will take the time to answer some of those questions.

Hon. Mrs. Caplan: There was agreement with the Health critic that there were a number of people who wished to have an opportunity to place their questions on the record today. I agreed we would do that, and so I will yield the floor to those who want to continue making sure their questions get on the record.

Mr. Villeneuve: I have several questions that will not be new to the minister. The minister has heard them before, but I want to try to pry some information from the minister and the ministry to help some people throughout Ontario.

Cystic fibrosis has been brought to the attention of this Legislature on a number of occasions by myself and a number of my colleagues. I know the minister has suggested and, I believe, has put into effect a study that I do not believe is required. For some cystic fibrosis adults, there is a very real penalty in living beyond the age of 18, because so many supports previously available to those people are no longer available once they turn 18.

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In Ontario, individuals with cystic fibrosis and families with children who have CF have to pay for all their CF medications unless they are eligible for the Ontario drug benefit plan. Adults with CF must be on public assistance or must have a very low income with almost no assets in order to qualify. Otherwise, a person must turn to his or her own resources just to survive.

Frequently in the past, arrangements have been made through hospital pharmacies that permitted persons with cystic fibrosis to receive medication from the hospital pharmacy on a free or almost free basis. Many adults with CF formerly paid only a nominal sum for their medications due to the subsidy from the hospital pharmacy, but will now have to pay and meet all the costs of their CF medication unless they pass a means evaluation test conducted by the hospital.

Action is needed now in order that these problems do not continue. Those already grappling with the heavy demands of CF, this terrible illness, deserve much better, living in a province with the resources and the budget the Ministry of Health presently has. For example, a young man earning $5.50 an hour has been told he does not qualify for any assistance through the provincial drug benefit plan. He is not eligible for a drug card because he has assets of some $3,000. He has been told that if he disposes of his cash assets by liquidating them or spending the money, he may be able to get a drug card. However, this party agrees that this type of decision is made on grounds that really do not provide personal dignity to the people who really need government assistance.

Private insurance is not the answer. Some families, particularly those with young children, have excellent private health coverage, yet such coverage often has a total dollar ceiling. Once the ceiling is reached, coverage ceases. As one young woman in her 20s explained, she received a memo from her personnel department stating that since she started with the company two years earlier, she had submitted a total of $11,800 of prescriptions and the lifetime maximum covered only $10,000.

We have a major problem. Minister, we do not have many CF patients over 18 years of age. It would cost the government a pittance when compared to the expenditures that are made, and possibly compared to the expenditure that will be required to complete a study. Many private health policies explicitly exclude medication that may be purchased without a prescription. Cystic fibrosis digestive enzymes fall within this category. Residual funding from the Ministry of Health may be required by individuals with cystic fibrosis covered in part by private health plans.

The solution is provided within this study by the Canadian Cystic Fibrosis Foundation: “The crisis confronting individuals with cystic fibrosis in Ontario is a relatively simple one to solve. It is one which we believe is fiscally responsible and humanly compelling,” states the CF foundation.

Simply stated, individuals with CF should continue to have their drugs dispensed through the hospital pharmacy associated with their local CF clinic. These medications should be paid for through the Ministry of Health without a means test. In this way, there would be no vast burgeoning of drug costs; rather, the mechanisms of current practice would be continued without the enormous stress of evaluation, re-evaluation and the ability to pay. Dignity would be preserved and the public purse would not be violated while we are dealing with people who desperately need some moral and financial support from their peers and from this government.

It is worth noting that adults with cystic fibrosis who are in the workforce are largely ineligible for life insurance and quite often suffer the added burden of planning their families’ financial security knowing that they face complete disability, and indeed, an early death. This is an issue that haunts the lives of all individuals with CF who are fortunate enough to have reached the age of majority and are still living today. So I certainly urge the minister to have her ministry complete its study as quickly as possible and get to the root of the problem, which is providing funds for those young people beyond the age of 18 who have CF.

Another concern was raised by the Canadian Nurses’ Association. They have brought a number of questions to the fore that remain unanswered. I would certainly like the minister to address some of the concerns that the Canadian Nurses’ Association, the CNA, has brought forth to her and to the different caucuses within this province. Many of the concerns surround the wording of a document that members of the Ontario Nurses’ Association, the nurses of Ontario, will have to abide by. Certainly, whenever we have a profession that has 50 per cent more or less of its members who do not practise actively on a full-time basis, we have a major problem.

Finally, on the problem of chelation treatment, I have written to the minister earlier on this very controversial subject. It is one that is difficult to understand for a layperson such as myself. However, I can assure her I have met with a number of my constituents who are presently receiving chelation treatment and I can tell her that they not only believe it is assisting them but several of them have told me that were it not for chelation treatment, they would probably not be alive today. I trust that the ministry is looking into the possibility of allowing chelation treatment.

I know the College of Physicians and Surgeons of Ontario has made some decisions that, based on its knowledge, it has found it difficult to accept it as a treatment for other than lead poisoning. However, I believe the ministry, in concert with the College of Physicians and Surgeons of Ontario, should be looking at this again in the light of some of these people. I must tell the minister I cannot think that all these people who are receiving the treatment now can be wrong, and they are receiving it from medical doctors within the province.

I could bring forth many other concerns I have regarding hospital funding, ambulatory services, etc. However, I believe my colleagues will be touching on those. These are the areas that concern me personally: cystic fibrosis, chelation treatment and the fact that I do not feel our very dedicated nursing profession is receiving the remuneration and consideration it should be receiving from the ministry.

Mr. D. S. Cooke: I am not sure how we are proceeding. Rather than let everything pile up, I would like to ask the minister a couple of questions and have her respond now. That is how I am used to doing the estimates debate.

The Deputy Chairman: On that point, the understanding I just had from the Minister of Health was that the Health critics of the parties agreed to put their questions together first and she would respond after all the questions were in. Is that correct?

Hon. Mrs. Caplan: That is the discussion I had today with the critic for the third party, who is here today. He has already placed numerous questions on the agenda. He asked that members of that caucus be permitted to place their questions, after which time I would have an opportunity to respond.

Mr. Eves: I am quite happy to allow the member for Windsor-Riverside to proceed with his few questions, if that is the way he prefers to proceed.

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Mr. D. S. Cooke: First of all, I would like to have the minister respond regarding the section of the Nursing Homes Act that was passed that provides for financial accountability. It has been raised in the Legislature a couple of times by our Health critic.

I would like to ask the minister why it is taking so long to bring in financial accountability. As the minister will be aware, more than $300 million a year of taxpayers’ money goes into private nursing homes in this province and still, as of today, there is no requirement for financial accountability so that the taxpayers, the residents and family members of residents can find out how those nursing homes are spending our money.

As the minister will know, the amendment to the Nursing Homes Act that was passed during the minority government time provided for an annual statement to be posted. I remember negotiating that section of the Nursing Homes Act with the Minister of Health at the time, as it was my amendment. We came down on the side of giving very little in the area of provision for regulations, and putting all of the requirements in the act.

The reason we did that at that time was because the bureaucrats in her ministry said that if it was spelled out clearly in the legislation, then the nursing homes could simply be expected to comply with the legislation and there would not be a requirement to go through a whole regulatory process; it could be done quickly. Now, here we are, a year and a half later and we are told everything is being held up on the regs.

Hon. Mrs. Caplan: A number of questions have been raised regarding nursing homes. One in particular was raised by the critic for the third party. Perhaps it would be appropriate now for me to answer those questions that have been raised, not only by the critic for the third party but by the member’s Health critic and himself, and deal specifically with the issue of nursing homes during this estimates process.

Mr. D. S. Cooke: I would prefer that --

Hon. Mrs. Caplan: I have the floor now, Mr. Chairman.

Mr. D. S. Cooke: I have asked one question. I did not ask that all questions on nursing homes be answered. I asked a question about financial accountability.

Hon. Mrs. Caplan: I think it is appropriate if at this time I respond to those questions that have been raised about nursing homes, and I would be pleased to start with the question that was raised. In fact, my colleague the member for Riverdale (Mr. Reville), also asked --

Mr. D. S. Cooke: On a point of order, Mr. Chairman.

Hon. Mrs. Caplan: -- “When will the minister ensure that financial statements of nursing homes are posted and can she give us a date for the regular” --

The Deputy Chairman: Order, please.

Hon. Mrs. Caplan: Oh, I am sorry.

Mr. D. S. Cooke: I just want to make it clear that I am not here to listen to all the answers to all the other questions on nursing homes. I have put a specific question on financial accountability, and I have a few other questions. That is how I would like to proceed. I think that is fair. The critics who asked the other questions on nursing homes will have them answered in the appropriate way the minister has agreed to before.

The Deputy Chairman: We seem to be meeting an impasse here. The member is not satisfied with the answers that are being given to specific questions, and he therefore has only one prerogative in my view and that is to ask further questions. He cannot direct what answer the minister is required to give.

Mr. D. S. Cooke: But it has to be on financial accountability.

The Deputy Chairman: We are dealing with questions pertaining to consideration of the estimates. The questions are being put to the minister and if one is not satisfied with the answers given, one continues the questioning for the allotted time for the estimates.

Mr. Harris: Mr. Chairman, on the point of order: I think the member has a few specific questions he would like some answers to. As for the critic for the official opposition, I do not see anything out of line. The critic for our party has indicated he is happy to defer answers to his questions for this particular period of time. I think it is normal in the estimates process to ask a few specific questions. If he cannot get an answer to one, it is tough to ask the follow-up question.

I would also suggest, in the interest of time, that if the minister wants to get written answers or wants to check with staff and everything else, she can table those answers after the estimates are finished. But there are some specific questions, as I understand it, which I have heard the critic place and I do not see anything the matter with that, unless there is other pressing business that the critics say is more important.

The Deputy Chairman: As I have indicated, the minister answers as she sees fit. If you are not satisfied with that, then you continue the questioning.

Mr. Harris: Mr. Chairman, let me try one more time and say that if a critic asks a specific question and the minister answers, “Well, cats go here and dogs go here,” I would say that is totally irrelevant to the proceeding. If the minister says, “I don’t particularly want to answer you, but I’ll do something else,” that is fine; that is her prerogative, to refuse to answer.

The Deputy Chairman: I appreciate the member’s representation, but we do not have a standing order that compels the person answering the question to give an answer satisfactory to the questioner.

Mr. D. S. Cooke: On the point of order, Mr. Chairman: I am not trying to make this complicated. The minister, in response to my question on financial accountability, said she wanted to give all the answers to questions on nursing homes that have been asked during the estimates. I do not think that is appropriate. I think it is appropriate, since there has been a question put on financial disclosure, that we address the issue of financial disclosure and not all the questions that have been put with regard to the issue of nursing homes up to this point. I do not think that is fair. I think that is an abuse.

The Deputy Chairman: As I have indicated, there is nothing that can compel anyone to give an answer you think you are entitled to.

Mr. D. S. Cooke: So at the mention of the words “nursing homes,” she can answer any question that has been asked in the past two weeks?

Mr. Harris: Mr. Chairman, there is nothing stopping us from dispensing with the answers to all the other questions. We have suggested that for the rest of today we dispense. If she wants to answer them, we are saying dispense. Let’s not waste our time and let’s get on to the only question we want the answer to, the one asked by the member for Windsor-Riverside. If she does not want to answer it, she can say, “No, I do not want to answer it.” She should not start talking about something else.

Hon. Mrs. Caplan: It seemed very appropriate to me at this time. Since another question had been asked around financial statements by the critic for the official opposition, it seemed it was reasonable to respond. However, I am pleased to respond to the question of the member of the official opposition and to tell him that the regulations under the Nursing Homes Act are currently being reviewed. They are expected to be ready by the end of this year.

He will note that the ministry has consulted widely, both with professional accounting bodies, the Institute of Chartered Accountants of Ontario specifically, and the Ontario Nursing Home Association. It should be noted, however, that some nursing homes have in the past sent copies of their audited report for the year. Even though they were not bound at that point by regulation to do so, they have done so. I know we are anxious to have the regulations circulated and then in due course they will be passed by the cabinet regulations committee and be available for the member to review.

Mr. D. S. Cooke: Could I ask the minister why it is so complicated to develop regulations with regard to financial disclosure that it has taken us a year and a half to come to the point where we might have regulations by the end of the year. Then it will have to go through the cabinet process and it will probably be another few months before they are put in place. What has made it so difficult for the ministry to develop these regulations and why is it taking so long?

Hon. Mrs. Caplan: Regulations are often complex. One of the things we have committed to is an open process of consultation during the drafting of regulations and/or legislation and/or policy decisions. I want to assure the member that the draft regulations under Bill 176, An Act to amend the Nursing Homes Act, are in the process now of being circulated for discussion among interested parties. I am hopeful we will see those available early in the new year for implementation as expeditiously as possible.

Mr. D. S. Cooke: Just a final point on this: I am asking specifically with regard to financial disclosure. What are the issues around this that have made it so complicated that we have not been able to implement something that was central to the Nursing Homes Amendment Act?

Hon. Mrs. Caplan: I am sure when the member has an opportunity to review the regulations in their final form, his question will be answered for him; when he has a chance to see those regulations, which are sometimes quite complex.

Mr. D. S. Cooke: What the minister is saying is that she does not know, that her bureaucrats will answer it and that when we see the regulations, we will understand why it is so complicated.

I would like to move to a local issue with regard to your riding, Mr. Chairman, and mine. I raised this matter in question period a couple of weeks ago. The minister was not fully aware of the development of the chronic care hospital down in the Windsor area, but I am sure she is familiar with it now since she has had a couple of weeks’ notice.

I met with the new administrator of the hospital a couple of weeks ago and I must say I was very pleased with the approach I think he is taking. I want to ask the minister what she and her ministry are prepared to do to speed up this process of the development of a new chronic care hospital in the Windsor area. As she will understand, the current facility that is being used was a school. It was converted to a chronic care facility. I believe it is 70 some-odd years old. It is totally and completely inadequate.

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This chronic care hospital has been our number one health care priority for the last number of years. The first proposal to come forward for a new chronic care hospital was in 1971. In the 1985 provincial election, the member for Windsor-Sandwich, the now Minister of Consumer and Commercial Relations (Mr. Wrye), promised that if a Liberal government was elected, the sod would be turned by the fall of 1985. It is now almost December 1988. The sod has not been turned. We do not know when the new hospital will actually be constructed. Even if the sod is turned next spring, we will be looking at 1990 or 1991 as the earliest that those chronic care beds will be put on stream. What is the minister prepared to do to make sure that decent health care is provided for the chronically ill in our area and to speed up this process, which has simply dragged on for much too long?

Hon. Mrs. Caplan: As I know the member is aware, there is actually a seven-stage capital planning process which all projects are subject to. It is quite a lengthy process and I know that at times it can be quite frustrating for communities that do not understand what that process is. It involves the announcement from the ministry of the intention to plan for future facilities. As I have travelled the province, I have heard from a number of communities their view that in fact that process is a difficult one for them, because at any stage in that process the concern about the change in the overall cost or the scope or the operating implications is addressed with the ministry.

We are at the present time reviewing our capital planning process, as well as projects that are out there, to make sure that they are appropriate to the needs of communities in the future as well as today. We respond to what we all believe is the goal, and that is to allow people to remain independent in the community for as long as possible. That is what seniors are telling us they want. However, when they do require institutional care, those services are available for them.

I have said to the member, as I have said to others in this House, that if he has specific questions about the status of a specific project, I am always pleased to get him an update and let him know where in our seven-stage planning process that project is.

Mr. D. S. Cooke: Of the seven stages of the planning process, this particular hospital is at stage 175. It has been going on for much too long. What the minister should do if she wants to get herself educated about the problems of health care in our area is to visit the current chronic care hospital. She should ask herself whether she would want a family member of hers to be in that current facility.

I am not talking about the staff, because the staff does the best it can with the facility that exists. It is simply inadequate, and we need to have the process speeded up so that the sod will be turned and the new hospital will be under construction.

All I am asking the minister is the same thing that the member for Windsor-Sandwich asked the former Minister of Health, Mr. Norton, back when the Conservatives were in power, and that was for direct intervention by the Minister of Health to see that the process was speeded up and the hospital was constructed.

I am simply asking the same thing of the minister that her party’s local member in Windsor asked of former ministers of health. I think that because this is a real difficulty and a real problem, the minister should make herself aware of the problem, just as former ministers of health had to do, because the history involved in this hospital is a unique one that requires intervention from the Minister of Health.

Specifically, I would like her to look at when the costs come through for what is now going to be a redesigned chronic care hospital. We had a hospital designed and now the hospital board has changed the plans. It is going to construct it in a different area of the hospital site.

I would like the minister to look at the new costs that it will be coming in with and I hope that the ministry will provide the capital funds that are required over and above the $22 million that has been allocated by the ministry, based on the original plans. As I understand it, they were just not properly thought out and the costs were inaccurate. Now we will have an accurate figure. I hope the minister will commit herself to the two-thirds portion that the ministry normally does on capital so we can get going with this hospital.

I just ask that she look into the matter specifically, become familiar with it and get the thing moving. It is a desperate need in our community. I know that I speak not only for myself, but for all three members for the Windsor area.

I would like to just touch on one other area that I do not think has received proper addressing by any members of the Legislature. That is the whole issue of what this province is doing for people with acquired immune deficiency syndrome. I would like to congratulate the minister. I remember when we had discussions on this a number of years ago in the Ministry of Health estimates. We were putting concerns to her predecessor about the lack of health promotion. I want to congratulate the government. I think in the area of health promotion, we have come a long way in Ontario. In many ways this province and this jurisdiction is showing a lead in the area of health promotion.

I certainly think the provision of funds for Casey House Hospice Inc. was a substantial commitment by the province. I think it was over $2 million a year and it was appropriate. There were capital costs involved. The province needs to be congratulated on that, as well. But there is one area that is a very much overlapping jurisdiction. I think what the minister has to do is show some leadership for the nation.

The federal government, with regard to the introduction of drugs for use in Canada to fight this disease, is very lax. The minister will know, I am sure, that doctors in this community write prescriptions for a drug called, I believe, aerosol pentamidine. The drug is not available here in Ontario, so that persons with AIDS go from Toronto, or wherever, to Buffalo to pick up the drug. Then they can come back to Toronto because the doctors can administer the drug in their offices.

At least it is available, but the minister must have concerns, as I do, that not everybody has equal access because of the cost involved in the travel and so forth. I know that this is a matter in which there is jurisdiction with the federal government, but obviously the federal government is not sensitive to this whole issue, or sensitive enough. I do have, at the end of this, a suggestion that I seriously hope the minister will consider.

Another drug that the minister might be aware of is dextran sulphate, which people are going to Japan to pick up and bring back here, or ordering from the Caribbean and having mailed back into Canada. Again, the drug has been shown to have some positive effects and should be available here. It is only available, as I understand now, in a few clinical studies. People do not know whether they are getting the drug or a placebo. You cannot get it unless you meet certain criteria.

There is a real problem with access to therapeutic drugs that are available to fight the disease. It is absolutely ridiculous that your access to the drug could depend on which doctor you have, which hospital you go to and how much cash you have, so you can get it from foreign jurisdictions. One other use of a drug that is available in this country is azidothymidine. The minister will know that because of the standards that are being used on whether someone will have access to that drug, there are actually people who get access to the drug, cut down the dosage that they take, stockpile the drug and then it is shared. I would not call it a black market, but it is being shared because other people cannot get access to it.

The only point that I am making is that access to therapies to fight the disease are really hit and miss in this country. I have read some articles and heard speakers from the United States who say very clearly that the attitude that is being taken in the United States is that this is a manageable chronic disease, that with proper access to proper therapeutic drugs, in most cases the various symptoms, whether pneumonia or cancer or whatever the spinoff disease the PWA experiences, can be fought by the use of a variety of drugs and certain types of diseases can be prevented by use of certain drugs.

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If our federal government is not moving quickly enough, and it is not -- many more drugs are available in the United States and used regularly -- I think it is incumbent on the minister to show some leadership, since she represents the largest province with the largest number of PWAs. I would suggest that one of the things the minister could do is to call a national conference of health ministers across this country where she sets the agenda and leads on some of issues, so that she as Health minister can show some leadership, involve some other health ministers and certainly involve the federal health minister, to try to get across some of the concerns that I think have been expressed to the minister on many occasions by groups across the province and here in Toronto that are working with PWAs.

I would ask the minister that she seriously consider this proposal and start putting some heat on Ottawa to make some of these drugs available through hospitals and through doctors’ offices, so that people here in Ontario and in Canada can have the same access to some of the therapeutic drugs that are readily available in most jurisdictions in the United States. I am talking about drugs, of course, that have been tested and have shown some therapeutic value.

Hon. Mrs. Caplan: I am pleased to respond to the issues which the member for Windsor-Riverside has raised. To briefly respond to the first issue which he raised, on the Windsor Western Hospital Centre, I want him to know that I am aware of the situation. The hospital, as I understand it at this point, is at the functional planning stage. They have been asked to rework some of the functional plan as it was submitted to the ministry. I think he is aware of that. I have some concern that, when the communities across the province submit plans which are changed in scope or nature or are more costly than that which was originally announced by the ministry, they must understand that we receive an allocation from the Treasurer (Mr. R. F. Nixon) and we then proceed to see that those resources are distributed on as equitable a basis as we can, recognizing that where the costs come in within what was anticipated and do not require additional resources, certainly that would be something the ministry would look at.

I am always concerned when I see costs rising over those which were anticipated. In our review of the capital planning which is being done in the province, as well as in our capital planning process, that is something which we will be reviewing specifically, because I know how frustrating that can be for communities. However, I would repeat again that I am always happy to get information for the member for Windsor-Riverside or any member of this House on where in the planning process a specific project might be.

The member, in his second question, addressed the issue of AIDS. I have described AIDS as being the public health challenge of this generation. In fact, we have two primary goals in responding to the AIDS epidemic. The first is to stop the spread of the human immunodeficiency virus infection and the second is to provide compassionate and effective medical care for those suffering from this disease. From his remarks, I think that he and the other members of the Legislature present would agree that those are the correct priorities.

I want to thank him for acknowledging the prevention and the promotion strategies of the ministry. I am pleased to say that I believe we have taken a major step in ensuring that we have achieved my own personal objectives of enhanced health promotion opportunities and prevention strategies, as well as the third, which he knows I stated a year ago was the expansion of community-based services.

I believe our response to AIDS has been a very important and aggressive one. We have an extensive education program which I know the member is aware of and which has been very effective. We have been monitoring it from the beginning of that program. It is a $7-million multimedia information program which includes a provincial hotline. The whole program is designed to give people the information they need, to give them a telephone number that they can call if they want more specific and explicit information. It is designed to dispel the myths and the results of that program which, I want the member to know, in fact are achieving our goals.

There are a number of other areas where we have been particularly active and involved. In fact, there are two advisory committees. One is OPEPA, which is the Ontario Public Education Panel on AIDS, which was struck by a previous minister to identify educational and information needs. The other group is PACA, the Provincial Advisory Committee on AIDS, to advise the minister on public health concerns, and this is a panel of experts.

At this point in time the province has spent over $20 million, and that does not include treatment dollars which have been submitted under the Ontario health insurance plan by physicians. That is over and above program dollars.

It is estimated that the cost of drugs and treatment for a single AIDS patient annually is in the neighbourhood of -- I am not sure if it is annually -- but the estimate for hospitalization, home care, drugs and tests for a single AIDS patient is approximately $200,000 per year.

Increased funding to expand our facilities, so that we could have appropriate levels of testing, has taken place; and in fact the azidothymidine trials to which the member alluded, at a cost of $1.7 million, were funded by the Ministry of Health to respond to the drug trials within the community.

The member is quite correct in saying that we funded Casey House Hospice Inc. at some $2.3 million, as a facility to respond to the needs of terminal AIDS patients. As well, there has been significant community-based funding for organizations out in the community, to attempt to reach those groups which are hard to reach, to offer them counselling, support and moneys for local health units, as well as for community-based groups in our efforts.

I want the member to note as well that there are significant research dollars being spent here in Ontario, some $2.75 million to date on AIDS research, and I believe what is particularly important and significant is the fact that we have some five outpatient hospital clinics which are responding as well.

The member raised specifically the issue of access to drugs and to new drugs. One drug in particular that I think he referred to was the aerosol pentamidine. I think it is important for him to know that that drug, as well as all new drugs, is controlled by the federal government and it is the federal government’s responsibility to license and permit drugs to be made available in Ontario and in Canada. In fact, the federal government is liberalizing the access to new drugs in controlled studies here in Ontario and across Canada.

The member should know that this week we will be hosting an AIDS working conference here in Toronto. We have invited 150 participants from providers, community groups, activists, those who want to come together, professionals as well, to discuss treatment in Ontario and also to discuss the next step.

When I was in Saskatoon at the conference of provincial health ministers, I invited other provincial health ministers who wished to come to attend this working conference. I extended the invitation to them. I understand that some will be attending, others will be sending representatives if they wish and having representation there, so that we can share our experience and share our information with our sister provinces across this country.

There will be federal representation as well at the conference, and in fact it is really important to note that the federal government does have responsibility for the drug trials and ultimate approvals in this country.

I want to tell the member, as I said, that I believe our primary responsibility is to stop the spread of AIDS, to respond to the need for effective, compassionate and timely treatment for those who are suffering from this disease. It is the goal and the responsibility which I am attempting to respond to, I believe in very appropriate ways.

I want the member to know that the resources we made available are significant and yet there is much to be done. It is the reason I attended the conference in Stockholm, Sweden in June.

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Mr. D. S. Cooke: I know it is. Could I ask a supplementary question? I want to specifically get at the issue of availability of drugs. The other things the minister has mentioned I think are appropriate. I know them. I should not even have mentioned them. I should not have praised her because then that meant she was going to run through the whole gamut.

I want to ask the minister if she thinks it is appropriate that we say in Canada that you cannot have access to the aerosol pentamidine and get the drug here but that a doctor will write a prescription and you can drive to Buffalo and get it. All I am trying to point out is that the therapeutic value of that drug and dextran sulphate and some of the other drugs which are widely used in the United States has been proven. I am not suggesting they are cures for the disease, but they certainly have had proven therapeutic effect. Yet they are not widely available in Canada.

I understand that it is a federal responsibility. I am simply asking the minister, as a minister who represents Ontario, where the largest number of PWAs or persons with AIDS exist, why she could not consider some representations to the federal government in the strongest way possible.

One of those avenues would be through a national conference of health ministers on the whole issue, specifically on the availability of drugs, which I would say is the number one issue in terms of the lobby groups or advocacy groups which exist in Ontario, the people who advocate on behalf of people with AIDS. The minister has got to recognize that that is the number one issue and she, as minister, could play a very positive role in the whole area.

Hon. Mrs. Caplan: I think it is very important when we discuss this issue to recognize that we would like to see that drugs are made available to people with AIDS in a timely and appropriate manner as soon as the effectiveness of those drugs are determined. We also have to acknowledge that we in Ontario are part of a great federation called Canada and that we play an important role. As I mentioned, the conference we will be holding this week will have representation from across the country as well as federal representation, and I know this very issue will be discussed.

I believe it is very appropriate for the federal government to show leadership on this very important issue and on an issue which is of concern to people across this country, not only in Ontario. I am hopeful that with the representations which perhaps will come from the conference and the working group of invitees, some 150 I mentioned who are getting together this week, they will be able to discuss that issue and others, because I know that access to new drugs is something which is of great concern to people with AIDS, to their friends and to their families.

As AIDS touches each and every one of us, as a friend or as a family member, it will be important that we know we are doing everything we can both to stop the spread of AIDS and to give people the information they need to protect themselves. We know that when you are dealing with AIDS, it is behavioural. It has nothing to do with who you are; it is what you do. Therefore, it is extremely important that people have that information. The other thing is that once someone has this disease, our response, both in being compassionate and in providing effective medical care, is extremely important.

As the hour approaches six o’clock, there is one short question that was posed by the critic for the third party at the start of estimates. I know that everyone is always interested in events in the minister’s office. I thought I would be pleased to place on the record the statistics regarding staffing in the minister’s office in the few minutes that we have left, since I think we have dealt with the last question that was raised by the member for Windsor-Riverside.

I see the critic for the third party and would like to respond to his question of November 14 when he asked how many people are on the minister’s staff and what their salary ranges are. I would be pleased to read into the record that there are 10 people presently on the minister’s staff in the office of the Ministry of Health. The minister’s secretary, Sheila Starkman, has a salary range between $29,120 and $39,520. The executive assistant is Paul Pellegrini, with a salary range from $52,000 to $71,760.

There are three special assistants: Jennifer Cole, Frank DeFelice and Jim Maclean. The salary range for special assistants is $35,000 to $52,000. There are five general assistants -- Duncan Armstrong, Debi Fisher, Lawrence Knox, Cheryl Timko and Pankaj Varma -- with a salary range of $18,720 to $33,280. As well, there is one special assistant, policy, a woman by the name of Sandra Lane. She is on secondment from the ministry. She is a civil servant providing very good advice to me as Minister of Health at this time. She is paid out of the budget of the office of the Assistant Deputy Minister of Health, planning and programs, as she is a civil servant and on secondment from the ministry.

I believe that is the response to the question that was asked by the critic for the third party regarding staffing in the minister’s office. I am pleased to have the opportunity to place that on the record at this time.

On motion by Hon. Mrs. Caplan, the committee of supply reported progress.

The House adjourned at 5:59 p.m.

November 28, 1988

MEMBERS’ STATEMENTS

HOME CARE

LOVESICK LAKE NATIVE WOMEN’S ASSOCIATION

DIAPERS

EMPLOYMENT ADJUSTMENT

AUTOMOBILE INSURANCE

BRAMPTON SPORTS HALL OF FAME

STATEMENT BY THE MINISTRY

SCHOOL DRINKING WATER

RESPONSES

SCHOOL DRINKING WATER

ORAL QUESTIONS

EMPLOYMENT ADJUSTMENT

WORKERS’ COMPENSATION

EMPLOYMENT ADJUSTMENT

PROPOSED HOSPITAL MERGER

INTERVAL AND TRANSITION HOUSES

CITY OF OTTAWA

AUTOMOBILE INSURANCE

AMBULANCE SERVICES

STUDENT NEWSPAPER

SOCIAL ASSISTANCE

FRENCH-LANGUAGE SERVICES

SCHOOL OPENING EXERCISES

PENSION BENEFITS

GREY CUP LUNCHEON

PETITIONS

EXTENDED CARE

RETAIL STORE HOURS

INTRODUCTION OF BILL

MUNICIPAL STATUTE LAW AMENDMENT ACT

ORDERS OF THE DAY

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)