SAVINGS AND RESTRUCTURING ACT, 1995 / LOI DE 1995 SUR LES ÉCONOMIES ET LA RESTRUCTURATION
PARKDALE COMMUNITY HEALTH CENTRE
CANADIAN ASSOCIATION OF RETIRED PERSONS
PARKDALE COMMUNITY LEGAL SERVICES
CONTENTS
Friday 22 December 1995
Savings and Restructuring Act, 1995, Bill 26, Mr Eves / Loi de 1995 sur les économies et la restructuration, projet de loi 26, M. Eves
Toronto Birth Centre
Wendy Sutton, president
Liz Iwata, vice-president
SmithKline Beecham Pharma
Dr Alan Davis, director, national accounts and managed care
Pam di Cenzo, associate director, national accounts and managed care
Parkdale Community Health Centre
Almerinda Rebelo, executive director
Frumie Diamond, community health educator
Canadian Association of Retired Persons
Lillian Morgenthau, president
Monty Mazin
Parkdale Community Legal Services
Elinor Mahoney, community legal worker
Elizabeth Kostynyk, client
Bedford Medical Associates
Dr Carolyn Bennett
Dr Bernard Marlow
Dr Rae Lake
Philip Berger
Ada Lo; Dorothy Sit
Bob Callahan
George Aregers
Doris Grinspun
Robert Richards
David Calvin
STANDING COMMITTEE ON GENERAL GOVERNMENT
Chair / Président: Carroll, Jack (Chatham-Kent PC)
*Carroll, Jack (Chatham-Kent PC)
Danford, Harry (Hastings-Peterborough PC)
Kells, Morley (Etobicoke-Lakeshore PC)
Marchese, Rosario (Fort York ND)
Sergio, Mario (Yorkview L)
Stewart, R. Gary (Peterborough PC)
*In attendance / présents
Substitutions present / Membres remplaçants présents:
Johns, Helen (Huron PC) for Mr Danford
Caplan, Elinore (Oriole L) for Mr Sergio
Clement, Tony (Brampton South / -Sud PC) for Mr Kells
Ecker, Janet (Durham West / -Ouest PC) for Mr Stewart
Lankin, Frances (Beaches-Woodbine ND) for Mr Marchese
Also taking part / Autre participants et participantes:
Bartolucci, Rick (Sudbury L)
Curling, Alvin (Scarborough North / -Nord L)
Ministry of Health:
Gardner, Paul, negotiations secretariat
Lindberg, Mary Catherine, assistant deputy minister, health insurance and related programs
Clerk / Greffière: Grannum, Tonia
Staff / Personnel:
Drummond, Alison, research officer, Legislative Research Service
Fenson, Avrum, research officer, Legislative Research Service
The committee met at 0903 in room 151.
SAVINGS AND RESTRUCTURING ACT, 1995 / LOI DE 1995 SUR LES ÉCONOMIES ET LA RESTRUCTURATION
Consideration of Bill 26, An Act to achieve Fiscal Savings and to promote Economic Prosperity through Public Sector Restructuring, Streamlining and Efficiency and to implement other aspects of the Government's Economic Agenda / Projet de loi 26, Loi visant à réaliser des économies budgétaires et à favoriser la prospérité économique par la restructuration, la rationalisation et l'efficience du secteur public et visant à mettre en oeuvre d'autres aspects du programme économique du gouvernement.
The Chair (Mr Jack Carroll): Good morning, everyone. In keeping with our practice of starting on time if we possibly can, we will begin the morning.
TORONTO BIRTH CENTRE
The Chair: Our first presenters this morning are from the Toronto Birth Centre. Wendy Sutton and Liz Iwata, welcome to our committee. You have a half-hour to use as you see fit. Any time that you leave for questions would start with the Liberal Party. The floor is yours.
Ms Wendy Sutton: Thank you very much. My name is Wendy Sutton and this is Liz. We are both members of the board of directors of the Toronto Birth Centre and are respectively its president and vice-president. I speak today not only on behalf of the Toronto Birth Centre but also on behalf of the St Jacobs Family Birthing Home and the Sudbury Birth Centre.
We'd like to thank the committee for the opportunity to make this presentation and advise you that due to the limited time we had in which to prepare and the existing commitments of the various other members of our organizations, we're not able to provide you today with a written copy of our comments, but we will do so shortly, with your permission, if that's acceptable.
As a general comment, I might just add that the time constraints on this have, I'm sure, made it difficult for many people in our case, just so that you are informed of that. We started our exercise on this presentation last night, and if I look like I got to bed at 4 in the morning, it's because I in fact did get to bed at 4 in the morning. I've also recently finished exams and am not feeling my normal feisty self, so please be gentle on me. I'm feeling somewhat vulnerable today.
Before we begin our comments, we'd like to add our voices to what appears to be a growing number of presenters to this committee who are saying that Bill 26 is simply too big and too complex to be dealt with in the short period of time that the government has allocated to it and it's not well served by hearings at this time of the year. We strongly encourage the government that the debate on this bill be extended and that the bill be divided into manageable pieces to accommodate its review.
The Toronto Birth Centre is a volunteer, non-profit organization with charitable status. Like its counterparts in St Jacobs and Sudbury, the goal of the TBC is to establish a freestanding birth centre in its community to serve the needs of healthy women who wish to give birth outside of the hospital setting. The model of care which we've envisioned is compatible with the midwifery model, and our expectations have been that the majority of practitioners privileged at the centre would be midwives, although we in Toronto have always anticipated that in lesser numbers there would be the involvement of physicians and nurses contributing to a multidisciplinary team of caregivers. We are committed to informed decision-making, continuity of care, universal access and providing the opportunity for women to choose their place of birth with the certainties of safety and satisfaction.
Over the years we've identified a level of demand among women wanting to use the freestanding birth centre that exceeds any level of service provision that we or the ministry have ever contemplated. Figures from a highly sophisticated system in the United States have confirmed the safety and efficacy of out-of-hospital birth centres, and those successes are being translated into the reality of practice of Ontario midwives. We've also repeatedly, and with cumulative improvements, been able to demonstrate the cost-effectiveness of the freestanding birth centre concept.
The TBC has been advocating for an out-of-hospital birth centre service for 17 years. It has known now four governments and 11 ministers, two of whom are delightfully present in this room. As members of this committee will know, the Toronto Birth Centre, along with groups in St Jacobs, Sudbury and Fort Albany, were successful proposers to the RFP issued under the Independent Health Facilities Act in 1993. As members may also know, after 18 months of negotiations with the ministry, the selection of sites, the signing of long-term leases, the hiring of staff, and an extensive expenditure of time and resources, the current Conservative government eliminated the program on September 28 of this year. Naturally we were, and still are, extremely disappointed and disillusioned about the cancellation of this program. We feel none the less that as one of the few groups, if not maybe the only non-profit volunteer group, to be approved as independent health facilities, we might offer a unique perspective to this committee with respect to the IHFA amendments that have been incorporated into Bill 26.
It's no secret that we did not feel comfortable that our program was to be governed by the IHFA. The member for Oriole will recall the number of spirited debates we had regarding its appropriateness as an application for the freestanding birth centre model. As well, the member for Beaches-Woodbine will remember our objections to the act when she first took office as Minister of Health. However, as the IHFA provided the only real mechanism for funding, because it created a protection of quality assurance and standards, and as we continued to receive encouragement from both the Liberals and the New Democrats, after 12 years of trying we accepted the IHFA as a vehicle to help us realize the Toronto Birth Centre.
Our concerns with the IHFA related to such things as its procedural orientation, the statutory assignment to the medical profession of the development of standards and quality assurance programs and at the time the uncertainties of government funding, and particularly those revolving around pre-operational costs.
Once we had been approved, many of these issues were resolved to accommodate birth centres. The College of Midwives was invited to participate jointly with medicine and nursing to produce standards, the results of which were remarkably compatible with our own. Successive governments confirmed their willingness to provide pre-operational capital in order for us to open our facilities. Adherence to procedural orientation gave way to permit hours in birth centres extended beyond the established 24 hours of other IHFs in order to accommodate the occasional situation that might demand it. In short, I think governments over those years made a considerable effort to try and accommodate the birth centre concept in a way that the act hadn't intended in the first place or contemplated in the first place.
I might add that none of this was easy to establish. On the contrary, a great deal of time and energy on the part of the ministry and ourselves was required in negotiations to get as far as we did. By last September, when our program was cut, we were projecting a per-birth cost in Toronto of $980, compared to ministry-verified hospital figure estimates of between $2,200 and $2,900 per birth. The combined savings of the groups in St Jacobs, Sudbury and Toronto, once at full capacity, would have returned well over $1 million per year to the public purse of Ontario, and the recovery of capital expenditure for these projects would have been easily and quickly achieved.
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We have serious concerns with the amendments to the Independent Health Facilities Act, and because we haven't had the opportunity to review Bill 26 in total, we will confine our comments, if we may, to the Independent Health Facilities Act portion of the bill. I'd like to run through them in a fairly clinical fashion, as it's the effect of them on what our vision as a volunteer, non-profit, community-based organization might be that we hope will provide this committee with some insight from our presentation.
First, in the definition of "independent health facility," the word "insured" has been removed. This suggests to us that facilities are open to profit orientation and we see this as a threat to universal access that's a principle that we are soundly committed to.
Similarly, in the definition of "facility fee," "insured" is once again omitted, entitling the operator to raise a fee for either insured or uninsured services.
Section 4, which entitles the minister to unilaterally designate both services and facilities, coupled with section 5, which eliminates the RFP process, represents a potentially astounding level of ministerial power as the sole designate to establish the province's program for independent health facilities.
Moreover, the revision to section 5 appears to completely eliminate the involvement of the district health councils in the IHF and overall planning processes within their districts. Their apparent elimination from the IHFA development process damages a valuable planning nexus between the government and the communities that it represents.
Section 6 takes our concern one step further, with the elimination of non-profit preference and the Canadian residency preference, which would appear to be an open invitation to both the private sector and the American entrepreneur.
We read section 24 as providing the minister with the ability to claw back from operational revenues moneys to offset any funds for capital startup. In the event that non-profit groups were successful in securing licences, this clause would render them highly vulnerable to repayment, resulting in either increased facility fees or the requirement that they independently raise additional funds.
We are concerned about the increased power of the minister contained within these amendments related to revocation, renewal, issuance of a licence. While powers such as these were contained in the original IHFA and criticized when it was drafted, the new act not only increases those powers but fully immunizes the minister from any action or liability resulting from their application.
Lastly, and this is reminiscent of our comments in 1989 before the standing committee on social development, when it conducted its hearings on the IHFA in the first instance, there are no regulations to review. Given the arbitrary powers granted to the minister by these amendments, we have grave worries about the potential for regulatory chaos or abuse that may result.
One cannot avoid hypothesizing about how the proposal of the Toronto Birth Centre would be treated in the light of these amendments if it were being presented for the first time.
First, we would likely not be designated as an IHF by the Minister of Health. The obvious reason for this is that we are non-profit and volunteer and would not bring with our application the funding to cover establishment or operational costs.
Even if we were lucky enough to be granted some form of funding, we would expect that the ministry would require funding recovery of these costs from us, under section 24, from future operating revenues. Under these circumstances we would not be able to maintain the low per-birth costs that we currently project because we would be required to increase our facility fees to offset repayments; or more likely, because of our commitment to universal access, conduct an independent campaign of fund-raising, and we think this a particularly onerous potential for volunteer groups.
Early in September of this year the Toronto Birth Centre, the Sudbury Birth Centre and the St Jacobs Family Birthing Home gathered their courage and met with Jim Wilson's staff. We knew of the potential for cuts to programs and we wanted to persuade him of the merits of ours, particularly the financial common sense that we thought we could offer. We did this also because we heard Mr Wilson answer a caller on a radio show who asked of his expectations for the future of community-based initiatives within the government's program of fiscal review.
He said that he would be persuaded by "good data to support the move to the community to justify the change from institutional care." We checked this comment in the Common Sense Revolution, and by golly, it's there, right there on page 19, an invitation to participate in reducing the costs of health care in Ontario. We accepted the invitation and it's now well known what value there was in that exercise.
Quite frankly, four months after we have been cut, after requests to meet with both Mr Wilson and the Premier have been refused, we still cannot understand the rationale behind this decision. Since September, we've been given no reason to allow us to believe that financial considerations justify this decision. In short, we really don't know what this government wants or what it would take to make it happy.
Before concluding my comments this morning, I would like to return once again to the issue of ministerial powers conferred by the amendments to the IHFA. When the IHFA was first introduced in 1988, section 9 was among the most heavily debated. It is of course section 9 -- that's the section that allows the minister to withdraw the issuance of a licence after a proposal has been accepted and to do so without any appeal or recourse from that decision whatsoever -- that was invoked to eliminate the birth centre program in September.
Ironically, we commented on this before the standing committee on social development, and we were not alone in our criticism. Others agreed with this. This statement was made in the Legislature during second reading of the IHFA as Bill 147:
"I am somewhat disturbed by...section 9...which allows the minister to completely override the appeal process in his or her wisdom....I do not question the current Minister of Health's" -- that was Mrs Caplan -- "motivations about this legislation. I have nothing but respect for the current Minister of Health...but members should bear in mind that there are going to be future ministers of Health and there are going to be different circumstances and different stressful situations that ministers of health are from time to time going to find themselves in.
"The minister is given the power under section 9 to decide to revoke a licence, to not grant a licence, to come in and take over independent health facilities, all of which can happen with absolutely no recourse of appeal whatsoever. I find that very disturbing. I find it disturbing as a matter of equity. I find it disturbing as a matter of law.... The possibility exists...for a Minister of Health to decide for whatever reason and the reason could cover anything from his own personal belief to political reasons to revoke or not grant a licence without any accountability to anybody whatsoever for that decision, at least not legally, not the way this bill is drafted, not the way section 9 of Bill 147 reads.
"I do not think that opportunity, however limited it is, for abuse of the political process should exist and be enacted into legislation."
These words are attributable to the then Conservative Health critic and now current Finance minister, Ernie Eves. The minister's comments are painfully meaningless to us now. What is frightening about this reflection and the hypocrisy it suggests is that Mr Eves, who is in the provincial driver's seat, will be driving the agenda that will set the new IHFA in motion. Unless it is altered, this will include all of the new powers afforded the minister by the amendments, and it would appear, based on past performance, that there will be no compunction in applying them.
Bill 26, as it is currently drafted, would appear to put an end to any hopes that the free-standing birth centre organizations have to open their facilities in the immediate future.
I'm just going to jump a little bit here. There's a section of this where my pages were out of order that I would like to touch on, and I will just pick it up at this point by saying that I have used the word "amendment" without qualification throughout this presentation. In fact, the IHFA, as we review it, has not been amended; it has been completely rewritten. It bears absolutely no resemblance to the act it presumes to succeed. Nothing remains of its ability to support the community-based initiative that the officials who approved it or advocates who promoted organizations like birth centres ever envisioned.
Instead, it sets the stage for the potential privatization of health care in Ontario. It extends an open invitation to profit-making operators to set up shop in our health care system. There is nothing in this act to prevent entrepreneurs from the United States to fill the void. It provides total and unilateral authority to the minister to decide who will be the operators of independent health facilities, what services these facilities will offer and at what price they will offer them.
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In this particular scenario, we certainly see a future for birth centres, but the birth centres we see are not governed by non-profit and volunteer commitment. They are market-driven, and this underlines the very serious contention that this government's goal in cost-cutting is paramount to all else. The kinds of facilities this legislation is telling us that the minister wants are privatized birth centres available to those who can pay for them and those who want them, in that sense.
Bill 26, as it's currently drafted, would appear to put an end to any hopes that the free-standing birth centre organizations have to open their facilities in their communities in the immediate future. For the Toronto Birth Centre, the possibility of realizing its goal within 20 years of having conceived the idea seems remote. We are quickly assuming that the record for the longest gestation period for any program in the history of Ontario health care will be the birth centre program. We remind the government and Minister Wilson once again, however, that our door is open, never closed. We will always welcome the opportunity to discuss to see if we can't resolve some way in which a birth centre program can be established in Ontario.
We urge this government to rethink its commitment to the many individuals and groups to whom it has extended its invitation and who, like us and like you sitting here, all of us, want to see a better, more efficient and more cost-effective health care system in place in this province. We urge you to consider the construction of the IHFA and, I'm assuming by what I gather and understand, other amendments to Bill 26 to allow this to happen. We ask this committee to support us and consider these efforts in effecting such a result.
That concludes my submission. We invite your questions, and we'll do our best to respond to them. Thank you. Excuse me for getting my pages out of order -- 4 o'clock in the morning.
The Chair: Thank you. We have about three minutes per party for questions, beginning with the Liberals.
Mrs Elinor Caplan (Oriole): Thank you very much. I share your frustration and your anxiety and your concerns, not only over the loss of the centre, but on the process by which that occurred and also the changes and amendments to this legislation -- excellent brief and excellent presentation.
I guess the primary question that I have for you is, given the speed with which this is going through and also the fact that there are huge policy implications in this bill -- and I think you point out quite rightly that the independent health facility legislation is not just amended, it is dramatically changed. I don't believe that legislation is something that needs to be in the government's hands by January 29. We could take some time. What we're asking them to do is to subdivide the bill and to allow for further scrutiny so people will fully understand not only what they are changing in the bill but why, because we haven't had any real understanding from this government as to what it is ultimately that they hope to accomplish and achieve with these massive powers and massive changes to existing legislation.
So you're up till 4 o'clock in the morning to present an excellent brief; many people are not going to be able to come at all, because there isn't time. Do you think it is important that these bills receive the greatest scrutiny?
Ms Sutton: Absolutely. I did indicate that when I spoke. I would say yes to that for two reasons. I suspect, and this is at the very least human nature, that with the speed and the size -- when I pulled this off the computer database I was amazed at what was in there and the extent of it -- there have to be errors. No one can humanly pull this kind of thing together and review it in the time frames that have been set out here without making those mistakes, and that will be something that, regardless of partisanship, everyone is going to have to deal with and likely pay for.
With respect directly to the Independent Health Facilities Act, my concern about review of this particular set of amendments is the fact that there's so much undefined. The difficulty of interpreting this particular act is coming to grips with the integration of different amendments that it contains, trying to anticipate the impact of what the bill will do in sum total. I don't feel confident that I certainly have seen all of the implications of these amendments as they combine themselves, married off with the very clear emphasis on ministerial power under this act and the lack of regulations. I think the potential for this is absolutely astounding.
Mrs Caplan: And given that --
The Chair: Thank you, Mrs Caplan. Ms Lankin.
Ms Frances Lankin (Beaches-Woodbine): Wendy and Liz, thank you both for your presentation and for the effort to be here. There have been some empty spaces; you may have heard that on the radio this morning. I was quite angry yesterday when I heard a member of the government say, "See, people aren't really interested." It's two days before the Christmas weekend. I've talked to some groups that were called to come in; they can't get their briefs together and they can't get people together in time. It is to your credit that you are here, but it is outrageous that you had to stay up till 4 o'clock in the morning to be here.
Having said that, my sense of what we have here is a combination of some things that the government itself knows that it needs in order to accomplish a fiscal agenda and then a whole lot of stuff from a whole lot of different ministry departments thrown in, because once the acts open up -- we know what happens within a ministry -- all of those changes that you ever wanted and suggested and whatever are thrown in, and that it hasn't been understood. I don't believe the government actually has full ownership of all of the elements in here. There's just too much that's not thought through and, "We'll get to it another time with regulations."
A doctor presented before us last night who said that some of the changes in the Public Hospitals Act provisions and in the health insurance provisions are things that have been kicking around the bureaucracy for nine or 10 years, that he was aware of, that other governments, taking time, had rejected with the input from people from the community. I think it's because there hasn't been the time; I think this government too would reject some of these things if there was the time for proper scrutiny.
I'm frustrated about that lack of time. We've tried again this week, and we'll continue to try, to get the government to divide this up, but they seem bound and determined to move ahead with it as a package, to get it over and done with. It's too controversial, it's too big, and if they cut it again, then there's another political blow. So that's a problem for us.
We need in this short time to be working with groups around amendments that they see necessary. You were up till 4 o'clock writing the presentation; I know you don't have amendments ready. Can you, over the course of the beginning of January, start to formulate some of the areas that you specifically think need to be amended? I know your concerns, but what elements do you think would help address that so that the two opposition parties can take forward some of those ideas and put them into the legislative language and table them?
Ms Sutton: I think that's reasonable.
Ms Liz Iwata: I think that's a wonderful suggestion. There's only one downside to that, in that we have confined our presentation today to the IHFA and the amendments thereto. The difficultly is going to arise when one looks at the interaction between all of these pieces of legislation. There are going to be huge holes that no one has anticipated when they actually take a look at how one piece of an amendment affects one act in concert with another one. Until that has really been evaluated and the implications of the changes made in the relationship between the acts have been studied adequately, then I don't think this government is ready to move ahead with such a massive change so quickly.
Ms Sutton: We'd certainly be happy to --
The Chair: Thank you, Ms Lankin. We have to go on to the next questioner. For the government, Mrs Ecker.
Mrs Janet Ecker (Durham West): Thank you very much. I think you've got an excellent presentation, given 4 am in the morning, and I certainly appreciate the comments that you have brought forward. I'd just like to echo the invitation of the opposition to bring forward amendments that you would like to see. The purpose of public hearings, as it is for all legislation, is to put forward things that may or should be changed, and the government is certainly prepared to consider amendments that are put forward.
I guess a couple of quick points: When the Independent Health Facilities Act was brought in originally, there were for-profit centres that were grandfathered in. The other thing is the point that one of the restrictions in the Independent Health Facilities Act as it got up and running was the fact that because it was limited to insured services, there were a number of procedures that were occurring out there that were outside of that umbrella, where quality control of what was being provided for patients and consumers was a serious problem. So one of the things that this does allow, as I understand it, the government to do is to extend the quality control procedures into other kinds of facilities, which I think would probably be an excellent thing.
I recognize your concern about the birthing centres. I know midwives offer a very unique and different experience, a choice for mothers that is different than what has traditionally been available in hospital birth wards. My understanding is that hospitals -- some hospitals, not all -- have made great efforts to change the way they provide birthing services within their walls, that many hospitals provide privileges for midwives so that you can practise there and that at the same time the extension of midwives has allowed many women to have home birth choices which they never had before, which I think many, many women appreciate.
At a time when we're being faced with the challenge of having to shut down hospital wings or hospitals, or whatever, how do we justify, when we're trying to maintain the services, at the same time establishing freestanding new facilities?
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Ms Sutton: Let's start with the fact that, for example, the Toronto DHC proposal contemplated the inclusion of the Toronto Birth Centre; it certainly didn't exclude it. It never had any second questions about its existence when it made the kinds of recommendations to the government with respect to hospital closures, and of course we need to see how that all is going to fall out.
If you look at births -- and I challenge you to compare that to any other procedure, if I can use that word -- births don't simply invent themselves to serve the needs of procedural service. Births are a static number; you cannot increase them. As you close hospitals, you will be looking for -- and certainly there are indications that there are going to be less interested attitudes among, I think, some professionals, obstetricians, if there are insurance crises involved and that sort of thing as well.
Births moving out of hospitals can go somewhere else. It's very simple -- and this is what absolutely astounds me about this government's decision -- to put it in a facility that costs less. From the standpoint of all those startup costs that we keeping being hammered about in terms of justification for these facilities, they were virtually paid for.
We would save somewhere between $600 and upwards of $2,000 per birth by simply taking a portion of an existing number of births and downsizing the cost of those births. This is a saving process, not an expenditure process.
The Chair: Thank you, ladies. We appreciate your interest in our process and your presentation.
SMITHKLINE BEECHAM PHARMA
The Chair: Our next group, representing SmithKline Beecham, Alan Davis and Pam di Cenzo. Good morning and welcome to our committee. You have a half-hour to use as you see fit. Questions, if you allow time for them, would begin with the New Democrats. The floor is yours.
Dr Alan Davis: Good morning. Hopefully we'll keep the presentation reasonably short so there's enough time for questions.
Thank you for the opportunity for presenting today. My name is Alan Davis. I'm the director of national accounts and managed care for SmithKline Beecham, and this is my colleague, Pam di Cenzo, associate director of the same department.
Our head office is located in Oakville. We are one of the top R&D companies in Canada, so we feel we have a large investment in this country, so to speak. We employ close to 350 people across Canada and a large number of these are located in our head office in Oakville. We span the entire range of research capabilities, from antibiotics, central nervous system products, vaccines to anti-inflammatory drugs and tissue repair drugs.
Our experience in Ontario is quite extensive, given that a large percentage of our R&D is spent in this province, and we spend approximately $1.7 million of our national R&D at the current time, which is 25% of our total expenditure.
Most of this research spending is in the traditional pharmaceutical products, but we are expanding beyond that. We are trying to take research and development into the 21st century from the point of view that we have a large investment in genetic research. We have the world's largest gene-sequencing group. Human Genome Sciences are working in the US to develop gene-sequencing data which will help us to develop pioneering drugs and diagnostic products into the 21st century. We believe efforts in this area will result in long-term lower costs in health care as people become more comfortable with prediction of genetic disorders.
We're also involved in expanding our domain, if you like, through development of health information management and services. Through our acquisition of Diversified Pharmaceutical Services, which is a US benefit management company, a drug management company, we've been able to develop tools for delivery of cost-effective quality health care. We're all involved in health care delivery, and I must emphasize that in this particular company the focus is first on quality and second on cost. We believe that's the correct priority.
We believe that to be successful we need to develop excellence in not only treatment and cure of diseases, which is where the major thrust of pharmaceutical investment is at the moment, but also prevention, prediction, diagnosis and patient management. Only when you've got that complete spectrum of capabilities do you really look after total health care.
As a consequence, we believe that no single stakeholder can achieve excellence in that realm. We need consultation and participation from all stakeholders, and that is an important aspect of our presentation today.
We want to move to specific comments on the question at hand today. They are comments which we'd like to restrict to schedule G, which is "Amendments to the Ontario Drug Benefit Act, the Prescription Drug Cost Regulation Act and the Regulated Health Professions Act, 1991." We want to address three particular issues: deregulation of pricing, introduction of copays and linkage of reimbursement with prescribing guidelines.
In general, we are very supportive of attempts to deregulate price in the private marketplace. As an industry, we are very heavily regulated. Most aspects of our business are indeed controlled in some way or another. We further commend the Ministry of Health for eliminating the current practice of offsets, which has been a very non-transparent activity and caused considerable uncertainty in our dealings with the ministry.
We are committed to the introduction of new, improved therapies for patients suffering from disease, a process based on pharmacoeconomic analysis. "Pharmacoeconomic analysis" is basically a long way of saying: "What is the best bang for the buck? What can we deliver? What are we going to promise we can deliver and how can we justify that?" Only in that sense will we get the quality first and the cost-effectiveness next.
We also recognize this government's leadership in the movement away from silo budgeting and the removal of barriers for business while improving health care. We do not believe those things are inconsistent. Again, market access decisions for new products based on pharmacoeconomic assessment is a cost-effective way of doing business yet provides Ontario drug benefit patients with much quicker access to newer therapies. It's our position that generic products should also gain access based upon the same types of decision-making process.
While we support the direction of price deregulation, we want to identify that our patented brand-name products would not experience price increases in the Ontario marketplace. Unlike the generics, all brand-name product prices are regulated federally by the Patented Medicine Prices Review Board, which has been in place, I believe, since about 1987. This controls our pricing in the sense that new products are priced less than the price of products in a basket of comparative countries. That's one out of six European countries and the US.
The other test is that the existing products must not increase their prices year-on-year larger than the rate of inflation increase. This is an important aspect. Indeed, most prices have been frozen across the country for the last few years as a consequence of different provincial pricing strategies. Overall, SB has not raised its prices even to the CPI over the last nine years, demonstrating our commitment to price control.
Our major concern, however, is the fact that the price that we set our products may not be the price that's actually delivered through to the consumer, and we have no control over those aspects. As a manufacturer, we will not be able to control the markup in pricing decisions of individual pharmacists under a deregulated environment.
In order to compete for lower dispensing fees, pharmacists may choose to significantly increase the markup on the prescription product to achieve pharmacy profits. This, however, would probably alter the consumer's perception on manufacturer's costs, because most consumers will not be aware that it's not us directly controlling the costs.
To avoid this practice, we recommend that there is some transparency in the process and that pharmacists be required to illustrate the breakdown of the cost components so that consumers will be adequately informed and be able to make a decision. Indeed, we believe that yesterday it was made clear that there is a regulation that could achieve this process.
A further pressure that manufacturers may experience is a demand for rebates and/or listing fees by third-party payors and suppliers. Our major concern here is that we have legislative requirements for other provinces that we have to adhere to. We have to deal with 10 different sets of regulations, and it's a very complicated set of affairs. As a consequence, we will not be allowed to enter into these arrangements without some price deregulation in other provinces, for example.
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Copays is an area where we believe there is not sufficient empirical evidence to validate whether copays serve their purpose or not. We are aware of research that shows an improvement in effective use of health services when users are required to contribute. However, we are concerned that introduction of different copays for different classes of persons or drugs will be inherently -- "unfair" is probably the word -- in the sense it may skew the effective, efficient use of health care resources. There may not be an easy way to validate why one particular therapy class may receive a higher copay than another. That has to be based on pharmacoeconomic decisions, not purely arbitrary decisions.
Differential copays could result in inappropriate drug therapy choices by either the patient or the physician, depending on the different levels of understandings. Any skewing of efficient use of health resources in the drug area will of course impact on drug costs in other areas. The last thing you want to do is to introduce copays that discourage patients from making the most effective use of drugs and end up incurring costs in other parts of the system like hospitals.
We're interested, therefore, to learn what the process would be for the determination of differing copays in the therapeutic classes selected. As a manufacturer of a broad number of therapeutic classes, we have extensive access to clinicians', academics' and patients' therapeutic experiences as one of our series of expertises we bring to the table. We wish to offer this expertise as a resource to the government's activity in the development of policy in this area.
The last point that we want to bring across is the linkage of reimbursement with prescribing guidelines. It is proposed to develop prescribing criteria that must be met in order to reimburse a given drug product or therapeutic class.
SB as a company is committed to the development of products or services that permit attainment of optimal therapy. In fact, we purchased our Diversified Pharmaceutical Services subsidiary in the US in order to develop these particular programs and services that allow proper usage of prescribing guidelines but at lower costs than current practices.
The simple thing is we believe that the right drug must be for the right person at the right time. It's a very simple statement. How do you achieve that? The way to go forward is not short-term; it's not easy. The right system must be in place to monitor the appropriateness of use, and we believe that the linkage of guidelines to reimbursement is the correct system to use. We have demonstrated with our experience in the US that intervention by the pharmacist and/or the physician can reduce inappropriate usage and create cost savings of about 25%. We have the data to support that using our current systems in the US.
The way to do this is through information technology, sharing of patient data among the care givers so that everybody is provided with the best information at the best time, because if there is an inappropriate linkage of prescribing guidelines for reimbursement, you can threaten optimal patient drug care, and the physician intervention process and their cooperation is also threatened. We believe that physician intervention with a patient must be encouraged and nurtured and empowered, as opposed to being controlled by outside sources.
In consequence, we feel cost savings can best be achieved through intervention systems using comprehensive data and intensive information technology networks in pharmacists' and physicians' offices, linked electronically, not through linkage to reimbursement but through linkage of data to make sure that every care giver is given the best possible information.
In summary, we're pleased with the direction of the ministry's reforms. Deregulation of pricing will create a fair, competitive market for the pharmaceutical industry. Competition is the best way to lower prices. Control of prices in Canada has been restrictive and has probably kept prices up in the past.
In turn, consumers will have an opportunity to benefit from this climate, provided that pharmacists do not offset lower dispensing fees with higher product markups. We believe regulation requiring the pharmacist to display the different components will alleviate this concern and be in the general spirit of transparency.
While we have some initial concerns about the interaction of differential copays and the proposed linkage of reimbursement with prescribing guidelines, we are confident that the government's collaborative approach with all stakeholders will allow for the mutual resolution of delivering high-quality drug programs at a lower cost. We do not see those two as inconsistent.
We offer our policy and drug expertise to facilitate solutions and we look forward to working with you in the development of new regulations and the redesigning of our current health care system.
Ms Lankin: I appreciate your presentation and your company's contribution to the economy of the province. As an R&D company, it's an important addition in the pharmaceutical industry. We're always looking for more in that area. I think SmithKline Beecham is a company we all are proud of.
Your presentation, and I'm sure you know this, is very similar to Eli Lilly's and Glaxo's, and your colleague was here yesterday with the PMAC Ontario presentation. So the industry really is speaking with one voice with respect to these reforms. I think most of the positions are very understandable.
The area that has raised the most concern, of course, is with respect to the deregulation of non-ODB drugs. I want to explore that with you a little bit. Let me say that I'm not committed to the regulation from an ideological perspective. I think in most areas, telecommunications for example, I've come to believe that competition is important and that it can lead to innovation and lower prices.
When you're dealing with drugs, and drugs becoming more and more a therapeutic alternative to institution and surgery and more invasive therapies, and in a system where we have a desire for universality of access, it's really important therefore that we know what we're doing here and that we know what the implications are. I'm having trouble understanding the argument that is put forward, that the companies are making, that competition here is necessarily going to bring down prices. First of all, if the regulation has artificially held prices up, why wouldn't the industry be embracing that? That would mean there would be higher profits for the industry. What is it about the competitiveness between companies, and particularly when many companies have unique brands, that are in different areas that you're looking for?
Secondly, Eli Lilly told us that it expected the Ontario government would simply adopt the federal Patented Medicine Prices Review Board prices. We know those are in a sense a maximum price. The ministry seems to be of the belief that there are going to be very tough negotiations and that as a very large buyer in terms of the ODB program, that will drive the price down.
If they're going to get rock-bottom price for the biggest user or customer of yours, how do you make up that profit that you're going to lose? Isn't there going to be the necessity for you to start to move away from one price to differential prices, one for the ODB and one for the non-ODB market? When you get to that point and individual insured companies or whatever -- large group plans -- want to negotiate with you, is it likely that you could end up having a different price there than you do with the small independent pharmacists?
I understand the point you're making about the markup, and I think that is another issue in small, rural Ontario where you only have one pharmacist, where it's essentially a monopoly, and that markup could be very high; I agree with that point. But just on the drug price, is it not possible that we're going to see the industry move away from what has been, I think almost by necessity because of regulation, the one price, to differential prices? What impact might that have?
Dr Davis: Those are excellent points. I'll answer your first question first. There is one comfortable aspect with dealing in a very regulated environment, and that is that you know the rules. With a combination of PMPRB, the patented price review board at the federal level and all the provincial pricing strategies, it's easy to set your price. What happens is that when you launch your product, you go to the patent board in Ottawa, the price is negotiated basically and it's seen that it's set at an international level; then that is your price and that stays like that because prices are frozen across the country. It's very easy: You bring in one price and you leave it like that forever. That's cost-saving in itself in the sense that things are frozen and you don't take hardly any inflationary increases.
That's a very comforting environment. What you see is that when you remove that environment, first of all at the provincial level -- and we have one province now attempting to break away from that -- we're going to see a fragmentation of the industry in a sense, because that's a very scary thought for somebody who has lived in that environment for some time.
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For somebody who's been used to having a very predictable price now to say that we're going to have to get into serious negotiations with our buyers is not a known paradigm in this industry. That's the challenge for the industry. Now we've got to behave like a real business and we've got to compete on the basis of our products. We have to say that our products are an important part of the system, but we've now got to prove it.
The trick on us is now to develop the necessary data to be able to come to the province and say, "We believe this will deliver these cost savings to the system and we'll prove it." We don't have that at the moment because we don't have the information technology system. That's where we believe the partnership needs to come. We need to share the data that's available within the provincial systems so that we can generate the interpretation of the data to say: "This is where our drug fits in. This is how much it's going to save in various parts of the system." Then you can come up with an appropriate price, based upon those known facts.
Mrs Helen Johns (Huron): Thank you for your presentation. I appreciate your information. I'm going to just try and follow through on Ms Lankin's questions.
The speculation on the pricing I think is important to all people in Ontario. It's important because people pay for drugs themselves, plus they pay through their tax dollars for the cost of the ODB drugs. People have to understand the whole effect of what's going on here. Not only are we paying for our own drugs, we're paying $1.3 billion for drugs through our tax dollars.
From the standpoint of the tax dollars that people pay for the ODB whether they utilize it or not, what's likely to happen with the price that the government, through the Ministry of Health, is able to negotiate on the taxpayers' dollars?
Dr Davis: In the medium to long term, the prices would likely vary according to the value of the delivery of the drugs. If we have a very good break-through product, then we deserve a better price for it. If we have a me-too product, we deserve to be thrown among all the other me-too products and compete like heck in terms of pricing. That's the reality. How it pans out will depend a lot on how the ministry approaches that negotiation process.
Mrs Johns: What happens to me as the consumer who doesn't have a drug benefit plan? Do I pay more for my drugs because I can't negotiate a fuller deal?
Dr Davis: What's going to happen in the private sector is that we believe there will be other vehicles which will help the individual consumer. The third-party payors: If, for example, prices in the private sector do rise as a consequence of the fact that pharmacists will try and recover their benefits, the third-party payors will receive pressure from employers, whose premiums will start going up. The third-party payors will start to say, "What could we do to decrease these prices?" and they will engage in the same negotiations as the ministry would take on.
We believe there will be some price pressure on the private sector as well. For example, the organization we have in the US, Diversified Pharmaceutical Services, does exactly that; they negotiate on behalf of employers with the manufacturers.
Mrs Johns: Okay, so that's someone who has a drug benefit plan you're talking about now. What about the individual who doesn't have any of those things, doesn't have a plan, isn't on ODB and basically pays for their own drugs?
Dr Davis: That's where the element of transparency comes in, I believe, in terms of they need the best tools to be able to shop around the different pharmacists, because that's where the price will vary, at the individual pharmacy level. There will be large chains, for example, which we believe will be very aggressive in keeping their drug prices down to draw people into their chains. The Shoppers Drug Marts, the Wal-Marts of the world I believe will provide a superior service as perhaps a loss- leader or whatever.
Mrs Johns: Do you agree that the prescribing guidelines linked to clinical criteria are properly developed, ie, in consultations or preventive health problems and hospitalization that can be caused by inappropriate use of medication? Tell me the costs associated with inappropriate use of medication, how this may resolve some of those problems in schedule G.
Dr Davis: There has been a recent study we've commissioned which basically shows that the cost of inappropriate prescribing is probably the largest single cost of disease around. Probably we could save 25% in terms of drug usage overnight by reducing inappropriate usage. We've got these figures from the US evidence. Inappropriate use is a significant component, and prescribing guidelines is one way of doing it if used appropriately.
Mrs Caplan: I'm going to make a comment. I want to thank you very much for an excellent presentation and also for your very frank comments. What I heard you say -- and I don't think they were the answers the parliamentary assistant expected -- was that the result of this legislation is tremendous uncertainty: uncertainty around the price the government will be able to negotiate for the ODB; uncertainty of the effects for other drug plans from third party payors -- in their desire to keep premiums down, they could well delist and push that into a place where individuals will have to pay more and more for drugs even where they have drug plans, and again, uncertainty around what the prices may or may not be that they can negotiate; and the last one is the effect on independent pharmacies and those individuals who have no insurance plans -- we know that's about 20% of the population -- especially those in smaller towns where they may not have access to a larger chain. They could see their prices vary dramatically and not have the ability to shop around. I would ask that you comment on that.
I guess the other concern I have is that in that aspect, there's nothing there that's going to lead to optimal therapy or the elimination of inappropriate prescribing, is there?
Dr Davis: I want to say that uncertainty is not something to be afraid of. Uncertainty in this context is basically creating competition. Let me be careful how I phrase that. Competition is working in an environment where you're not really sure what's going on, where you've got to compete aggressively. If you live in a regulated environment, everything is predictable. By bringing in competition and raising uncertainty, what you're doing is opening the environment to cost-saving efficiencies.
Mrs Caplan: My colleague would like to ask you one further question.
Mr Rick Bartolucci (Sudbury): Mr Davis, presenter after presenter has come to us and said that they weren't consulted, that there wasn't the collaborative approach you alluded to several times during your presentation. Are you the exception? Before amendments to schedule G took place, were you consulted?
Ms Pam di Cenzo: I think we all recognize the process when it comes to public policy and the development of legislation and the need sometimes for confidentiality or privacy prior to a public announcement. In that sense, we weren't consulted prior to the omnibus legislation being introduced. However, I think as PMAC and also as individual companies, we've established a good working relationship with both the senior bureaucrats in the Ministry of Health as well as with the office of the Minister of Health.
On that point, a lot of these issues had been clearly delineated in meetings with Jim Wilson, as PMAC as well as SmithKline Beecham, and I think also we were able to present our positions through written communications. In that sense, a lot of our issues have been represented, and although we weren't involved in the process immediately prior to the introduction of the legislation, we also recognize the nature of public policy in that development.
Mr Bartolucci: You know, Ms di Cenzo, you are unique, because everybody else has been shut out almost in entirety: birthing centres, OMA, OHA. There are so many people who feel excluded from the process. Consider yourself very, very fortunate. You are in a very unique position with this government.
The Chair: We appreciate your attendance this morning and your interest in our process. Thanks for your presentation.
Mr Clement: Mr Chairman, I am in possession of a response from the ministry to a question asked by Mrs Caplan regarding physiotherapy services. Can I table that with the clerk?
The Chair: We'll have the clerk pass those around.
PARKDALE COMMUNITY HEALTH CENTRE
The Chair: Our next group is from the Parkdale Community Health Centre, represented by Frumie Diamond and Almerinda Rebelo. Good morning, ladies, and welcome to our committee. You have a half-hour to use as you see fit. Any time you leave for questions will begin with the government. The floor is yours.
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Ms Almerinda Rebelo: Thank you. Good morning. I do appreciate the emphasis on my name -- sounds a real rebel; I'm not a rebel, just Rebelo.
Mrs Johns: He's having trouble with names all week.
Ms Rebelo: It's just the paper outside says "Alma Rebels." It sounds much more interesting.
Thank you for giving us the opportunity to come before you to share our views concerning Bill 26. I am Almerinda Rebelo. I am the executive director of the Parkdale Community Health Centre. With me is Frumie Diamond. She is our community health educator.
As a community-based agency, we are deeply concerned about the impact that this bill will have on communities such as ours. We serve a vibrant and diverse area of Toronto. We are deeply committed to ensuring that our community, as well as other communities in Ontario, have the resources and the ability to contribute to the betterment of Ontario.
Bill 26 will directly impact on the provision of health care service, and as such, we will focus the majority of remarks on those sections of the bill. However, we will also comment on the far-reaching and sweeping changes that are being proposed in this bill. We will address the latter point first.
Ms Frumie Diamond: We're going to start by talking first about the democratic process. The government's mandate to bring about change does not relieve it of the responsibility to ensure that changes are made in a democratic and fair way. This includes giving citizens the opportunity and the time to critically analyse and have meaningful input into any bill which has such a profound impact on our daily lives. More specifically, many provisions contained within Bill 26 will erode our precious democratic systems, including the checks and balances put in place to protect democratic processes.
The bill gives sweeping powers to the ministers of Health and Municipal Affairs. Public consultation, consultation and negotiation with affected parties, with hospitals/hospital boards, with doctors, with the Ontario Medical Association, with pharmacists, with municipalities, to name only some of the affected parties by Bill 26, are all to be set aside. In most instances, the bill makes it clear that there is to be no appeal from the exercise of these powers.
The Minister of Health, it appears, will only enter into discussions with such groups as drug manufacturers and those privileged to be invited to submit proposals for establishing independent health facilities while excluding community participation in determining the direction of health care provision.
The Conservative Party has emphasized the important role communities have in establishing local health care priorities, and yet what we see are communities such as ours being further excluded from the decision-making process. It is of utmost importance to protect all aspects of community participation, including the participation of those segments of the community with which the government may disagree.
I'd like to go on now and talk about patient confidentiality, which I think is schedule F, part IV. Schedule F, part IV, allows the Minister of Health to pass regulations "prescribing conditions under which the minister may collect, use or disclose personal information under subsection 37.1(1) and conditions under which the minister may enter into agreements under subsection 37.1(2)."
This provides the government with the authority to disclose personal information to any party it enters into an agreement with, including foreign-owned companies that are not subject to Canadian rules and regulations.
The relationship between health care providers is a sacred one and must be protected at all costs. The proposed legislation puts that relationship at risk and threatens the privacy, dignity and individuality of Ontarians. The fear that confidentiality may be breached will deter many patients from confiding in their caregivers about their most intimate problems, since they will no longer have the assurance that the information will not be shared with whomever the minister wishes. This will put our patients' health at risk, and providers may not have the full information with which to make treatment decisions.
We are aware that the minister has indicated a willingness to improve the protection of confidentiality of patient information. This is very encouraging and we urge and support the minister in pursuing this direction.
I'll go on now and talk briefly about the Ontario Drug Benefit Act, schedule G. The changes proposed in schedule G have potentially devastating effects for all low-income seniors, persons on social assistance and other people on fixed incomes. For instance, single persons with income below $16,000 will be subject to a $2 user fee for all prescriptions. For persons with incomes above $16,000, a $100 annual user fee will be levied. This is in addition to the cost of dispensing fees of up to $6.11 per prescription.
The link between health and income has been well documented. Those with the least have the poorest health. Consequently user fees target those who are most ill and least able to pay. While $2 may not seem like very much to those with adequate incomes, it will be a burden for those on fixed incomes. Very often, those people on social assistance and seniors on fixed pensions have multiple health needs and require a number of medications. The $2 fee will add up quickly and people will be forced to choose between taking their medications or eating.
For example, a patient taking eight necessary medications will incur an extra $16 per month in fees. In other cases, a patient who is suicidal may be prescribed medication on a daily basis and therefore would incur extra fees of at least $14 per week. This is a not a policy designed to get people out of poverty and into jobs. Instead, it condemns them to a cycle of poverty and ill health.
To further worsen the situation, the proposed legislation would deregulate the drug industry, leaving citizens unprotected from soaring drug prices.
Other solutions of dealing with the high costs of drugs would be far more effective. We support the Ontario Coalition of Senior Citizens' Organization's proposal to:
-- Pressure the federal government to repeal Bill C-91, the drug patent legislation.
-- Enact legislation making it mandatory to prescribe and dispense generic drugs where there are no other contraindications.
-- Negotiate with pharmacists to lower their dispensing fees.
-- Address the issue of misuse and overprescription of drugs by educating both the public and the physicians.
In addition, adding user fees will add bureaucracy, something which the government is trying to avoid.
Ms Rebelo: I will continue referring briefly to the Independent Health Facilities Act, schedule F, part IV.
We are deeply concerned that changes to section 5 of the Independent Health Facilities Act will allow for the introduction of American-style, private for-profit companies to take over more of Ontario's health care system. Ultimately, this will lead to a two-tiered system of health destroying our beloved medicare. Opinion polls continue to show massive support for the five principles of the Canada Health Act: universality, accessibility, portability, public administration, comprehensiveness. The dismantling of our health care system was not mandated to you by the people of this province.
The privatization of our health care system serves neither the health of the citizens of this province nor does it demonstrate fiscal responsibility. It is well documented that the American health care system is far more expensive than ours, and it does not meet the health care needs of millions of its people.
We also believe that it continues to be important to give preferential treatment to Canadian and non-profit, independent health facilities. This is another aspect that the new legislation would negate.
We must also comment on the seeming unfairness of giving "the minister discretion to specify persons who may send in proposals for a licence to establish and operate an independent health facility, instead of being required to request proposals from the public in general." This appears to be attacking very basic principles of fairness that must be fostered in any democratic society. This will leave the government open to potential conflicts of interest.
Another preoccupation that we have is the role of community boards. Bill 26, schedule F, part II, goes on to set up a system where the minister could seize control of community institutions for particular hospitals. This approach undermines the role of volunteers and their ability to maintain ownership and partnerships at community level.
There are other aspects of this bill which we have not had time to comment on that would adversely affect the health and wellbeing of Ontarians. The elimination of such things as safety inspectors, especially around mine closings, and the elimination of environmental hearings, especially around the issues of land use, will in the long run pose health hazards to the general population. In effect, the increase in environmental degradation will negatively impact on people's health and cost the health care system much more money. It also causes loss to industry through illness and loss of productivity.
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Short-term fixes, while appearing to deal with deficit issues, do not always make economic sense in the long run and will cost society more both economically and in terms of human pain and suffering.
Bill 26 is too massive with far too many points to be adequately debated. We therefore call for the repeal of this bill and for the government to start working with the people of Ontario, even those segments of our society with which it disagrees, to build a better and brighter future.
The Chair: Thank you. We've got five or six minutes per party for questions, beginning with the government.
Mr Tony Clement (Brampton South): Thank you very much for your presentation; I enjoyed hearing from you. Let me just assure you that the government treats these hearings very, very seriously and certainly we are looking for advice from all sectors of the health care field on ways to improve legislation. In my limited experience in government, I found it doesn't matter whether you look at legislation for 500 days or for five days, there are always ways to improve it. So I'm quite looking forward to having that opportunity through this committee.
Let me also say that in my previous political incarnation, I did a lot of work in Parkdale in the community, including Parkdale community action. So I think I know a little bit about some of the special challenges, which can be overcome, quite frankly, in Parkdale and I recognize your group and certainly you've done your part as well.
I have two specific questions: First of all, with your characterization of the Independent Health Facilities Act and the possible changes, you've painted a very bleak picture, and that's your right to do so. I wanted you to react, though, to something a doctor in my riding of Brampton South said to me recently which was that -- he's a cosmetic surgeon and he'd like the ability to perform hand surgery in certain cases. There's a waiting list in Brampton of several months for hand surgery and he has had patients who have excruciating pain because they've been waiting for this service from the hospital. But because of allocation of resources and its elective surgery, it just gets to the bottom of the list all the time.
He thinks that, quite frankly, if he is given the opportunity to have an independent health facility in that area, even if there are people who are paying for it, that so-called two-tier system, what that does it is relieves pressure from the hospital. If there are people who can pay for it, they go to him and get excellent service; if there are people who don't have the ability to pay, they can go to the hospital and get excellent service because we have an excellent hospital in Brampton, Peel Memorial Hospital.
So from his perspective, he thinks he's actually helping the health care system. Even if it was a for-profit situation that he's actually relieving some of the pressure, some of the waiting lists, some of the queues inherent in the system, do you think there's any validity in that kind of view at all?
Ms Rebelo: I do understand the issue of the demand and the opportunity to offer a service and the fact that there are people who have the money who could pay. I understand that. I think the danger I see -- it's only when we try to use examples like that to look across the health system and say that's then a good direction to go.
In my life, for 11 years as the director of the community health centre, I met actually with a number of people from the states. I had a recent visitor from Los Angeles who talked about actually some of the issues that affect the people in the area she serves who have to have actually community health centres funded by the government and by corporations and the foundations to be able to survive and relies on a team. She had a team of 20 volunteer doctors, doctors who go up to the section to work for what's called the indigent. So this is one example.
I'll give you another example. About a year and a half ago, I had six physicians from Vermont, in the States, who actually specifically came to visit me to talk about how the system works. In a particular community health centre, in a particular section of the city with a variety of issues to deal with, all of the six were desperate of what they were actually seeing.
They were in private practice and they were under the HMO; for the ones who are not familiar, health maintenance organizations. They were fighting with an aging population of patients who actually were begging of them to cheat on their system so they could be able to be covered by the insurance companies. They were ready to move to our system then.
It's not that the point of the demand in a consumer society is valid or invalid. I think it's valid, if I could answer you directly, but basing public policy of something as sacred as health -- because when you talk about conflict of interest, that's perhaps one of the areas we must protect. I will be concerned in trying to use that example to generalize a validity to the problem, to the issue.
Mr Clement: All I was trying to say is there is a demand for these services.
Ms Rebelo: I'm sure there is.
Mr Clement: If we can improve the health care system, then surely you are not against that.
Ms Diamond: Maybe there are other ways of improving the health care system that don't introduce a two-tiered system like that, so that people who have money go to the front of the line and people who don't have money then still have to wait. I think there's also been evidence that when you do have that kind of a two-tiered system, it drains resources away from the publicly funded sector, so that the people in the publicly funded sector in fact end up getting second-rate care. I think that is the real danger about introducing that kind of a fee-for-service and profit within the health care sector.
Mr Bartolucci: Thank you very much for a very, very interesting presentation. We've heard from other centres and the concerns are certainly shared by the other centres. I guess I have a major concern here that I'm seeing that there could be some type of discrimination within the new policy, within the new legislation. Do you consider schedule G in particular to be discriminatory against lower-income and seniors?
Ms Diamond: Yes, absolutely.
Ms Rebelo: Absolutely. I would like to tell you also that in Parkdale -- Parkdale is a very proud community with a range of incomes and a range of people. We have a very active board of directors. They are totally in fear. I don't control my board. They're really active. They are the epitome of what we consider a very active group of people. They get involved in their own coalitions, and we get to know later on. They really wanted to make a point to any government, they understand, they are responsible. That's what I have seen there for 11 years of working.
They have a lot of fears. They believe they will be shut off, especially since Parkdale has this reputation for being a difficult area, and people usually ignore the struggle and the pride they have to make it a better community in every day of their lives. So that's there too.
Mr Bartolucci: Great, thank you. Another thing, and something that's common throughout the presentations, is that no one's opposed to deficit management. We all see it. Every presenter has seen it as being very, very necessary, but you can't only manage the deficit from a fiscal point of view. Do you not have to also ensure that the values are in place that will protect a health care system, and do you believe that there's a weakness in this legislation with regard to that?
Ms Diamond: Yes, absolutely, and I think that we said in our closing that in the long run it costs society both economically but also in terms of pain and human suffering. I think that those are immeasurable kinds of things and we can't put a dollar value on that suffering. Those are the things that we have to be looking at as well. Yes, you have to manage the deficit, but we also have to make sure that the people do not suffer because of that.
Mr Bartolucci: And you're given the opportunity today to present to us, but truly do you feel that you've been excluded from the process?
Ms Diamond: Absolutely.
Ms Rebelo: Absolutely. I guess my prior answer actually referred to the fear of the members of our community, both clients, patients and our board of directors. They are volunteers, they are there, and they expressed that. They have encouraged me to get involved as much as I could, just because they feel at least if there is someone who could get -- the professionals who have an entry point, which is sad to say.
I would like to refer a bit to discrimination, because again there is a lot of fear around that our city may not be a city where we can live in. If I could put a personal comment, I am in Toronto for 20 years now. I love this city with a passion. I cannot bear the idea I may be about to lose this.
And look at history. I appeal to the people in government: Look at history, look at the States. Look at what happened to the cities in the States. I had the privilege to be a tourist visiting in the 1970s Boston and areas like that -- my parents immigrated to that area -- and it's shocking. Now they are trying to revitalize that city, and we are trying to open it up by having a lot of what I call the discrepancy between the haves and the have-nots.
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Your question addressed the issue of the price that we pay. It's an important responsibility of governments to take care of the budgets and govern adequately and properly. It's very important. You have total support for that. But I think Canadians are feeling very nervous, and anyone I talk to -- and I tend to have a lot of people who have more conservative ideas around me who are hardworking people who really believe in discipline and control -- they are totally in panic with the idea that we may have a long price for our children and grandchildren. So I just think it's important to put that appeal, and it's based on that.
Mrs Caplan: I guess the question that I have is about your real concern that you've expressed so well about the fact that what this bill really does is say, "We're not going to tell you how we're going to use any of these powers that we're taking." You don't know what the policy direction is, and in the name of restructuring, this minister and this government could do anything they wanted without further consultation. That creates a sense of powerlessness. Is that what I've heard?
Ms Rebelo: We need consultation. We need consultation with adequate terms. Actually the public, and personally, we need to have a sense that we have been heard, not shut off.
Mrs Caplan: And this bill shuts you off.
Ms Rebelo: And needs to be efficient. There is also a sense of desperation when things go forever and results are not achieved. So we need to bring a balance to that and we need to do that with an ethics base on it. We are in Canada. As Canadians, we have a sense of duty to a lot of things that make this country so special.
Mrs Caplan: When this bill's passed, that door is closed.
The Chair: Ms Lankin.
Ms Lankin: I think you've touched on this point, but Mr Clement was asking you questions about, surely, if we are going to improve the health care system by these measures, then you'd be in favour of that. I think one of the things that's missing from the government's analysis is a whole framework of looking at things from the determinants of health. In fact, when we see the cuts to welfare, the doing away with housing programs, the limitation on pay equity for low-paid women, cutting back on access to child care, the negative environmental steps that have been taken, you put all of that together and from a determinants-of-health point of view, there's going to be a lot heavier demand on our health care system in the future.
I know that you've asked for the bill to be withdrawn and for it to be divided up and let's take a bit more time, and a lot of groups have asked for that. I think last night we were doing a count. Out of the some 70-odd groups that have presented already, I think only eight or so were supportive of the government's bill as it was proceeding, and even there some of those groups had some small concerns. Overwhelmingly people have said, "Split it up, slow down; let's look at these in pieces and understand them." However, I'm not sure that the government is going to listen, and we may end up having to deal in the third week of January with a huge number of amendments.
With that in mind, I'm wanting to ask you if you've given some thought to amendments to certain areas, and particularly I want to pick up on the concern of your board in issues around volunteerism and the role of community input into the process.
This government is undermining volunteerism in a major way with its ability to take over hospital boards and directing hospitals on a day-to-day structure, but more importantly, this restructuring commission that they're putting in place, there are no objectives, there are no goals, there are no guidelines, there are no criteria. It doesn't say what they're going to do, and there's nothing in the legislation that ties it to the community consultation process being led through health planners locally, like DHCs. Can you see that as an area that requires some amendments, and do you have any other thoughts with respect to amendments in this area that deal with volunteers and community consultation and community-led planning?
Ms Rebelo: We have not had the time to digest the whole bill yet, to be honest. That's the problem. But I know Frumie in her part, she really talks about the health determinants. A lot of my time right now is working with actual local hospitals trying to prepare for the overload of more problems that we have. These are serious partnerships we have. There are regular meetings and regular negotiations about how we can deal with the load. We talk about maybe having to increase urgent care. These are things where as a community health centre we still may contain some of the costs in the whole system.
But there is no question that we would like to be involved in the area of some of the points you raise. The issue of housing is a tremendous one, any avenues that you mentioned. Frumie, maybe you could refer -- because you work with groups. People in the community really would like to be involved in some of these things.
Ms Diamond: It's true, and I think that the recommendations that you're making are very important and I think that we would suggest that there be very strict guidelines to the number of areas that you mentioned.
I'd just like to make one further comment: I think, Mrs Caplan, you mentioned the participation and I have to say we had very short notice with which to prepare this. This is a bill that's over 200 pages long and we don't have expertise. We're just a small organization and we really don't have that kind of expertise and it's taken the work of several staff members away from the other daily work in order to be able to do this. We don't have the kind of professionals and policymakers who look at these kinds of things in order to present a bill. So certainly we have not had very much time to look at this in detail and give it the kind of in-depth thought and research that it really requires.
The Chair: Thank you very much. The one thing I want to do, I would invite you to submit any further thoughts that you have in writing to the committee some time before we meet for clause-by-clause. I believe the deadline for those submissions is January 18, so any further information you'd like to share with us we'd be happy to receive and take into consideration.
Ms Diamond: Thank you. We just didn't have time to bring you the 30 copies that you requested, but we will do that.
The Chair: Thank you very much for your interest in our process. We appreciate your being here this morning.
Ms Diamond: Thank you very much for having us.
The Chair: The next presenter is currently presenting at the other committee and they're running about five minutes late, so we'll take a five-minute recess to have a cup of coffee.
Mr Clement: Mr Chairman, just for the record, I also have responses from the ministry with respect to Ms Lankin's questions around the earlier part of the hearings respecting responsibility of supervisors and the effect of section 8 on district health councils which I'd like to table.
The Chair: Okay, we'll have the clerk distribute those. Okay, a five-minute recess.
The committee recessed from 1027 to 1034.
CANADIAN ASSOCIATION OF RETIRED PERSONS
The Chair: Welcome, Lillian Morgenthau, from the Canadian Association of Retired Persons. We appreciate your attendance here. You have a half-hour to use as you see fit. Questions will begin with the Liberal Party at the end of your presentation. The floor is yours.
Mrs Lillian Morgenthau: I really would have liked to wait until everybody came, because anyone who has taken the time and effort to come should be heard. Of course it's kind of you to give this time to us.
Our position paper is one we feel very strongly about and of course would, because seniors and people over 50 can be put into different categories. We can put in those 50 to 60 as the junior seniors -- they're the "sandwich generation," who have parents and children -- those 60 to 75 as the middle seniors, and then those over 75 as the senior seniors. Seniors are not a homogeneous group. They're very individual, with very individual talents and abilities.
Allow me to introduce myself. My name is Lillian Morgenthau, and I'm president of the Canadian Association of Retired Persons. CARP is a national association for Canadians over 50 years of age, retired or not. CARP is a non-profit association that takes no funding from any government and therefore is very neutral. Our membership is over 225,000, with about 140,000 members in Ontario. The aim of this organization is to improve and maintain the quality of life for Canadians over 50 years of age. We therefore maintain a deep interest in government programs relating to this age group.
This government was put into power by the voters of Ontario to reduce the deficit, get rid of bureaucratic albatrosses and to find workable solutions to complex problems. Mr Harris rode in on a wave of these promises, but also explicit promises of maintaining our health care system and the protection of seniors' programs, with no user fees.
Bill 26 is a bill created in secrecy and delivered to the Legislature when members and stakeholders, myself included, were in a lockup awaiting the Finance minister's mini-budget. No information was released that this important bill was to be presented, let alone passed. How could any responsible government expect to pass a bill of 211 pages without time to study and assess it? We cannot but presume that the absence of members was a deliberate ploy by this government to ram through an obnoxious bill. Perhaps we should remind the majority members that the "d" in democracy does not mean the "d" in dictatorship.
"Slash and burn first, think later" is not the Canadian way. Omnibus bills are not new, but were designed to take care of loose ends and for clarification, not to grab new powers that allow ministers to play God. Democracy is very fragile and must be protected.
This bill allows a minister to change or take over local boards and have no House debates on municipal restructuring which the minister can do by an order in council. Why do we need politicians if this can be done without them?
When asked about the changing of school boards without public debate or consultation, Al Leach, the Minister of Municipal Affairs, is reported to have said, "Quite frankly, I don't know." Neither did anyone else affected by this legislation. Education minister John Snobelen was equally at sea, saying, "Candidly, I don't know at this point." We feel that there should be time to find out what is in that 211-page document called Bill 26.
While CARP is concerned about several aspects of this bill, we will concentrate on the parts of the bill that will hit seniors and all Ontarians hardest: health care and its many aspects.
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Let's look at the Ontario drug benefit program. CARP strongly supports open and timely access to new medications. We believe that the trend by the Ontario drug benefit program to delay and not list new theories may save costs only in the short run, since without these medications, costs will rise in other areas of health care such as increased physician and emergency room visits and longer hospital stays. In addition, many seniors depend on new medications to keep them active, mobile and in their own homes. CARP believes that timely access to new drugs is one of the most cost-effective means to control health care costs. We are concerned that Ontario is the slowest province to approve drugs for the formulary, drugs which are covered in other provinces -- Proscar for one. To speed up the process, duplication between the federal and provincial approval systems must be eliminated. These layers delay the access of seniors to new medication.
Our view is simply that once a drug has been passed federally, it would save millions of dollars to accept their findings and pass it provincially. Duplication of this kind between federal and provincial areas costs millions. It is almost monumentally difficult to get a new drug on the formulary. Generic drugs, though cost-saving in most cases, must come after patent drugs. These drugs may be cost-effective, but are not up to date. There should be choice. At least let us give an option to the patient.
If we can save one day in hospital by use of a newer drug, let's do it. Let's have healthier patients and save costs by keeping patients out of the hospital.
We also believe that appropriate use of medications is critical. Overmedication and inappropriate utilization of medications by seniors is a serious problem. We support any programs aimed at ensuring appropriate use.
CARP recognizes the cost constraints faced by the Ontario government and the Ministry of Health. We understand that copayment systems have been implemented in many provinces to try to control rising drug budgets, and that Ontario is considering implementing a copayment or deductible for the ODB program. CARP is concerned about any fee which may deter seniors from receiving necessary prescriptions.
We oppose the new regulations governing the Ontario drug benefit program whereby low-income seniors and welfare recipients would pay a user fee of $2 for every prescription, and single seniors earning more than $16,000 or senior couples more than $24,000, which is the poverty level, will pay the first $100 plus $6.11 per prescription. The threshold, in our opinion, is too low. Moreover, unlike other provinces there is no maximum beyond which seniors will not have to pay. We would like to see a higher, more realistic threshold and a maximum set.
We understand the fiscal pressures facing the Ministry of Health as the government tries to balance the budget while still delivering quality health care services to Ontarians. CARP believes that there is enough money in our health care system. The problem lies in how it is spent. As changes to our health care system are made and with our members disproportionately high users of medicare, CARP is concerned about the impact of changes to health care on Ontario's seniors.
Mr Harris himself said that annually Ontario pays out over $640 million on health fraud. We sent in a brief in which we suggest that there are recommendations to overcome this. I would suggest that you read that brief.
Hospital restructuring: CARP is concerned about the recent recommendations of the report of the Metro Toronto District Health Council's hospital restructuring committee, HRC, to close six acute-care hospitals in Metro Toronto, as well as other hospitals that are not acute-care. We disagree with the recommendations to close the Northwestern, the Orthopaedic and Arthritic and the Branson hospitals, and are concerned about the negative impact these closures will have on seniors living in the affected areas.
We recognize that a lot of time and study went into the preparation of this report undertaken by the previous, NDP government. However, care of the elderly in Metro Toronto was not identified as one of the key groups to be served. With approximately 225,000 members, CARP represents a sizable portion of the fastest-growing segment of Canada's population. It is our understanding that the HRC did not seek specific input from the geriatric medical community during the writing of the report and its recommendations. We sure were not asked and we're a big group.
CARP believes that instead of closing the Northwestern General Hospital, it should merge with the Humber Memorial Hospital and serve patients on two sites instead of one. This would achieve cost savings through the merger and rationalization of services but would continue to ensure quality care to seniors and other patients.
The Humber is in a secluded residential area, difficult to get to by transportation other than by automobile. As a matter of fact, I tried and I just couldn't get there. There was waiting room and standing room for the transportation and so finally we went by car. We had to find our way round and round to find a parking lot. It is a very good hospital, but it's on the wrong site. An expanded Humber with increased volume of ambulances, patients and staff would encroach even more on a community not willing to accept the noise and activity that would destroy its area even more.
Northwestern, on the other hand, is on a main street, Keele Street -- easy transportation -- and with Harold and Grace Baker Centre, a retirement and long-term-care centre built next to Northwestern for availability of care. We must not disregard this. This can be compared to the Baycrest Centre concept. It also has a building that was built specifically to add three extra floors to it and would be a lot cheaper than trying to build a new building over at Humber. That's why we suggested two sites and let them decide which way they want to run.
It's imperative to allow the hospitals to have their own discussions. The hospitals should be allowed to negotiate possible mergers or alliances, based upon some of the recommendations of the report. To this point, the hospitals have not had any input into recommended mergers, and their involvement is essential for a better health care plan. In many cases, there are better options and better alliances. Let's look at Wellesley and Orthopaedic. I think we have to give them a chance to do their own planning and not destroy a community.
In addition, CARP does not support the recommendation to close the Orthopaedic and Arthritic Hospital and to move their services to Toronto East General Hospital. The O&A is a centre of excellence for -- oh, how does one say this word? Come on, help me. Come on.
Mrs Caplan: Musculoskeletal.
Mrs Morgenthau: Musculoskeletal -- that's it. Sometimes, you know, as you're reading along --
Mrs Caplan: I know, they're hard.
Mrs Morgenthau: After all, I'm older; I'm a senior. You have to give time to that, and allowances. I left my wheelchair outside.
It provides care to seniors from across the province, not just Metro Toronto. Its expertise should be recognized and in fact could be expanded by taking on the orthopaedics from the Wellesley Hospital, also slated for closure.
Wellesley has been the community centre of low-income areas for decades. These people will find it horrific to find ways to get to Toronto East General. Have you ever tried it? I tried these things. You know, before I came, I sort of tried these things out. It would be great if we all did it together. You need about four different transfers to get from the Wellesley Hospital over to East General. Of course, these people do not have cars. They're a very low-income area. Again, the poor are the losers.
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This would make more sense than transferring the Wellesley's orthopaedics program to Sunnybrook, if we would have the Orthopaedic and Wellesley hospitals together. The O&A is a much more convenient location for seniors than Sunnybrook.
Women's College Hospital is a unique facility with a culture all its own. The facility is known throughout the province for looking after neo-natal babies -- see, I said that one right. A study was done on this a few years ago. It was decided another facility was needed in this area, and Mount Sinai Hospital was selected.
Women's College Hospital has a world-renowned reputation for meeting women's needs; it was created for that. It has a large volunteer organization devoted to the hospital. All my four children were born there. It's a good hospital. I'd hate to see it leave. It behooves us to look at this facility again. It would not be in the best interests of this city to lose this hospital.
Finally, we believe that Branson hospital should be retained because without its presence there'd be no hospital to serve seniors between Leslie and Jane in north Toronto. The York-Finch hospital is too far away. There is a notable movement to North York General Hospital for the patients who went to Branson, and if this continues, North York will be overwhelmed.
The Chair: Could I interrupt just for a minute. I'd just kind of make you aware of the fact you've got about 12 minutes left. If you want to allow some time for questions, I just want to make you aware.
Mrs Morgenthau: You cut me off. I get 12 extra minutes. You cut me off.
The Chair: No, no, I am giving it. I just wanted to make you aware of the time so you could make a decision about whether or not you wanted to continue your presentation or leave some time for questions. It's your choice.
Mrs Morgenthau: There are a couple of things that have to be done. I think that we should continue.
The Chair: I just wanted to make you aware of that.
Mrs Morgenthau: I want my extra 12 minutes.
The Chair: I'm giving you all the time.
Mrs Morgenthau: I won't give you an inch.
CARP disagrees with the recommendations to close these hospitals because of the negative impact the closures will have on the treatment and care of seniors, but also because of the amount of knowledge base. We'll lose all the medical expertise of the staff that's there. They'll either go on unemployment and then, when that's through, they'll go on welfare and then they'll be on top of the Ontarians for their tax base. It's not a good idea.
Let's go on. It's our understanding that the ministry is currently involved in negotiations with the Ontario Medical Association regarding the payment of physicians. CARP encourages a more cooperative relationship between the OMA and the ministry. As a matter of fact, we understand that the government is thinking of doing away with the OMA. This would be very sad because it would indicate that this government is not interested in meeting the head of a group that has designated the OMA to be one of their spokespersons. If they're not going to meet with the OMA and they're going to make their own decisions, and the minister decides this, that and the rest, then that's not the Canadian way.
Discrimination of the elderly is a subtle new invention. The elderly are at risk because the standard to get people out of the hospital is paramount. The magic age of 70 may allow them an extra day, but then out they go -- where is not important. We have to recognize we have an aging population. Every acute care hospital has a significant number of beds that are being occupied by patients who shouldn't be there and can't find a bed elsewhere. They should be in nursing homes or retirement homes.
It would make more sense to keep the hospitals and make several of their sections ALC -- more cost-effective and not requiring capital investment. The bricks and mortar are already in place. We can keep a functioning hospital available in the community. Voters are happy, costs are down and you open up services that your voters will cheer and that cost less. Everybody wins.
Because seniors are crippled doesn't mean they can't get to the voting booth. I would suggest very strongly that you keep in mind that every senior votes.
We feel that the members of Parliament will go to the head of the emergency line when they're ill, get a private room and, after they're no long an MP, special treatment will not be available. It also will not apply to their children and grandchildren. Short-term solutions make long-term debacles.
What concerns us most of all is the fact that the process of appeal is unbelievable and unfair. In medical areas there's no appeal and in other areas the appeal would be expensive and may be determined to be frivolous and therefore not acceptable. Furthermore, and I quote from the book, "No proceeding shall be commenced against the crown or minister or a person appointed by the minister," is part of this bill. Where then is the government's responsibility if there's no liability? Even Brian Mulroney, a Conservative, is able to sue the government. But not us? Responsibility for actions must be part of anything we do. Immunity is not acceptable and will not be tolerated.
A frightening part of this bill, which you will find on page 68, and I quote, will allow the minister to "collect, directly or indirectly, use or disclose personal information for purposes related to the administration of" various health acts "or for other prescribed purposes." What other purposes does he have in mind?
In practical terms this means that the minister can send someone into a doctor's office or a hospital office and take out a patient's file without a court order. As we know, that file, regardless of promises, may be leaked somewhere along the road. This is a direct attack on your privacy and cannot be tolerated. The doctor-patient relationship must remain privileged and not subject to bureaucratic snooping or harassment.
On pages 54 and 55 of Bill 26 we read that the minister has the power to direct the board of a hospital to cease to operate, to remove any staff or physician or facility. In plain language, that means the minister will be able to close hospitals, force the board to hire of fire, regardless of the wishes of the board, staff or public served by that institution.
At the same time, this bill gives the minister the power to "refuse the application of any physician for appointment or reappointment to the medical staff or for a change in hospital privileges" of any doctor without due hearing, and the board, obeying the minister's instructions, cannot be held liable. One man alone will have such power. Frightening, isn't it?
This bill allows OHIP to charge back any fees for tests they feel were unnecessary, but makes no provision for liability if tests are not ordered by the doctor because of restrictions. Who is to decide what tests are necessary: the bureaucrat, a disgruntled competitor or a computer? If the patient and doctor feel it is necessary, that's the criterion and should be good enough for others.
It's time to stop doctor-bashing and start to doctor-value. We have already destroyed health care with the interference of politicians who have used the health care system as a political step up the ladder. The result of their climb has been long lineups for operations, new babies and their mothers thrown out of hospitals within six hours in Scarborough or, if lucky, 24 to 48 hours at other hospitals. From experience, I know babies develop jaundice after this and new mothers don't recognize the problem.
This bill allows government to take over the day-to-day management of hospitals of which they have no knowledge, and if they're going to appoint people, we are faced with more bureaucracy. So where are the savings? This bill will encourage patronage, and we don't need that. It will allow the licensing of clinics and other health facilities and removal of that licence at any time without regard to the expenditure of the owner -- no recourse. In other words, a radiologist may set up hundreds of thousands of dollars' worth of equipment to set up an office and, without any explanation, be closed down, losing everything. This would definitely encourage patronage.
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It allows the minister to appoint a supervisor whose power supersedes that of the hospital board, a corporation, religious communities. It allows him to do away with the Salvation Army, the Sisters of St Joseph, any board. Such organizations in the past have provided great, great wonders for this community.
The refusal to make a contribution to the Canadian Medical Protective Association, which provides doctors' malpractice insurance, will certainly deter doctors from delivering babies, taking on high-risk but necessary surgical cases or provide anaesthesia in rural settings. In many areas it is almost impossible to get doctors to work in these stressful conditions. Right now, patients are too often being removed out of intensive care units when they should do better remaining a few more days, simply because the bed is needed, while sections of every hospital are available but closed for lack of funding.
Unreal, isn't it? If we allow finances to be the driving engine of health, we deserve what we get: cheap, inexpensive, bargain-basement health care. CARP members won't accept this. Why should you?
Government in a democracy, which I hope we still have in Canada, does not have the right to interfere with and dictate an individual's way of life. I've great respect for Mr Wilson, our Minister of Health. However, once this monumental power is established it will be there for future ministers. You know, today he may be Minister of Health; six months from now he'll be the Minister of Transportation. Ministers move as the cabinet moves and we don't know who we're going to get up there.
It's wrong to give that kind of power. A little bit of power is a dangerous thing; a lot of power corrupts. We shouldn't tempt our ministers. Let us go back to checks and balances.
I realize this is a majority government of 82 members, but I wish to remind this government that most of its members are new and should be given a chance to grow within the system and become acquainted with their constituents' feelings.
The Minister of Health, as I said, may be there tomorrow or may not. Take the bill apart, or, as one big general said, "You know when you should retreat." I think this bill should be taken off and brought back with its good points, and that we would support. We are a large seniors' group but we were not asked to sit on this committee. We want to help and we want to have input and I hope you'll let us.
I'm not going to do the financial considerations, because we don't have it. It's all here -- the costs. I'm glad we're saving Western. I hope we'll save others, because we're going to need them and I think there are other and better ways of doing it and still save costs.
I'm sorry to have taken so much of your valuable time but I think it's important.
The Chair: Thank you very much. You've taken exactly what you were allotted, and that is 30 minutes. We appreciate your interest in our process and your being with us this morning.
Ms Lankin: Mr Chair, could I ask, given the size of the membership of this group, if we had unanimous consent for one quick question from each of the three parties. We only have two other groups before lunch. It would eat a little bit into the lunchtime, but I would be prepared to give up that time.
The Chair: I would like to suggest that we're now in the fifth day of our hearings. We've been very consistent on 30 minutes. We're trying to stay on time today, especially because people have planes and trains to catch to get home for the season.
Ms Lankin: But there's a lunch break coming. There are two groups before lunch, and with unanimous consent -- it would be very quick, if there is unanimous consent; if there isn't --
Mrs Caplan: We'll give unanimous consent, one question each.
Mr Bartolucci: Makes sense to do it, Mr Chair.
Mr Clement: It's at your discretion, Mr Chair. That's why you're the Chair.
Mrs Caplan: Well, it's unanimous consent. If you'll give it, we can do it.
Mr Clement: No, no. Don't put words in my mouth, please.
The Chair: If it's my discretion, the answer is no. Thank you very much.
Mrs Caplan: But we've asked you to give unanimous consent. You can do that.
The Chair: Our next presenter is --
Mrs Caplan: Just say yes and then we will accept your ruiling.
The Chair: Thank you, Mrs Caplan.
Mrs Caplan: With unanimous consent he must --
The Chair: Thank you, Mrs Caplan.
Mrs Morgenthau: I'm going to be here for a few minutes. You can have me.
The Chair: Thank you very much. We appreciate your interest.
Mrs Morgenthau: Thank you for the time.
Mr Bartolucci: Just as a point of procedure, Mr Chair: If someone asks for unanimous consent -- is it not proper for unanimous consent to be asked for? If it's not granted, that's fine, but should it not be asked for?
Throughout this process I'm frustrated because, in trying to be fair, you're being unfair; in trying to remain by the rules, you're denying the rules as they exist. You're not doing it intentionally, I know that, but unanimous consent was asked for. If it's not granted, that's fine, but at least you should be giving the committee the power to do it. So, Frances has asked for unanimous consent --
Mrs Caplan: You asked for it.
Mr Bartolucci: -- and I'm asking for unanimous consent.
Mrs Caplan: To allow one question from each caucus to this witness. We're asking, Mr Chair, if you would allow the government to say whether or not it will give unanimous consent to allow for each caucus to have one question from CARP.
The Chair: I did not hear that there is unanimous consent.
Mr Bartolucci: But you didn't ask for it.
Mrs Caplan: Will you ask if there is unanimous consent?
Mr Clement: I'm asking the Chair to decide whether it's in order to ask --
Mrs Caplan: You have to ask, "Will you give unanimous consent?" Mr Chair, you have to ask that question. Ask if there is unanimous consent so that on the record we can hear yea or nay.
The Chair: We're going to take a five-minute recess.
The committee recessed from 1106 to 1111.
MONTY MAZIN
The Chair: We're back in business. Our next presenter is Monty Mazin. Good morning, sir, and welcome to our committee. You have a half-hour of our time to use as you see fit. Any questions will be divided up evenly at the end, starting with the Liberals. The floor is yours, sir.
Mr Monty Mazin: I was hurriedly called to this hearing and I welcome it. I just want to say at the outset that I'm so-called retired, as an unpaid volunteer, but busier than ever. I'm very active with the B'nai Brith, Rotary International, am very closely working with Doreen Wicks, who runs an organization called GEMS of Hope, and I've been working most of my life with the elderly, young people and people in need. So I can truthfully say that, to begin with, I represent a community in north Toronto that will be impacted by Bill 26. Thank you for providing me with an opportunity to address the concerns that I have as a resident of the community.
I live in a community of over 170,000 people, a community where almost 20% of the population is over the age of 65. This community will be significantly impacted by Bill 26 because of the recommended closure of a community hospital. I'm talking about the planned closure of the North York Branson Hospital.
This bill gives the minister the power to close hospitals or to delegate that responsibility to others. While I support the need for fiscal responsibility, I believe that closure of some institutions will not be in the best interests of the community and will not save money, but may actually cost, in terms of the care provided to a community, an actual capital and operating cost in the long run.
I'm talking today as someone in the community who has had actual experience in assessing the North York Branson Hospital and its program and services.
Branson has been serving the people in North York for almost 40 years and has developed the services required by that community. The hospital has purchased the equipment and renovated to ensure that it can meet the needs of the community it serves over the next 20 years. The hospital provides medical expertise, facilities and equipment that meet the needs of the aging population in the community surrounding the hospital.
The following are some of the areas of excellence that have been developed to meet the needs of the aging community:
(1) Currently has an acute geriatric care unit recognized for its excellent programming.
(2) The Diabetic Education Centre is recognized throughout the city as a program of excellence.
(3) The laboratory is one of the top laboratories in the country in terms of progressive management and quality of service.
(4) The medical imaging department is second to none, with a brand-new CT scanner, nine ultrasound machines and four nuclear medicine cameras.
(5) The emergency department has the highest percentage of staff with advanced life support training, 79%, of any community hospital in the city; 24% have trauma life support training. This is to meet the needs of the aging population surrounding the hospital.
(6) The GI unit has recently moved to a refurbished area and how provides the best physical facilities for GI procedures in the city. These changes were made to meet occupational health and safety concerns identified by staff regarding environmental venting of cleaning solutions.
(7) The operating rooms, recovery rooms, labour and delivery suites are all new and have the latest equipment.
(8) The hospital is equipped to handle cardiac cases. The hospital purchased $1 million worth of heart monitors to handle the community needs in the past three years. There is a total of 40 heart monitors in the emergency department, critical care unit, stepdown unit and post-coronary care units.
(9) The hospital has a new Jewish chapel to complement the existing Christian chapel.
(10) The hospital has numerous services to meet the needs of the elderly patient in the community. These include hearing clinics, foot care clinics, diabetic education, respiratory care, speech pathology, physiotherapy, occupational therapy.
(11) New outpatient pharmacy.
(12) New labour and delivery room and remodelled maternity unit.
(13) A new hospital library open to the public.
New equipment purchased to meet patient needs includes: a new laser for prostate surgery; new bathing equipment for elderly patients; integrated patient commuter systems to provide transfer of patient care information.
All of these improvements have been made at the hospital to better meet the changing needs of the community the hospital serves. These changes were not made without community support. The community has participated in this process by supporting the fund-raising activities for projects such as CAT, heart monitors, respirators, critical care upgrades and clinics, new laboratory, operating rooms, labour and delivery rooms and stepdown unit.
How do I know that all this equipment exists? Because I personally have used much of this equipment myself, having been a patient at the hospital following a massive heart attack, which was a year ago. Thank God I was spared and thank God for Dr Martin Strauss at the Branson. I received the proper care and I'm with you today.
I know that the hospital is equipped to meet the needs of the community it serves. If a decision is being made to close Branson hospital, I believe that the process should include consultation with all organizations and community groups that will be affected. I'm not talking about the one-way communication that was experienced in the DHC process, but actual discussion with the communities impacted to give them an opportunity to understand the rationale for decisions, to ask questions and clarify misgivings.
Just to review, the community served by Branson hospital is made up of a high percentage of senior citizens, as already stated, just under 20% in North York around the hospital. There's a large number of senior buildings, and the B'nai Brith -- and I was personally associated with this -- put up a building directly opposite Branson thanks to a philanthropist who gave $1 million. It's affordable housing that houses now over 150 people, deliberately chosen because it was opposite Branson.
The cultural understanding of Branson of the Jewish faith and cultural requirements: Will this same understanding exist in a merged facility that is not readily accessible to many who today can walk to Branson hospital?
These issues and the fact that capital will be expended to duplicate the services already provided but in a location remote from our community is of great concern to me as a former patient and to our organization, which represents many seniors and aging adults. We seek further consultation prior to capital being expended to save on overhead costs that can be reduced in many ways through shared services without loss of access to emergency and inpatient service in a large metropolitan community.
In coming down, I made some very hurried notes, because I just read an item in the Toronto Sun, a supporter of the Harris government, in which was the headline, "Harris Regrets Lack of Support." It says:
"Premier Mike Harris' biggest regret of 1995 is that many Ontarians don't seem to be buying into the Conservative Common Sense Revolution.
"`I regret very much, and perhaps it's a lack of our communications, that a significant portion of the population believes what we are doing is the wrong direction and the wrong motive,' he said....
"Harris said public disillusion will wane as voters begin to understand Tory goals.
"`I believe what we are doing is in the very best interests of some groups -- women, children -- '" -- didn't mention elderly -- "`it's for them we are doing it.'
"Harris said his communications staff will have to step up their efforts to sell the program in 1996."
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With the greatest respect to the Premier and yourselves, let me give you an example where I think the funds could come from. I've been a fund-raising, a public relations person, all my life. I've worked in various not-for-profit organizations. Corporate giving in this country, and it applies to this city and province, is no more than 2%. With all the hullabaloo, no more than 2% is given of profits from corporates. This is backed up by the Canadian Centre for Philanthropy, which just published a report of its findings.
The good book, which I'm familiar with, going way back to the time of Jacob, talks of giving back, for those who have, 10%. All the way through it talks of pious Jews, Christians, what have you, to give back, those who have, 10%. That 8% could make quite a difference. If the direction of Harris would be with his communications staff to those people who have the wherewithal -- and we're blessed in this city, and I know many personally through the fund-raising events that I've been associated with, some outstanding philanthropists. The Lieutenant Governor himself this week made a very handsome private donation.
What I'm saying is we have people who have not only given beyond their 10%, but who have the clout and influence to get others to do likewise. This could be a tremendous source of funding for the government to offset any deficit or for the very hospitals that are in dire need to survive and exist. So I say, concentrate on selling your program to these very corporate people who have the wherewithal and are not giving nearly enough by giving just barely 2%.
I want to end with a story which I think makes a very telling point. The story is of a boy on a beach. The beach is full of starfish, hundreds and hundreds of starfish. This little boy is picking them up one by one and throwing them back in the ocean. A stranger comes by, who says to the boy, "What are you doing?" The boy says, "I'm giving them back their life." The stranger looks around the beach and he says: "But there are hundreds of them out there. Do you think it's going to make a difference?" The boy holds up the one starfish in his hand and says, "It makes a difference to this one."
I tell you, it makes a difference to the elderly, the sick, the disabled, the poor who are distressed, who are depressed. If these cuts go through, it means their lives will be shortened, and I'm not being alarmist. So I say, please, to the government, people like yourselves who make the recommendations, give us back a life of hope that you will not go through with these closures and these terrible, terrible cuts. TLC stands for tender, loving care, but as far as this bill is concerned, it's terrible legislative cruelty. Let's get it back to TLC tender, loving care, especially at this time of the year, when we're celebrating Christmas and Hanukkah.
I can tell you that through Rotary, I've been involved in helping Salvation Army, the needs are greater than ever. They can't cope. The needs are greater than ever. I know you're all aware of this. Through the B'Nai Brith just last Sunday -- Elinor Caplan knows what we do in the community through B'Nai Brith -- we had lists from the Jewish child welfare and senior care, nearly 400 names, to give them a Hanukkah gift. I want to tell you that when we delivered the gifts, we found too many of the elderly using their food money to help pay their rent. It's not getting better; it's getting worse.
Bearing all this in mind, at this time of the year, let's have the spirit of Hanukkah and Christmas every day and not go through with this terrible, terrible bill that will affect so many people.
The Chair: Thank you, sir. You've allowed about four minutes per party for questions, beginning with the Liberals, Mrs Caplan.
Mrs Caplan: Thank you for a very passionate presentation. You mentioned the fact that seniors that you're meeting, poor seniors, are using food money for rent. What's going to happen to those people when this bill passes and they're now forced to pay a $2 copayment -- that's if they're under $16,000 for an individual, or $24,000 for two seniors together, if that's their income -- each time they get a prescription they have to pay $2? That's for the poor seniors.
Mr Mazin: I'm very, very frightened; very fearful. We're talking of $2. I don't have to tell you -- you people are in touch with your community -- $2 to us is like $20 to the very people you're mentioning. It's not just the one item; it's the fear of the rest now. There are so many fears they have. In other words, they're living in fear, waking up from sleepless nights and living in fear, and I see it getting worse. So they become more chronically ill because of this. You're absolutely right in raising that question. These are additional burdens to the very people who were looking forward to golden years at this time of their life.
Mrs Caplan: I know that many of those people believed Mike Harris when he said that his policies were not going to hurt seniors. How are they feeling? I know you said they're feeling fearful, but for those --
Mr Mazin: Well, I'll tell you the truth and I'll use their words --
Mrs Caplan: -- the thought that he wasn't going to hurt seniors.
Mr Mazin: -- he lied. I'm not associated with any political party.
Mrs Caplan: I know that.
Mr Mazin: I tell you as a community worker. When you ask people their thoughts, this is what they're coming up with: "He deceived us. He lied." There were many who did support the Harris government, yes.
Ms Lankin: Mr Mazin, I'm very moved by the passion of your presentation and by the depth of your beliefs. I share your level of concern for how the cumulative effects of some of the actions of this government, many of which will be enacted through this bill, are having an impact on people, and particularly people who don't have the financial wherewithal to protect themselves and to be able to withstand this. Quite frankly, I'm angry and I feel sometimes desperate to try and get the message across. I feel personally that this tax break of 30% that is going to benefit primarily the wealthiest people is immoral when it comes on the backs of poor seniors and welfare recipients and persons with disabilities. It's just wrong and it runs against all of my personal ethics.
I actually wanted to ask you some questions and they seem so sort of technical and picayune compared to the big picture that you've delivered and the big message that you've delivered. I am interested in some of the comments you made about Branson hospital in particular and your concerns about the district health council report and the process. In this bill, powers are given to a restructuring commission. There are no terms of reference set out, there are no objectives set out and there's no relationship set out to local consultation processes, or even DHCs.
I think many people have felt that the DHC process in fact was a fairly thorough community consultation, but in your presentation you called it one-way and you felt that the people from your community didn't have input. I'd like you to tell me what your experience was and what happened during that because I know of some other communities that in fact felt that they had a good dialogue and when they didn't like the end result of the report in the second phase of consultation were able to get some changes in it. Why do you feel your community didn't have that opportunity?
Mr Mazin: I was called upon, as I told you, through B'nai Brith back in October without any prior knowledge of any consultations taking place or anyone coming to us to discuss in detail what the proposals were. It was thrust upon us. I found myself before a committee actually half this size at that time -- there was just the chairman and two people and then they had to have another hearing to make up the group -- and I felt there was not serious attention given to such a serious situation that would affect so many people. In other words, if there'd been more prior research and then discussion, "This is what we propose," at that time rather than throw it into here -- there have been many accusations about being undemocratic and what have you. I do welcome this hearing, but I tell you, it has upset a lot of people and there's a lot of fear around that maybe it's too late. I'm hoping they're wrong, that it's not too late.
The Chair: For the government, Mrs Ecker.
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Mrs Ecker: Thank you very much, Mr Mazin, for a very excellent presentation. I appreciate your taking the time to come in and put forward your views. As someone who was raised by a parent who believed in the traditional Christian duty to tithe, I quite sympathize with your comments that more of us should do more of that. I think we'd all be better off, including corporations, if we did.
I just wanted to ask a little bit about the restructuring exercise and what's happening at Branson. I'm very sympathetic to the concerns that you raise about your hospital.
I guess the concern that our minister has wrestled with is, how do we restructure the hospital system in an appropriate way? Other provinces have brought in legislation where, for example, the cabinet of the government can constitute the hospital board, or where all the hospital boards were disbanded and made into one board underneath the government. There have been a lot of draconian things which other governments have tried to do.
The concern we had was that we wanted to base it on the community-based recommendations that were coming through district health councils, as here in Toronto. That system which had been set up under the previous government we thought might have some community input, would bring forward community recommendations which would be useful. I know in my own area, the district health council process, while it also had flaws, did bring forward recommendations which I think are going to be very helpful in my particular region.
The minister has designated a commission which is to implement those kinds of recommendations. You're flagging a concern that that DHC process has not worked well for your area. What advice would you give to the minister to try to implement restructuring in the province in order to try to save some of those resources and reinvest them in other areas?
Mr Mazin: My personal experience, as I've already mentioned, is with Branson. I can go way back to 1981 when it saved my life when my appendix burst on the way to hospital. Although it's seven kilometres more up to York-Finch, I was at death's door and I would not have survived. I'm really worried about many, many people who use that hospital as their local hospital, who without a car would not be able to get to York-Finch or have the same accommodation in an emergency as they do at Branson.
But apart from that, I mentioned earlier the facilities that Branson has now had after 40 years. There was a time, when I came into this province about 17 years ago -- and being in PR, I know they had a hell of a job to get rid of a bad name -- Branson did not have a good name. Somehow when they'd mention Branson: "Oh, no. Oh, no." It's changed around tremendously. They have some of the finest doctors, the equipment that I've already spelled out, and they've put in millions. And I know personally because I helped to raise funds. Hasn't the government considered all this? It's a bigger hospital, by the way, as well as having better facilities than York-Finch. There doesn't seem to have been any thorough research taking that into consideration. Did they go around and speak not only to the doctors and nurses and the staff, but to the patients?
Let me bring up another point as a volunteer. Do you know how much money we, as volunteers, save the government, federally and provincially? They just announced this week what a housewife is worth, and they're saving billions if they had to pay housewives for the work they did. They would spend billions if they had to pay their volunteers. We're saving them billions, and in this province certainly millions. None of this has been taken into consideration, the feelings of the very people like myself who work in the community, who are not in an ivory tower making decisions but are with the people on a day-to-day basis. That's my plea.
The Chair: Thank you very much, Mr Mazin. We appreciate your interest in our process and your presence here today. Have a good day.
PARKDALE COMMUNITY LEGAL SERVICES
The Chair: Our next presenters are from Parkdale Community Legal Services, Elinor Mahoney and Elizabeth Kostynyk. Welcome, ladies. We appreciate your being here. You have half an hour to use as you see fit. Any time you leave for questions will begin with the New Democratic Party. The floor is yours.
Ms Elinor Mahoney: Thank you very much. My name is Elinor Mahoney and I'm a community legal worker at Parkdale Community Legal Services, where I've worked for the last 14 1/2 years. This is Elizabeth Kostynyk. Elizabeth is a member of the community and a client of the clinic who came forward just within the past couple of weeks with concerns about Bill 26 and asked if we could help her get a position here so that she could come and express her concerns to you.
First, I'd like to tell you a little bit about the Parkdale community and the work we do, and then I'd like to turn it over to Elizabeth and then come back to me, so whoever is on the microphones can do that, and express some of the concerns that we at the clinic have with Bill 26, specifically with the health care provisions.
Parkdale is a west-end Toronto area, basically south of Bloor to the lake, Parkside Drive over to Ossington Avenue. It's an area that is predominantly tenant-occupied. It has a large number of seniors and a large number of disabled people and people with both physical and psychological ailments or disabilities. Approximately 3,000 of these individuals are in boarding homes in the Parkdale area living an extremely marginal, poor existence.
We also have Queen Street Mental Health Centre in the Parkdale catchment area. It has a large inpatient and outpatient program. So we at our legal clinic, in addition to doing the normal landlord and tenant casework, helping people with social assistance concerns, also do work in the area of mental health, both in advocacy and attempting to help people access the services to which they're entitled.
So that tells you a little bit about the Parkdale area and a little bit about the clinic. Now I'd like to turn it over to Elizabeth and let her express her concerns to you.
Ms Elizabeth Kostynyk: Hello. My name is Elizabeth Kostynyk. I'm here today to speak on the section of Bill 26 that most concerns me, the section pertaining to access to medical records. I have fibromyalgia. Some people call it CFIDS, chronic fatigue immune dysfunction syndrome; myalgic encephalomyelitis; there's also another name that slips my mind. I'm on disability and have already given consent to release of information of my medical records to family benefits and Health and Welfare Canada as required under the law as it stands today. What more could you ask? But it seems you do ask for more.
When I first heard about Bill 26, it was on the news the night Mr Alvin Curling made his stand. The next day when I called Mr Bob Rae's office to call in my support, I was told about the gathering at Queen's Park in support of this stand. I made a concerted effort to get there. Shortly after I arrived, it was all over, at least the part of Mr Curling being escorted from the chamber.
It took a couple of days, perhaps a week, for my senses to come to me. When they did, I called my constituency office, Mr Derwyn Shea, and asked for a copy of the section on access to medical records. I was politely told that I could purchase the entire document, to which I replied I would gladly wait and have it read to me over the phone. I was put on hold. The next voice that I heard was that of Mr Shea's executive assistant, Ms Jennifer Daly. She said she would send me a copy of this four-page section, but first would have to check and see if there had been any changes and send them on as well. That was Thursday or Friday of last week. On Tuesday or Wednesday of this week, I had reason to contact Ms Daly again and was told that the information on Bill 26 I asked for was in the mail as at that day or the next morning. It is Christmas and I do understand mail might move just a little slower. Throughout this week I have tried, to no avail, to gather information on my rights to privacy, until of course I contacted Parkdale Community Legal Services.
I have a couple of major concerns about this bill: the speed with which it has been rushed before hearing/passing; the timing being Christmas; no time for public debate; hoping no one is listening.
What little I do understand about this bill is that my medical file would actually move from the security of my doctor's office into the hands of someone other than that person in whom I confide. This relationship between doctor and patient is sacred, like that of lawyer-client or a priest in a confessional or life partners in their intimacies. This bill seems to want to violate my right to privacy, and perhaps even more than that, it seems to be a kind of rape of my psyche. How can I trust again if what I reveal in this relationship will move from the sanctuary of the doctor's office? Perhaps that is just what this is trying to do here: to silence me, and all others. No one can give me an ironclad guarantee that my right to privacy will be upheld and honoured once my file leaves the doctor's office. I would feel most secure if things were left just as they are. Surely there must be a way to address the fraud situation without violating me as a person.
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I am also very concerned about what is not being said or revealed, a kind of secret agenda that hasn't been tabled. I have these fears because Mr Harris has recently spoken in ways that concern me greatly. He has used semantics to bring in user fees, calling them "copayments." In very clever and roundabout ways he has managed to do exactly what he said he would not do, simply by using the law to twist things in his favour. He has publicly said that it is "human nature to cheat, or to try and cheat." This speaks volumes about this man. I wholeheartedly disagree. I believe most people feel they are being pushed into "survival mode."
Make no mistake: I do understand the government's intentions of good. But good for whom? Who stands to gain the greatest good, what is the price of this good, and how do we achieve this good? For me, it is through compassion, reverence and understanding for life itself, not just as I see it but as others see it too, and how we treat one another that is paramount; it must always be with honour and respect, not disdain, distrust and indignity. Mr Harris, my answer to you is a simple no. PS, what part of "No" do you not understand?
Ms Mahoney: I would like at this point to make a few comments about the process that is involved here this week and in January and how difficult it is for me as a community legal worker representing the clinic and the population of Parkdale to adequately address the concerns we have about the bill.
I've appeared before this committee and other committees on dozens of occasions over the last 14 years talking about tenant bills, social assistance issues and so on, and in every instance I've been able to appear with a written brief, having done the requisite legal analysis and comparison. I'm a plain-language legal writer, among other things, and I've been able to point out ambiguities that are in the bill which are helpful to the government of the day in correcting and improving the bill before it becomes law.
I've been unable to do any of this. As Ms Kostynyk indicated, this is the Christmas season, and although we are a multicultural society, Christmas has become probably the biggest holiday season of the year for everyone, and certainly for me. It's also year-end time, which for people in government-funded businesses such as ours means doing all the accountability, statistics, planning and so forth for the coming year.
So in among all of this, we have had to take the bill and try and look at what the bill means. With an omnibus bill, it's very, very difficult to do that. Those of you who have some legislative drafting experience know that if you want to look and see what the effect of the bill is, you really have to pull out 47 statutes, some of which you may not be familiar with. Then you have to go back to the actual Bill 26 and say, "Okay, well, subsection 7(c) is amended to add the words `and therefore,'" and then you look in the statute and you see, okay, well, what does that mean in the context of that particular law? Then you go back to the next change. You go back and forth and back and forth.
This is the largest omnibus bill I've ever seen in 14 1/2 years of working at Parkdale Community Legal Services, and I quite frankly have been unable to do that in any kind of adequate way, even though that's where my training is. The fact that it's an omnibus bill makes it twice as difficult to do this even with respect to the health care provisions. I apologize for not coming with a written brief, for not coming with a detailed analysis which could assist the government in at least determining what the bill says, because my understanding is that the government really doesn't know what its own bill says.
I can sympathize with you. If I don't know, and I'm trained to know this -- most of you probably aren't trained legal experts and you're being asked to comment and pass a bill that you don't understand yourselves. This is a scary prospect for me as a legal worker. It should be a very scary prospect for you, as people who are custodians of the faith and the trust of the province, not to understand your own legislation and to be pushing it through fast.
That leads me to the issue of timing, the fact that it is right before Christmas. Many people who could assist you in understanding your bill, in pointing out the difficulties in your bill, so that you could say, "We didn't realize that. We'd like to change that in good faith," are unable to come to the public hearings at this time, even though some of us have made some effort to come, unprepared as we may be.
I think it really is incumbent upon the governing party, the Progressive Conservatives, to have a full consultation that will enable you to accomplish what is useful in the bill without accidentally and incidentally causing harm and stress and problems for individuals that can otherwise be avoided.
You've been given a timetable and, as committee members, you have to fulfil that timetable. But when you report back, you have the option of presenting a no report, you have an option of not voting on certain clauses. You have quite a bit of freedom as committee members, and I would encourage you to exercise that freedom to indicate to the other members of your caucus and your party that you feel this bill needs a bigger analysis and a better analysis before it can become law. This is what responsible government is about, and I think most of us here in this room really want this government to be responsible and accountable to the people in a properly consultative and thoughtful manner.
I'd also like to comment at this point concerning the speed at which the bill is going through; not just the timing but the speed. Many people, and editorial commentators, have suggested that this bill has wide-sweeping effects, if passed, and gives the government wide-sweeping regulatory powers, and my quick reading of the bill indicates that this is indeed so.
The government's position, as I understand it, is that this has to happen so quickly that there's no opportunity for consultation. In the past few months we've had a number of items go forward to the government. Some have gone slowly, some have gone quickly. One of the ones that has been implemented very quickly is the 21.6% welfare cut, which our clinic and other clinics are fighting in a charter challenge case, the decision from which is expected next week.
It was determined, without any reference to the financial needs of people on assistance, that they could sustain a 21.6% cut. Compare that to the attitude of the government in dealing with salaries of members of the provincial Legislature. At almost exactly the same time that people on social assistance were cut by 21.6% the government established a commission to look into what is an appropriate salary for people with your position.
This commission took several months. It did studies, it did a comparison of what other MLAs were getting across the country, looked at the job descriptions and came up with recommendations. Speaking personally and professionally, I deeply regret that this government decided it could cut the incomes of the people with the lowest incomes in the province arbitrarily, harshly and swiftly and, at the same time, spend taxpayers' money to have a commission look into its own salaries. It's this type of mindset that I'd like to quite seriously ask you to change, as committee members, as members of your own community and as members of the Legislature.
In dealing with the omnibus bill, Bill 26, it has wide-sweeping effects in many, many areas, but health is the area that you folks are focusing on today. I'd like to make just two or three comments about particular areas of the bill that I feel need to be rethought. I know you've heard other comments, probably very similar, on these. The ones I want to speak about are the drug user fee and the possible delisting of OHIP procedures.
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Ms Kostynyk has spoken more articulately than I could about freedom of information concerns, and I don't feel at this time I can speak about deregulation of drug prices. Quite frankly, if I were to say I opposed or I supported it on behalf of our clinic, I would be doing so without sufficient information to make an informed argument, so I'm not going to oppose deregulation of drug prices. I'm just going to say that I and our clinic have tremendous concerns that this issue has not been fully thought out before being presented in Bill 26, and we would like more time for that.
With respect to the drug user fee, it ties in, for people in my community, Parkdale, very much with the fact that there has been a 21.6% welfare cut, that there have been cuts to social service agencies that are providing other types of support to people with physical and emotional and psychiatric difficulties, to senior citizens, to other poor people. So the drug user fee comes on top of a series of cuts and inconveniences and harsh measures that have been taken that affect people in my community.
To those of you who are healthy, and I hope you continue to be healthy, you think about drug user fees as $2 that you might pay three or four times a year, perhaps when you have an antibiotic or a birth control pill prescription or something like that. But to a person who is a senior citizen in their declining years or a person with physical or mental difficulties that require medication, I can tell you that many of our clients in south Parkdale have to have eight or 10 prescriptions a month, because each drug has its own series of drug side-effects, so then they get prescribed another drug that is meant to relieve the nausea or prevent drooling or whatever the issue might be.
For someone on a fixed income, social assistance for example, which is not indexed according to the consumer price index, having what could be a $20 or $24 per month extra expense for drugs is a disincentive to take some of the drugs that their doctors are advising them to take. Certainly in the case of people with psychiatric difficulties, sometimes there is a feeling that they don't always necessarily want to take all the medication and their doctor's saying, "We think you should take this medication." This is another disincentive to follow their doctor's advice. In some cases that may cause difficulties for the prognosis of the individual.
On the drug user fee, we don't believe any study has been brought forward by the government that would show that this has worked in a positive way in any other jurisdiction in Canada. If I'm wrong, I'd like to read that study and then be able to come back in January and comment on that study, but I don't believe any such study exists. Therefore, we would like the drug user fee taken out of Bill 26.
With respect to OHIP coverage procedures, we see that now the government wants to streamline the process for delisting them so it can delist them by regulation; in other words, through cabinet consultation only and not necessarily with the approval or consultation with the Ontario Medical Association.
Generally I have a concern when governments usurp to the cabinet powers which are normally left in the hands of the Legislature, and we've seen certainly with the regulatory changes to welfare and family benefits part of it is government by regulation rather than government by legislation.
I'm concerned with this trend appearing in Bill 26, taking powers out of the hands of the Legislature and placing them in the hands of the cabinet. Even if you have tremendous faith in your own powers and your own will and good faith, I ask you to consider what would happen in your case if you did not get re-elected and another party were in. You would have handed over to that other party tremendous powers that you would not want them to implement. For many people in the province, democracy means having a chance through the Legislature to have full and fair consultation, to have debate, and you remove that opportunity for all of the people of the province when you take powers from the Legislature and put them into regulation.
I'm particularly concerned, and our clinic is particularly concerned, with the thought that some OHIP procedures might be covered and insured only for people of certain age groups. We see this as rank discrimination. We think the government would be leaving itself open to a charter challenge because we believe this would discriminate against people on the basis of age. I have no doubt that if the government passes this, it would be taken to court in a series of lengthy and costly court appearances. I ask you to reconsider that. People of all ages should have equal access to medically necessary procedures.
At this point I'm sure you might have some questions of my colleague or of myself. I'd be happy to answer any questions or concerns that you might have.
The Chair: Thank you very much. We have a very short period of time for questions actually, about two minutes per party. That goes by very quickly. Ms Lankin.
Ms Lankin: Thank you for your participation, Ms Kostynyk. There have been some incredible individuals who have come forward before this committee and who have been most articulate in voicing their thoughts and their opinions and their desire for this government just to hold on a minute and take a second look.
I'm reminded of Ms Margles, who was here the other day, who said that she'd been watching us on TV on her holidays. I told her maybe she should get a life, but that's how important it was to her, and if she's out there watching, I'm sure she appreciated your coming forward with your own personal story as well.
Elinor, your overview is very thoughtful and very thought-provoking. I understand the point you're making about not having had the time to do the kind of analysis you usually do and provide to committees, and we're all aware of the quality of that work. Besides not having had the time, I just want to point out that it's only in the last week or so that the bill has even been available in the bookstore with the legislation that goes along with it.
Before that, you had to go to the legislative library and pay $600 and photocopy it yourself. Now, to purchase the whole thing, it's $352.14. I don't know how you can have access to democracy when people have that kind of a financial burden just to get access to see what it's all about. We've been photocopying it and trying to give it out to people, but caucus budgets are restrained as well.
Your plea to slow things down is one that has been echoed here. I also believe it needs to be broken up. I don't think just slowing things down at this point is going to allow people to focus on discrete pieces of legislation and understand them and understand the relationship.
Ms Mahoney: I believe my colleague Tanya Lena, who spoke at the other hearing, made that point. Here the issue is relatively focused on health care, so because I'm speaking on health care, I didn't talk about breaking it down further. But yes, our clinic believes other aspects of the bill should be broken down into similar categories.
Mr Clement: Thank you for both of your presentations. You've given us a lot to think about, and I appreciate your efforts to be as informed as possible before appearing here.
Let me, because of the limited time available, just focus in on access to patient records because that seemed to be a particular concern to both of you, and it should be. We should not treat such information lightly.
Under the current act, however, there is access to patient records already by physicians or other treating physicians, by College of Physicians and Surgeons' investigators within hospitals for quality assurance and data collection. It can be subpoenaed in court, and of course the OHIP general manager already has access to those files. We are expanding the access. I do take that point, but there are in other parts of the law as it exists right now severe penalties if any ministry employee or other officials misuse any of that information.
I just wanted to assure you that that's already in place, but I do take your point that perhaps we have to make this clearer in the legislation to alleviate some of your concerns. If we did do that, if we did make some of the rules clearer on this, and given the current state of the law as it now exists, would that be helpful to you to alleviate some of your concerns?
Ms Kostynyk: Quite truthfully, I'd have to see what it is specifically. I'd have to know and have an absolute guarantee that you're not going to change words and use semantics to change things, to manipulate things in a way that puts you in a position of power over me. It would take a long process, to be quite honest with you, and when we're talking about trust, trust is something that grows and develops. It's not a gift that's given, you earn it, and at this point in time I don't have any for this government.
Mrs Caplan: Thank you for both eloquence and passion. The freedom of information commissioner, and his other title is the privacy commissioner, expressed the concerns that I think you've shown great passion about. I want to thank you for coming and tell you how sorry I am that more people are not going to have the opportunity to come before this committee.
Because of the speed of the hearings, many people are not able to prepare in time and for others, frankly, it just can't be organized quickly enough to come as they start to realize the importance of this bill. We know that the phones are ringing and that people are calling to say, "I want to come." To this point in time, there have been 850 people and organizations that have made requests and we're just hearing a small fraction of them.
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Ms Mahoney: At this point I'd like to respond to that about not having the time to look at this bill properly. One of the things we tell our clients again and again and again in our legal clinic is: "Don't sign this document" -- whether it's a lease or a welfare statement of rights or whatever -- "unless you're sure you understand it and unless you're sure you agree with it. This is the standard. Read the small print." Lawyer talk that you get from a clinic.
I don't have any confidence from what I have heard and seen over the last few weeks, from members of your party and indeed members of the opposition, that people truly understand this bill. If I don't understand it, if other lawyers don't understand it, if the political hacks who work for all of you don't understand it, the question is, how could you sign this bill and put this into law as people who are supposed to hold the trust of your constituents?
I urge you not to. I urge you to come back with a no report from this committee and to indicate to the Legislature that the people of Ontario need more time to come up with improvements and understanding of the bill before it becomes law.
The Chair: Thank you very much. Thank you, Mrs Caplan.
Ms Lankin: Mr Chair, I would like to make a motion when you're finished thanking the group.
The Chair: We appreciate your interest in our process and your attendance here at the committee this morning. Thank you very much.
Ms Mahoney: Thank you for the opportunity.
The Chair: Ms Lankin?
Ms Lankin: Thank you very much and I think it's particularly appropriate, in light of the comments of these last presenters. I have copies here if the clerk wants to distribute it.
Whereas there has been overwhelming public interest in Bill 26 and requests to appear before the standing committee on general government far exceed the number of spaces available; and
Whereas since Wednesday, December 20, when this matter was last discussed, there have been over 200 more applicants for the out-of-town hearings and this is before the ads have been placed;
I move that this subcommittee recommends to the government House leader that when the House returns on January 29, 1996, the order with respect to Bill 26 be amended and that the bill be returned to the standing committee on general government so that further public hearings can be arranged;
Further, that this committee recommends to the government House leader, based on the submissions to the committee to date, that the bill be separated into several bills to allow the public an opportunity to adequately analyse the bill.
Further, that this committee recommends that the three House leaders meet as soon as possible to discuss this issue.
Mr Chair, I would like to suggest, given that when we adjourn today at 6, I know there are members from out of town who will want to be travelling home to their constituencies, perhaps we reconvene at a quarter to 1 to discuss this. The reason I suggest that, rather than discussing it right now, is I would like to give the government members some time to think about this, to talk to each other, to speak to whoever else they need to, to reflect on the discussions and the presentations we have heard today and over the course of the last two days since they last voted against this.
The Chair: Anybody have a problem with a quarter to 1?
Mrs Caplan: A quarter to 1 is fine.
The Chair: Just a couple of things before we break: You've been handed out this document, which is all our arrangements for our travel up north and in southern Ontario. I trust you to keep it safely.
The second question: Do we have any problem with the ministry staff and whoever else is going to be travelling with us sharing our bus?
Ms Lankin: Why would we?
The Chair: If there's room. We just had to get approval for that.
Ms Lankin: No, they're good folks. All except for the person from Jim's office there. No, Rick can come too. That's okay.
Mrs Caplan: Particularly, Mr Chairman, just on that, and very briefly, there are a number of members of the Legislature who would like, I think, a chance to participate. I just ask that members be given priority to space available.
The Chair: Sure. Will we know in advance?
Mrs Caplan: We'll do that as soon as we can.
The Chair: Because we have to make arrangements for the other staff.
Mrs Caplan: We'll notify our members and ask that they let you know if they'd like to have space on the bus.
The Chair: Okay. And of course, we also need for them to show up.
Mrs Caplan: I don't understand that.
The Chair: Well, if they ask for a place in the bus and we've told some staff they couldn't be there --
Mrs Caplan: Oh, of course.
The Chair: We expect that the members will show up.
Mrs Caplan: We'll let them know that they would have to be there.
The Chair: We're recessed till a quarter to 1.
The committee recessed from 1206 to 1248.
The Chair: Welcome back to our committee. Prior to our break for lunch, Ms Lankin moved a motion. I don't think I need to repeat the motion, but because this motion is exactly the same as a motion that was previously moved and we did not pass, the motion is out of order.
Ms Lankin: Mr Chair, may I ask for a clarification?
The Chair: Yes, Ms Lankin.
Ms Lankin: The wording of the motion, you're correct, is exactly the same. The whereases that give the reason for it do explain that the conditions since this motion was last discussed on Wednesday have changed. Is it necessary, therefore, for the wording of the motion to be different, or should I in fact have moved reconsideration? Would that be the appropriate way to go?
The Chair: The motion begins where you say, "I move."
Ms Lankin: I understand that.
The Chair: And basically, since it is the same motion, it cannot be dealt with twice.
Ms Lankin: Even if conditions have changed.
The Chair: Even if conditions have changed.
Ms Lankin: So therefore is the correct procedure for this committee for me to move reconsideration of the earlier motion that I put forward on Wednesday?
The Chair: I guess if you would choose to do that, then --
Ms Lankin: I choose to do that. Now could you explain to the committee the rules or the procedures that would govern that motion?
The Chair: We'll have a five-minute recess.
The committee recessed from 1250 to 1255.
The Chair: The decision of the Chair is that you would have to submit a new motion.
Ms Lankin: I am prepared to do that at this time, if I may begin, then:
Whereas there has been overwhelming public interest in Bill 26 and that requests to appear before the standing committee on general government far exceed the number of spaces available; and
Whereas since Wednesday, December 20, when this matter was last discussed, there have been over 200 more applicants for the out-of-town hearings, and this is before the advertisements have been placed;
I move that this committee recommends that the government House leader meet with the two opposition House leaders as soon as possible to discuss the time for public hearings and the form in which the bill gets reported back to the House on January 29, 1996.
The Chair: Thank you, Ms Lankin. If I may suggest something, we do have an opening at 1:30 because of a cancellation. Could we defer discussion on that until 1:30 out of respect for the people who are here to make their presentation?
Ms Lankin: Absolutely. Thank you very much.
BEDFORD MEDICAL ASSOCIATES
The Chair: Representing Women's College Hospital, Dr Carolyn Bennett, Dr Bernard Marlow and Dr Rae Lake, if you could have a seat at the microphones. Welcome to our committee. You have a half-hour to use as you see fit. Any time you allow for questions will be divided up evenly among the parties, beginning with the government. The floor is yours.
Dr Carolyn Bennett: We welcome the opportunity to come. These hearings on the proposed Bill 26 have provided, I think, an opportunity for all of us in the trenches of health care to crystallize and articulate our concerns to one another, and we welcome the opportunity to share them with you.
We are worried about the future of health care in Ontario, and although it said "Carolyn Bennett, Women's College Hospital," originally on the booking, more specifically the three of us represent eight physicians, two nurses and about 23,000 patients from all socioeconomic and multicultural groups and all parties. Bette Stephenson: I promised her I wouldn't wear my red jacket, even at Christmas. We believe that our patients happen to be some of the most knowledgeable, committed patients in the province, and we are coming to report that they're worried. In some ways, every day at Bedford Medical Associates is a small version of your hearings. We feel that we are every day receiving about 30 deputations each.
Our patients recognize that there isn't more money from government to throw into the health care system. They know we should start to begin to spend the money in the system more wisely. They are very worried that copayment systems will adversely affect the care of seniors and the disabled, and they are concerned about increasing bureaucracy it would take to administer those.
They really want to help. They do know that the status quo is not okay. They are ready to participate in a patient as partner model that we at Women's College have so desperately tried to achieve, and I believe the patients know that means shared responsibility.
Patients I think are increasingly understanding of the difference between what they need and what they've come to expect. They want more evidence-based care, and they know they should be able to have their cystitis treated over the phone. The research says so. Why is money being spent on office visits and unnecessary cultures?
They want a system, a real system, that rewards good practice, where there is time to discuss disease prevention and health promotion and time to explain why an antibiotic won't work for viral infections. They respect the various roles in a proper multidisciplinary team and recognize their needs can often be met by talking to the nurse on the phone.
They are extremely grateful for our 24-hour, seven-day-a-week coverage. They're grateful for the house calls we make, the palliative care, the family practice obstetrics and our association with a unique institution, Women's College Hospital, where they do feel safe, where they feel listened to, they know they've got choices and they know somehow it really is different. They are trained to studiously avoid walk-in clinics and phone us first. In fact, they've chosen a practice that refuses to sign out to an answering machine that tells them to go to the walk-in clinic or an emergency room and then blames the patient for doing it.
All three of us are assistant professors in the department of family and community medicine at the University of Toronto and on the active staff at Women's College Hospital. Dr Bernard Marlow, who will speak next, is also the director of continuing education for the department of family and community medicine and is a long-time Tory supporter. Dr Rae Lake is the director of the family practice obstetrics program at Women's College Hospital and a peer reviewer for the College of Physicians and Surgeons of Ontario. Perhaps more importantly, we all still make house calls, we all deliver babies and we spend a great deal of our time training family practice residents to do the same.
Dr Bernard Marlow: We agree with this government that the status quo is not okay. There have to be changes that will increase the audit and accountability in the delivery of health care in Ontario.
I believe that the aims and objectives of the health care parts of Bill 26 are correct, but I voted for less government, not more, and I can't believe that a third of the budget of this province can be successfully micromanaged without adversely affecting patient care and increasing the bureaucratic headaches.
The minister, even one as knowledgeable as Mr Wilson, will never be able to have all of the information necessary to make the right decisions at the right time. We have witnessed time and again the difficulty that the ministry has had in physician manpower planning, often not being able to recognize underserviced areas because they often don't receive the information when doctors leave the country.
This bill places the Minister of Health in a very vulnerable position. Without the protection of credential committees, the College of Physicians and Surgeons of Ontario or other professional colleges, he will be at risk of unfortunate decisions because of lack of information. The information will always be more accurate on the ground.
There is a better solution. All we need is the willingness of the providers and the patients to design a system of incentives for quality care, and I think we're ready.
Primary care reform -- hard-envelope funding -- will achieve the same goals as well as achieve massive savings from the much smaller bureaucracy required by a decentralized system. Rostering patients also deals with the physician manpower issues and service for underserviced areas. Responsibility for appropriate laboratory investigations and referrals is much better dealt with by peer pressure, such as that found in the GP fundholding model in Britain.
I've often been struck by the paradox of practice after 23 years of practising in downtown Toronto. I am expected to be a small businessman. I have to negotiate leases with a landlord, I have to hire staff and I have to meet payrolls every month, and yet I've been faced with increasing bureaucratization of my practice. I now feel like a civil servant, and yet I'm not treated as a civil servant.
Physicians across Ontario are under fire right now. They're under tremendous pressure. As director of continuing medical education at the department of family and community medicine, I can tell you that this is reflected in declining attendance in CME across the country, not just in Ontario. This is a concern to me as the director, but it should be a concern to all of you as patients. Your doctors don't have time to attend continuing medical education. We need a new system.
Doctors like those in our group are ready to leave their fee-for-service model and ready and willing to help. We want to work with government, our patients and the university towards a health care system of which we can all be proud.
Dr Rae Lake: I appreciate the opportunity to speak to the committee about the health care implications of Bill 26. Like many responsible Canadians and Canadian doctors, I share the concerns about the cost of health care and about our ability to maintain a health care system in this province, and indeed in this country. Therefore, I'm here to outline some of the aspects of the bill that, in my experienced opinion, will make it impossible to reach or even come close to the government's stated aims and objectives.
Overall, I believe that the bill places far too much emphasis on micro-management of the system and of doctors in particular. Rather, you should be considering some of the basic elements that cause problems in the system and then tackle those in an orderly and appropriate manner. One, clearly, is that patients have not had the opportunity to work with their doctors in a way that would lower costs.
On the basis of my quarter-century in practice, I believe a more effective, cost-efficient system would be realized by the following:
(1) The government should close all walk-in clinics. They are costly, inefficient and unable by their nature to offer effective care. In today's fiscal climate, the idea of patients popping in and out of doctors' offices is no longer practicable, and the vast majority of these clinics, certainly in this area, are open for business fewer hours than are many doctors' offices.
Furthermore, the most frequent resolution offered to patients who use them is a stopgap prescription of some kind or other, given with the suggestion to seek regular medical care. In other words, doctors in such clinics have no investment in the long-term health of patients or in the viability of a system that rewards them, as it were, for piecework.
(2) Moreover, the walk-in clinic does not fit into a truly rational and cost-sensitive system. The Ontario College of Family Physicians has asked you to look at rostering, the method of practice by which a member of the public is on the roster of a general practitioner and is required to look to him or her as the primary caregiver and referring agent. In such a system, the doctor has made a commitment to a population of patients based on community needs.
(3) It precludes solo practice, which in any event is an anachronism from an earlier day when geography, communications and primitive technology made it possible for a person working alone to maintain at least a minimal standard of practice. Realistically, solo family practice no longer makes health or fiscal sense. In fact, repeated research into costs show that it is the most expensive way of offering service to the community.
Supposing that instead the government mandated group practice, so that for primary care, a patient, once on the roster, would be assured not of always getting the same doctor but of being seen by a member of the same group. This would end an expensive form of family practice while assuring patients that a primary care provider was always available.
In large centres the result would be to take out an aspect of family practice that only encourages overutilization. In small communities, particularly those in remote areas, the requirement for group practice would avoid some of the current problems of burnout, isolation, lack of professional stimulation and the like. Family practices in those remote areas would be placed by government regulation in towns where hospital services are available, and in fact might use space within these hospitals.
When referred to a specialist, a patient might seek a second opinion, but not a third or a fourth. Right now, for example, an expectant mother may audition as many doctors as she likes before making a choice of provider. That too is an anachronism, a luxury in a system that can no longer afford luxuries.
(4) Group practice puts enormous responsibility on family doctors to make sure they are well-trained and up to date, to ensure that they know the health care system and local specialists well and are able to recommend them. They would have to be willing to see the doctor-patient relationship as a partnership in which the doctor is open, non-judgemental and informative, and in which the patient takes responsibility for health maintenance by not smoking, by exercising, and for being candid with the doctor.
Finally, there are other steps the government could take to strengthen and improve the system. One of the most potent examples is to overhaul capitation. Dealing with capitation on a global rather than a doctor-by-doctor basis is not only costly, it is unjust. The dermatologist who overutilizes the system is not made responsible for his or her behaviour. Instead, the punishment is levied equally on that doctor and on those like myself and other members of the Bedford group who are doing their damnedest to make medicare work. Given computerization, keeping track of each individual doctor's billing would be a simple matter.
Consider an analogy: If the government were to cap members' expense allowances but not on an individual basis, making all members pay for the provable extravagance of the few, how would those who were frugal and cost-conscious respond?
Obviously, there is not enough time today to explore all the potential benefits of making family doctors and their patients responsible partners in primary care, but discussion about these and other rational and logical changes is long overdue. Thank you.
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Dr Bennett: We also want this committee to know that our patients are worried about the confidentiality issues in the bill and they have been relieved by the strong stand taken in the privacy commissioner's letter to Mr Wilson in response to Bill 26. The patients seem confident that the government didn't intend this and won't do this.
They are worried that the bill might mean that the Minister of Health could inadvertently dissolve a community-based hospital board that knew them and represented them and fold it into a large, faceless, monolithic institution unable to respond to their specific needs. Some patients are very conversant with the fact that economies of scale are difficult to defend in health care. They want the flexibility of smaller, well-run hospitals where they don't worry about falling through the cracks, yet they understand that linkages and cost savings must be explored. They are appalled that something such as the Metropolitan Toronto District Health Council report on hospital restructuring could be so flawed. Two years and $5 million later, it is frightening to us as well as to them that recommendations could be made based on a complete overestimation of savings and an underestimation of the costs of implementing it. We know that those savings are achievable without those top-down decisions.
The patients are also worried that certain services may evaporate if the fee is set too low or zero, as recommended in the bill. They're very worried that the wonderful family practice residents they come to meet, who they recognize as practising a much higher standard of care, may not be able to practise, while those elderly solo practitioners that they worry their mother is still going to see are still able to practise at a much lower level of care. They had hoped that maybe they could get their mother to switch to one of our graduating residents. They have seen their mother prescribed too many drugs, asked to come in for results, prescription renewals and too-frequent blood pressure checks. They've seen her sent for too many tests and too many referrals. They don't trust that Bill 26 can really address these issues of quality and service.
We, as teachers of family medicine, worry that this bill will mean that our brightest and best residents will leave Ontario, as our chair, Dr Rosser, so eloquently predicted in his deputation. We also fear that the research and teaching part of our commitment will be accidentally ignored in the silo-within-silo budgeting process.
We know that the American HMOs have demonstrated 60% savings without compromising quality. I think we can learn from the mistakes made south of the border and that as Canadians we can add the compassion and accessibility we expect and design a great system.
I too believe that the time is short. We need serious change, and we need it now. We can't just tinker with this system. We need real reform. We implore the minister to give those of us in the trenches a chance. Organized medicine has let us down. It has been ineffective and it has looked self-interested. It has been resistant to change and has been unable to harness the goodwill of patients.
We believe that the proposal of the Ontario College of Family Physicians should be implemented. We at Bedford Medical Associates would be pleased to begin the pilot tomorrow. We believe that the changes should take place without the powers contained in Bill 26. We suggest a fast-track of primary care reform. We believe we would be able to demonstrate the savings, improved quality, as well as patients and providers working together with government for real long-term solutions. We believe hard-envelope funding would enable dollars to finally follow patients. Great programs that attract patients would get more money. It's time that the market forces were applied to health care such that quality and value for money were rewarded.
The Minister of Health must be encouraged to decline accepting the extraordinary powers within this bill so that he can forge the true partnership that the health care sector expected from him. He has an opportunity to set an example for the rest of Canada. Carrots work, and sticks make people mad.
The Chair: Thank you very much. We've got about four minutes per party left for questions, beginning with the government.
Mrs Johns: Thank you very much for the excellent presentation. We learned lots about that, and we will certainly be considering a number of the things you've said.
I have a question about the general levels you talked about today, without talking about specifics. From the perspective of the government, we have been concerned about distribution. In all phases of government, no matter what political stripe, we have been, for somewhere in the neighbourhood of 26 years, asking doctors to solve the problem about us not having rural or northern doctors, and nothing has happened. We've asked hospitals to find some way to realign. As we've closed hospital beds, we've never turned off a light or closed a building down. If all those beds were in the same hospital, it would equate to I think 30 hospitals in Ontario. Why should we believe as government that things you have been unable to do for 20 or 30 or 11 years in the hospital situation will now be resolved?
Dr Bennett: Have you ever heard a group of fee-for-service physicians come to you saying, "Put us on salary"? Have you ever heard the fact that we actually want a health care system and that rostering patients will solve all your manpower problems? In the north, they can do whatever they want; they can hire nurse practitioners in that group, they actually get whoever's rostered to the group, and then they have to run quality programs in order to get people to roster with them, because otherwise the people will drive 100 miles to roster somewhere else that gives them better care.
This is going to be a long-term problem. It's quite clear that the OMA promised to look at this years ago and has been extraordinarily unsuccessful, but we believe we have to start with which kids we take into medical schools, we have to stop closing the residency programs in Thunder Bay. Here we are from U of T but saying that giving all of us the residency slots and closing the ones in the north just doesn't make any sense if you want doctors in the north.
It's so ripe and ready. I don't think we've ever had an OMA primary care reform group that's about to deliver a paper that makes sense. The college of family practice for Ontario has never been involved in anything but education. All of a sudden it's saying, "Let's get on with real reform because it's good for patients, it's good for family physicians' education." Everybody's ready and I think Ontario can set the lead, and it's a very different time from before.
Mrs Johns: How about the hospitals too?
Dr Bennett: One of the things about closed beds is that it's a very old tool. When people start talking about closed beds to me, it just makes me go crazy, because what's happening in where those closed beds were is fabulous outpatient care.
In 1989, when Women's College was threatened, they said: "Go become more like the Mayo Clinic. Do more of your stuff as outpatients." Well, 48% of our budget is now in outpatients, and it's not even mentioned in the report. Outpatient surgery is a little more intensive, it can take more hours, but it needs the space to do it, so where there were inpatient beds are fabulous, exciting outpatient programs now. It's not a bricks and mortar issue; it's a matter of service and the way that service is being delivered now is very different. If we keep using the old tools, like closed beds, we aren't going to actually get at, what is patient care?
The hospitals, I think, are starting to come. They know we need hospitals without walls, need community-based service, need doctors to make house calls so these people won't actually be admitted to hospital any more. Everything that happens in the fee-for-service model gets in the way of that happening. Everything that would happen in hard-envelope funding rewards good behaviour. If you talk about prevention, the patients don't get sick or they know to call you before they get so sick that they might end up having to be hospitalized. If they can't get telephone advice, they sometimes just don't come in.
I think it's an exciting time, and the government has an opportunity to really be a leader.
Mrs Caplan: Thank you very much for an excellent presentation. As a former Minister of Health, I agreed with just about everything you had to say. I hope this government listens to you, because I think sticks not only make people mad but stop good things from happening. I agree, we've never seen such a time when good things could happen, but if they pass this bill which is full of sticks, as I said at the beginning of these hearings, the well will be poisoned and those good things won't happen.
At the very beginning of your comments, you raised the issue of the administration of copay, the user fee for drugs, and also in hospitals and so forth. I've been thinking about what administration would be required to do that, and you raised that. Since there's been no discussion with the Ontario Pharmacists' Association, we can only assume that they will be having some kind of bureaucratic mechanism, which is the micro-management you referred to, where people will likely have to come in and show their T4 or income tax forms to show that they earn either less or more than $16,000 or $24,000. They will have to find and have some mechanism for the collection of the deductible and the $2. Have you had any information from the government -- certainly we have not -- as to what the mechanism might be? How do you foresee the collection of those and those decisions being made, and what size of bureaucracy would be required to collect all of that? Obviously you're worried about that.
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Dr Bennett: We have a great relationship with one of the local downtown pharmacies that delivers for us, and I know that last night they expressed some serious concerns about it that we share, because we're worried that, particularly people with $100 deductible, in the way that certain drugs are priced at the moment, that $100 could be the first prescription we write for somebody and they might not fill it knowing that they don't have $100 -- in the way that people with only a certain amount of money might just not fill it.
I think what the pharmacist was saying -- what was he saying? -- he's a little concerned that he is made the heavy in terms of the pharmacist saying, "You have to pay for this one." and I guess in the online way -- what did they say, Bernie? They'll say on their screen whether this person is above or under and needs a copayment or not.
Dr Marlow: That's what I understood, that all the pharmacies in Ontario are now hooked into a central computer system and that they would be able to determine whether the patient was covered or not.
Mrs Caplan: So every pharmacist will have the income status of every patient in the province, that's what you think is being contemplated?
Dr Marlow: Or just whether they're in the deductible status or not.
Mrs Caplan: The suggestion then of the copay is that it will be collected by the pharmacy and submitted to the ministry. Is that what they think is going to happen?
Dr Marlow: No, they said the first $100 was deductible and that the patient would require to pay them directly for the first $100 with their prescriptions.
Mrs Caplan: And then the $2 copay for those under the limit --
Dr Marlow: Would be collected by the pharmacist.
Mrs Caplan: And submitted to the ministry.
Dr Marlow: Or deducted from their payment by the ministry for drugs that were covered.
Mrs Caplan: I must admit that this is something that we have not heard from the ministry as to how they're going to go about doing this. I know there's been no discussion with the Ontario Pharmacists' Association or pharmacists so I'm curious as to what exactly they have in mind and what kind of bureaucracy is going to be required to try and implement something like that.
The Chair: Thank you, Mrs Caplan. Ms Lankin.
Ms Lankin: Mr Chair, could I give notice that I intend to table a question with respect to this matter? I'm giving notice because I see that Mr Paul Gardner from the ministry is here, who I suspect can answer this question for us, and given that we have half an hour coming up and we only have one item of business, maybe we could invite him to answer that question at that time.
It was really wonderful listening to you and your vision about primary health care reform and rostering of patients and the hard cap. These are things that, with all due respect to Mrs Johns's questions, three years ago, in my experience there were very few people who were prepared to talk about that in real terms; and I think a lot has changed. I think we've all come to terms with the need for both government fiscal restraint and what it means in terms of various kinds of government programs. I remember saying at one point in time there's enough money in the health care system, we have to spend it differently. Everybody who's been coming forward to these hearings is saying that now. It wasn't the consensus back then. It is now.
Hospital administrators are coming forward saying, "We need to restructure." District health councils are doing studies and communities are saying it. We may not have the exact, right answers and we're still quibbling about that, but we all are accepting and embracing change and trying to find the answers. This is the time to call on the creativity of people, not to, as you say, use the sticks that are just going to get people angry and defensive and the results will be predictable; and that's what I'm going to ask you.
In the past when physicians haven't liked what government has been doing, it has been said that many physicians will leave the province. I know that if you look at the stats over the last 10 years in fact that hasn't been the case, it's been very stable. But this week I have heard from more physicians coming forward here, as their personal choice on this issue, they are now considering this, and that this isn't an idle threat any more, that this is real, that this bill takes it just that step too far. Is this real or isn't it? I don't know how to get you to answer that in a way that really convinces us this is not just an idle threat.
Dr Marlow: I personally don't know anyone who's considering leaving. I think we're down to the hard-core people. The ones who are going to leave have left; the ones who remain are firmly committed to this system and trying to make it work. I think the next generation, certainly the doctors who are graduating, will make the decision not to stay and we'll be faced with a serious physician shortage, a gap, in the future if this continues, but for those of us who have been in practise for 25 years, we've answered that question a number of times: "Should we go to the States or shouldn't we?" We've always said, "No, we're staying here and we're committed to making it work." That's why we're here today.
Ms Lankin: Let me ask you why you think the government is making some of these changes. For example, in the past if someone provided some information to the general manager of OHIP that they had reason to suspect a doctor's billings, that general manager would take the information, refer it to a Medical Review Committee, peer review. They have their own medical investigators. If they went through it and saw a need to do an investigation, they would do all of that.
Now, the change says that if the general manager has reasonable grounds to suspect on a number of grounds, that general manager will make a decision. He also has inspectors now, new powers -- can go in and seize files, can do all of that sort of stuff, not necessarily medical inspectors, not like over in the Medical Review Committee -- and they're going to make the decision. Then if you don't like it you can appeal it over here. Why would the government make that change? What are they trying to accomplish? What has been wrong that you know of that they're trying to fix with that?
Dr Lake: I think from the MRC point of view -- that's the Medical Review Committee -- the cutoffs are fairly high. In other words, you have to be really bad to have your name show up at the MRC level. I'm just second-guessing this government. I think what they're trying to do is set a wider net and pick up more of what is supposed fraud in the system that does not get picked up by the general manager in the computer. That's the only comment I can make.
The Chair: Thank you very much, Ms Lankin. Thank you, doctors. We appreciate your interest in our process and your coming here today and taking some time to present to us. Have a good day.
Ms Lankin: Mr Chair, I'd like to ask the ministry and Mr Gardner if he could respond to inform us what mechanisms the minister intends to put in place to collect the $2 copayment from every ODB participant; the $100 deductible to administer that for every ODB participant; to inform pharmacists of the cutoffs for payment of dispensing fees by those ODB participants who are over the thresholds; what information will be required to be shared with pharmacists about seniors' incomes; how seniors are going to be required to submit that information to the ministry and what bureaucratic departmental requirements there will be within the Ministry of Health to administer this.
I think that covers most of it. There may be a couple of odd pieces in there that you could fill in, in terms of how this is going to be implemented.
The Chair: Are you prepared to answer that now?
Mr Paul Gardner: I'd be happy to provide the information before the end of the break. I believe we can have all of that within 25 minutes.
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The Chair: Okay, we'll deal with this motion. Just to refresh your memory, I'll repeat it:
"Whereas there has been overwhelming public interest in Bill 26 and that requests to appear before the standing committee on general government far exceed the number of spaces available; and
"Whereas since Wednesday, December 20, when the matter was last discussed there have been over 200 more applicants for the out-of-town hearings and this is before the ads have been placed;
"I move that this committee recommends that the government House leader meet with the two opposition House leaders as soon as possible to discuss the time for public hearings and the form in which the bill gets reported back to the House on January 29, 1996."
Basically, can we kind of adhere to the same rules we had before where each person gets to speak once in the interest of time and we wrap this up before the next presenter is due.
Ms Lankin: Thank you very much. I want to ask the government members of this committee who voted against a similar motion that I put forward on Wednesday to think about what they've heard over the course of this week. By my count, there have been roughly 80, plus or minus a couple, presentations made here this week. By my count, about 65 or so of those have not been supportive of this bill, another 12 have been supportive, but virtually all of those have had one or two areas that they also thought needed to be addressed, and then there are a couple of odds and ends in there, a couple of slots that weren't filled.
Of the 65, let me just concentrate on that, folks who were not supportive of the bill, you heard from virtually every one of those presenters that they didn't feel prepared to comment on the full aspects of the bill, they hadn't had time to read it and analyse it, that it was too big, it was too massive, just the health pieces that we have together here, let alone some of these groups have been trying to deal with issues before the subcommittee in the other room, that there was too much happening here for them to be able to have proper, informed opinions and to participate in an informed debate.
From virtually all of them, you heard, "Please split this bill and please give us a bit more time in public hearings." From the opposition you've heard, "We'd be willing to try and work through a process where the absolute essential things that are tied to the fiscal requirements of the government immediately could be carved out and dealt with," but there are many other large policy areas, and many other areas of bureaucratic changing and wording that, quite frankly, it has become very apparent to me, as I've been struggling to find out these things and understand that, that the members of the committee themselves from the government don't understand all of these things and are finding them out and discovering them along with me.
This is no way to make laws in this province.
When we discussed this on Wednesday, at that time, there had been 232 applicants for the 188 spots in Toronto. As of yesterday at 5 o'clock, there were 263. It had gone up. Now you might think that's surprising, because we've had a couple of spots that haven't been filled. Well, the clerks tell me they've been calling through the list and people are not home or they call them and some people say: "I can't get there that quickly. I can't get it together."
We had a woman this morning who stayed up till 4 o'clock last night when she was called last night to be here. I applaud her for doing that, but that shouldn't be the test of whether or not you're truly interested in participating. I'm very annoyed at one or two members of the government who have used the fact that there were some slots that we couldn't get people from the waiting list to come in and pick up right away on short notice as a reason to say, "See, people aren't interested." And that has been said.
I also believe very strongly that you have to look at what has happened over the course of the last two days with respect to the out-of-town hearings, and I draw this to your attention because there have been no advertisements to notify people in those towns yet of where we're coming, and that list of towns hasn't been published since the first week, the beginning of last week when there was a newspaper article that listed them. There has been no other communication out to people, and on Wednesday, I remind you, we had 396 applicants for 274 slots in the 11 cities that we're going to go to, as of last night, there were 599 applicants. That's 600 applicants for 274 spots, and the ads haven't gone in yet.
Let me just tell you that that's all as of 5 o'clock last night. This morning as a result of some of the comments that I just referred to a few minutes ago about spaces on the committee here, and therefore people aren't that interested, some of those comments that were made -- there was an article in the newspaper talking about that. As a result of that article, the clerks tell me the phones have been ringing all day today for people to come in to be able to fill spots, to get spots in the hearings. People who hadn't been called back or who had not been home to get the call when the call came to them if they were on the waiting list are calling and saying, "Have I missed my chance?" You have to respond if you really are saying that you're listening.
I've heard a number of you say to the people who have been sitting here, thank you very much, and we are listening. If you're listening to their comments and their concerns about the legislation, why aren't you listening to their comments and concerns about the process and about the fact that they don't feel that they're prepared yet; that you haven't given them enough time; that squeezing in a week of hearings before Christmas, when people do have other things that they're trying to accomplish in their lives at this point in time and yet want to participate in this -- haven't you listened to them that that is unfair? Now we're going to be off on the road in those communities that will have had a little bit more notice, but when the ads go in and we get another 100, 200 to 300 applicants, and we have 900 applicants for the 274 spots, what are you going to say to the other 625 people?
I hope what you're going to say is not what the Premier of this province says -- "Put it in writing and send it in and the committee will consider it" -- because you know as we are travelling on the road 11 cities over the course of the two weeks and we are sitting every minute in the hearings listening to people and talking to them and making notes of it, that we will not have the time to read hundreds and hundreds of written submissions before we go into the clause-by-clause analysis the week immediately following the end of the hearings. You know that all of that work that the Premier's asking people to put into written submissions won't get the attention that it duly deserves in this process because of the unrealistic time frames that have been put on such a large bill with so many policy ramifications. It's not that the time frames for committee hearings are abnormal in and of themselves; it's what you're asking people to deal with in that limited time that is significantly problematic.
When we moved this at noon and we were going to debate it at a quarter to, I popped up to my office to pick something up. A gentleman, Calvin Boise, had just got off the phone from speaking with my leg assistant. He is from Hamilton and he was watching and he said, "I'm sending a letter immediately saying I want to support the motion." But he says, "Let me just say that just to go through the health-related section," because he was just going through the bill as he was watching these hearings, "and to understand this piece of legislation, it has taken me personally six hours of manpower and time," and he proposes extensive numbers of hours on this section alone. He is going to be appearing before this committee. He is one of the lucky ones; at least he thinks he will be. He's applied to see us in Hamilton. We don't know whether he'll be one of the ones who will get on or not, because there are many more people in Hamilton who have applied to come before the committee than the number of spots that are available. I hope we will have the opportunity to see him there.
I want to just wrap up by reminding the government members of this committee what the motion actually says. It is not asking this committee to decide that the hours of hearings be extended. It's not asking this committee to decide that the bill be broken up. It's not asking this committee to decide in what form the report from the committee should come back to the House on January 26 in the event of the possibility of extended hearings or splitting the bill. It's only asking this committee to recommend that the government House leader sit down and meet with the other two House leaders to discuss this in light of what we have seen in terms of volumes of applications to come before the committee, in light of what we have heard from 90% of the presenters to the committee this week. If you are truly listening to what people are saying, I don't see there's any way that you can vote against this motion.
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The Chair: Thank you, Ms Lankin. For the government, Mr Clement.
Mr Clement: Thank you, Ms Lankin, for your views on the matter. Unfortunately, I don't feel obliged to support the motion as you have presented it to us. I disagree with your premise. I do not feel comfortable being part of a committee that is going to recommend something to the House leaders or to the government House leader when I disagree with its premise, so I'll be voting against the motion for those reasons.
You spoke, first of all, about the quality of the presentations, and we have heard some presenters expressing some frustration, I acknowledge that. But from my perspective, the quality of the presentations has been excellent. People have been able to review the legislation, come forward with excellent commentary, excellent critiques in some cases, and excellent suggestions for change. So from my perspective, the process is working.
We are hearing from a multitude of different groups, both the stakeholders that one would expect to see at a gathering such as this, such as the Ontario Hospital Association, the Ontario Medical Association, and those large groups that represent large chunks of the health care sector. We have heard from those groups but we've also heard all the way down to individual doctors; in a couple of cases, wives of doctors; in a couple of cases, patients. We've seen the gamut in the Toronto hearings, and this is just the Toronto hearings. We've got 11 other cities to go to where I suspect the range of presenters will be as wide and as broad in terms of representing their respective communities. So I'm quite looking forward to getting that breadth of commentary, the breadth of input that we have had in the five days to date.
I should place on record that as far as I can determine, no one on the government side has ever said on record, that I can detect, that we are somehow happy that the slots were not filled or that this proved that no one was interested. I've detected a great deal of interest from the community, but it's been a broad range of interest. We have heard deputations from persons who acknowledge the need for restructuring, who see the need for change. They see the need to change the status quo, which doesn't exist anyway because it's a deteriorating status quo, and they are quite looking forward to a government that will actually be the impetus for change in the health care system not only for government's sake but for taxpayers and for patients who use the health care system. So I extract from them a sense of urgency. There is a sense of urgency out there and a sense of frustration. I've sensed frustration as well from persons who have been part of the process to change our health care system for 10, 15, 20 years, and I think they're almost going to throw in the towel and say we'll never change the system.
They have come before us, a gentleman last night springs to mind, and said, "Finally, a government that's actually going to put the tools in place to do something to get us out of the hole that we're in, that is detracting from patient care in our system." So while Ms Lankin, quite rightly, from some of the presenters has detected a plea to expand and extend this process, I have detected from other presenters an urgency to get the job done.
Finally, I repeat what I said two days ago: In the past two parliaments, no committee, no bill before us as legislators has had more committee time than this bill and this committee. We are satisfied with the process and we want to continue.
Mrs Caplan: Listening to Mr Clement, who speaks on behalf of the government, I have to say at this point, after a week in this committee, it doesn't surprise me and I'm not surprised they're not going to support this motion. It was this government's intention to have this bill done, passed, finished, by Christmas without public hearings across the province. I understand that, but I had hoped, because there were occasions when the government members said, "We're here, we're here to listen, we want to hear what people have to say," I thought they might have, through this process, recognized that one of the things people were telling them was that they hadn't had enough time to prepare or they were just beginning to understand the implications of this bill. In fact more people than I think any of us anticipated, or could have anticipated, particularly at this time of the year, would have wanted to come before committee, and I would have hoped, having heard some of the comments of the members on the government benches, that they might have considered that, because the only thing that the motion before us is saying is to ask the House leaders to be aware of what is happening at these committees and consider additional hearing time to accommodate those people whose consciousness has been raised to the impact of this bill.
Let me tell Mr Clement and the other government members of something that happened to me last evening. I was talking with some people who said: "Let's see if I understand what's happening. This isn't a specific policy that you're talking about, is it?" I said, "Well, they're calling it restructuring." They said: "Well, what exactly does that mean? What are they going to be able to do with these tools that they're talking about?" I said, "Well, that's the problem," because no one on the government benches has been specific as to what these tools that we call powers can actually do.
When we ask a question such as the question that I asked about physiotherapy -- and the answer was just received today. The question was, "Can physiotherapy be included in this bill?" We know from the reading of the bill that it can be in an independent health facility, and you say to the government, "Are you intending to include physiotherapy?" Or as I mentioned to chiropractors, they could be included in this bill. "Is the government intending to do that?" The answer that we get is: "Well, we really haven't decided. We're considering it. We're not considering it at this exact moment, but we'll have the tools and the power to do that without ever having to hear from chiropractors or physiotherapists or anyone in this province who is now not included in an independent health facility but delivers an insured or an uninsured service." They can, at the stroke of a pen, by regulation, be included in a bill that they don't believe has any impact on them, because these are tools to restructure.
So people are just beginning to understand that it might affect them, and they want the chance to come before this committee and ask those questions, because the other thing that they're beginning to understand is that while it may not affect them today -- it may not be this minister's plan -- once those tools, those powers, are in the hands of the minister and the government, any future minister and any future government will be able to use those tools without scrutiny, without process, without hearing. And so this, Mr Clement and Mrs Ecker and Mrs Johns, is their only chance to come and have a say.
We have on the list requests from 850 individuals and organizations, and we can accommodate here and across the province about half, and we have not yet advertised in those communities across the province. We've just about completed the week of hearings here in Toronto and we have only heard from half of those, because we know that there are two more weeks across the province. There were 263 people who have applied here to be heard, and we know that we have heard from, and we will have heard -- I want to be absolutely clear. I believe the number that we will not have heard from -- let me put it that way. There will be 136 individuals and organizations who applied to be heard here in Toronto that will not be heard. There were no advertisements here in Toronto, and the phone calls are coming in every day, every minute of every day, as people start to realize that. That's Toronto.
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In Sudbury there are already 89 requests; in Thunder Bay there are already 44 requests; in Ottawa there are already 73 requests; in Kingston, where we're only going to be for half a day, 35 requests; in Peterborough 37 requests; in Windsor 60 requests; in London 70 requests; in Kitchener 47; in Niagara Falls 37; and in Hamilton 95.
There have been 587 requests for 274 spots in 11 communities across this province and we haven't advertised yet. This is the only chance people will have to come before a committee to talk about these enormous, broad, unprecedented, sweeping powers that you call tools.
Mr Clement, I've been here 10 years. We have seen numerous omnibus bills and we have seen numerous bills before committee that deal with policies individually, such as the Independent Health Facilities Act, and when you say that this bill will have received more time than any one bill, that is correct.
Almost all of the omnibus bills ultimately had no controversial parts to them -- most of them. Most of the omnibus bills that were finally passed by the Legislature in the 10 years that I have been here had all the controversial sections removed from them before they were passed, so they required very little committee time.
The policy bills, whether it was health policy, whether it was labour policy, whether it was social policy or justice policy, most of those bills dealt with an issue like drugs or changes to the Public Hospitals Act or independent health facilities or substitute decisions, consent and advocacy, and the list goes on and on. You can review the legislation to see all the different kinds of legislation.
The Chair: Mrs Caplan, can I interrupt you for just a second, just to kind of make you aware that we do have eight groups and we've committed a half-hour to each this afternoon and we have to stop at 6. That's the standing order we're operating under. I would hope that we wouldn't infringe upon any of their time.
Ms Lankin: Mr Chair, we committed to be done by 1 o'clock.
The Chair: Okay. I just want to make her aware of the fact.
Ms Lankin: It's not 1 o'clock yet.
Mrs Johns: Two.
Ms Lankin: Two, sorry.
The Chair: I just want to make you aware of that.
Mrs Caplan: Thank you very much. I will not go on much longer, but I feel very strongly about this. Never before, in the 10 years that I have been here nor in the history of this province, have we ever seen one bill with 211 pages that covers 47 different pieces of legislation and all of the different ministries. Not that we haven't seen that many covered, but this is the important part: such significant policy issues and such significant potential as a result of the powers that you are conferring on your minister, not only your Minister of Health, which this committee is dealing with, but the Minister of Municipal Affairs and other ministers.
If this was just health, if this was just health alone in this bill, I would say to you, Mr Clement, that not only should the bill be divided so you could have the time, but if you refuse to divide them you must give people who realize how these powers could potentially impact on their lives a chance to come before this committee, because they will never have the chance again.
I think it's very reasonable for this committee, which understands, is beginning to really understand the tools that you have asked for and the impact on the lives of the people of this province -- it's reasonable for us to ask the House leaders to consider some additional time. That's the democratic thing to do.
Mr Alvin Curling (Scarborough North): Could I just have a minute? I know that Ms Lankin needs the time to wrap up, but I just wanted to say to you how strongly I feel about this. I'll just take up on the point that Mrs Caplan had mentioned, that this is a motion asking the government and all of us to recommend to the House leaders for extended time. You're not making a decision, one way or the other, that this should happen. Leave it to the House leaders to make that decision that the committee has recommended.
We are in the trenches here, seeing those people coming here. I feel very, very passionate about this, because the fact is we know that people have been calling them in and out of committee, because people have been calling me, saying they got calls last night to present today and haven't had the time. I've known people who have withdrawn because their advisers told them that this has a profound impact on them, and if they're going to present, they must present something that is authentic and able to present their case in that kind of manner.
We're asking and urging for that democratic process, by your common sense, by basic common sense and your Common Sense Revolution that you stated, that you want participation here. People are feeling very hurt. You know that today this bill would have been law and you have said how impressed you are about the excellent presentations that you have had, that you expect, and many thousands out there who would like to participate.
Allow the people to have that democratic process. All this committee is doing is recommending to the House leaders to do so. Don't snuff it; don't strangle it. That's all I'm asking. I strongly support this motion put forward by Ms Lankin.
Ms Lankin: Mr Clement, I'm distressed to hear the reasons why you won't support this and I hope your caucus members are not of the same mind. I heard you say that you had been listening. I heard all of your members say to groups that have sitting here that you have been listening to what people are saying, that you appreciate their participation and you're listening, that the government is listening. Then I heard you say just a few minutes ago that yes, you heard some groups talk about frustration with the amount of time they had, but that you equally heard groups come forward and urge you to get on with it, urge the government to get on.
I told you at the beginning that I've counted up about 65 groups that have come forward not supportive of this bill. The vast majority of them have asked you to split this bill and to give it more time. Of 12 groups that came forward that are supportive of the bill, some still want amendments within it. My recollection, and I am going to go through the Hansard and check this, is that there are about four or five of them who said, "Get on with it and do it and pass it right away," others didn't comment on that issue and some of them who were supportive even said they understood the complexity of it and that groups were having trouble responding to certain areas.
If that's how you're listening to people and if that's what you've heard out of the course of this week, I fear for what we're going to have to deal with when we get into clause-by-clause, because I suspect you're not listening at all to those people who aren't coming forward and simply agreeing with your government. That's what it sounds like to me.
Mr Chair, thank you for the opportunity to have spoken on this. I hope that the other government members will see fit to vote differently from Mr Clement. I would ask for a recorded vote on this.
The Chair: A recorded vote's been asked for. All those in favour of Ms Lankin's motion?
Ayes
Caplan, Lankin.
The Chair: All those opposed?
Nays
Clement, Ecker, Johns.
The Chair: The motion is defeated.
The answer to the question that was put forward -- would you come forward to one of the microphones, please, and introduce yourself.
Ms Mary Catherine Lindberg: My name is Mary Catherine Lindberg. I'm an assistant deputy minister for health insurance and related programs in the Ministry of Health. As I understand it, the questions are related to the drug program and the implementation of the copayment and deductible.
As you know, the copayment will be based on an income. The people receiving social assistance, single seniors with less than $16,000 per year and senior couples earning less than $24,000 per year, residents of nursing homes, homes for the aged and home care, will all pay $2 each. That $2 comes off the dispensing fee. The current dispensing fee is $6.11. The pharmacist will be paid, by the ODB program, $4.11. They will collect the $2 from the recipient. Pharmacists could waive that $2, pharmacists could make it a dollar, but the dispensing fee paid by the ODB will be $4.11. The maximum that can be charged is $6.11. Is that clarification?
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Mrs Caplan: Have pharmacists been notified of this or is this the first time they're hearing it?
Ms Lindberg: The pharmacists were notified on November 30. It's not to be implemented till June 1, 1996, so the introduction of the first copayment will be June 1.
On the $100 deductible for those seniors over $16,000 and $24,000 -- and because it's not being implemented until June 1 we haven't worked out all the details -- what we hope to be able to do is to put the notification to the pharmacists on the drug network, so that when you key in the health card number, the information will come back as to how much money you have currently put towards your deductible, up to $100. If your prescription is more than $100, you will pay the portion that is more. Say you were at $95 and the next prescription was $10; you'd pay $5. You would not pay the dispensing fee or anything else at that point until you had paid the $100. That notice will come down on the network, so the pharmacists will not access income information.
Mrs Caplan: Let me clarify. On the network across the province, in every pharmacy, when someone goes in to ask for a prescription, the pharmacist will know how much they have to pay as that deductible automatically across the whole network?
Ms Lindberg: Yes, up to the deductible. It will be cumulative, yes, up to the $100. After that --
Mrs Caplan: And they will also know whether the person is under or over the cutoff of $16,000?
Ms Lindberg: They won't know the income. They will know whether they're eligible for the $100 or eligible for the $2. That's all they will know.
Mrs Caplan: How are you going to determine that income level of whether or not the $16,000, $24,000 -- are you going to require income testing?
Ms Lindberg: We will require income information, as we do currently with the Trillium program.
Mrs Caplan: How will they do it? Will they do it on their income tax forms?
Ms Lindberg: Currently, we use the income tax form for the Trillium program and we will continue to use that form, but it's not given to the pharmacist. You don't take your information in to the pharmacist. It's all done through an application process into the ministry.
Mrs Caplan: So everyone now who believes they are eligible will have to fill out a form and send it in to the ministry. How many people do you think it's going to take, Mary Catherine, to administer that?
Ms Lindberg: We have not worked out the details, and what we hope to do --
Mrs Caplan: So you have no idea of the cost?
Ms Lindberg: We haven't worked out the details of how we're going to do the information and how we're going to put that information. There are a number of ways of doing that, such as just having people declare their income, sending in a letter with a declaration of their income, so that there is an individual declaration. We could do some kind of income-sharing --
The Chair: Can I just interrupt this a bit.
Ms Lindberg: -- but we have not made up our minds.
Mrs Caplan: You haven't made up your minds.
The Chair: The original questions have been answered. We are here today basically for public input, so I would thank you very much for your answers.
Ms Lankin: I appreciate your ruling, and may I say that I don't think my original questions have been answered and that I didn't get a chance to ask any. You seem to forget that it was I who asked the questions. I respect your ruling that we proceed at this point, but I would ask that perhaps Mary Catherine undertake to provide us an extensive briefing in writing on this matter.
Ms Lindberg: Will do.
The Chair: So we can get that in writing. Thank you.
PHILIP BERGER
The Chair: The next presenter is Dr Philip Berger. Welcome to our committee, sir. You've got half an hour of our time. Questions, should you leave time for them, would begin with the Liberals. The floor is yours, sir.
Dr Philip Berger: Thank you very much. My name is Philip Berger and I work at the Wellesley Hospital in Toronto, Ontario. I would like to begin my presentation by again keeping a promise to a patient, one of those ongoing agreements we occasionally make in life to people who are dying, never knowing really how to keep the promise after the person dies.
My patient's name was Clarice. She died of AIDS in May 1994. Clarice came to Toronto from Nova Scotia in the early 1980s and became addicted to heroin shortly after her arrival. She was the second patient for whom I prescribed methadone, a very successful treatment for heroin addiction. That was in late 1991.
She remained on methadone and abstinent from heroin until her pain from AIDS required a switch to a continuous morphine infusion, which she took until her death. She had been struck with a debilitating peripheral neuropathy, a condition which produced a fiery pain down her legs and eventually paralysed her. Clarice died from progressive multifocal leukoencepalopathy, or PML, an unusual AIDS complication which punches holes at random in people's brains. She died hallucinating and in a psychotic state. She also died at home, in my neighbourhood, six blocks from where I live. She died, as they say, in my backyard.
A few years prior to her death, Clarice made a candle for me. When she gave me the candle, she said, "Light it and remember me." I promised her I would. I want to light this candle now and, as I talk, hope it will remind all of us that Bill 26 is a lot more than a debate about amendments to legislation or testing political and economic theory on an unwitting populace. It is about real people and, in the case of health care of which I will speak, sick and scared people, bewildered by the government's proposed accumulation of state power, state control, over their lives.
Although some might say Clarice deserved her fate, once off heroin she became, as the preachers would say, repentant. She sought the solace of religion and God. She had been raised in a fairly devout and loving Catholic family and she reunited with her family a few months before her death. She could have been a member gone astray of your family or mine.
The omnibus legislation covers many subjects which would have affected Clarice and will affect other vulnerable people. I'll discuss only four specific elements in Bill 26 which are of particular importance to the patients I see: first, the amendments to the Ontario drug benefit plan; second, the bill's provisions for government access to private health care information; third, the government's proposal to determine what is medically necessary for Ontario's citizens; and finally, the proposed power of government to decide which services people receive based on their age.
The Minister of Health, Mr James Wilson, spoke on Monday about a $2 user fee for each prescription filled by people on social assistance. He claimed -- estimated -- that one half of those single persons on social assistance would pay $8 per year under the plan. I cannot speak to the veracity of the minister's claims; even he admitted it was only an estimate. But I can tell you that for Clarice her cost under the new plan would be $30 per month, or $360 per year, 45 times the minister's estimate. That holds true for my patients not just with AIDS, but with other terminal and chronic illnesses.
The minister, even if he believes in user fees, has applied the principle of user fees in an erroneous fashion. User fees have customarily been instituted to dissuade people from using services inappropriately, to compel people to more carefully consider the use of services. What choice does a chronically or terminally ill patient have when a doctor recommends a treatment, a prescription? For that matter, what choice does any patient on social assistance have in regard to prescriptions? Does the minister expect patients to disregard the recommendations of their physicians? The only consequence of this legislation is that social assistance recipients, who are the citizens with the most illness in our society, will not take their medications, placing them at higher risk for complications, serious illnesses or hospital admission.
Further, the Minister of Health has spoken publicly of patients bargaining and negotiating the best price from pharmacies for medications prescribed by physicians. Is the minister really serious? Can you imagine an 80-year-old woman hobbling from drugstore to drugstore trying to strike the best deal for her four different heart medications or the cancer patient requiring morphine exerting some kind of leverage on her local pharmacist, particularly in smaller communities where there might only be one pharmacist? Life-sustaining medications are not like shoes or kitchen chairs; the patient whose life depends on drugs is hardly in a fair position to make deals with their local pharmacist.
The Minister of Health appeared defensive in his comments Monday on patient confidentiality. No wonder. Look at the provisions, whether under schedule G, section 12, of Bill 26, amendments to the Ontario Drug Benefit Act, or schedule F, section 34, amendments to the Independent Health Facilities Act, both of which provide unconditional power to the minister to collect and to disclose personal information to everybody and anybody. And of course, under the schedule H amendments to the Health Insurance Act, government employees can walk unannounced into any doctor's office clinic or hospital and seize the medical records, the charts of Ontario citizens.
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The minister can inform anybody of the private and personal information contained in records of drugstores, independent health facilities, family physicians' offices, outpatient departments or records contained in the operating rooms of Ontario's hospitals -- and I mean, inform anybody. The minister himself said so on Monday. He could tell Correctional Services employees or, worse, private insurance companies information contained in all those records. Can you imagine? In the late 1970s, Mr Justice Horace Krever, who now is heading the inquiry into Canada's blood system and AIDS, authored a seminal work on patient records, including the unauthorized disclosure of information to insurance companies. This government seeks to make legal provision of medical records without patient consent to those same insurance companies. And all the minister can do is to compare the alarm at unprecedented government invasion of privacy to a red herring.
On Monday the minister also spoke of "continued physician disengagement from the rest of the health care system," of the "lack of...incentives to...encourage appropriate care," of "inappropriate billings" by physicians, of "excessive referrals for lab tests or imaging tests..., and for consultation to other physicians." And in public statements he has spoken of fraudulent conduct by doctors. It is a serious matter when a Minister of Health promotes fear and doubt in the minds of already anxious patients who must now wonder whether their doctors are prescribing proper therapies or are committing criminal acts.
What does the government proposes to substitute for the decision-making skills of physicians? Under schedule H, section 11, amendments to the Health Insurance Act, government employees will determine necessity and payment of medical services based on:
"Frequency" of provision of insured services; Ontario citizens better not get sick too often.
"The period of time when the insured service is provided." What could that possibly mean? Do not get sick during the Christmas holiday; it might not be an insured service?
"Such other factors as may be prescribed" by the minister. God knows what that could be. Your guess about these unknown factors which determine coverage for doctor visits or operations is as good as mine.
Further, under schedule H, section 18.2, it will be the Minister of Health and his employees who will determine if referrals to specialists from family practitioners are necessary. I am not exaggerating; read the omnibus legislation. Gone will be the days when citizens can act on their family physician's recommendation to see a specialist for that mark on the skin that could be skin cancer, that lump in the breast or that profound depression. It will be the government, without examining the patients, that will determine what is best and what is needed.
That is not all. Senior citizens and citizens of any age should pay particular attention to schedule H, section 7 of the bill's amendments to the Health Insurance Act, which defines insured services. It says, in regard to OHIP-covered services, "Such services are as may be prescribed are insured services only if they are provided to insured persons in prescribed age groups." This amendment is unambiguous. The government and Premier Michael Harris, who leads the government, want to determine OHIP coverage, coverage of lifesaving, life-sustaining treatments, on the basis of age. It cannot mean anything else.
Does Mr Harris really believe that a 70-year-old citizen does not deserve heart bypass surgery because of her age, that an 80-year-old retiree of modest means does not deserve kidney dialysis or that the 90-year-old, previously fit grandmother should not get lifesaving treatment for her pneumonia. Do not tell me that I am confabulating or misinterpreting. The omnibus legislation says that OHIP coverage will be dependent on the age of the person receiving the medical care. What does the Premier have to say about that?
The Premier's Minister of Health spoke on Monday of so-called special-interest groups "greasing their wheels, with the squeakiest getting the most grease," and he reiterated that his "government is not going to give special treatment to people who shout the loudest."
But all the same, Premier Harris proposes to give special treatment to the poorest and sickest: He seeks to make it difficult to get the medicine they need. He proposes special treatment for private pharmacy and medical records: He can disclose personal information to whomever he wants. He proposes special treatment for medical therapies that people receive: He can deem them unnecessary and charge doctors the cost. Finally, he proposes special treatment for our elderly: In fact, he proposes no treatment if Ontario citizens are too old.
As for squeaky wheels, well, the Minister of Health does not have to worry about Clarice. She is dead. And with that, I will blow out the candle and hope I have kept my promise to her. Thank you for listening to me.
The Chair: Thank you. You've allowed about five minutes per party for questions, beginning with the Liberals. Mrs Caplan.
Mrs Caplan: I don't think that people understand the implications of schedule H, section 7, subsections 11.2(4) and (5). Can you give us some examples of what kind of explicit rationing on the basis of age could result if an insured service were defined for someone in an age category? For example, you referred to heart bypass legislation. Is it your reading of this that they could decide that over the age of 70 or 75 it would be an uninsured service? Dialysis treatment? Kidney transplant?
Dr Berger: This legislation is completely clear -- there is no other way to interpret it -- that the minister will be able to decide what is insured and what is not insured based on a new factor, and that is the age of the person. In the medical literature and in the lay media for many years there have been debates about the so-called cost-effectiveness of providing certain treatments to people who are older. The classic ones that come up are bypass surgery, transplant surgery, dialysis and -- I do not exaggerate -- even treating pneumonia in someone who is very, very old. Being old does not mean one is disabled or necessarily sick. Someone who's 75 could live to 90; someone who's 80 could live to 100.
Under this legislation, the minister will be able to say, for example with dialysis: "No dialysis for anybody above the age of 80, period. You can pay for it yourself if you want to, but it is no longer an insured service once you hit that age."
Mr Curling: Doctor, you have blown Clarice's light out, but I know you have lit, I would say, thousands of people's lights because we basically on the opposition side will continue to light that candle and maybe the fire under the posterior of the government, that the people's voice will be heard.
What confuses me all through this process is, why would the government, and maybe you may give me some insight on this, want this power? I know they say it's to balance the budget and to pay off this deficit, but would you have any views on that, on why they would want to amass this power for themselves?
Dr Berger: I've never spoken to or been asked by anybody in the government about my views on any of these matters, so I really don't know why. I hear the argument of paying off the debt and deficit, but in my judgement, the only thing that the government is doing is selling the soul of Ontario, and there's no price that anybody can put on the soul of this province. To me, the deficit-and-debt argument does not justify such massive centralization of power and utter and absolute control over the lives and the deaths of the citizens of Ontario.
On a personal note, I'm flabbergasted just from a point of understanding what I always thought the Conservative Party was about, because Conservative Party spokespeople -- and I've spoken with them; I get along with them. I'll speak to anybody; I'm not a member of any political party, as I think this side of the table knows. I've been critical of every government in this province. But I always have understood the Conservative Party's platform to be a devolution of state power, about letting people and communities control their own lives and make their own decisions, not amassing central power with the government and making decisions on behalf of people. That's the best insight I can give you.
Mr Curling: Doctors especially have had extremely confidential matters with their patients, and I know they hold that very close to their hearts and souls. The concern that people do have -- the privacy commissioner established that -- is that this can be extremely dangerous. Do you see any sense really of passing this kind of information on to bureaucrats or to politicians?
Dr Berger: It's beyond that. The minister scared me when he talked about passing it even further, to insurance companies, because once that information hits one insurance company, it's all over the western world and can go absolutely anywhere.
I should tell you that in 1984 I appeared before a parliamentary committee and a Senate committee on the Canadian Security Intelligence Service. I studied that legislation very closely and I went in there on the point of access to medical records, and it is much, much more difficult for a security agent of this country to get medical records than for this minister to get medical records. The only reason a state security agent can get medical records is if there is a threat to the national security of Canada. I don't see anything in Ontario that is equal to a threat to the national security of Canada. I'm talking about invading countries -- that's the type of threat they look at -- or subversive groups attempting to overthrow government.
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I have no objection to the government attempting to end fraud or to prevent people who don't deserve OHIP numbers from using them. That does not require the widespread dissemination of information and the powers to do that that this government wants. I normally have a pretty thick skin and I'm not too offended by anything politicians have ever said, but I was amazed the morning I woke up and read the minister's comments that seemed to say that all doctors in Ontario were committing fraudulent behaviour. I say to the minister, produce the evidence if there's widespread and massive fraud and charge the doctors if they're committing fraud, but don't go to the citizens of Ontario and say, "Your doctors are committing fraudulent behaviour when they see you in their offices."
Ms Lankin: Dr Berger, thank you for being here. Thank you for being in this province and continuing to stand up for medicare and for what you believe in and what's best for your patients. I appreciated it when I was minister, even though there were times it was tough to find the answers. For example, we have the beginnings of a methadone treatment program in this province today because of your work and the others who supported you. I just say, please keep it up.
I want to come back to this issue about age, but I want to come at it in a different way and explore this with you. When I first read this, I was a little disturbed as well. It was pointed out to me by a member of the media. You should know that we are all trying to understand this and we're all helping each other get through this, trying to find the different parts of the bill. In the old act, in the regulation prescribing powers, there was the power to prescribe in regulations services by age. It's now been imported into the act directly in this section; that's section 7, the amendments which create a new 11.2 in the Health Insurance Act. But I want to tell you what hasn't been imported with it.
They repeal a section in the regulation making powers that was there, under subclause 45(1)(j)(ii). There's a paragraph that follows that which says, "but no service or age group shall be prescribed under this clause that would disqualify the province of Ontario, under the Canada Health Act, for contribution by the government of Canada because the plan would no longer satisfy the criteria under that act."
There's another piece in this omnibus bill under the Health Care Accessibility Act which allows, again by prescribing in regulations -- this is section 39 of the bill under the Health Care Accessibility Act, on page 114 of the omnibus bill. It's clause 9(1)(a), "prescribing insured services for which hospitals may charge insured persons."
I got really nervous about this, and I asked and found out that what it's intended to do is that there was a regulation under the old act which said hospitals couldn't charge for insured services, and one particular hospital has threatened to sue the government saying, "You can't do that." This is to give the government the power in the legislation to prescribe in the regulations what hospitals may charge for.
I asked, "Why wouldn't you simply say they can't charge for insured services under the act?" They said, "Well, there is one under the Canada Health Act that you can: copayments for chronic- care beds." I said, "Why don't you say that's the only one you can charge for," or "Why doesn't it say here you can't do something that's contrary to the Canada Health Act?"
I put this to you (1) because we're all scrambling to figure out how these different pieces fit together and (2) because I'm coming to the opinion that references to the Canada Health Act are being pulled out here, there and everywhere. We heard the Minister of Finance last week say, "We want flexibility on the Canada Health Act." I think they're preparing for that flexibility to be able to do something which would create the two-tier system we all fear.
Without the protection of the Canada Health Act, what would happen with medicare, and what you think that means for the health of the people of this province?
Dr Berger: In my judgement, the Canada Health Act, through its five principles, guarantees a system that is accessible to all and provides more than adequate health care to all. If there were not a Canada Health Act, this province and other provinces would be free to play a little or a lot with the system in whatever fashion they felt.
Because of the time limitations, I did not go into the many clauses in this legislation that permit massive privatization of our health care system. There are some very scary clauses lost in -- and this is very difficult to read, I have to tell you. I'm an ordinary citizen, and this is the most difficult document I've read in 20 years of trying to be a responsible citizen and follow legislation. You have to have four dozen pieces of other laws around you on the table to cross-reference. I think that's disrespectful of the citizens of Ontario -- I'm not talking about elected politicians and bureaucrats; I'm talking about ordinary citizens, and I am an ordinary citizen -- who actually are trying to do their duty as a citizen and understand the laws that are being passed around them. It's disrespectful to put something out like this. It should be readable.
What is in here in different sections are provisions that would lead to privatization, and without the Canada Health Act it would be easy.
I should also add in regard to your comments that if it is really true that the Minister of Health only wants these powers for very narrow, narrow purposes, why doesn't he just come out and do it in legislation instead of terrifying the population? These are open-ended, unconditional powers and I --
The Chair: Thank you very much. We'll go on to the next question, the government.
Mrs Ecker: Thank you very much for coming, Dr Berger. It's good to see you again. We appreciate the passion and the concern with which you express your views, some of them, you may not be surprised to hear, that we do not completely share.
I would say there were references to prescribe groups by age in the previous legislation. There is also an attempt in the new legislation to preserve the Canada Health Act because this government is going to abide by the law and the Canada Health Act. I would also say that decisions as to "medically or therapeutically necessary" are ultimately judged by peers from the Medical Review Committee. I do believe there are checks and balances within this legislation.
I know from previous meetings and presentations and submissions you have made that you have frequently expressed the concern that there are not enough physician resources in the area of HIV primary care. One of the things the minister has said he would like to do is to reinvest more in the HIV primary care area. I wondered if you would comment on the kinds of reinvestments that are needed in that area. Second -- many governments have tried to do this; we've all wrestled with it -- how do we get those resources out of some of the other areas into areas where there is a priority, for example, HIV primary care? How do we get some of that restructuring going on? We've had many areas that have tried to restructure that have said we need mechanisms to get on with it because there are roadblocks to that. I just wondered if you wouldn't mind commenting.
Dr Berger: I'd first like to make two personal comments. I know Ms Ecker and I've always respected her professionalism and the work she's done with the College of Physicians and Surgeons. She's been personally helpful to me in several cases we've dealt with. Secondly, I have to say about the minister -- it's important to give praise as well as criticize, and this minister has so far done well in the area of HIV-AIDS. In my own hospital, he provided an exemption to an out-of-province physician because we were looking for an AIDS doctor for a year and a half for our hospital and couldn't find one, and on October 12 he signed an exemption giving this doctor a licence to practise in my department, which is very helpful in our family practice department.
To get to the specific question about resources for HIV primary care, and I suppose resources in any underserviced area, I think the minister must act. I'm going to get specifically to what I think you're talking about, which is, how do you put physicians in places where there are not enough physicians and how do you take out physicians where there are too many?
I have no problem with the government compelling doctors about where to practise, but under the following circumstances: I think it is unfair to do it after students enter medical school, and I'm giving you an answer that I gave 25 years ago. I do think it is fair, as part of the terms and conditions of entering medical school, so any applicant in the province knows ahead of time: "Part of the terms and conditions of the state funding your education, Mr or Ms Medical Student, is that you will have to repay the province three years of service in a designated underserviced area. We'll consider the expertise and training you've had so it's an appropriate placement, but that's how you have repay the citizens of Ontario." When you apply to medical school, you know ahead of time, and then it's fair. But it's not fair to change the rules so dramatically midstream. That's the only objection I have.
You can do it with HIV primary care; Seaton House, where I had a lot of trouble finding a doctor for the homeless in Toronto; Ignace, Ontario -- and I have to tell you I know about the problems in northern Ontario because I have a brother who's a physician who calls himself the king of northern Ontario locums. He's always done his locums, for 10 years, all over the province, and I've heard personally from him how desperate it is in these communities. But it's not going to work by forcing people under changing rules.
The Chair: Thank you, Mrs Ecker, and thank you. We appreciate your interest in our process and your presentation this afternoon. Have a good day, sir.
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ADA LO
DOROTHY SIT
The Chair: Our next presenters are Dr Ada Lo and Dr Dorothy Sit. Welcome to our committee. We appreciate your attendance. You have a half an hour of our time to use as you see fit. Questions, should you allow time for them, would begin with the New Democrats.
Dr Ada Lo: I'm Dr Ada Lo, and this is Dr Dorothy Sit. Thank you for letting us speak. I graduated from the U of T medical school in 1993 and finished my family medicine residency this year.
I have never been interested in politics before and I consider myself a physician at the grass-roots level. All I want is to be left to my own peace so I can practice true compassionate medicine. I derive great satisfaction from caring for my patients, although it is emotionally draining to see the depths of pain in the human heart every day. I see first hand the problems the health care system is facing. Granted that my experience is on an individual basis, it may represent a microcosm of the greater problem.
I have come to the public hearings in the last few days and heard a lot of frustration being vented out. But that's not why we are here today. We are here today in the hope of offering some constructive solutions in the best interests of our patients. We will try our best not to complain or lay blame on anyone.
First, the public really does need more time to absorb the entire bill. Mr Frank Klees told us yesterday that it took the government three years to come out with this bill. There will be a lot of changes in people's lives and people are naturally resistant to changes. They arouse feelings of fear and insecurity. If you truly want to hear the public and work with the public for solutions to the huge deficits, you need to give us time to feel the frustration first, time to understand this bill as much as possible, then we also need time to think of constructive solutions.
With regard to the psychiatrist shortage issue, in my experience, even in the greater Toronto area there is a shortage. For example, a patient with an eating disorder was rejected from the Toronto General Hospital eating disorder clinic because of too long a waiting list. A patient with a history of childhood sexual abuse who finally found the courage to tell me had to wait a year to see a GP psychotherapist, and we are talking about a family doctor who has some experience in psychotherapy, not a psychiatrist.
The taxpayers in Ontario subsidized our education and it is reasonable for them to expect us to serve them. By forcing doctors up north, the public will see immediate results and it will seem to solve the shortage problem. But this is not the long-term solution. We will all be deluding ourselves if we think so.
Virtually every study which has looked at this question has concluded the same thing: encouraging doctors to go north is preferred to forcing them north. The most recent examples can be found in the PCCCAR underserviced area needs committee report released in June 1995, and the joint government OMA-OHA report by Graham Scott. We all have to realize that it is not the quantity that counts, it's the quality. Northern people want doctors who have the necessary experience for northern practice, who are committed to stay and who have it in their heart to serve others.
There are several solutions, all voluntary, which will work but have not been implemented yet. I have several suggestions.
First, we need a reasonable recruitment and retention program. In this program, there must be supportive measures to prevent physician burnout, including replacement locum doctors, educational and vacation leave, reasonable on-call schedules, specialty backup services, satisfactory payment methods for small hospital and emergency room services, financial incentives which reward doctors who stay in underserviced areas, and support for spouses and family members.
During the social contract talks in 1993, the government and the OMA agreed to a direct contract program which has most of the abovementioned features, but the government never implemented it. The OMA also agreed to include the cost of a recruitment and retention program in the hard cap so there will be no extra cost to the taxpayers.
Second, we also need more training programs for doctors in underserviced areas. Experience shows that doctors trained in underserviced areas tend to return to those areas when they finish training. Doctors in training want to be exposed to the realities of northern practice.
When I applied for my family medicine residency two years ago, I had considered going up north and sent applications to those programs, but because of limited funded positions, I was not even granted an interview. I ended up doing my residency in Women's College Hospital, which gave me a wonderful learning experience. I was trained so that I will be able to deliver babies, do in-hospital medicine, in addition to office practice. When I go to underserviced areas in the future, I will not be as ill-equipped, but this is my choice, and the fact remains that a lot of doctors in training plan to stay in a big city and have not geared their training program to the requirements of a northern practice.
I am not happy with the status quo, but I believe that by passing this bill into law, the situation won't get better, but will only get worse. A lot of people are going to suffer. Even though the government has very good intentions, the end does not justify the means in this case. I am sure that when you go into politics, you have it in your hearts to serve people. It's important, especially during these times, to keep your nose on the horizon and see the vision that you had when you first went into politics. Hopefully, you will try your best to kindle a greater understanding between the public and the government.
Dr Dorothy Sit: Thanks for giving me the opportunity to speak before you. My name is Dr Dorothy Sit. I'm a family doctor who graduated from the University of Toronto, class of 1992. Following my residency program in family practice at Mount Sinai Hospital, I decided to venture up north of the 401 and practised as a locum physician and as an emergency doctor for the area of Muskoka, mainly in Gravenhurst and Bracebridge.
After one year at this location, I decided I would like more diversity and I joined the Ontario Medical Association underserviced locum program. I was fortunate to be able to join this program because currently I am single, unattached, without major family commitments, and also because I enjoy travelling.
I do believe that I should make a contribution to society, because the Ontario government invested in my medical training through all those years of med school and post-grad. Perhaps that is the reason I decided to go off and practise in isolated settings. You must also understand that in making this decision, I sacrificed some of my social life, since my home base has always been Toronto, having been born and raised here. I do not expect any of my colleagues and friends to make the same choices as I have, because they are all individuals.
I can understand that the Conservative government has tried to put forward Bill 26 in order to attempt to fix the deficit problem. There are many reasons why we have this huge debt. Four possibilities are: mismanagement in the Ministry of Health; mismanagement in the hospitals; irresponsible billings by doctors; and patient abuse of the system.
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However, I do not believe it is fair to label doctors of Ontario as a scapegoat for the fiscal irresponsibilities of the past. By reading the Star and listening to the Health minister speak, I sense an accusatory tone from them, especially when they say that all doctors are responsible for fraudulent billings. This is an impossible generalization. It is like saying all doctors are endeavouring in criminal activity.
The government then decides that on this premise they can push through a bill that empowers them to obliterate all privacy rights. As a result, they will step into all doctors' offices to check for duplicate billings and apparent inappropriate use of investigations and treatment from a financial point of view, not a medical perspective. The inference here is that accountants and non-medical personnel will be judging what is appropriate health care, not the doctors. I would also like to let the MPPs know that in fact OHIP has already implemented a computer program that checks all physicians' payment submissions for this duplication problem.
In addition, I would like to address the amount of $65 million that OHIP has accused physicians of cheating the system. In fact, an article from the Toronto Star of March 26, 1995, stated that the Provincial Auditor in 1995 found that amount to be in the neighbourhood of possibly $1.3 million. Personally, I find any amount of fraudulent billing to be deplorable, but I do wish the Health minister could get the facts straight before making such wide-sweeping, dictatorial legislation and such wide-sweeping comments pertaining to the medical profession.
As a result of this threatening environment, doctors have left the province. New doctors are not willing to set up their own offices because of the unstable atmosphere, with each government breaking its contract with the doctors. Effectively, this is the brain drain.
Yesterday I had the opportunity to speak with the Conservative MPP from York region, who mentioned that after several days of public hearings, he noticed some repetition of similar anxieties expressed by members of the health profession and by the public at large. He wanted to hear more ideas for cutting costs in the health care system and attracting physicians to the underserviced areas of Ontario. I believe my medical friends and I can offer a few suggestions, and I do hope you will pay attention, particularly since I have practised in both urban and rural areas. People I have met have often made insightful comments that I would like to share with you now.
In my opinion, the health care system is being abused in several ways. For example, I believe that walk-in clinics are a good idea in theory, but they are also extremely open to abuse of the health system. They allow for double and triple doctoring without their own family doctors realizing it, as many walk-in patients are encouraged to follow up with their own GPs the next day due to medical-legal purposes. Often the patient takes it upon himself or herself to look for second and third opinions after a walk-in visit. We can correct this problem by expecting the family doctors to be responsible for their own patients during after hours.
One can take the example of some physicians in the Credit Valley area of Mississauga and another group in the Brampton-Peel Memorial area who set up their own after-hours clinic in their medical building, available for a few hours in the evening and for longer hours on the weekends. At least there the patients will be cared for, and this will prevent inappropriate emergency room visits. Also, the family docs will be informed of the patients' visits and can provide some continuity of care.
I believe another source of abuse in the health care system is the house call service. This is a phenomenon of the urban centres. I have never in my experience in the north and south seen such a pampering of the urbanites, and exclusive to the urbanites, especially in a city where the public transit is a doorstep away or where there are taxi services. I must tell you that in many of the isolated communities where I worked, there is not even a taxi to transport people without cars. Can you imagine? But I have come to find that people there are more resourceful. In cities, it must be the 24-hour convenience store mentality which encourages irresponsible use of the health system. I do think house calls should be made available to people who are disabled or housebound due to their unfortunate circumstances. But the trend is, for example, the call comes in that there is a sniffle at High Park and Bloor. The doctor arrives and the whole family of seven has been attacked by the sniffles. Therefore, the doctor sees seven instead of one sniffle. Did this sniffle merit a house call for one person, let alone seven? I believe the public must be educated to appreciate their precious health care system and to utilize it appropriately.
On yet another point, Bill 26 tries to address the problem of servicing the underserviced areas that severely lack doctors. To start with, I will remind you of the numbers published by the Ministry of Health in their October-November Bulletin pertaining to the physician shortage in the underserviced areas of Ontario. They are as follows: In the north, 47 communities are looking for 64 GPs; in the south, 16 communities are looking for 24 GPs.
For example, I worked in two towns situated along the Trans-Canada Highway in northern Ontario. The population is approximately 7,000 between the two places, where they shared one hospital with 25 beds and had only two doctors. In another town with 15 doctors, the turnover rate of MDs was extremely high. In that northern community, five doctors have left for the US in the past year; in other words, one third of the total number of physicians in that area. These types of communities are challenging places to live and work. The government needs to attract people not only to come, but also to stay.
It is in these circumstances that I sincerely believe the Ontario Medical Association's rural locum program is essential. I must say I am proud and honoured to be a part of this program. The program is essential to prevent doctor burnout in these areas and to halt an already growing attrition rate. I believe young doctors should be encouraged by the government to consider working in rural settings by following through with, for example, direct contracts at graduation, such as the one mentioned by PAIRO in 1993. This, plus financial incentives and short-term contracts for periods of one to two years on a voluntary basis, would be a more positive initiative. I believe it would be more effective than forcing doctors against their will to comply with government legislation.
From the grapevine I have heard that the government plans to lower current billing caps and also plans to cut the fee schedule by 20%. They have not considered the differences between urban and rural practices. They haven't considered the rising cost of overhead in offices, CMPA, the absence of sick-leave benefits and pension plans.
Perhaps I can better speak from the point of view of a rural doctor.
Firstly, with the current cap, most hardworking rural docs and those who do all-round family practice in cities would have a difficult time reaching it, "hard work" meaning working in an office, seeing hospital inpatients, doing emergency, obstetrics, anaesthesia, minor surgical cases and psychotherapy. The reason the workload is so great is that the people in the area require these services and usually are quite distant from any major referral centre. With another cap and a possible further reduction in the fee schedule, I believe the rural doctors will feel insulted for the amount of service they provide.
From a more concrete perspective, all GPs who see inpatients in the hospital are paid $16 per visit before social contract deductions. With a reduction of 20%, the visit is $12.80. This could be a patient who is very ill -- crashing, so to speak -- needing a great deal of attention and a lot of time from the doctor, who works in a setting with minimal backup. I think this would discourage doctors from coming to stay in isolated areas and taking on privileges at the hospital and again risking burnout.
In cities, this would lead to the family doctor consulting with the specialists more often. Perhaps in these situations, rather than a fee-for-service environment, the government could offer a rewarding alternative payment plan where doctors are guaranteed vacation time, continuing medical education time, the next day off after being on call for 24 hours etc. This was actually undertaken in the Red Lake area, where I also had the privilege to work for a period of time. Lastly, I wish to mention briefly that each new government seems to have nullified the previous agreements made with the OMA. I would like to ask you what had been wrong with these past agreements. The government not only must try to tackle the health care debt from the supplier's side -- in other words, physicians and hospitals -- but also from the demander's side, the general public. It is imperative that the public realize that the system has tremendous cost. The users of the system should be expected to be equally responsible for health care spending along with the health care providers.
To conclude, I have made many points in these last few minutes. We have come up with these suggestions only because I've had the opportunity to work in various areas of this province and also had the opportunity to talk with many doctors, nurses and other health care providers. I hope you will consider our suggestions and insights, as we have spent time to reflect on the way the current system works, both the positives and the negatives.
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I honestly believe that the MDs from both the urban and rural settings have indicated that they wish to participate in improving the current system. I think the government still needs to include doctors more in future health care reforms. This would bring the MDs alongside with your concerns rather than antagonizing us, making us increasingly frustrated with the current working environment. Please open your ears and allow us to participate in any legislation concerning health care matters, because we as doctors and as citizens of Ontario understand that there are still problems, but we do wish to see change for the better and can offer input into your solutions.
The Chair: Thank you very much, ladies, for your presentation. We have about three minutes per party left for questions, beginning with Ms Lankin.
Ms Lankin: I appreciate both of your presentations. I have noticed you here on and off through the course of the hearings this week, and so I know you have been listening to other presentations and to the questions and the comments from the members of provincial Parliament as well.
There was a young woman here earlier in the week as well, Michelle Wise, and you may know that over the course of the week I've been reading in some statements from various doctors. She's a second-year medical student at the University of Toronto, and she says:
"The main part of the bill that really concerns us is the government having the power to direct where we're going to practise and where we're going to live. It affects me directly. I am a future doctor and I've grown up in Toronto, all my friends are here, my family is here and I plan to work here when I graduate. There's also people in my class who have significant others who wouldn't necessarily be able to work outside of the larger centres that we may be restricted from working in. On the other hand, there's definitely people in my class who do want to go up north. They might be from some smaller communities and want to return there or they might, for whatever reason want, to work in an underserviced area. We just don't think that forcing doctors to work there by restricting billing numbers is the way to do it."
You've spoken most eloquently about some of the recommended solutions to this problem. I want to point out to the government members who have asked many presenters, "Well, what would you do? What are the solutions? Other governments have tried to solve it; no one's been able to solve it," I want to remind them that in fact the previous government put in place two processes: PCCCAR, which you've referred to, which just in July came out with a set of recommendations, and the working committees are putting the final touches on that; and the Scott report, which came out just prior to the election. This government has indicated support for those processes, but it hasn't fully implemented the recommendations yet, and yet it's proceeding with legislation on the billing numbers restrictions.
Can you tell me how those of your colleagues that you know will be affected by this they feel about the government's actions, and what does it mean about their own practice choices for the future?
Dr Lo: For example, my brother is in second-year family medicine residency, and he really wants to practise in Toronto, but now the future is so uncertain. He has a girlfriend in Toronto too, and she has a nice job in Toronto. So I really don't know what will happen to his personal and professional life if this bill passes. He is actually this week calling on lots of medical recruitment services to talk to people in the States, and he is considering going down to the States.
Ms Lankin: Do you think that feeling is widespread among students right now?
Dr Lo: Yes, because he told me most of his friends are calling around and panicking.
The Chair: Thanks, Ms Lankin. To the government, Mrs Johns.
Mrs Johns: I also want to add something from a letter from Minister Jim Wilson that deals with something that you particularly have talked about. He's writing a letter to the editor and he says:
"I have not, nor will I ever, accuse all of Ontario's physicians of defrauding our health care system. We see physicians as essential gatekeepers and catalysts in the reforms we must undertake to maintain quality and keep our health care system sustainable for future generations of Ontarians.
"At no point during my remarks to the committee examining the government's Savings and Restructuring Act did I attack physicians and accuse them of widespread fraudulent behaviour. What I actually said to the committee was:
"`I'm not here to say in any way that provider fraud is a large problem, but we do need tools where we think it's occurring to check out to see whether it is occurring and to refer inappropriate billings and practices to other proper authorities.'
"In other words, the majority of physicians bill appropriately. The problem is confined to a small group that is substantially overbilling the system. Currently, we lack the ability to recover these funds in a timely manner.
"For example, $2.7 million is still owed to the public health insurance plan by physicians who were found -- by their peers -- to have overbilled the plan. As well, there still remains a backlog of 170 cases of alleged inappropriate billings, which could total $9.5 million, that have yet to be reviewed by the Medical Review Committee.
"I believe it is the irresponsible actions and hyperbole of the opposition parties that have exaggerated the powers contained in the Savings and Restructuring Act and the extent to which these powers in practice will intrude on the provision of medical service. By misrepresenting Bill 26, the opposition, and not the government, has blown the issues of provider fraud out of proportion.
"I look forward to continuing to work constructively with physicians, whose input I value, to make Ontario's health care system the best that it can be."
I know that you've expressed that you want to make Ontario's health care system the best that you can make it and that you want to help us, and I want you to know that we want that also.
Dr Sit: Thanks for your comment. I appreciate the Health minister's comment about doctors, and I do realize that there is a group, perhaps a small group, that is abusing the OHIP system among the group of doctors. I know that OHIP also has a way of retrieving that money from the doctors, because they do that to us every month with our OHIP by remittance. They've taken portions of all our billings off monthly, so I know that there is a way of retrieving the money that has been fraudulently billed. I don't know what is the problem with the Health minister, but I know that there is a system in place already.
The other thing that the Health minister did not address is the public's overuse or abuse of our current health care system, and I think there's a check and balance that we need to install. It's not up to me to offer you solutions, because I know that the solutions currently aren't quite acceptable in the face of the public. But the doctors can't function only as a gatekeeper; we also have to have the public behaving responsibly.
Mr Curling: Thank you very much, doctors. I think your presentation was quite balanced and direct, and you made it quite open that you were not interested in politics but somehow politics are very interested in people, and they should be.
I think that the letter of the minister, who is trying to explain his remarks, is indicative of what's going on continuously, that the statements and the position of legislation are so insensitive and sometimes not taking into consideration people's feelings.
I just want to ask your views on this. I know the locum and the continuing medical education program that you mention here are involved in the agreement and the negotiation with the OMA in 1991 and 1993. Do you realize that this legislation itself wipes out this agreement? What this means is that the program you have spoken about now, that you support the program very strongly and are very happy to associate with it, will disappear under this legislation. Does that make common sense to you?
Dr Sit: Most certainly it doesn't, and that's why I came here today, to voice my opinion and my concern that they do continue with the OMA rural locum placement program.
Mr Curling: I know the government said that we have blown many things out of proportion. I just hope that what was blown out of proportion is the fact of participation. As a matter of fact, the excitement, as you may want to call it, that was developed or demonstrated at times involves an excellent presentation on your part, and I hope it is the opposition who will try to educate the people outside and say, "This affects you directly."
You spoke so eloquently about that. Do you feel --
The Chair: You can't have another question, Mr Curling. You've used up your time.
Mr Curling: Limited time.
The Chair: The time goes by quickly.
Thank you, ladies. We appreciate your interest in our process and your being here this afternoon.
Our next presenter is Dan Vrekaliza. Okay. We're going to take a five-minute recess because Mr Bob Callahan -- or Dr Bob Callahan, who's scheduled for 4, is in the building. We're going to go and find him and slot him in now.
Mr Clement: Don't call him a doctor; he's a lawyer.
The Chair: I'm sorry. He's not a doctor, he's a lawyer.
Mrs Caplan: That's worse.
The Chair: Lawyer Bob Callahan. That is worse.
The committee recessed from 1500 to 1505.
BOB CALLAHAN
The Chair: Welcome, Mr Callahan, to some familiar territory, I understand, for you. We're pleased to have you here at our committee. You have a half-hour to use as you see fit. We appreciate your being early. Should you leave any time for questions, they would begin with the government. The floor is yours, sir.
Mr Bob Callahan: Thank you very much, Mr Carroll. I was watching you on television last night. I understand that I've been elevated to the august position of a doctor as opposed to a lawyer. I have to tell you I'm a lawyer, have been one for 30 years. As you probably know, I spent 10 years down here in the Legislature and I involuntarily left the Legislature after the election in 1995.
It's a little different situation for me to be on this end of the picture, having been for 10 years on the other end of the picture and having chaired a number of committees in the Legislature. But quite apart from that, my purpose in being here today is not to go into the bill. I think, from my observing of the televising of this, there have been some very excellent briefs. People have brought to the attention of the Legislature significant factors in terms of this bill.
It gives me a bit of a shuddering feeling to realize that this bill would have been passed before Christmas had it not been for certain members of the Legislature. I have to recognize my good friend Alvin Curling and all those who supported him. It's unfortunate that in our system, when there's a majority government of whatever political stripe, such procedures have to be taken to ensure that democracy prevails.
For the 10 years I was here I, with a number of other members of not just the Liberal caucus but other caucuses, worked hard and certainly spoke on a number of occasions in the Legislature in terms of democratizing this place. The procedures by way of which the Legislature operates require a number of reforms. Thus far, those reforms have not been forthcoming, although I have to say that my then leader and my still leader, Lyn McLeod, brought out a very excellent document after she was elected as leader of our party which went a long way towards regularizing and democratizing this august body.
Having said that -- that's the last partisan hit I will make; I'm here in a non-partisan way -- I'm here to share with you what I believe is necessary, particularly in a case of a bill which is 211 pages long. I'm not sure that the public is aware of the fact that when a bill is presented to the House, there is a small, little story or explanation of what the bill contains.
Unfortunately, the way the legislation is put forward, particularly when it's amending legislation, it goes something like this: "Section 4 amends section 5 of the ophthalmology act," for instance. If you haven't got on the one side of the page that and on the other side of the page the section it's amending, then I would suggest, with all due respect to the members of the Legislature, that probably 129 members of that Legislature have no idea what that amending bill means, unless they're prepared to go behind the Speaker's chair and pull out the Revised Statutes of Ontario and determine what it means.
What they do is they rely on briefings that are provided by the various caucuses or they rely on briefings from the ministry. I'm suggesting that that's not adequate. That's not fair ball for the taxpayers of this province, because it means very often the people in that House are voting without any understanding of what's in the bill, and particularly when it's a 211-page bill, it becomes almost an impossibility.
I have suggested at least 20 times, over the period of 10 years I was here, to two Speakers, and most recently to Speaker Warner about a week before the House adjourned and the election was called, that this is very easy to do technologically. With word processors and computers, it's very simple to put on the one side of the page the amendment and on the other side of the page the section that is being amended. In fact you could even underline the lines that are being amended so that a person can simply look from one side to the other. I noticed this afternoon Dr Berger sort of alluded to that, but I don't think he quite understood just how bad the problem is.
I find it incredible that Speaker Warner said he agreed with me. He thought it was a good idea. I've spoken with the Clerk of the Legislature. He thought it was a good idea. Ten years have gone by and it has not be done. I suggest to you that that is unacceptable because it means that where everybody stands up and votes, do they know what they're voting on?
I'd put that question to the present members of the Legislature and I'll bet you the answers would be no. You people in committee get a much better understanding of what the bill is about, but I think it's fair to the taxpayers of this province, I think it's fair to the voters who elected you and gave you a sacred trust, that you know what you're voting on, that you don't just stand up because the party whip says, "We're all voting for this." That to me is unacceptable.
In fact Mr Harris in the Common Sense Revolution suggested that we reduce the numbers of the Legislature to 90. Unless this is changed, I'd suggest you reduce the Legislature to about four people, because they're the only people who know what's going on. In this case, as we've seen from the press reports, and I hope you'll accept the fact that I'm not being partisan -- I would say this about any party -- we have the Minister of Municipal Affairs admitting that he didn't know the bill contained X. I think we even had the Premier, with respect, admitting that he wasn't sure what was in the bill.
That's frightening. That is absolutely frightening because that means that the bills that are put before the House are the product of a fine civil service we have in this province, but they're a product of the civil service. The civil service is not accountable to the people of Ontario. You are, each one of you who is elected to the Legislature.
If you're relying on the civil service, I'm sure that you will probably get the honest goods every time or most times, but just think about it. If somebody decided they wanted to slip something in and everybody just sort of let it go by and nobody bothered to investigate it -- and I suggest to you, with the greatest of respect, this omnibus bill, as it turns out, is something that would have slipped by; it would have been passed before Christmas.
Some of the horror stories that we're hearing from people who have come before this committee in terms of dealing with this bill and some of the revelations that have been produced tell me as a now taxpayer, non-politician that this is frightening. This bill could have been passed before Christmas and we would have found this all out afterwards. What do you do afterwards? It's very difficult to change it afterwards.
I suggest a very simple thing and it would be in existence for whatever party is in power and it would give true democracy to the Legislature in that the people in the Legislature would understand what they're voting on. I remember when I was there, we used to suggest that people were joined at the hip. That's not acceptable.
I'm surprised the press around here have known for ages that this is how business is done and have never raised it once, the fact that we can provide our statutes in both French and English, which is marvellous because they are the two official languages of Canada, but we haven't got to the technology to do what I've just suggested. That's my number one observation, and I pass it on to you and I hope that it will be rectified.
The second one is the question of regulations. When I came down here 10 years ago and I heard this august statement of it being by order in council, I thought, "My heavens, the Lieutenant Governor comes down and he gives his blessing to legislation." I think the public should be aware, if they're not by now, that what a regulation is is simply the cabinet, of whatever political stripe, receiving from a committee a proposal for public policy for this province and enacting it by way of regulation. It never gets to the floor of the Legislature. It never gets debated or scrutinized by the people who have been elected and given a sacred trust by the people in this province. I exhort you to take a look at a very excellent report of the standing committee on regulations and private bills, much of which can be attributed to David Fleet, who was then a member, which does an excellent report on just how the regulatory system should be changed. I urge you to read it, I urge you to get it to your caucuses, because I think it's commendable.
As you know, regulations are considered to be the silent laws for the reasons I've stated. They never get debated on the floor of the Legislature. They come before the regulations and private bills committee, and I know that. I chaired it for years. But because of the standing order, the only thing you can examine that regulation for is (1) does it offend the Charter of Rights and Freedoms, and (2) does it in fact enact policy?
We're seeing more and more statutes, particularly this omnibus bill, that contain a basket clause and regulatory powers that are no longer just regulating fees, which was the intent of regulations, or content of forms; they're regulating very serious powers to the ministries, to the ministers, in terms of how they provide services to the people of this province.
I suggest that what you're doing if you don't look at that, if you don't change that process, is you are abdicating your responsibility as elected representatives of this province to ensure that what happens to the people of this province through the laws that are passed in fact passes the scrutiny of you as elected representatives who are responsible to the people of this province. So I suggest you take a good, hard look at that report. It goes a long way.
The third thing is -- and I go back perhaps to where I started -- the whole issue of how the procedures in this Legislature operate. As you well know, at first reading there is no debate. At second reading there is extensive debate and, if you have a majority government of whatever political stripe, the bill is passed in principle, which means that you're not going to change the principle of the bill. You may tinker with it, you may toy with it, but you're not going to change the principle of the bill, because when it gets to you people in committee, the principle has been established.
Then you go out and you travel this province and spend extraordinary amounts of money to travel this province to hear from the public. My experience down here, in 10 years in the Legislature -- and this is something that doesn't just arise, this has been something that is historic -- when it comes back to the committee, the opposition members who have listened to the public usually introduce amendments.
Sometimes they introduce them because they're playing politics, yes. But more often than not they're introducing amendments to that legislation, as is their duty as the official opposition and the third party, to ensure that legislation is the best legislation for the people of this province. They introduce them, and because our structure is such that the government of the day, of whatever political stripe, has more members than the opposition, those amendments almost 99% of the time are defeated.
In essence what you've got is, you've gone out and spent probably $500,000, maybe half a million dollars, maybe a million if you've travelled extensively, to hear from the public. The public think they're being heard from, and then there's not an amendment to the bill brought in when it comes back. How long do you think you can fool the people? How long do you think you can actually get away with that in terms of telling the public that you're hearing from them and not change one i, t or anything in the bill?
As I said, my leader is the first leader that I'm aware of in this province who extensively did a report, a study, on how we could reform this place. The federal government is light-years ahead of you people. They now refer a bill after first reading to the committee. They haven't taken that next step which I'm going to suggest to you, and I hope you will pass it on to Mike Harris, who's a decent guy.
I hope you would pass on to him the fact that when it gets to the committee it should get here after first reading, before the principle of the bill is established. There should be no majority in this committee. There should be no majority that can overrule amendments of the opposition. You should travel this province, yes, spend the money to hear from the public, because that's democracy, and when it comes back to this committee, you should in fact be able -- all of you, anybody, government members or opposition members -- to submit amendments based on what they heard from the public and what they consider to be relevant in terms of what the public was trying to say about the bill.
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If you do that, it doesn't mean that those amendments are going to get passed. What it means is you then refer it back to the Legislature, and the minister of the day, he or she, has to justify why those amendments are not appropriate. It then becomes second reading, full debate in the House. The minister who is finally responsible for the legislation, truly responsible under our system, he or she then has to defend why the amendments, which are received from the opposition, from the third party or even from government members, should or should not be accepted.
Let me tell you something: If you push for that, particularly as members of the government, particularly in a government that has such a large majority, you will find that you will become empowered. If you don't, what you'll do is you'll spend five years, 10 years, whatever, here as a backbencher and the best you'll get to do is catcall across the floor of the Legislature. You will never have any input into public policy. You will have to take the tin can tied to your tail when your constituents ask you why a particular piece of legislation affected them so much, but you will not have had your say unless you are in cabinet, and even in cabinet you may not have that final say.
So I suggest to you that the time is ripe for this. People are tired. Their dollars are being spent; they want to be sure the dollars are spent wisely. I suggest to you that if you adopt some of these changes and push for some of these changes, it will make the Legislature a very much more democratized place.
I think I've basically put forward the points I felt responsible to put forward. As I say, I came down here with stars in my eyes, I was going to set the world on fire, and it doesn't happen, but it doesn't have to be that way. In fact, what you can do is you can take the power out of the central control of the Premier of the day, maybe four cabinet ministers and maybe nine or 10 spin doctors down on the second floor who in fact are making policy, not based in the main on what's good for this province, but they're making it on the basis of what the polls tell them will get them re-elected. If I'm correct in that regard, then in fact what you've done is a great disservice to the people who elected you and gave you a sacred trust to come to this place.
Finally, I have three wishes for 1996: There is an excellent report that was done by the public accounts committee -- and you can find it, and I've told Tony about it and I've told Joe Spina, the two members who replaced us in our ridings -- on learning-disabled kids. Get that report. There is an excellent presentation by a fellow by the name of Dr Hurst from northern Ontario. It is a major breakthrough, I think, in terms of dealing, not just with learning-disabled children in the schools, but more importantly, in the correctional system.
That report told us that 80% of the kids in young offender lockup are learning-disabled. That tells me that Bill 82 has got a chasm a mile wide and these kids are falling through it. It costs you $100,000 a kid to keep them in young offender lockup. Think about it. You could give that kid individual tutoring for $10,000 and keep him or her from coming back into the system. You could save $90,000, and if the government is pursuing -- and I'm sure everybody agrees they should pursue the question of deficit-cutting -- there is a great opportunity for it.
The second thing I would ask you to do is to revisit the Mental Health Act. The Mental Health Act was skewered in 1985, I think, well-meaning -- one member I can think of whom I will not name, had thought that certain things should not be contained in that bill, ie that you should not be forced to take certain types of medical treatment. We have in fact abandoned the schizophrenics of this province. The people you see floating around the streets of Toronto and sleeping on grates, many of them -- not all of them, but many of them are schizophrenics.
I would hope to God that your government doesn't retreat and take risperidone, which is a drug that's on the formulary, off the formulary. These people are street people. If they have that drug, perhaps they can carry on at least a decent existence.
Those are my two wishes and I am quite prepared to answer any questions, but before I do that, I wish you all a Merry Christmas and a happy holiday. I'm sure you're looking forward to it. This is a yeoman's task, believe me, and particularly on a Friday three days before Christmas. If you haven't got your Christmas shopping done, you're in trouble. Thank you.
The Chair: We've got a couple of minutes left per party for questions, beginning with the government.
Mr Clement: I'd like to publicly thank Mr Callahan for continuing to be involved in the process of government. I've always respected him and he always gives me what for whenever I'm not doing a good job as his servant. There was a couple of things that he mentioned which are germane to our discussions, and all of it is germane but particularly germane to what we're doing. First of all, I wanted to assure you that with respect to Dr Hurst, I have received that report and have forwarded it on to the Solicitor General, but when you were speaking, it absolutely makes more sense to also bring it to Community and Social Services and the Ministry of Education, because it's something that's preventive rather than punitive, I suppose is the way to put it. So fortunately, Ms Ecker to my right is very involved as the parliamentary assistant to the Minister of Community and Social Services, is very involved in child care and thinking of new ways of how to deliver services better.
The second thing I wanted to say was that the Premier does believe very strongly in not only the Legislature but also the caucus. You know what it's like to be in a government caucus. The frustrations that my colleagues opposite sometimes evidence publicly, it has been known to happen that government backbenchers evidence them privately. So the frustrations do exist for backbenchers and what we are trying to do, and this is only part of the solution, is to have very active caucus committees that actually help the ministers write the legislation before it goes to cabinet, before it goes to P&P, before it is written in stone I guess is the way to put it.
From your perspective then --
The Chair: Unfortunately, Mr Clement, your statement has used up all your time.
Mr Clement: I do apologize.
Mr Curling: Thank you for coming in, Bob. You're always direct in your approach to things. As you have stated, you are a lawyer, you were a politician and now you're a citizen, so you've seen it from all sides of it all. And you know how complex legislation is, bills are to be read.
What would be your suggestion if the government decides to maybe publish this in a newspaper, the entire Bill 26 in, as we would call it, plain language? Do you think that would be helpful?
Mr Callahan: I'm trying to figure out who you'd find to do it.
Mr Curling: The government.
Mr Callahan: No, no, who could put it in plain language. I think 211 pages, you'd probably up the deficit by -- I understand that people -- and this is not a criticism, I can see 211 pages -- have found difficulty in getting copies of the bill, which is rather astounding.
Mr Curling: That's the point I'm making too.
Mr Callahan: But today, with the technologies we have, we've got to get out of the 19th century. We've got the opportunity here to put it on Internet, if somebody wanted to reel it in on Internet.
Ms Lankin: In plain language.
Mr Callahan: In plain language, yes. I think it's simple enough. In fact, if you had it in plain language in addition to what I'm saying about the amendment, then the section that's being amended and then maybe a little thing on the side explaining what this does. That type of stuff is great. I think the more publication, the more public knowledge that people have, the better. If putting it in the newspaper would help people, and I think you're getting that press now -- unfortunately, I don't think you would've gotten that press if this bill had been pushed through before Christmas. The press would've just said, "Well, it's not an important story," and that would've been it.
I chide the press for that. I can do that now, you see. I'm no longer a politician. I don't have to kowtow to these people any more, but I would chide the press, because the press, who in essence have the ultimate responsibility to ensure that this place is made known to the public, they didn't do it.
Ms Lankin: I have two questions. The first one: I really do appreciate, Bob, your coming here and your overview of the process, and I think it's been very helpful for people who are watching as well. The only concern I have is the way in which you characterized what actually goes on in committee and the clause-by-clause dealing with amendments, because it has been my experience -- if the government doesn't want to listen on a piece of legislation, your characterization is correct. But it's been my experience that there are pieces of legislation that have been dramatically improved by the process of public hearings and the input and with the government listening and the opposition working with amendments that have changed the legislation.
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I remember a time as Minister of Health, when we were doing regulated health professions, a series of concerns from the public and stakeholders appearing and amendments that I decided to put forward from the government's perspective, opposition parties put forward. I remember having our legal director and the policy team doing that legislation go and meet with the opposition critics -- it was Ms Sullivan, but you were also involved too, Ms Caplan, and Jim Wilson, the now minister -- to sit down, negotiate wording to help improve the opposition members' amendments' wording so that it would be acceptable to the government. We passed a number of amendments to that legislation. We worked collectively.
I have had no contact from the minister, no sense that the minister is willing to talk to us about amendments and suggesting that we work together on amendments, as wanting to listen, and no indication that they're -- well, I mean, here we are, we're at the end of the first week. It hasn't happened and we haven't even had the amendments tabled from the government that they've already said that they're going to introduce. So there's that caution.
Mr Callahan: Could I just respond to that just very briefly? I don't want to hold up the public. Their right is to be here, not me.
The Chair: How briefly is this going to be?
Mr Callahan: Just very briefly, that you're quite right. I remember that bill having had that done, but my suggestion about first reading here or second reading back in the House is to take a recalcitrant government that is not prepared to listen to task and put them before the entire House and make the members have to participate.
Ms Lankin: I want to know what his third wish was.
Mr Callahan: My third wish is that I get home in time for Christmas.
The Chair: I hope his third wish isn't to become a doctor, which I apologize for misstating --
Mr Callahan: It's tough enough being a lawyer these days; I feel sorry for the doctors.
The Chair: Thank you, Mr Callahan.
Ms Lankin: Mr Chair, I have a motion that I would like to place and I have copies for the clerk to distribute, and I'll read it very quickly. I believe it is substantially different and I hope one that people can support.
Whereas there has been overwhelming public interest in Bill 26 and that requests to appear before the standing committee on general government far exceed the number of spaces available;
I move that this committee acknowledges that there are hundreds more applicants to present to the standing committee on general government hearings on Bill 26 than hearing spots available;
And that this committee wishes to pass on this information to the government House leader;
And that this committee recommends that the government House leader meet with the two opposition House leaders to discuss this dilemma.
The Chair: The motion has been tabled.
Ms Lankin: I would like a recorded vote. Members should be able to have the motion in front of them, Mr Chair, and perhaps you could read it once more into the record before we vote.
The Chair: Okay, we'll read the motion to make sure it's in the record. Moved by Ms Lankin:
"Whereas there has been overwhelming public interest in Bill 26 and that requests to appear before the standing committee on general government far exceed the number of spaces available;
"I move that this committee acknowledges that there are hundreds more applicants to present to the standing committee on general government hearings on Bill 26 than hearing spots available;
"And that this committee wishes to pass on this information to the government House leader;
"And that this committee recommends that the government House leader meet with the two opposition House leaders to discuss this dilemma."
If there is any discussion on the motion, I would prefer we do it when we get to a break in the action rather than hold up the presenters.
Mrs Caplan: No discussion.
Mr Clement: I think we have to discuss it, sure.
Ms Lankin: Okay. Then we can wait till the break. I'm satisfied with that.
The Chair: Okay, we'll move it to the break.
GEORGE AREGERS
The Chair: Our next presenter is George Aregers. Welcome to our committee. You have a half-hour to use as you see fit. Any questions would begin with the Liberals. The floor is yours, sir.
Mr George Aregers: I'd just like to tell the committee that I had no problem being here. I called last week and I was very fortunate to be told this morning I could be here. The agenda that I'm going to present, I've quickly done it in the past hour. I'm not a professional speaker, and I apologize. I want to tell everybody here that I've got five kids and I'm married and I've been living all my life in this province, and I'll tell you something: This is the best government we've got, Michael Harris and his team. If you just give me the opportunity to read some of the notes that I have just made, firstly, I would like to thank the organizers for this public forum who allowed me the opportunity to present my concerns.
I know that this government is on the right track. The people who are mostly bitching and groaning are the ones who have been on the government dole too long and want it to continue forever. We hear frequently, "Ramming this bill too fast," "We want to further discuss it," "Want more time." Hogwash. This is a stalling tactic. Self-interest and greed -- that's the reason most of the speakers have come before you. All are threatened that their lifestyle will be curbed by this proposed legislation.
While I was listening to the last speaker, I recall going to the last government on particular bills that I was interested in, and I found myself talking to these politicians because I wasn't a special-interest group. I'm a family man. I work hard for my money. I'll give you just four bills that were rammed through that these politicians didn't listen to.
The building code: That was rammed through. Sure there were hearings. Penalties were made if you just put a little spike or a post -- fines of $50,000. A person could lose his home. And then what you had, the NDP put in the victims' tax -- 15%. Who did that victims' tax go for? Have you people ever found out? Where does it go? Horror stories where you give this 15%. You get a ticket -- 15%.
Then we had the Municipal Act, Bill 163, another horror story. You could own a piece of land tomorrow. "It's yours, yes, but you can't do a damn thing with it." There was public input. I got up. "Sit down, fella. You're not a special-interest group."
Then there was the equity bill. That's another horror story. I've got five kids, four of them who are in their 20s. They can't find a job. Why not? Two of them aren't female, not one of them is disabled and not one of them is a minority. But they're the second generation here in this country. When I went to this last government, they laughed at me. However, that's what came to my mind when I heard this last speaker.
What you have here as the problem in Ontario is the self-serving politicians, and I don't have to explain that; and various special-interest groups and associations have been the problem. For the first time we have a government that is listening to the working poor. I do not want myself to be continually overtaxed to support a vast number of welfare bums. I'm sorry I'm using this language and I normally don't. This piece of legislation is the right step forward. However, it does not go far enough and quick enough.
Our medical system has degenerated from the best to the Third World class. Our medical association leads us to think that it is the best. The reason that prompted me to be heard today was the continued threat to this committee here that the good doctors will leave Ontario for the States. I am involved with the health field and I know a lot of doctors, and my wife does. I'm not saying I'm an expert, but I know from personal experience that the medical association wings must be clipped now. They have continued to protect their association members with little regard to the public they serve. Would you believe the medical insurance doctors want us to pay through OHIP if they're negligent on things? Why don't they pay it for themselves? If they're negligent, they get sued. Let them get out of business.
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My proposals on the thing to relocate doctors in needed areas -- that's rural areas -- to curb overspending are these: This piece of legislation should go further and demand that all foreign doctors be allowed to practise without any roadblocks that the medical association has now. For example, why is it so easy for our doctors to go to the States, and they're welcome, but any American doctor who comes into Canada, you say, "No, you've got to pass an exam and then try to get to be an intern." That's virtually impossible. It's okay for our doctors to go to other countries, but we don't allow other doctors to come in. The Americans are nice to us.
Then we talk about -- you know, I hear a lot of this from the NDP and the Liberals -- that we don't want medical records opened up. Why not? I've got nothing to hide, but the doctors have something to hide: the vast numbers of overbillings and the vast numbers of prescriptions. All billings by doctors should be made available to the public if I want to know. Just like a bill that has been passed that civil servants making over a certain amount should be public, I think all doctors' billings should be made available to the public. If I want to know what my doctor charges, it should be posted on the wall how much he made last year and the year before.
How long is this province going to pander to special-interest groups? I don't care if some civil servant can look into my OHIP account if the doctors are overbilling. What's the problem? If someone knows my medical history, I'm not going to get fired. We've got laws to protect us. The doctors and their associations have milked the system. Before OHIP was introduced, no person was neglected. The system worked well.
I don't know if I'm older than a few of you people. When OHIP was introduced, I remember I got a bill from OHIP to tell me how much my doctor billed OHIP. Slowly, the association confronted the present government, Davis at the time, and said, "We don't like that. Maybe George's wife might take a look and find out he's got some communicable disease," so all of a sudden that receipt or something like that which went to the patients was totally wiped out.
We don't know, as patients, what the doctors are charging us. Are they abusing the system? We know from a lot of studies that the doctors are abusing it. I think this government that we've got today is going to open up things. I don't like to go to doctors and keep going to them and going to them and be tested on and tested on when it's not necessary.
This government should take a look at Israel. They've got a fantastic medical system, one of the best, and do you know, all their doctors are actually close to minimum wage? The doctors aren't leaving. The best hospitals are in Israel -- the best.
I think really what we should have is just private contracts to accountants that the way they should be paid is how much fraud and overbilling they find. That would cure our medical system. Because I tell you that if we don't get this thing rolling, there's not going to be enough money for any one of us. We're going to be our own doctors.
Today, there are a lot of senior citizens, and I get to see that every day in the line of work I do. Their medicine cabinets and purses are just full with prescriptions -- continually, continually. I had a good friend who just had, last week, a stroke, and it turns out his doctor pumped him with so many pills that he didn't know this person had diabetes. He's half-dead now. What can you do about this doctor? Nothing. I don't want to be like my friend, in hospital at Toronto East General.
The medical association is no different than heads of unions. They are not there to protect the patient but their colleagues and members. Let's open Ontario's medical doctors' books.
The second part of me talking is that I fully agree that the transfer payments to the municipalities be cut, as they are, or further. For many years the municipalities have taken the payments to be free money, without being accountable. It's been easy for welfare recipients, and all kinds of other programs the municipalities do that are funded by the province, to receive payments because the money was not from the municipalities. There always have been very few checks by the province if the payments have been issued to the real needy.
In this bill that's been proposed by this government, I feel that the municipality will be more accountable. It is a fact that the municipalities spend the most money of all governments, the provincial or the federal, but you know, it's always the provincial that gets the abuse, it's always the feds, it's never the municipalities.
I think a lot of the money that's been given to the municipalities, there haven't been checks. I think this bill is the appropriate one, perfect. I for sure will know when money's been spent foolishly that I can go to not my member of Parliament, but my council members or my mayor and say, "You haven't spent it right." I don't want to blame Harris or anybody else.
You know, I keep hearing on TV that there are such things called poll tax, gas tax etc. This is fearmongering. It's perpetuated by municipalities. If they took proper care, as I said, in spending, they wouldn't have to fearmonger all the residents. There's no need for such taxes.
The most spending done by many municipalities is Ontario's money, which requires accountability. This new bill will give the residents of a municipality an indication of how good their municipal government is. For years, the provincial government has taken the whipping on overspending. It's about time that the real spenders, the municipalities, be made accountable.
For ending, I'd like to say, good work, Michael Harris and his team. It's a fantastic team. I've never seen such a good team. Really, sincerely, the people who Michael Harris has chosen, they're the best. Thank you very much.
The Chair: Thank you. Are you prepared to entertain some questions, sir?
Mr Aregers: Yes.
The Chair: We have about two and a half minutes per party left, beginning with the Liberals. Mrs Caplan.
Mrs Caplan: I have no questions. I want to welcome you to the committee and thank you for coming. I've been arguing and hoping that other people can come and express their views, whether they're your views, which I don't agree with, or views which I do agree with. I believe this is a democratic forum. We have an obligation to hear people who want to come here and express all kinds of views. So I just want to thank you for coming.
Mr Curling: I just want too to say to you that I'm glad that the opportunity was provided to you, because overwhelmingly the other side is saying that they're against this. Now you've put your point of view and those can be weighed.
Ms Lankin: Mr Aregers, thank you for appearing. I'm sure that the government members will be heartened by your unqualified support for the whole team. I'm not sure how you've had a chance to assess that whole team yet -- we're all still starting to get to know them -- but I'm glad you have that faith in them.
One of the suggestions that you made with respect to the act, that it should go further, I think you were expressing a potential solution to how to deal with underserviced areas with respect to doctors. You said that all foreign doctors should be allowed to practise without any roadblocks. Are you aware that there are currently procedures in place and that foreign doctors who are recruited to come in to serve in underserviced areas, in fact the roadblocks are removed and those people are brought in? The Minister of Health has that opportunity to sponsor people through the federal immigration process.
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Mr Aregers: Yes. But Frances, my wife is a doctor, not in this country, and I know that there is some grumbling that there is this, but she is told that she has to pass these exams. I've looked at exams, I'm a professional in certain areas and it was even hard for me to answer these questions. Even I couldn't find them in textbooks, and also I found that it's very hard to become an intern in this country -- very hard.
The thing is that the Immigration department is going around all over the world saying, "Hey, we need more doctors." But there are so many doctors out there who are car-washing, and it's true. My wife has got lots of friends. I mean, let's make it easy for these people.
The thing that makes me mad is that these doctors are saying: "Hey, we're going to threaten you people. We're going to go to the States." But why are the States so nice to us and saying, "Your doctors can come in and practise," but we make it so hard for anybody to come in?
Ms Lankin: I think the point that you make in the broad sense, about acknowledging foreign credentials and assisting them to do that, is an important one. In fact, the government has said it's going to put something in place to try and make that easier. I think that's a good point.
I would just very seriously caution you that with respect to physicians, if you're talking about for underserviced areas, fine; if not, you're handing out billing numbers in the Toronto area that this government is saying it doesn't want to do because it's already overserviced and that will cost the system more. So your suggestion actually is running counter to what your government is proposing at this point.
Mr Aregers: But Frances, please let's check and see what they're making. My wife does work with the doctors and I'm telling you what they're doing is criminal, I mean, unbelievable. I don't want my wife getting into trouble, but the way they're billing -- there are a lot of people who are forced to come back and back for tests that are not necessary. There's got to a system of opening it up and checking these doctors. I don't like to see, when I turn on the TV, that they're coming in front of you people, crying. It's not right.
The Chair: Thanks, Ms Lankin. For the government, Mrs Ecker.
Mrs Ecker: Thank you very much, Mr Aregers, for coming. I think one of the unique things about the hearings on Bill 26, as we go through this, is that we're hearing not only from organizations of various kinds that are used to coming forward to hearings like this, but also from individuals like yourself who have felt, for whatever reason, that you wish to come forward and let us hear your views. So for that I certainly thank you.
You make a very excellent point about overmedication of seniors. Actually, we were just handed, while you were speaking, a study that estimates that the misuse in that area can add up to about $7 billion to $9 billion, which is about as expensive as treating coronary heart disease as it costs the system. So we would certainly agree that there's a lot more that we need to do in terms of utilization guidelines, education of both physicians and patients about medication for seniors.
I wonder if you would also comment, and obviously your wife is working within the system -- you've mentioned your views about physicians who are misusing the system. One of the things I've heard very much from physicians is that patients are not necessarily using the system appropriately, that they're "double-doctoring," is the phrase, as you know, going to see a range of physicians for the same services and that kind of thing. Do you think that is also a problem in the system? Is that something that you and your wife have assessed?
Mr Aregers: Yes, it's there, but I think that doctors are at fault. There's one particular doctor who I know only wants to treat people who don't have a severe problem, heart problems, and any time some senior citizen gets severe heart problems he says, "Go to the emergency," and a young doctor will pick him up. It's a horror story.
I've got another one there that the system doesn't check for. This person's on welfare, he's a taxicab driver, he continually comes where my wife works and he wants prescriptions all the time. He goes from doctor to doctor, he loads his taxi with them and guess what? He sends them out of the country and he gets $150. There's abuse out there, Janet, serious abuse.
The Chair: Thank you very much, Mrs Ecker, and thank you, sir. We appreciate your coming forward this afternoon and being interested in our process. Have a good day.
Ms Lankin: Mr Chair, I'll say this is a point of order and you can tell me whether it is or not, because I'm not sure. A point was just make by Ms Ecker that one of the unique things about these hearings is that not only groups were coming forward but that individuals were coming forward. I wanted to clarify on the record that there is nothing unique about that with these hearings at all, that in fact in all public hearings we've had on all major policy pieces of legislation, groups and individuals have come forward. We welcome them, and that's why we would like to have more hearings, so more groups and individuals could come forward to speak on this bill.
The Chair: It's not a point of order, but obviously you got it on the record.
Is Doris Grinspun here? No? Okay, let's get back to the motion that was to be tabled a few minutes ago. Does anybody wish to speak on the motion?
Mr Clement: I'm afraid I'm going to have to not support the motion, that is to say, vote against it. Again, Ms Lankin, no offence, but I'm just having difficulty characterizing the process, with which all of us are involved in the same manner as you, and therefore I reach different conclusions, which militate against my supporting your I'm sure well-meaning motions.
As I said earlier, we are seeking and getting a broad range of views at this committee for Bill 26, against Bill 26; for splitting up the bill, against splitting up the bill; for substantive changes that are encompassed there and vociferously against. That's what this whole process is all about. From my perspective there's no dilemma here. We are just about to go on the road, where we'll have another two full weeks of hearings on this matter and hear from other communities outside of Toronto. But we've had five very robust days in Toronto. That is why I cannot support the motion.
Ms Lankin: I would like to speak to this motion but I just have one quick question of Mr Clement. If I were to amend this and drop the last word, "dilemma," and just ask the House leaders to discuss this, period, would you support this?
Mr Clement: As I say, I do not agree with your characterization.
Ms Lankin: Which characterization?
Mr Clement: Your description of what we are going through and therefore your conclusions. I should also mention, which I forgot to mention, in paragraph 3 she wishes to pass this information on to the government House leader. The government House leader is aware of our circumstances so there's no real need for this committee to formally do so.
Ms Lankin: I want to make sure that everybody understands exactly what it is that Mr Clement and I assume his colleagues are going to vote against. This is the third occasion I have tried to get the government to acknowledge what is occurring with respect to the applications to this committee for spaces to present. I have, in each subsequent motion, tried to modify it, to present more information. This one is about as bland as I could make it; it is about as inoffensive in terms of taking a position one way or the other.
I want to make sure everyone understands the words. I would ask that, and this is what I'm moving, "this committee acknowledges that there are hundreds more applicants to present to the standing committee on general government hearings on Bill 26 than...spots available." I have informed you, direct from the clerk as of 5 o'clock last night, that there are a total of 862 applicants. We're just about to finish the Toronto hearings. When we go on the road, as of 5 o'clock last night there were 599 applicants for 274 spots, and the clerk tells me that more people have called today.
It goes on to say that we wish "to pass on this information to the government House leader." Heaven forbid that the government members let this committee pass this information on to he government House leader and that we ask the government House leader to meet with the other two House leaders "to discuss this." I've taken the word "dilemma" out. There's no judgement in the motion at all. It simply acknowledges what is occurring in this province in terms of the interests of this bill and the fact that there isn't enough time to hear all the people who have applied, it passes the information on to the House leaders and it says: "You guys meet and discuss it. If you're not going to do anything about it, fine, but we recommend you discuss it."
You can't get any more innocent in its direction, without judgement, without comment on the government. There isn't anything here that you as committee members should find yourselves unable to support, other than just going along with the pack and doing the government line and, "The Premier said we don't want to talk about this any more, so it doesn't matter what we hear from any committee members who come in here; we're just going to vote along with the pack." That's the only reason I can see for it. Mr Chair, I would like a recorded vote.
Mrs Caplan: I'm going to speak in support of the motion. I think it is reasonable for the members of this committee, who are acutely aware of the tremendous interest in this bill and the desire of citizens, individuals and organizations and associations, not special interests but people who have an interest in this bill and wish to come before this committee and have a say, in huge numbers, frankly, that I don't think we've ever seen. The reason we've never seen those kinds of huge numbers is that we have never seen, in the 10 years I have been here, and I'm only going to speak to that time frame, a bill like Bill 26 that delivers as much power to the hands of the government in as many areas.
We have never seen as many significant policy decisions possible, not even having been made, just the potential for those decisions, and what we're finding out is that as people are aware of it, they want to come and have their say.
Whether or not the government House leaders, and ultimately the leader of your government, decide that they want to allow additional time or not, we know it's their decision and you are given instruction as to whether to support this bill or not support this bill, support amendments. We've both been in government. We understand your role in committee.
But I want to tell you something. All three of you are new members here. You heard Bob Callahan, who was here for 10 years, talk about the role of the individual government backbencher. If you ever want to be able to influence within your own caucus, you have to be willing, when there is something that is as benign as this -- and it is a very benign motion that just says: "Look, there are a lot of people who want to come. You should be aware of it, talk about it, and if you decide there's something you want to do about it, it's up to you."
To resist passing along that information, what it says to me is that you might as well put tape across your mouths and tie your hands behind your backs. You are going to have no influence whatever in this place over the next four years unless, by your actions of keeping your mouths shut and sitting on your hands, you expect that's going to mean a promotion for you. If you're doing this in your own self-interest, you're not acting in the interests of your own constituents and of the people who want to be heard here.
People don't think very highly of politicians, and it's because when they see people sitting in hearings like this who are not even willing to pass along information because it might be seen as a career-limiting move, and act in their own self-interest as opposed to the interests of their constituents and those who want to come before this committee, then you deserve the public disdain you will get if you vote against a motion like this which just says: "Here's the situation. We've got 900 people who want to come before the committee. We haven't yet advertised. This is the situation. You should just be aware of it." I can't understand why you'd vote against it.
I've sat on committee. I've been a committee member. I've always felt that committees should be free to at least give information to the government, and committee members have to feel they have some role to play. I have felt tremendously frustrated at these hearings and that frustration on occasion has erupted. But I can tell you at this particular moment I'm feeling a profound sadness because you are diminishing the role of every member of this committee by refusing to support this amendment.
The Chair: Okay, Ms Lankin has called for a recorded vote. All those in favour of the motion?
Ayes
Caplan, Lankin.
The Chair: All those opposed?
Nays
Clement, Ecker, Johns.
The Chair: The motion is defeated 3 to 2.
Our next presenter is not due until half past 4. But in the essence of time let's just adjourn for 10 minutes in the hope that maybe she'll come a few minutes early.
The committee recessed from 1605 to 1632.
DORIS GRINSPUN
The Chair: Welcome, Doris Grinspun. You have one half-hour to use as you see fit. Questions, should you allow time for them, would begin with the New Democrats. The floor is yours.
Mrs Doris Grinspun: Thank you very much for the opportunity to share my views on Bill 26 with the committee. I am presenting to you as a concerned citizen of Ontario and as a conscientious registered nurse.
My first concern deals with what I see as an attempt to violate the democratic process. Being born on a continent where democracy is constantly violated, I see the attempt to pass a bill, especially one as significant as Bill 26, without adequate consultation as a serious potential danger.
My second concern stems also from my background. Originally from Latin America and later on living in the United States, I have seen the great human suffering which derives from a two-tier society. My spouse and I chose to come to Canada and also chose to become Canadian citizens of what we believe is a magnificent country. We also had the privilege to choose to live in Ontario.
During my voluntary work as a consultant for the World Health Organization in different countries, I always take great pride in sharing my experiences of living in this amazing country. I say to people that Ontario, my province, defines health as a right and not as a privilege. I share with them that here, regardless if you are poor or if you are rich, you get the same type of health care services. I also tell them that here, one is not afraid of aging or not afraid of becoming ill.
We, as many that I know, chose to become Canadians because we wanted to participate and raise a family in a fair and just society. I am extremely concerned. Was this just an illusion? Can Ontario change so drastically its values just with the change of government? I hope this is not the case.
Let me detail my concerns with (a) violation of a democratic process, and (b) moving to a two-tier society.
(a) Violation of a democratic process: Mr Harris stated during his campaign that a central goal of his government, if elected, would be "to empower the consumers of the health care system with the rights to proper care and to participate in decisions regarding that care." That was stated, as you well know better than me, in the Mike Harris Forum on Bringing Common Sense to Health Care.
I am extremely concerned that this goal was not kept in mind in the initial attempt to pass this bill without consultation. I become very worried when a government requires public pressure to maintain democratic processes. The attempt to pass Bill 26 without consultation is in my view only a symptom of a very serious disease. As Robert Vipond stated in his column in the Globe and Mail on Monday, December 18, "Whenever a king, a president or a cabinet make important decisions of great significance without consultation, there can be no democracy."
I am glad that Mr Harris has listened to the voices of Ontarians and responded with opening the bill to public hearings. However, great concern remains. Has he indeed not only listened to the voices, but also heard the message? For one, a bill which alters 44 provincial statutes and creates three new ones is far too extensive to deal with as one bill. With the short notice made available for the hearing, I, for example, could not review, even less interpret or understand well, all that is contained in this enormous bill.
The bill, as I understand it, introduces new and extraordinary powers for the Ministry of Health, some of them impinging on the right of citizens for privacy.
The intent of the bill is also, in my view, unclear. For example, the power to disclose patient files is claimed to be needed in order to decrease fraud. However, this section could also be interpreted as giving the power to the Ministry of Health for transferring patients' files from OHIP to private insurers. How can Mr Harris or Mr Wilson assure me, a citizen and a nurse, that disclosure of patients' files will not be used for a purpose other than that which is claimed?
(b) My second concern, moving to a two-tier society: The health of Ontarians is under attack not only through the health care provisions of Bill 26 but also other government measures. Health is going to be impacted through the dismantling of our social safety net, the funding cuts to community organizations and to education.
As a nurse, I don't see health as the absence of illness; I see health as something much, much broader than that. Innumerable studies show the direct link between socioeconomic status and health outcomes. There is absolutely no doubt that the dismantling of our social programs and the horrible prospect of a whole generation of Ontario children growing up in poverty is going to bring a huge increase in health care costs, and serious effects on our quality of life, a deteriorating social fabric and increased social problems such as drug use, crime, suicide, family breakdown, an increase in mental health problems, and a sense of insecurity, particularly for women and the disadvantaged. This may be the fate of Ontario in the future. Unfortunately, I know first hand what it means to live in a two-tier society. This is not what the government had promised in the Common Sense Revolution.
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I would like to expand a little bit on that, because talking with colleagues, nursing and otherwise, it seems to me that somehow people think that when you have a social problem, it only affects the people who are in that group. Let me tell you that I lived for 18 years in Chile, I am the daughter of a very well-to-do family and I can assure you that is not the case. When I see my sister still living there who needs to have a guard outside of her house because of social problems, because of poverty and mothers who, when they don't have any money to buy food for their children, will do whatever to get that food, because that's what they steal sometimes, just food, it's not fun to live in a society like that -- not for the well-to-do and not for the poor.
Make no mistake, health care costs are not diminished when you deny an individual the ability to become productive because of lack of health care services, in the same way that health care costs are not diminished when you force a person on social assistance or a senior to copay for prescription drugs or you allow drug companies to set up any price they wish. What really happens is that magnified costs appear in other forms, such as is happening now with the deteriorating health status of people on social assistance, resulting from the cuts to social welfare programs and, as it may happen, when a person on social assistance will have to forgo medicine since they cannot pay the user fee. Actually, you can see that in San Francisco, not in countries farther than that.
An additional concern relates to schedule F, part IV, amendments to the Independent Health Facilities Act, which states that the minister has the ability to authorize the director to issue a licence to a specific person to operate a new facility without a formal request for proposal. This amendment, in the context of no preference for Canadian health care facilities, could easily lead to more US companies entering the Ontario health care industry. Some US health care companies are notorious, as we know, for placing profit above other considerations, and increasing their role in Ontario is sure to unleash, in my view, forces of privatization and regression towards a tiered health care system.
Mr Chair, members of the government and of the opposition, while as a citizen and as a registered nurse I believe that Ontario's health care system needs serious restructuring, I question the thoughtfulness of the changes proposed in Bill 26. I am concerned that the bill, if passed, will change in a fundamental way a health care system in which we all take pride.
I am also most concerned that the proposed changes will increase rather than decrease health care costs. I fail to see in this proposed bill how registered nurses will be better utilized within a health care system. I am sure that you are as aware as I am that registered nurses as well as professional models of care delivery have significant impact on the rates of morbidity, mortality, decreased lengths of hospital stay and readmission rates. The studies that I mention there in your brief are studies conducted by, in general, doctors, not nurses, so they're not self-serving studies.
This bill, in my view, represents a dangerous step towards weakening a worldwide-respected Canada Health Act. I recommend:
(1) Bill 26 should be partitioned into smaller acts, each one clearly specifying its intentions and its impact.
(2) In the redrafting of the act, the government will remain truthful to its election promise of:
-- not tampering with the Canadian Health Act;
-- maintaining the integrity of our current health care system and only making changes that will improve the current health status of Ontarians;
-- not cutting overall health care budgets but, rather, reallocating budgets appropriately;
-- and, lastly, empowering the consumers of the health care system to participate in decisions regarding that care by widening and extending the consultation process.
I thank you for listening.
The Chair: Thank you very much. You've allowed some time for questions. We've got about five minutes roughly per party, beginning with the New Democrats.
Ms Lankin: Mrs Grinspun, thank you very much for your presentation and for sharing with us your experiences, both here in Canada and internationally. I am struck just listening to your recommendations and particularly your plea that the bill be split up and that there be further time for consultations. I am not sure if you are aware, but I have attempted three times this week to place motions before this committee to express the need for those sorts of things to happen. The last one was quite innocuous. It just said, "Let's acknowledge as a committee that there are hundreds more people who have applied to come and be heard than there is time for under the current schedule of committee hearings and let's pass that information on to the House leaders and ask them to discuss it." The government members are the majority and they've defeated every one of those motions, including that last, very innocuous motion. It seems to me to be a fairly strong indication that they are not prepared to listen to what I calculate to be about the 85% to 90% of the presenters who have been here before us this week who have expressed those various concerns.
You have a moment here to speak to these people, and I am sure they're going to continue to hear this. It's only if the public convinces them that they might listen. I can't convince them, obviously.
Mrs Grinspun: Yes. I want to tell you my own experience, okay? I consider myself a well-educated person. I'm currently in the third year of a PhD program, so one could say that my intelligence helps me, or should be with me. This is a huge, huge document. There's no way any person can absorb it in such a short time. Actually, I was here the last three days during the hearings, in the evenings. I came after work because I was very interested and very concerned with what is happening. Yesterday evening, the last gentleman who presented here, I was quite amazed but not surprised he didn't know anything about the bill.
I have talked with colleagues from nursing and otherwise. They know very little about the bill. And we're talking about educated people. What about the broad public? If we are talking truly about the democratic process, I think that once you start to tamper with the democratic process, there's no end to that. That's why I say it's a symptom and I think you all should be very cautious with that. It's dangerous.
I will repeat again, there's no doubt that there needs to be serious restructuring. I think that your government, as well as previous ones, agrees and has said that and has done from their perspective what they thought. As a nurse, I as well as any other nurse you will ask will tell that we would agree that restructuring is needed and will be more than willing to participate in that. The question is: What do you restructure? Do you restructure the Canada Health Act? I don't think so and I don't think you will get support from any nurse for that, quite frankly, although I am representing only myself.
I think you need public hearings to really absorb, digest the immensity of what you are proposing here. Do it part by part, do different sections and then see which ones really are going to improve the health status of Canadians and which ones are not going to do that.
Ms Lankin: Very quickly, you have extensive experience and you have in your comments reflected on the determinants of health. This government has cut income assistance by 20%; capped pay equity payouts to the lowest-paid women; eliminated social housing projects; taken regressive steps on environmental measures; put user fees in for community recreational services, or at least allowed municipalities to do that; reduced access to early childhood education. Are we going to have a healthier society as a result of these moves?
Mrs Grinspun: No. I think we are talking more about the value issue than about understanding what impacts health, quite frankly. Anybody who understands health knows that the key determinants for health are socioeconomic status and education, in any country of the world actually. Basically it's a question of values. Do we value continuing to move this province forward? If yes, then we need to invest in health and in education. If we don't value that, then we will have a portion of the society that will have that and a portion that will not. It's an issue of values.
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What I want to caution people who don't share those values -- and I am not assuming that anybody here doesn't, but I want to state that -- is that once you have a two-tiered society, meaning those who have and those who have not, being education, health, money, happiness, whatever, it doesn't impact only those who do not have. It makes a miserable life for everybody and it makes a very unpleasant place to live.
The Chair: Thank you. We have to get on to the next question because we're rather tight on our time frames here. For the government, Mrs Johns.
Mrs Johns: I'd like to thank you for coming today and putting this presentation before us. Nurses are very important in health care and we recognize that from the standpoint of the government.
Mrs Lankin has given you her opinion on why government is doing what they're doing. I'd like to just say that from my own particular vision, not talking for anybody else on this side, I have two very small children, four and six, and I feel very strongly about why I'm here. I believe that with a $100-billion debt, if we allow it to grow at the rate we've been letting it go, there will be no health care for my children, there will be no education for my children.
From my standpoint I have a vision too, and it's just as admirable as the people who are across the table. I believe that we're a "have" generation and we have to make sure we spend within our means, and I believe the people of Ontario believe that too. So from my standpoint, to tinker with the system as opposed to fix it once and for all is just not an acceptable alternative.
I look at this and I look at this democratic process that's happening here and I say: "Give me amendments. Tell me what you think is wrong with the bill." But I want to proceed forward because I want to make some substantial change so that this debt doesn't increase one more cent for my children. It's important to me; that's why I ran for politics. I'm not being political. It was quite a step, and with young children it's even more of a step, but I have that ideology.
We all agree that there has to be change. You said there has to be change. We can't just tinker; we have to really look at how we're going to make change. Hospital restructuring is one of the areas we believe has to happen in Ontario. I'd like to ask you, as a nurse and working in the system, how the nurses can best help us work with change in the hospital restructuring. I understand that there's a joint provincial-nursing committee and the health sector training and adjustment program. How effective are they? How will they help us manage the change we have to have in hospitals and health care in Ontario?
Mrs Grinspun: I will be happy to answer. I only want to ask you a question based on your comments. I am sure, I have no doubt in my mind, that you are concerned about your children, as I am about my children. We also need to be concerned about the children of people who have much less meals than you and I.
Mrs Johns: I agree with you.
Mrs Grinspun: My question is, how can you explain from the point of view of the government such a concern with deficit when actually we will be moving $5.5 billion from public funding to $5 billion on decreasing taxes? Who is going to benefit from that?
Mrs Johns: I don't want to get into that debate today, because I believe that there's two parts to our program.
Mrs Grinspun: Yes, but it is a concern.
Mrs Johns: To stimulate and to have jobs for people is the most important thing in Ontario, but let's get on to the hospital restructuring.
Mrs Grinspun: Yes, it is a concern. It is a great concern and I needed to express that to you.
In any case, in terms of hospital restructuring I also will pose a question to the government, as well as to the previous one actually. I haven't seen any relocation of registered nurses from hospitals to communities, and I don't see that happening now. I don't see absolutely any mention of it here. We are talking a lot about decreasing costs by addressing the medical profession, and I will not get into that theme. But my question is, how come we haven't looked at other health care professionals such as nurses, nurse practitioners, which were initiated with your ministry, really more introduced within the content of the bill?
Mrs Johns: This government has looked at nurse practitioners by putting them into the education --
The Chair: Mrs Caplan.
Mrs Caplan: Thank you for an excellent and thoughtful presentation. I think you raised an excellent point, and I think it should be addressed, as opposed to being glossed over.
The point you made was, how can you justify a $5-billion tax cut which is effectively giving additional dollars to the people who have the most in our society when you're saying you're concerned about the deficit and the debt? The fact is that the government members have to answer that question, because the $100-billion debt that we are all so concerned about is going to continue to increase and will be more than $120 billion by the end of their term in government, primarily because that tax cut is going to require borrowing, tremendous borrowing. The deficit is not going to be reduced to zero until March 31, 2001, and the debt will continue to grow until that point in time. The primary reason that debt will grow is because the $5-billion tax cut, annualized through that period of time, will require enormous borrowing.
I think your point is well made, and you deserve that answer. The reason she glossed over it is that it's unjustifiable. They can't justify it, so they don't want to talk about it.
The other part you said is the need for consultation, and I couldn't agree with you more. The government members say how important that is. But we just received a letter today with the presentation from the Ontario Nurses' Association. You're a nurse. I don't know whether you're part of the ONA or not, but they said this:
"We would have expected this government to have sought our input prior to the drafting of any bill of this magnitude and importance. We urge the government to extend the consultation process to allow the Ontario Nurses' Association and other interested bodies to give these important changes due consideration."
We've heard from presenter after presenter, from the Ontario Hospital Association, the Ontario Medical Association, the College of Physicians and Surgeons, and the Ontario Nurses' Association through this letter, that there was no prior consultation. These committee hearings are the first opportunity for all of those front-line individuals and organizations to come before the committee.
I appreciate your coming today. I don't really have a question. You've been extremely articulate.
I despair that they have not consulted beforehand on what I consider to be the most comprehensive, extensive and unprecedented piece of legislation this Legislature has ever seen. I can only speak for the last 10 years that I've been here, and I can tell you that I've never seen anything like this.
The thing that concerns me the most -- and if you want to comment on it you can -- is that this is not policy-driven. You raised it very well when you said: "When you say `restructuring,' do you mean the Canada Health Act? What do you mean?" This bill doesn't say what they mean. This says "tools." That means power, absolute power, in the hands of the government to do whatever it believes in the name of restructuring should be done, and it can be done without any further debate or discussion or scrutiny. This is about the accumulation of those powers. You've come from a country where you've seen that kind of power in state control.
Mrs Grinspun: I think personally this is a wonderful country.
The Chair: Unfortunately, the time is up. We appreciate your interest and being here today and making a presentation to us. Thank you very much.
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ROBERT RICHARDS
The Chair: Dr Robert Richards, come forward to whatever mike you choose. Welcome to our committee. We appreciate your being here. You've got a half-hour to use as you see fit. Any questions you've left time for will begin with the government. The floor is yours, sir.
Dr Robert Richards: My name is Robert Richards. I'm an individual practitioner. I may take about four minutes to present, because Mrs Caplan just said what I came down to say.
I was in bed this morning and I listened to the radio and heard there were cancellations, and I said, "My God, that's better than Christmas shopping." I tell you, you're better to be here. The traffic is bloody awful, north and south. You're not missing anything, believe me.
I gave you my little curriculum vitae because I am an individual physician and as such, there's an immediate perception. I'm in private practice with a partner. My background includes working in 18 different hospitals in Quebec and Ontario, I've been in administration work, I was in the Navy, I worked in a youth drug clinic in the streets, and now I'm in private practice. The reason I say that is just to show that my comments come from someone who has been in fee-for-service practice and community practice and military practice and hospital practice and societal practice, just to show you I have a broad background. I don't have any particular axe to grind. My concerns today are not particularly about that.
I've got several points to bring up, and they're listed at the bottom of the sheet there. My concerns about this bill are the civil liberties concerns; my concerns as a patient, because I am a patient -- I've had a lot of things; my concerns as a physician; and particularly my concerns about the recent misinformation concerning the profession.
No system is ever perfect, and scapegoating is easy. Good faith is essential to any system to provide the best medical care to the public. Good faith is a very delicate matter and is now being injured by advice being given to the minister. The first thing I want to talk about is the attitude and good faith of the profession. The attitude and good faith of the profession are absolutely essential, with mutual respect, with regard to both administration and the patients. Without that mutual respect and good attitude, medical care obviously suffers for us all.
The recent comments by the minister and particularly by his advisers -- who those are, you would know better than I -- have been insulting, denigrating and down-putting to the profession. As such, they've caused a problem in attitude that I believe is eventually a disservice to patients. The scapegoating and innuendoes must stop. The comments about over-seeing patients, unnecessary tests, unnecessary referrals, all that sort of thing, this constant theme is constantly talked about. No fact has ever been given.
My first appeal is that when all this material is done, ask them for facts. No system of any type, I don't care if it's a system in Russia or a system here, is ever perfect. No system is perfect, and it's sure easy to scapegoat any system which isn't perfect, but when you scapegoat it, ask for facts. If you're going to say the fee-for-service system is crappy or the capitation system is crappy, that's fine, but ask for facts and ask for facts that document the virtues of the other. We've not had that from this bill or indeed, Mrs Caplan, from some of your bills -- but that's irrelevant. We want the facts.
The recent comments concerning fraud and so on and so forth are an insult. We've had a government-controlled monopoly of medicine, practically speaking, for 25 years, with very, very well-entrenched investigation methods and accountability, with the Medical Review Committee of the college and a variety of other things, extending right up to the Ontario Provincial Police. For them to be claiming that they need these draconian measures to be put in place for fraud is just nonsense. They're using a sledgehammer to kill a fly.
This is a great concern, because it causes a great change in attitude of physicians, which is a disservice to their patients, and it's also making, unnecessarily, the revealing of patient records.
As an aside, I have some personal problems at the moment. I don't want them in the records, and I'm going to be getting my personal matters done in the States very shortly simply because I don't want my personal stuff on medical records here. I know there are quite a few patients like that. Fortunately, I'm in the position where I can afford to do that and have the knowledge to do it and medical colleagues in the States, but many other people don't. Our medical records are simply too accessible.
In short, the minister is getting bad advice, and the minister should ask for facts and not opinion. The scapegoating must stop, because what for many of us in medicine was our whole lives has now become a job, and that's a constant theme from my colleagues. What was a life's work has become a job -- a conscientious job, an interesting job, a nice job, but not quite the way it was before. That scapegoating is much responsible for that. The scapegoaters constantly talk about money, money, money, money, money, but it isn't just money, it's the constant down-putting.
I would ask you all to reflect. When in the last 10 years have we ever heard a senior civil servant say one good thing about the medical profession in Ontario, one good fact? Every once in a while the Toronto Star comes out with some major surgery, this or that, but when did you ever hear one good thing about regular practitioners in the province of Ontario from someone coming from the government side?
He's a little bit older than me but there was a good friend of a friend of a friend of a friend years ago by the name of Othello who had an adviser by the name of Iago or something like that. It makes one wonder sometimes about the advice: What's in it for me or what's in it for them? That's the first point. Ask for facts.
The next thing is controls, and this is what Mrs Caplan was talking about when I came in. It's my view that central-government-controlled monopolies have never worked in any jurisdiction anywhere in the world, in eastern Europe, and even Britain when it went through that short time demonstrated this. This committee demonstrates process. We're not turning control over to even the MPPs. The MPPs come and they go. We're turning control over to the senior civil servants, who stay there. There are no checks and balances.
You may remember a very august report written by Mr Macaulay on the commissions and agencies in Ontario back in 1989, and he had pages and pages and chapters and chapters upon the checks and balances of the commissions and agencies. My Lord, in this particular case, we aren't even dealing with commissions and agencies; we're dealing with the absolute unchecked power of a few senior civil servants. Believe me, human nature is such that it happens. I've sat on the board of governors of a hospital and sat on this and that, and everybody in this room has obviously been on different committees. As a practitioner, I've had phone calls from someone sitting on the board, who wants someone seen now and wants a bed for this and that. That's just human nature, and this almost formalizes the route for that type of special service that I think most of us dislike.
All modern thinking is that you must have a mix, and this committee demonstrates that. The College of Physicians and Surgeons of Ontario is 50%, or indeed over 50%, laypeople now. The police commission has been a constant fight, as we know, for the last 50 years, but even the police commission is gradually getting more laypeople into it. Yet in the senior civil service, who will be controlling this draconian bill, where is the check and balance, where are the other people in?
My first point was, let's have documentation and facts, not opinion. My second point is, let's have some other people involved in this decision-making and these controls, some far better checks and balances than we now have.
The next issue is a civil liberties issue. You may think I'm whining here, but I'd like to read you a comment afterwards. The medical profession is the only group, to my knowledge, in the country that has been conscripted. That of course is against the laws of the original Canada Health Act, and it's being conscripted further, which I'm not sure is quite the Canadian way. It's fine for me, as a well-established physician whose time to retire will be coming in the next few years, or certainly to slow down, but when you've got young people coming up now who've spent seven to 12 years in training, to be told within a six-month period, "You're out," I just have great trouble accepting that. As an individual, I would personally rather see my income drop considerably and have them take a piece of that pie than have this happen. It just isn't fair. It brings up that old question: "Where were you went the carts and the trucks came in the middle of the night? Did you have a sound sleep?" I have trouble sleeping when I think about colleagues who have trained for 12 years who now have no place to go. It just doesn't make sense.
I had a patient in the office the other day from Egypt, who was a pharmacist, and we were discussing it. He said, "When I went into pharmacy in Egypt, they told me when I went in that when I finished I had to spend two years in the boonies." That's great. If, when I had gone in 40 years ago, they had said to me, "You'll spend two years up in Thunder Bay" -- that's maybe not being up in the boonies, but maybe up in Igloolik or something -- I'd say: "Hey, that's great. Isn't that exciting?" But after 12 years of training, when you may have a wife who thinks different things or a husband who thinks different things and three children, it may be a little difficult to arrange that. The civil liberties issue is of concern to me.
There is a writer I'll quote: "Given their earnings, it is hard to whip up sympathy for doctors, but as go the doctors, so go all of us. If one group is treated illiberally, all of us can be -- from millionaire to welfare recipient." The civil liberties issue is the next issue.
The last one I want to mention is the patient privacy issue. I've already mentioned that as a personal basis, and that was not just for example; that happens to be true. I'm going south in February and I am going to a doctor in February in the States. I'm not going to the doctor here because I don't want it in the records here because it's a personal matter, and I have other colleagues who have done the same thing. The patient privacy I think has been spoken to you about enough and I won't belabour the point. This is probably the shortest presentation I've ever had: nine and a quarter minutes. How's that?
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The Chair: Thank you, doctor. You've left some good time for questions. I just want to make one statement before we get into the questions. The whole week we've been very respectful of one another, and I sense that we're tired and it's getting close to the end and I sense we're spending a little more time maybe taking shots at one another rather than asking questions of our presenters. So I might just ask us in the spirit of the season to continue in that vein that we've practised all week and not to lose our decorum at this point in time. That having been said, we've got five minutes for the government. Mr Clement.
Mr Clement: Thank you. I hope that wasn't directed at me.
The Chair: It was just a general comment.
Mr Clement: I certainly mean no harm or ill will at this season for my colleagues across the way at all; quite the opposite.
Thank you very much for your presentation. As usual, I find the physicians who have been before us have been very cogent and focused in their presentation, and I appreciate your remarks.
I do have some questions for you, doctor, but I just wanted to read into the record -- a previous presenter, just before you, created a bit of a discussion about the tax cut proposals that we have, and you might want to comment on this, actually. According to 1993 figures for Ontario tax filers, 58% of tax filers had an income of less than $25,000, and 66% had an income of less than $30,000. So in fact our tax cut, as we are going to be proposing it, will affect the great majority of Ontarians, middle-income Ontarians who deserve the break, and that was the entire intention of it.
But I wanted to come back, having said that, to some of the concerns that you raised. It's your time and it shouldn't be our time. The relationship between the government and the OMA has been a subject of discussion among doctors. Certainly I realize that. The minister met with the OMA representatives on September 28, November 14, had numerous telephone conversations with them. The OMA met with the ministry eight times during October. The Deputy Minister of Health has been, I would say, in almost constant contact with the OMA, according to my understanding.
So there is a relationship there, I guess is what I'm saying. I guess we don't always agree, but I think it's fair to say that we are treating the representatives of the doctors with the respect they deserve and we are genuinely trying to come to some conclusions that will be a win-win situation for everybody. I'd give you your opportunity to comment on that. Is there anything you want me to tell the Minister of Health with respect to his discussions with the OMA? Let's put it that way.
Dr Richards: No. I'm pleased to hear that you're discussing. I just hope the Minister of Health gets advice from those in practice as well as the OMA and in addition to his own senior advisers who, when the power is transferred, the power is transferred to those same senior advisers. So I think advice must come from multiple sources.
Mr Clement: That's a very fair point.
Let me turn to your discussion about controls on the system. In my previous life I spent a lot of time in central and eastern Europe trying to help those economies get out of the mess they were in, which was a result not only of political bungling but economic command-and-control bungling. So I take very seriously your comments with respect to how central monopoly, central control, in fact causes more misery than good.
Having said that, we do have a form of socialized medicine system here where the control and decisions are not entirely the doctor's, nor are they entirely the patient's. They are also the control of the government presumably acting on behalf of the taxpayers. That's the system we're in. I sense from the deputations we've had that except for a couple of people, no one wants to entirely throw away that system. We want to make improvements to make it work better.
So given that overlay, but given what you and I agree, that command and control tends to create dysfunctions and misery, how can we inject more choice, more individual control, into the system that we have created and that we want to work? I ask that, very truthfully, not with any agenda, but I want to hear your answer to that.
Dr Richards: I'm not sure that's perhaps relevant to my particular presentation, because that gets into the whole issue of remuneration, setups, organizations, health councils, the whole sort of thing. I have to come back and come back to my process --
Mr Clement: I'm sorry to put you on the spot.
Dr Richards: I'd be quite prepared to do that some other time and come back prepared, but that in itself is a whole ballpark. Some of those issues are raised in some of the material I handed out, because I have thoughts about financing, but I'm not sure that's really what Bill 26 is about. I agree with the needs for financial restraints. I'm just concerned about the concentration in the power of a few, and my answer to that is, look at the College of Physicians and Surgeons. We've got the laypeople there. On all those concentrations of power, a few, make sure with those civil servants who are making those decisions that you've got one OMA or one doctor member there, and particularly an MPP there who's got his foot in the community. I'm very concerned at the civil service itself having all that power, or one board or one agency.
Mr Clement: So we've got to act as a check and balance for you.
Dr Richards: Mr Clement, to much extent, the MPPs are our bastion of freedom.
Mr Clement: I agree.
Mrs Caplan: I want to make a couple of comments, and then you're welcome to comment on what I have to say. I appreciate your coming forward. One of the things that I've been very concerned about has been the lack of prior consultation to the legislation coming forward.
It's normal and common practice in government to see policy papers issued to allow public participation and debate prior to the drafting of legislation. It's common practice to see draft legislation presented and to have public hearings on draft legislation based on a policy intent or direction. It's very common as well to have prior and full consultation with interest groups, stakeholders and sometimes individuals in forums and so forth across the province before legislation is drafted or after legislation is drafted. And it certainly is common practice for organizations like the College of Physicians and Surgeons of Ontario, the Ontario Hospital Association, the Ontario Medical Association, the Ontario Nurses' Association, the Registered Nurses' Association of Ontario to participate and have the opportunity before legislation is tabled for first reading in the House to see that legislation, to comment on it, to offer advice and suggestions. It's common practice to respect the fact that they will keep that confidential. That's normal practice in government.
And what we know happened with this piece of legislation is that none of those organizations were consulted. They were not privy to the legislative proposals that were in this bill. Some were shown the bill for an hour. None were allowed to have a look at it or have their lawyers look at it.
I just received a copy of a letter to the Premier from the Bernard Betel Centre for Creative Living -- this is their social action committee -- saying: "We're outraged at the changes to the Ontario drug benefit plan proposed in Bill 26," the omnibus bill. "The Conservative Party is reneging on its promise not to make changes to health care" and not to change programs affecting seniors.
We know that consumer groups and organizations were not consulted and this legislation was not shared with them. I guess I'm feeling particularly concerned about this, because we had an election not so long ago where you had Mike Harris clearly saying, "We have no plan to close hospitals, no plan to bring in new user fees," and in fact he was promising less government. What Bill 26 does is not only break those promises, but he gives his minister absolute power to unilaterally close hospitals, interfere with every aspect of the delivery of health services, not only bring in new user fees, but to do it in a way which hurts seniors. He promised he wouldn't hurt them. That's user fees called copayments for drugs. But there's also potential for new user fees for hospitals.
As far as the notion of less government, this bill centralizes power and could allow, as you rightly said, bureaucratic intrusion, because if the ministers have the power, it's actually the civil service that use those tools on behalf of the minister. They get delegated.
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Dr Richards: I wasn't joking about Iago.
Mrs Caplan: No, it's true. We have this committee, which is the only opportunity for people to have their say. Many don't know what's going on. They're just beginning to realize it. We have hundreds of people who have been denied the opportunity, group after group. I would say we've had 10 or 12 that have come in and like some aspects of the bill, but the overwhelming majority are saying: "Split up the bill. Allow for consultation. Have full debate and discussion. Let people be heard."
I'm going to give you the last few minutes of your time here to try and convince them to at least allow people to be heard.
The Chair: Unfortunately, Ms Caplan, you used it all.
Mrs Caplan: I don't think so.
Ms Lankin: I don't think she went that full time.
The Chair: I've been keeping the time pretty accurately, and she did.
Ms Lankin: Doctor, thank you very much for appearing. Your comments on Iago are, I think, appropriate. I actually think it's something the now Minister of Health would have agreed with when he was Health critic.
Do you remember Bill 50 that the previous government introduced?
Dr Richards: Yes.
Ms Lankin: There were some measures in there that would have set up practitioner review committees and looked at certain areas of insured services. There was a huge outcry from the opposition Health critic in particular, but, to be fair, from the medical profession. As a result of the work that was done over the course of the months in between second reading and when it went to committee in October, there were major amendments to the bill. That was a 13-page bill. I want to tell you some things that Mr Jim Wilson said about that 13-page bill and I want you to listen to this in light of what you said you think he's saying about doctors and this particular bill at this point in time.
"I think cabinet ministers should take...an oath to the people of this province...such an oath that would require cabinet ministers, Bob Rae, Dr Ruth, the NDP cohorts, its party, its members, to go to the public when they want to make major changes such as contained in Bill 50, when they want to make a draconian power grab unto themselves, to tell every patient in this province what services he or she will be entitled to under medicare; how often that treatment will be provided; who will provide that treatment; where that treatment will be provided," all of the details that we don't see in this particular act in front of us.
He also said, "I hope that the people of Ontario understand the widespread powers that the cabinet, Bob Rae, Ruth Grier -- Dr Ruth," he calls her, "and their cohorts in the NDP -- I hope people understand the massive power grab that they are doing."
He also said, "While the current minister and her predecessor" -- that was me -- "rail against the evils of rationing health care, Bill 50 will empower bureaucrats to make arbitrary decisions on what health care services will be insured and how often a patient can receive treatment.
"Simply put, this legislation will facilitate the further rationing of health care services. But instead of the public and health care professionals determining what services should be insured, it will now be left to Dr Ruth and faceless bureaucrats at the Ministry of Health to make these critical decisions....
"Instead of bashing doctors, the minister should seek their assistance on how to obtain savings without endangering the quality and accessibility of Ontario health care."
Mrs Caplan: Did he have a brain transplant?
Ms Lankin: I suspect you might agree with me that it couldn't be better put and that perhaps it was inappropriately put with that bill in comparison to what we see. I think maybe if you could comment on that and on what you would want Mr Wilson to do now.
Dr Richards: I think I made my presentation fairly clearly and fairly briefly, but I will note that I've written and faxed Mr Wilson on two occasions warning about the perils of central controls. I wrote Ms Lankin, when you were minister, concerning central controls and the perils therein. And I have spoken, at North York, Mrs Caplan, on more than one occasion, with Stuart Klein, as you know, and met you on more than one occasion and discussed the same issues and my own issues, and I'm a bit of a maverick that way. I'm here as an individual, my own issues. I'm a great believer in process. I think process is the basic fabric of society, even regardless of my own political affiliation, which is neither here nor there.
But I think in this particular case Bill 26 has abrogated process, and that concerns me greatly. Its financial intentions are good. I happen to support, basically, for what it's worth, the fact that we need a cutback in this province. That's neither here nor there. But the way it's being done is draconian and unacceptable to me and I think the attitude is a disservice to patients. If anyone wants to talk to me or to some of my colleagues personally -- my address and phone number's in there -- or to my partner or something about how we feel as individuals, as long as you don't talk to us, please, about money; I'm not interested in talking about money, but if you talk to us about attitudes and how we feel.
And again I say, if you think of it from the senior civil service, and I guess I'll leave you with this, not one single comment has come out about the average good practitioner in this province. Again, there's nice articles in the Star about Tirone David. By the way, everything they say about him is true; he's a genius, in case you didn't know. He's a genius's genius. A friend of mine works with him and he's just incredible. But outside of that, nothing is ever said. We're all just money-grubbing bastards, and that's very, very demeaning. These present scapegoating comments that came out recently intensified it, which is why I am here today.
Ms Lankin: Thank you for your contribution to this committee and for your contribution to this province.
The Chair: Thank you, Ms Lankin, and thank you, doctor. We appreciate your interest in our process and your being here this afternoon.
DAVID CALVIN
The Chair: Our final presenter is David Calvin. Take a seat of your choice up there, sir. Welcome to our committee. You have about a half-hour of our time. Any time you leave at the end will be divided up evenly among the parties, starting with the Liberals, for questions. So the floor is yours.
Mr David Calvin: Thank you. Let me say at the outset that I am just a private citizen and I'm concerned about Bill 26, that it's leading us into giving the government almost dictatorial powers.
What I'm most concerned about are the health matters that the bill presents, cutting down on payments for drugs and hospital services. It will affect the people who are not so well-to-do financially and make them poorer than they are already. I don't know how to really express myself.
Mrs Caplan: You're doing very well.
Mr Calvin: But the health of the people is a very important issue. Some people can well afford to pay for medical services out of their own pockets, but there are a lot of people who can't, and since we had this Ontario health insurance plan, it's a very good thing for the public.
I have to take certain drugs and they are covered, but I'm just wondering how long they're going to be covered and how much I'll have to pay out of my own pocket for them if the doctors say I continue to need them.
I have a newspaper article; there are certain things here that I marked, if you'd be a little patient with me.
The Chair: No problem.
Mr Calvin: Another thing I'm concerned about is new taxes that municipalities may have to charge because of cutbacks from the province. That is going to be, to say the least, a nuisance for the general public. The municipalities, they say, may charge income tax, poll tax. Does having that poll tax mean that we'll have to carry identification slips around with us all the time?
Another thing is the privacy of medical records. A medical record is something just between you and your doctor and should not be made public in the slightest degree. Why does the government need to know all about my medical history?
I mentioned user fees for drugs, hospital charges. Those are really all the things that I was chiefly concerned about. But there's one matter that I think should be brought up.
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For a long time the government paid out money for the general public, paid out money it didn't have, went into debt, but nobody seemed to mind, people weren't concerned. How did the government get its money? Oh, just put out a bond issue. It paid out money it didn't have. How long could we as individuals get along managing our personal finances that way? A day of reckoning had to come and it has come, and I commend the Harris government for cutting back on their payouts. But I would say they are doing it too fast, trying to do too many cutbacks too quickly, before the public are really ready for them.
The day of reckoning has come. They're talking about cutting provincial income tax. That sounds nice. But where are they going to get the money that they are forgoing themselves by making that cut? By cutting back health payments, hospital maintenance. I don't think any hospitals should be closed if we're to maintain a healthy province.
Those are the main points that were brought out in this newspaper article that I saw.
The Chair: Would you entertain some questions, sir?
Mr Calvin: I'll try to answer them.
The Chair: Are you finished with what you wanted to say?
Mr Calvin: Yes, I've said all that I wanted to say and I hope I've said it effectively.
The Chair: You've said it very well actually. We'll start with Mrs Caplan.
Mrs Caplan: Thank you so much for coming to the committee. Did you read about this or see it on the TV? Is that how you found out?
Mr Calvin: I just saw it in the newspaper and I phoned a phone number that they gave. I phoned that, and then last night, when I got home, there was a message on my recorder. So I phoned Carol this morning and she said come here at 5:30.
Mrs Caplan: Do you consider yourself a special-interest group?
Mr Calvin: A special-interest group? No, I'm speaking only for myself as a private citizen.
Mrs Caplan: Maybe the government will listen to you, because they're not listening to anybody they consider a special-interest group, even though they may not be a special-interest group. If enough people like you will come, have the opportunity to come down here and say what you have just said, maybe they will listen, because they should listen. Your concerns are valid, and it's when people like you come forward, speak as well as you have from the heart, expressing your concerns, government has a responsibility to listen to you.
My question is, when Mike Harris was elected, is this what you thought he was going to do? Is this what he promised during the campaign?
Mr Calvin: No, the one thing that he promised to do and has done on which I back him thoroughly was the repealing of Bill 46, I think it was, that didn't allow struck factories to hire replacement workers.
Mrs Caplan: That was Bill 40.
Mr Calvin: Bill 40; I wasn't sure of the number.
I fully believe that labour has the right to bargain collectively in a free society, but if I'm trying to do business with you and we can't arrange terms, we both go elsewhere. That's part of a free society, and I was glad to see Mr Harris promise that, repeal Bill 40, and live up to his promise.
Mrs Caplan: What about the promise not to bring in user fees for seniors? He promised no new user fees.
Mr Calvin: For what?
Mrs Caplan: For drugs, for hospital services, for health care. Remember he promised that?
Mr Calvin: I'd forgotten that matter until it was mentioned a minute ago, but I certainly think he should live up to those promises. He shouldn't make them if he can't see his way to carrying them out.
Mrs Caplan: I agree with you.
Mr Calvin: I'm fully behind him in this labour legislation. I'm behind him, generally speaking, on cutting back on payouts, because a government cannot pay out money it hasn't got any more than an individual can.
Mrs Caplan: Do you think they should borrow to give a tax cut? That's what they're doing. They're going to have to borrow money in order to give a $5-billion tax cut.
Mr Calvin: Where are they going to get the money to pay the interest on the loan?
Mrs Caplan: They have to borrow it. The debt will increase because of their tax cut and public debt interest will continue to rise. Do you think they should borrow money to give a tax cut to the wealthiest in society?
Mr Calvin: That doesn't make sense. The wealthy people who lend the money to the government are the ones who will get the interest.
Mrs Caplan: You're right.
Mr Calvin: Who will be benefiting from the tax cut? It will probably be the well-to-do people. I'd have to look at a tax form to be sure, but I don't think everybody who files a T-1 return with the federal government necessarily pays provincial tax. I stand to be corrected on that. I'd have to look up the tax returns to see. As I remember, it's 58% of your federal tax that you pay to the provincial government, but in many cases that 58% might be so small as to be negligible. It's the well-to-do who would benefit from his promised tax cut, so what's the use in cutting taxes if you have to borrow money to do so and pay interest on the debt?
Mrs Caplan: Good question. Thank you.
Mr Calvin: Maybe my argument sounds very elementary.
Mrs Caplan: No, I think it sounds very wise.
Ms Lankin: Mr Calvin, thank you very much for coming down. I think people who have the years of experience of life and have seen our governments come and go and our systems change and develop have a wisdom in their knowledge and experience that we should listen to.
I know the government will say over and over again about their tax cut that people who are low-income but taxpayers will benefit and the majority of people are middle-income. But the fact of the matter is, when you look at the $5 billion a year it's going to cost, the majority of the money goes to the wealthiest people, because of course they pay the most income tax in a progressive tax system. A 30% cut for them is a lot bigger than a 30% cut for you, I would suspect, in terms of the taxes that you pay.
I think you have been very eloquent in raising your concerns. Most people like you have only been able to get a quick overview of what's in this bill by what they've read in the media, and I am very impressed that you took the time to come down and to raise your concerns with us. I hope we will be able to hear from other people like you who are on the waiting list and want to make presentations.
I don't actually have any questions for you, sir, I just want to thank you very much for coming and contributing to this process.
Mr Calvin: I might just say a little bit about myself, if you want to hear.
Ms Lankin: Yes, please.
Mr Calvin: I am a retired person, retired from business 12 years, 77 years of age. I'm a widower. I go down to the Canadian Diabetes Association to do volunteer work. I've been there every day this week, as you can see by the decorations.
Ms Lankin: The volunteer button.
Mr Calvin: My son's life was taken by diabetes at the age of 33.
Ms Lankin: So you've contributed through your working life and you contribute now as a senior through volunteering.
Mrs Caplan: You've made a great contribution here.
Mr Calvin: Thank you ever so much for saying that. Does anybody else want to ask me anything?
The Chair: Mrs Ecker's got a question for you and that will be the last one.
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Mrs Ecker: Mr Calvin, thank you very much for coming down this afternoon. I thoroughly enjoyed your comments, and I think you have a lot worth saying. I'd like to agree, you're quite right that cutting back on the government's spending has been a significant problem, and frankly I must take issue with the comments from across the way, from the past two governments in the past 10 years, who used the Visa card to pay the mortgage and doubled government spending, doubled the debt and gave you and I 65 tax increases. I really think that it's about time we tried to change that. I appreciate that you do understand and appreciate what we are trying to do in that respect.
I would like to ease your mind on a couple of other points, if I may, because I think that's appropriate. We're not going to have a poll tax in Ontario. That's not what the legislation is going to be doing.
Ms Lankin: How can you guarantee that? The minister says you can.
Mrs Ecker: Mrs Lankin, I have the --
Mrs Caplan: You have to amend the legislation to guarantee that.
The Chair: Mrs Ecker has the floor.
Ms Lankin: Mr Chair, on a point of order.
The Chair: No, there is no point of order.
Ms Lankin: On a point of order, Mr Chair: I'm sorry, but we have had very clear statements from the Minister of Municipal Affairs and Housing that this legislation allows for a poll tax. It is inappropriate for a member of the government to provide incorrect information to people.
The Chair: There have been several things said here which are questionable in their nature and we haven't objected to any of them. So Ms Ecker has the floor. It's not a point of order.
Mr Calvin: I'm afraid I didn't get the question you were trying to put.
Mrs Ecker: I was just giving you some information. The other point that I'd just like to make is that we will not be making your health records public in any way. The confidentiality is protected and will be protected for your health records, and I appreciate that. Other than that, I just wanted to thank you very much for coming down, and I appreciate your input very much.
The Chair: Thank you very much, Mr Calvin. We appreciate your interest in showing up today and your presentation. Have a good day, sir.
Mr Calvin: Yes, thank you very much.
Mrs Caplan: A point of order before you adjourn. The point of order that I would make is we adjourn this session at the end of this week and we're heading into the holiday season. It's just I'd like to take this opportunity to thank all of the staff that have served the committee this week and wish everyone, all those who've been attending and watching and participating, just a very happy holiday. I think we all need a good rest.
The Chair: Thank you, Mrs Caplan. Ms Lankin.
Ms Lankin: Yes, thank you, Mr Chair. I appreciate Ms Caplan's comments, and of course I think all members of the committee support her thanks to the staff. They've been terrific.
If I may table some questions for the ministry, the first one is with respect to the ability of the minister to impose billing number restrictions. I would like some information about when it is the intention of the minister to impose those billing number restrictions; how that would be done; details on the program for billing number restrictions; which groups of students graduating, for example, will be subjected to billing number restrictions. There are students who are coming into their last semester now who are going to be graduating in the course of the next few short months who would like to have this information.
The second question is with respect to the changes in the Health Insurance Act that give the general manager of OHIP the power, with the assistance of inspectors, to make decisions about the medical necessity of services or on other grounds to decide that services rendered were in fact not insured services, for a number of reasons. As you know, they're set out in the act.
I would like to know what process is going to be put in place in the ministry for that decision-making. For example, will there be a committee structure similar to the Medical Review Committee, which was the first place of decision-making under the old structure? Will this be a parallel process? How will it work? Who will be involved? What will the credentials of the people inside the ministry be that will be involved? If we could get a complete explanation of that, please.
In conjunction with that, we'd be interested in knowing if the ministry is planning to introduce a pre-authorization system for physicians, for example, a 1-800 number for doctors to call into to get approval before proceeding with certain services. There is, I know, in the United States in certain areas this kind of a procedure in place with insurance companies and details of the cost estimation for this whole new system of investigators and decision-making within the ministry.
Thirdly, with respect to the CMPA, Canadian Medical Protective Association, changes, the minister has indicated his concern with the knowledge that certain specialty groups may in fact retract from performing services, and he has indicated that he would be instituting a rebate for certain specialty groups. I would like to know which groups he is implementing the rebate for, a detail of what the structure of the rebate would be, what formula, how is it going to be calculated, how that will be administered, what is all the mechanism and when will this be implemented. Most particularly, will it be implemented by January 1, as that is when the CMPA rates are due from the individual physicians. Thank you.
Mrs Johns: Can I just ask a question?
The Chair: Are we going to get into an exchange of questions here?
Mrs Johns: No, I'm not getting into it. Forty-eight hours puts it on Christmas. When and how should we get it to you, Frances? Sorry, Ms Lankin.
Ms Lankin: Helen, Mrs Johns, it's okay. Obviously, we would like the answers as soon as possible, but I certainly would not request that staff work during the holiday time to provide that.
I think that, out of all of those, the one piece of information that could be very important and would be timely is how the rebate for CMPA is going to work, and I guess most particularly whether it will be in place for January 1. We, I think, could receive that information in the new year, but I would request that whoever knows that information in the ministry convey that immediately to the OMA, because I know that there are doctors who are calling and wanting to receive that information.
If you could undertake to get it to the committee as soon as possible, not incurring overtime during the holidays for staff, but that the holder of that knowledge contact the OMA immediately, we would appreciate that.
Mrs Caplan: Just one comment, very brief, on the questions: To be honest, the reason I haven't tabled our questions now was because we were heading into the holiday season. Our intention is to do that at the hearings when they begin. Although it is out of town, they're still on the record.
I have been anticipating an announcement from the minister prior to January 1 because of the concerns on CMPA and I would encourage that as quickly as possible, not only through the Ontario Medical Association, but I do think there should be a public announcement by a press release because patients are also worried.
Women who are expecting are concerned about, will doctors deliver their babies, and particularly in the rural communities that you're so concerned about, in the areas of anaesthesia and others, they are very concerned about that as well as obstetrics. So my request is that the minister make his announcement public, that he do it expeditiously and that this problem be resolved before January 1.
The Chair: As we finish up our hearings in Toronto, I'd like to thank all of those who came forward to make presentations to the committee. We appreciate your involvement in the process. On behalf of the committee, I too would like to thank the staff people, Tonia, Alison and Beth, for their help and everyone else who has been here.
Mrs Caplan: Better name the other researchers.
The Chair: I also want to thank the members of the committee for what has been a difficult week. Everyone has been very cooperative.
We stand adjourned until January 8 at 9 o'clock in Timmins. Have a merry Christmas.
The committee adjourned at 1748.