NURSING ACT, 1991 / LOI DE 1991 SUR LES INFIRMIÈRES ET INFIRMIERS
OCCUPATIONAL THERAPY ACT, 1991 / LOI DE 1991 SUR LES ERGOTHÉRAPEUTES
OPTICIANRY ACT, 1991 / LOI DE 1991 SUR LES OPTICIENS
OPTOMETRY ACT, 1991 / LOI DE 1991 SUR LES OPTOMÉTRISTES
MEDICINE ACT, 1991 / LOI DE 1991 SUR LES MÉDECINS
CONTENTS
Monday 28 October 1991
Regulated Health Professions Act, 1991, and companion legislation / Loi de 1991 sur les professions de la santé réglementées et les projets de loi qui l'accompagnent
Nursing Act, 1991 / Loi de 1991 sur les infirmières et infirmiers
Occupational Therapy Act, 1991 / Loi de 1991 sur les ergothérapeutes
Opticianry Act, 1991 / Loi de 1991 sur les opticiens
Optometry Act, 1991 / Loi de 1991 sur les optométristes
Medicine Act, 1991 / Loi de 1991 sur les médicins
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
Chair: Caplan, Elinor (Oriole L)
Vice-Chair: Cordiano, Joseph (Lawrence L)
Beer, Charles (York North L)
Haeck, Christel (St. Catharines-Brock NDP)
Hope, Randy R. (Chatham-Kent NDP)
Malkowski, Gary (York East NDP)
Martin, Tony (Sault Ste Marie NDP)
McLeod, Lyn (Fort William L)
Owens, Stephen (Scarborough Centre NDP)
Wessenger, Paul (Simcoe Centre NDP)
Wilson, Jim (Simcoe West PC)
Witmer, Elizabeth (Waterloo North PC)
Substitutions:
Daigeler, Hans (Nepean L) for Mrs McLeod
Jackson, Cameron (Burlington South PC) for Mrs Witmer
Clerk: Mellor, Lynn
Staff:
Bohnen, Linda, Legislative Counsel
Burrows, Allan, Legislative Counsel
Spakowski, Mark, Legislative Counsel
The committee met at 1533 in room 151.
REGULATED HEALTH PROFESSIONS ACT, 1991, AND COMPANION LEGISLATION / LOI DE 1991 SUR LES PROFESSIONS DE LA SANTÉ RÉGLEMENTÉES ET LES PROJETS DE LOI QUI L'ACCOMPAGNENT
Resuming consideration of Bill 43, the Regulated Health Professions Act, 1991, and its companion legislation, Bills 44-64.
Suite de l'étude du projet de loi 43, Loi sur les professions de la santé réglementées et les projets de loi, 44 à 64, qui l'accompagnent.
NURSING ACT, 1991 / LOI DE 1991 SUR LES INFIRMIÈRES ET INFIRMIERS
The Chair: I will follow the McCague rule. Apparently former member George McCague, at the appointed hour for starting many meetings, used to look around the room, and even if there was no one there used to say, "I see a quorum," and begin the meeting.
Interjection.
The Chair: I thought you might find that interesting, Mr Wilson. I see a quorom. The standing committee on social development is now in session. We are proceeding today with Bill 57, An Act respecting the regulation of the Profession of Nursing. We will begin, as we have, in calling the clauses of the bill.
Sections 1 and 2 agreed to.
Les articles 1 et 2 sont adoptés.
Section/article 3:
The Chair: Mr Beer moves that section 3 of the bill be amended by inserting after "the practice of nursing is" in the first line "the promotion of health and."
Mr Beer: Just briefly, the purpose of this is that a number of the witnesses had said they believed part of the practice of nursing was the promotion of health and we wanted to underline that and for that reason have added those words.
Mr J. Wilson: I know the Liberal amendment is exactly the same as the Progressive Conservative amendment on the next page. I just indicate that we also propose the inclusion of "promotion of health" and are supportive of it. Health promotion is a widely-used nursing intervention strategy that is supported by extensive literature. It is formally taught to all nursing students across the province, thus making nurses qualified to include health promotion in their practice.
Mr Wessenger: We will be supporting the amendment. Certainly nurses play a very strong role in the promotion of health, particularly the public health nurses. Also, I do not think this in any way diminishes the fact that we should recognize every other profession that also contributes to the promotion of health.
The Chair: Mr Wilson, did you wish to withdraw your amendment?
Mr J. Wilson: Yes.
Motion agreed to.
Section 3, as amended, agreed to.
L'article 3, modifié, est adopté.
Section/article 4:
The Chair: Mr Wessenger moves that subsection 4(1) of the bill be amended by striking out "on the order of a qualified person" in the third and fourth lines of paragraph 1, in the second and third lines of paragraph 2 and the second line of paragraph 3.
And he further moves that subsection 4(2) of the bill be struck out.
Mr Wessenger: This is related to the fact that with the other bills we are removing "on the order of" and it also is related to a subsequent amendment that we will be making with respect to section 4.1.
Mr Beer: We will be supporting this amendment and reserving comment on a further amendment that will be coming later.
The Chair: You also have a motion to section 4 that is identical.
Mr Beer: Yes and we would remove that.
The Chair: You withdraw it. Further discussion?
Mr J. Wilson: I would also like to say that we are pleased to support this amendment. We would have brought forward our own amendment had the government not already done so in this area. We do not believe that the words "on the order of" adequately reflect the realities in the nursing profession. I would point out though, as I did in the Legislature this afternoon -- we will deal with a more specific amendment in a few minutes, that it is ironic that the government is, in this case, removing "on the order of," but is now requiring nurses to take orders from midwives and chiropodists.
Motion agreed to.
The Chair: Mr Wessenger moves that subparagraph 4(1)(3)ii of the bill be struck out and the following substituted:
"ii. beyond the point in the nasal passages where they normally narrow."
Motion agreed to.
Section 4, as amended, agreed to.
L'article 4, modifié, est adopté.
The Chair: Mr Wessenger moves that the bill be amended by adding the following section:
"4.1(1) A member shall not perform a procedure under the authority of subsection 4(1) unless,
"(a) the performance of the procedure by the member is permitted by the regulations and the member performs the procedure in accordance with the regulations; or
"(b) the procedure is ordered by a person who is authorized by the Chiropody Act, 1991, Dentistry Act, 1991, Medicine Act, 1991 or Midwifery Act, 1991 to do the procedure.
1540
"(2) In addition to the grounds set out in subsection 49(1) of the health professions procedural code, a panel of the discipline committee shall find that a member has committed an act of professional misconduct if the member contravenes subsection (1)."
Mr Wessenger: The purpose of this amendment is that because of the change in section 4 removing "qualified person" it is necessary to designate under what acts the persons who can make the orders are. "Qualified persons" were under the Chiropody Act, the Dentistry Act, the Medicine Act or the Midwifery Act. In effect, that aspect does not change the act at all. It is exactly the same as it was under the previous act. This also permits the regulations to be passed by the college to authorize the procedures by members.
The Chair: Mr Wilson, I ask that you let me know what you want to do with your amendment.
Mr J. Wilson: I think I should move my amendment to the government's amendment at this point.
The Chair: Mr J. Wilson moves that the motion to add section 4.1 to the bill be amended by striking out clause 4.1(1)(b) as set out in the motion and substituting the following:
"(b) the procedure is ordered by a person who is authorized by the Dentistry Act, 1991 or Medicine Act, 1991 to do the procedure."
Mr J. Wilson: We believe that clause (b) of the government amendment will mean, in practical terms, that nurses will have to take orders from midwives and chiropodists. We do not feel that nurses should have to take orders from midwives in particular. There was compelling evidence before this committee and a real disdain from nurses before this committee that the hierarchy in health care would continue to be reinforced and in fact promoted by this government now that nurses, who receive far superior training to date than midwives, would be required to take orders from midwives and chiropodists adding yet two more levels to the hierarchy.
For that reason, I ask the parliamentary assistant how the government can justify promoting the health care hierarchy when this whole legislation has been sold to the public as a means of down playing the current hierarchy that exists.
Mr Wessenger: The purpose of this act is not to create a hierarchy and the purpose of this amendment is not to create a hierarchy. The purpose of this amendment is to allow health professionals to work together. What the amendment means is that orders written for patients by chiropodists and midwives can be implemented by nurses. If the Conservative amendment was accepted, orders written for patients by a chiropodist or a midwife could not be implemented by a nurse. In effect, the nurses would not be able to work with either chiropodists or midwives.
That would create a difficulty in the whole question of delivery of health care and create great inflexibility in it. We have to know that both chiropodists and midwives are authorized, under their respective acts, to prescribe drugs and to administer substances by injection. In many instances, the chiropodist or the midwife may not be available to administer the substance and it would be necessary for a nurse to be present to carry out that act. For the benefit of the whole health care system, it is important that nurses be authorized to carry out those orders. Otherwise we are putting rigidity into the health care system.
If the Conservative amendment was accepted, it would interfere with hospital-based and community-based care. It certainly would not be in the patient's interest and it would also interfere with employment opportunities not only for midwives and chiropodists, but also for nurses.
The Chair: We will keep our remarks directed to Mr Wilson's amendment of the amendment at this time.
Mr Beer: Because they have both been presented, I have a couple of comments that I want to make about them. We reject both and feel they are very much against the spirit of what we were discussing when we made a change to the scope of practice. What we really need to look at is the fundamental principle I believe we accepted when we made the change in the scope of practice, which is that they are all of a certain equality -- the profession of nursing along with the others -- and the issue raised by this amendment is one the colleges themselves can sort out. There is no need for this, and in fact it creates a continuing dependence of nurses doing things only through the orders of other professions.
It seemed clear to me that what we were trying to do in the original legislation was to make clear how this would work, not just among the nurses and the other organizations mentioned here, but broadly speaking, among the different groups of health care professionals. There would be a number of procedural matters to resolve, and we should leave the colleges to sort out how that is going to be done.
The other thing I find somewhat disturbing, and I raised this with the parliamentary assistant, is that the government amendment was made known to the Ontario Nursing Association, but not to either the college or the Registered Nurses' Association of Ontario until very recently, perhaps just within the last few days. Coming at this time, it seems to me it sends a message that what we have done in effect is to say that while we are taking it out of the scope of practice -- that you do not do these things on the authorization of these other professions -- we are putting it back in through another door.
I am not convinced by the arguments of the parliamentary assistant, and say quite frankly to my colleague from the Conservative Party that I do not understand why we need either amendment. I suggest that both be rejected and that the wording presently found in the act be left as it is. Whether speaking to the amendment to the government motion or to the government motion itself, we do not feel that this makes sense. Indeed, we feel it goes quite counter to the spirit of the legislation as amended up to this point.
Mr J. Wilson: I would say to Mr Beer that it is unrealistic not to try and change the government's motion, since we know the way this committee operates. The government's motion is going to go through, so I am simply attempting with an amendment to improve the government's motion, as we know it is a fait accompli. It is unrealistic to argue that neither of these amendments should be here, since the government did put one forward and we all know how they are going to vote. I agree with much of what you said, but I think you can figure out the parts of your remarks that I do not agree with.
The Chair: Any further debate on Mr Wilson's amendment to the amendment? All those in favour? Those opposed?
Motion negatived.
Mr Wessenger: I would like to comment on the comments of Mr Beer concerning our amendment.
First, it should be clear that clause 4(a) sets out that the nurses are authorized. The performance of a procedure by the member is permitted by the regulations, and the member performs a procedure in accordance with the regulations. In effect, the college is setting out what authority nurses have to perform acts and it can pass appropriate regulations. It is within its own authority, through the regulatory power, to determine what authority nurses have. To say the college does not have that power is incorrect. It does have that power. It is something that gives the college expanded authority, which I am sure it uses very responsibly.
I would also indicate that there was consultation with both organizations, the college and the professional association, with respect to this amendment. Certainly there was no problem with the amendment as it related to the authority provided under the regulations. We understand it was very acceptable to the groups.
1550
Mr Owens: I have a question around the area of grounds for misconduct. Could the parliamentary assistant explain to the committee how subsection 2 applies, and how this amendment is seen only as an avenue for nurses to participate in health care, with the expanded scope that has been given? Second, how does subsection 2 get around the issue of standing orders not being signed retroactively that nurses raised during the hearings?
Mr Wessenger: I will call on counsel to answer that question.
Ms Bohnen: Prior to the amendment that appears in subsection 2, if a nurse performed an authorized act that had not been ordered she was liable to be prosecuted. This amendment, with the restructuring together with subsection 2, makes it clear that she cannot be prosecuted if she acts in the absence of an order that is necessary. She could only be held to account for what she did by her own college and that change, as I understand it, is viewed very positively by all nursing organizations.
With respect to how it relates to standing orders and the retroactivity, it does not do so directly. Standing orders and protocols will likely still exist in the health care system, at least for some time, and would fall within the authority granted in 4.1(1)(b). But since the nurse's only liability, so to speak, would be to her own college, I think we could expect the college to take into account the difficulty the nurse was placed in in operating under the authority of a standing order, with perhaps greater sympathy than a court might have if the nurse had been prosecuted.
Mr Beer: If all those organizations were consulted, I accept what the parliamentary assistant has said. I was informed that consultation had not been as set out. However, that being said, I want to underline again that we believe very strongly that this amendment moved by the government goes very much against the spirit of what we are trying to do. It is not necessary, and for that reason we will be opposing it.
Mr Martin: I understand where Mr Beer is coming from on this. If in fact it is against the spirit of levelling out the health profession field in terms of who can do what and creating more of a team approach to the delivery of medicine, I would like to hear somebody from counsel or the ministry speak to that for a minute.
Mr Wessenger: I would like counsel to speak to that, as per your request, Mr Martin.
Ms Bohnen: The health care system certainly will be enhanced by teamwork and the government believes that better teamwork will result from it. Better teamwork also depends on the members of the team knowing what their authority is. Right now, under the Health Disciplines Act, the scope of practice of nursing is not even defined or described, and in practice in hospitals and in the community, nurses have very little clearly defined authority to act without a medical order.
These amendments and the earlier amendments not only clarify what the scope of practice of nursing is, but provide an ongoing mechanism for nursing to say nurses decide for themselves to do the following, A, B, C or D, whatever it may be that nursing determines nurses do on their own authority. That will be clear to nurses, who need the clarity to know how to operate in the settings in which they work; it will be clear to hospitals and community agencies that employ them, and it will be clear to other members of the team. Doing it in the way the government has proposed also provides safeguards so that the government and the public, through the advisory council and its review of the Nursing Act regulations, know that patient care is going to be advanced by the regulations made by the college of nurses and that patient safety and the wellbeing of patients is enhanced by it.
I think the government's position is that in principle it absolutely agrees with what Mr Beer has been saying. The issue has come down to, should the act be silent on what things nurses do on their own authority or should this proposed mechanism be put in so that it can be defined in the regulations?
Mr Martin: To help me understand this a bit, what you are saying then is that in many instances nurses operate autonomously and do what they are trained to do, but there are some instances in which, perhaps because of the seriousness of the act or the situation, somebody has to decide what needs to be done and in that instance it is somebody who has a specialization in that particular area. Is that what you are saying to me?
Ms Bohnen: First of all, remember we are only talking about authority to perform things that are controlled acts. Much of the scope of practice of nursing is not controlled by the controlled acts in any way. Nurses do those things on their own authority, but there are hazardous things for which orders much be written for the patient, and the question is, who should write those orders? When you say that a member of a particular profession should write the order or should be able to write the order, what you are really saying is that a member of a particular profession has the qualifications, the experience and so on to make treatment decisions about the patient.
This legislation recognizes that nurses are qualified to make certain treatment decisions but not all treatment decisions, that some are sufficiently hazardous that they ought to be made by a physician, a dentist, a midwife or a chiropodist because of their more specialized training in the area, but that, yes, there are things that nurses are qualified to make treatment decisions about. Paragraph (a) of the amendment authorizes the college of nurses to determine, in the way the system has those determinations made, what those things are.
Mr Martin: I have just one more question for the parliamentary assistant. In your initial comments you said that this gives the midwife permission to do certain things. I am wondering why that would not have been included in the Midwifery Act.
Mr Wessenger: I think what I referred to is the fact that midwives are authorized under their act to prescribe drugs and to administer substances by injection. That is part of their authorized acts. They can write an order for a patient, and then a nurse might administer that substance, might follow that patient order, just like a doctor might do the same type of order.
Mr Beer: We want to remember what it is we are trying to do. In terms of where the act is silent or not silent and what ought to be in the act or not in the act, fundamentally we are still creating a college of nurses which I believe is going to operate and act and make decisions in an appropriate and responsible way. In doing that and in working out how they do that, they will have to take heed of other colleges and other professions that are active. I have no problem in that context with clause 4.1(1)(a), which seems to me clearly one of the things the college of nurses will do, but I believe that (b) is inappropriate in the legislation, that this is something which is more appropriately dealt with by the colleges in working out how this will take place. It does insert a certain hierarchy, which may not be intended but none the less is there, as to where nurses fit into the scheme of things.
1600
With this legislation we are clearly establishing some new norms, some new directions, some new ways in which we are in effect going to require colleges to work together, one with the other. I simply read clause (b) as a step backwards. In a very real sense it appears that what one has taken out from the scope of practice with one hand, one has put back in through the back door. While I understand the practical arguments around how the various professions ought to work together, I believe that can be sorted out in a way that does not require a specific legislative act. Because of clause (b), I just do not believe we can support this amendment.
Mr J. Wilson: Those comments ignore the fact that nurses already are under a hierarchy in that they have to take orders from dentists and medical doctors. I will be voting against the government amendment, as I have already made clear, because we very strongly feel that the government, contrary to what it has said publicly time and time again to nursing associations, is again reinforcing this hierarchy by dictating that nurses now will take orders from midwives and chiropodists. We are going from bad to worse.
Ms Haeck: I would have to disagree with my honourable colleague Mr Wilson.
Mr J. Wilson: At least we got "honourable" today.
Ms Haeck: It is more than that. In fact, you have been an extremely active member of this committee and I feel that you have had a lot of good things to say. However, I think there is another side to this. That is the side of the midwives. Thinking about all the discussion we have heard, be it here in Toronto or on the road, I feel that having it written here in this part of the legislation reinforces and supports a very strong concern on the part of the midwives that they be allowed to practise in hospital as part of the nursing team, which I do not feel would necessarily happen if it was strictly left to the college.
It behooves us as legislators to have it clearly outlined that midwives are part of the health care team. They are going to be able to follow their patients from their home into hospital and practise appropriately within the hospital setting. I think it is an extremely important portion of this piece of legislation to make sure it is here and is supportive of a very new, innovative procedure that does not exist at the present time.
Mr Beer: I would like to make very clear that I am not arguing that midwives and nurses, or chiropodists and nurses, should not work co-operatively together. As we have done in supporting the Midwifery Act, we see them as a very important new part of the whole area of the health care professions, but what is still a key element to recognize is how we do that. To do that, I do not believe having this part in the act is necessary, and I believe it sends out a variety of other messages about the place of nursing. I think we need to deal with that through the colleges.
The Chair: Further debate on the amendment? All those in favour of the amendment? Those opposed?
Motion agreed to.
Sections 5 and 6 agreed to.
Les articles 5 et 6 sont adoptés.
Section/article 7:
Mr J. Wilson: Perhaps I may make a comment on section 7 on behalf of registered nursing assistants, or practical nurses as they are referred to in section 7 and the remainder of the act. We certainly believe registered nursing assistants should have their own college. We share the disappointment of registered nursing assistants that the government did not bring forward a profession-specific act for RNAs.
This is just to point out that Ontario remains the only province where RNs and RNAs register with the same board. Many RNAs are unhappy about being regulated with RNs by the College of Nurses of Ontario. Twice in the past eight years, the Ontario Association of Registered Nursing Assistants has surveyed its membership and found that over 90% of those who responded favoured separation. One of the main reasons for RNAs' dissatisfaction is that their profession is outnumbered two to one by RNs on the present council, which is section 8 of the act.
I would like to ask that this matter be referred to the advisory council. I would also like some sort of guarantee from the parliamentary assistant at this time that this matter will be looked at in a timely manner.
Mr Owens: I would like to suggest to the member of the third party that it is my understanding the government has referred this issue, or will refer this issue, to the advisory council for determination as to whether the two nursing groups should be divided. It is the feeling that there is clearly enough evidence pointing to the fact that there are differences, that there are problems with respect to their current association, and that an investigation should take place with a view to perhaps separating the two groups into two separate colleges. That has been done or will be done, and if there is any clarification on the matter, I ask the parliamentary assistant to correct or add to the record.
Mr Wessenger: Yes, I would like to confirm that. In my opening statement, I indicated the matter would be referred to the advisory council, so it is clearly on record that this matter will be dealt with.
Mr J. Wilson: Do we have a time frame for that?
Mr Wessenger: I understand the intention is to set up the advisory council. That is the first aspect of this legislation, so it will be operating first and we can deal with the matter before the rest of the bill is implemented.
Mr Beer: I think this is an issue where there is agreement. Indeed, in the nursing assistants' presentation, they asked that this be done. I am certainly glad to see it is going to happen. I agree with my colleague from the Conservative Party that in these things we need to ensure there is a time frame that is going to be reasonably quick so that this can get resolved.
Mr Hope: As the RNs and RNAs indicated, there is also another health care provider out there called the health care aide, who has a very important role in our community settings and with our nursing homes. I hope that through the advisory committee, they will also look at individuals who work in that profession, making sure the determination is there. I feel confident that among them, those professionals on the advisory committee will be able to come up with a good standard, providing for the people of Ontario.
Section 7 agreed to.
L'article 7 est adopté.
1610
Section/article 8:
The Chair: Mr Wessenger moves that clause 8(1)(a) of the bill be struck out and the following substituted:
"(a) Twenty-one persons who are members elected in the prescribed manner, fourteen from among members who are registered nurses and seven from among members who are practical nurses."
And he further moves that clause 8(1)(b) of the bill be amended by striking out "eleven" in the first line and substituting "eighteen."
Mr J. Wilson: I would not want a week to go by without commenting on the section 8s -- nothing to do with the MASH show, I am sure. I will be voting against this amendment. Members will recall that I put forward an amendment earlier dealing with Bill 43 that said that rather than having just under 50% lay representation on the councils, our party felt a more responsible approach would be a 60-40 split, with 60% professionals and 40% members of the public. We are very concerned about and want to make an earnest attempt to preserve the principle of self-regulation.
The Chair: All those in favour of the amendment? Any opposed?
Motion agreed to.
Section 8, as amended, agreed to.
L'article 8, modifié, est adopté.
Section 9 agreed to.
L'article 9 est adopté.
Section/article 10:
The Chair: Shall section 10 stand as part of the bill? All those in favour? Those opposed?
Section 10 deleted.
L'article 10 est rayé.
Sections 11 to 16, inclusive, deleted.
Les articles 11 à 16, inclusivement, sont rayés.
Section/article 17:
The Chair: Mr Wessenger moves that subsection 17(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Motion agreed to.
The Chair: Mr Wessenger moves that subsection 17(2) of the bill be amended by striking out "dental nurse" in the third line.
Mr Wessenger: I believe this was requested. It removes an exception for dental nurses with respect to title protection.
Mr J. Wilson: Could we have a further explanation?
Mr Wessenger: I will have counsel explain this.
Ms Bohnen: You may recall we heard from the Ontario Dental Nurses and Assistants Association, an association of individuals who work as chairside assistants for dentists in their offices. They are not registered nurses or registered nursing assistants. Some time in the past they used the title "dental nurse" but now they use the title "dental assistant." It was in the public interest not to permit these dental assistants to continue to use the term "dental nurse" because it is confusing to the public who might reasonably believe that they are registered nurses with dental qualifications. Since the association did not object to the deletion of this exception for their members, it seemed like an appropriate amendment.
Mr J. Wilson: If we remove "dental nurse" from the section, you are saying there is no objection whatsoever, and there is no longer any need to protect the term "dental nurse"?
Ms Bohnen: That is correct.
Mr J. Wilson: Okay. I have it straight.
Motion agreed to.
The Chair: Mr Wessenger moves that subsection 17(6) of the bill be amended by striking out "dental nurse" in the last line.
Motion agreed to.
Section 17, as amended, agreed to.
L'article 17, modifié, est adopté.
Sections 18 and 19 agreed to.
Les articles 18 et 19 sont adoptés.
Section/article 20:
The Chair: Mr Wessenger moves that section 20 of the bill be amended by striking out "college" in the third line and substituting "council" and by striking out clause (a).
Motion agreed to.
The Chair: Mr Wessenger moves that clause 20(c) of the bill be struck out and the following substituted:
"(c) permitting a member to perform a procedure under clause 4.1(1)(a) and governing the performance of the procedure including, without limiting the foregoing, prescribing the class of members that can perform the procedure and providing that the procedure may only be performed under the authority of a prescribed member or a member in a prescribed class."
Mr Wessenger: This relates to the prior amendment we passed providing for the passing of regulations to set out who may perform certain procedures. It sets out in more detail the aspect that they can prescribe that certain classes of members may perform certain procedures.
Mr Beer: I am afraid this is one where, in reading it, it is not terribly clear. Could the parliamentary assistant lead us through this? Dare I ask for an example? What is going on here? Who is doing what to whom and why?
Mr Wessenger: I may have to ask counsel to advise me, but my understanding is that, certainly within the nursing profession, there are sometimes special courses that can be taken by nurses that would give special qualifications. Therefore, under the act you could prescribe that people who had taken certain courses would have the authority to perform certain specific procedures. What is happening in nursing is that there is a wide variety of training in the nursing profession. I know that very highly specialized types of nurses even now perform work that was formerly done by medical residents, and of course the whole idea is to expand the scope of practice for the nursing profession.
Mr Beer: In effect this deals, at least in part, with some nurses who would have particularly specialized training. They would be allowed to do certain things that, let's say, a regular nurse would not. Is that, in simple terms, what this is about?
Mr Wessenger: That is correct. In addition, it allows a distinction between the role of the practical nurse and the registered nurse.
Mr J. Wilson: I think it essentially says, if I understand it, that regulations will be set for certain procedures and this gives the legislative authority for setting out who actually will perform the procedure as set out in the regulation, which class of nurse.
Mr Wessenger: I may ask counsel to add something here.
Ms Bohnen: Basically that is what it does. The opening words simply give the college of nurses the authority to make regulations that might list those procedures that nurses are authorized to perform on their own authority. The rest of the words just go on to give examples of some of the issues these regulations might also address, such as, is it all nurses who can authorize them or some special class of nurses? It also makes it clear that the regulation could permit, say, an RN to make an order that could then be implemented by a practical nurse. It gives examples of the nature of the regulation-making authority to be exercised by the college.
Mr J. Wilson: Just for the record, I did not have any problem with clause 4.1(1)(a) of the government's earlier amendment to section 4.1; it was clause 4.1(1)(b) that we had a problem with when it referred to having orders taken from midwives or chiropodists. I do not have any particular problem with this amendment either and we will be supporting the amendment.
Motion agreed to.
Section 20, as amended, agreed to.
L'article 20, modifié, est adopté.
Sections 21 to 23, inclusive, agreed to.
Les articles 21 à 23, inclusivement, sont adoptés.
1620
Section/article 24:
The Chair: Mr Wessenger moves that section 24 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
Mr J. Wilson: I will be opposing this amendment because it relates to the patient relations program. In earlier debate last week we made the point that we believe the patient relations program does not include real help for victims and is therefore incomplete. Therefore I will be voting against this amendment.
The Chair: All those in favour of the amendment? Any opposed?
Motion agreed to.
The Chair: Shall section 24, as amended, carry?
Mr Beer: Before we do that, not to argue against section 24, I have a question. I was not quite sure of the appropriate place to raise it, so I decided I would raise it here and you can determine how we ought to handle this.
The question is with respect to the French title and some of the French-language phraseology in the act. We are talking about An Act respecting the regulation of the Profession of Nursing; the French title is Loi concernant la réglementation de la profession d'infirmière ou d'infirmier. It specifies, in French, both the feminine and masculine.
In other bills we have not necessarily used both the male and female modifier. I raise it here simply because I am not quite sure whether we ought to have it in those other bills. Throughout this, and I notice back in section 17, we were quite clear in talking about "infirmier" and "infirmière." It may be unfair to ask the parliamentary assistant for a linguistic ruling, but I raise it as a question as to whether there is any particular problem with those acts that only use the one and not both.
The Chair: The appropriate time for this discussion is when I call, "Shall the title carry?"
Section 24, as amended, agreed to.
L'article 24, modifié, est adopté.
Section 25 agreed to.
L'article 25 est adopté.
Title/titre:
The Chair: We have a question. Mr Wessenger.
Mr Wessenger: I refer that to the legislative counsel. I think he is the person who might be able to give us some guidance in that area.
Mr Spakowski: I am not a bilingual legislative counsel. We can certainly have someone available to answer it if you need the answer in more detail than I can provide. I know some of the issues that arose around the question of how to deal with the nursing title. My understanding is that the French feminine form has been used traditionally.
Normally in French the masculine for things like professions is used as the neutral or generic word. For nursing, the feminine form was used so the masculine form of "infirmière" could not carry its generic function. It did not sound right. Unfortunately, grammatically, the feminine form cannot be used as a generic so it was felt that the appropriate way to deal with it was to use both the masculine and the feminine form.
Mr Beer: I do not want to get into an extended debate over this and it risks getting into a whole series of gender-related observations. What you explain may be the way this has been done in the past, but I leave that as a question which perhaps legislative counsel might raise with other colleagues. For example, in Bills 48, 59 and 61, the masculine is used. It may be that for consistency as well as for other reasons we should be using both. If it is felt that here for some reason one will not do and you need both, then I suggest you probably need the same in others. I simply leave that as a question because it struck me in the way this particular bill has been done.
The Chair: Are you requesting we hold this down so there can be that discussion?
Mr Beer: No, we do not have to hold it over, because I think it is quite correct, but it raises the question and I simply would like to get a clearer response on it.
The Chair: It might be appropriate if that question were responded to on November 5. We had reserved that time for any others. I would point out that we would have to reopen the other bills to deal with the title, but I think it would be appropriate to have a response from legislative counsel at that time.
Mr Spakowski: This is a topic we have fought long and hard on, and perhaps the best is to have a bilingual legislative counsel available, or someone from our French side of the office to explain more fully how we did what we did.
The Chair: Could they be here on September 5?
Mr Spakowski: Yes.
Title agreed to.
Le titre est adopté.
The Chair: Shall the bill, as amended, carry? All those in favour? Any opposed? Carried.
OCCUPATIONAL THERAPY ACT, 1991 / LOI DE 1991 SUR LES ERGOTHÉRAPEUTES
The Chair: We have some observers here this afternoon whom I would like to point out and acknowledge and welcome. A delegation of federal representatives is here looking not only at the committee process, but at the televising of the committee. I hope we can prove helpful as you decide how to televise committee hearings on the Hill.
Sections 1 to 3, inclusive, agreed to.
Les articles 1 à 3, inclusivement, sont adoptés.
The Chair: Mr J. Wilson moves that the bill be amended by adding the following section:
"3.1 In the course of engaging in the practice of occupational therapy, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to communicate a diagnosis within the scope of practice of occupational therapy."
Mr J. Wilson: We believe that occupational therapists should be able to communicate a diagnosis within their scope of practice, and we believe there is compelling evidence before this committee that they should be allowed to do so. The current practice of occupational therapy includes direct communication to their clients about diagnosis. Presentations before the committee showed how this communication is inherent in treatment planning and patient education. The Ontario Society of Occupational Therapists remains unconvinced that paragraph 26(2)1 of Bill 43 will not restrict treatment planning and patient education, so I would ask for members' support on this amendment.
Mr Wessenger: I will be speaking against this amendment, as I have spoken against the previous amendments in other acts, because we believe that occupational therapists perform assessments and not diagnosis.
The Chair: All those in favour of the amendment? Any opposed?
Motion negatived.
Section 4 agreed to.
L'article 4 est adopté.
Section/article 5:
The Chair: Mr Wessenger moves that clause 5(1)(a) of the bill be amended by striking out "at least seven and no more than ten" in the first line and substituting "at least six and no more than nine."
And he further moves that clause 5(1)(b) of the bill be amended by striking out "at least four and no more than six" in the first line and substituting "at least five and no more than seven."
The Chair: All those in favour of the amendment? Any opposed?
Motion agreed to.
Section 5, as amended, agreed to.
L'article 5, modifié, est adopté.
1630
Section 6 agreed to.
L'article 6 est adopté.
Section/article 7:
The Chair: Shall section 7 stand as part of the bill? All those in favour? Any opposed?
Section 7 deleted.
L'article 7 est rayé.
Sections 8 to 13, inclusive, deleted.
Les articles 8 à 13, inclusivement, sont rayés.
Section/article 14:
The Chair: Mr Wessenger moves that subsection 14(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Motion agreed to.
The Chair: Mr Beer moves that subsection 14(1) of the bill be amended by striking out "No person other than a member" in the first line and the following substituted:
"All practising occupational therapists in Ontario shall use the title `occupational therapist,' a variation or abbreviation or an equivalent in another language in the course of providing or offering to provide, service in Ontario."
Mr Beer: I believe one of the points raised was to make clear the use of OT as an abbreviation.
Mr Wessenger: I have some difficulty understanding the purpose of the amendment because I find the amendment would prohibit non-members from using the title "occupation therapist." If it does not prohibit it, it requires that the title be used, rather than prohibiting non-members from using the term. It takes away from the title protection as far as I see. I do not understand why we would want to take away the title protection from occupational therapists, unless I am missing something.
Mr Beer: If you have been missing something, I have been missing something as well. The concern that was raised was about the use of OT, which I gather is commonly used. There was concern expressed in the submissions that others could use that. If what you have suggested captures that, I would be prepared to withdraw it.
Mr Wessenger: In our opinion, certainly --
Mr Beer: I have great respect for your opinion.
Mr Wessenger: My opinion is that the abbreviation is covered, so OT is covered; it would be protected.
Mr Beer: That and 10 cents will get you a cup of coffee.
The Chair: Mr Beer, as I understand it, what you have requested from the parliamentary assistant is clarification that the legislation would not permit, or would permit the use of OT? By whom?
Mr Beer: The legislation would not permit the use of OT by people who are not authorized to be called occupational therapists.
Mr Wessenger: That is correct; it would not permit the use of OT.
The Chair: And with that clarification you are withdrawing your amendment?
Mr Beer: I am.
The Chair: Then it is withdrawn. Mr Wilson?
Mr J. Wilson: That is fine, Madam Chair.
Section 14, as amended, agreed to.
L'article 14, modifié, est adopté.
Sections 15 and 16 agreed to.
Les articles 15 et 16 sont adoptés.
Section/article 17:
The Chair: Mr Wessenger moves that section 17 of the bill be amended by striking out "college" in the third line and substituting "council" and by striking out clause (b).
Motion agreed to.
Section 17, as amended, agreed to.
L'article 17, modifié, est adopté.
Sections 18 and 19 agreed to.
Les articles 18 et 19 sont adoptés.
Section/article 20:
The Chair: Mr Wessenger moves that section 20 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
Motion agreed to.
Section 20, as amended, agreed to.
L'article 20, modifié, est adopté.
Section 21 agreed to.
L'article 21 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: Shall the bill, as amended, carry? All those in favour? Any opposed? Carried.
OPTICIANRY ACT, 1991 / LOI DE 1991 SUR LES OPTICIENS
Sections 1 and 2 agreed to.
Les articles 1 et 2 sont adoptés.
Section/article 3:
The Chair: Mr Wessenger moves that section 3 of the bill be amended by striking out "upon the prescription of an optometrist or physician" in the last two lines.
The Chair: Actually, there is a second one. They are identical. It is my understanding they are placed in order of when they have been received. I am assuming, Mr Beer, that should the government's motion carry, you will be withdrawing yours.
Mr Beer: I think that would be a good assumption to make, and I would so do.
Simply put, we feel, for the reasons that have been advanced, that this is a change we wanted to make. It was agreed to by those who have spoken to it and simply reflects that.
Mr J. Wilson: Is it my understanding that if this amendment were to pass, we would no longer be prescribing eyeglasses through opticians?
Mr Wessenger: No, that is not the case. It just changes the scope of practice statement; it does not change the aspect --
Mr J. Wilson: Well, why are we doing it?
Mr Wessenger: Because we have been doing it in all the acts, if I remember correctly.
Mr J. Wilson: You have taken out "on the order of."
Mr Wessenger: Yes, in all the acts. We have taken out "on the order of" or "upon the prescription of" in all the acts with respect to scope of practice. It was felt unnecessary to be in the scope of practice.
Mr J. Wilson: Okay. I think the photocopier missed this one. I just did not have it in my package so I asked the question now.
Motion agreed to.
Section 3, as amended, agreed to.
L'article 3, modifié, est adopté.
Section/article 4:
The Chair: Mr Wessenger moves that section 4 of the bill be amended by striking out "upon the prescription of an optometrist or physician" in the last two lines.
Mr Beer: We have a similar amendment which I would withdraw.
Motion agreed to.
The Chair: Mr J. Wilson moves that section 4 of the bill be amended by adding the following subsection:
"(2) In this section, `dispense' means the final verification of an ophthalmic appliance for conformity to the prescription and the final fitting and delivery of the appliance."
1640
Mr J. Wilson: We believe that dispensing should be precisely defined in this act. There has been a great deal of debate among professionals as to what it means in this act. We believe this definition appropriately identifies and controls the limited risk involved in the dispensing of eyewear and also preserves the role of the optician in the process.
Without a definition of "dispensing," there is no certainty as to what the government intends to be controlled and therefore to be limited to the profession of opticians and what is permitted by their unregulated assistants. Our definition of "dispensing" will ensure that no one leaves a retail eyewear outlet without having an optician examine the final product. I think that is very important. This will ensure that the proper checks are in place to protect children under the age of visual maturity and those who are purchasing contact lenses.
Our definition will also ensure that everyone who walks in with a prescription will walk out with the prescribed prescription. We believe that allowing unregulated frame stylists to assist in the choice of frames and to do initial consultation and other clerical duties associated with an ophthalmic dispenser's practice will result in cost-effective delivery of these services. I remember we argued that a great deal during the committee hearings. At the same time, enormous advances in technology are recognized and the quality of the professional service will be ensured by the timely intervention of the opticians in the final fitting and delivery stage of the ophthalmic device dispensing process.
Mr Beer: Just to try to understand more clearly the point of this amendment, would the optician not be responsible within his or her place of business for the final verification of the appliance? I am trying to understand how this would make the optician's responsibility any clearer than it is under the wording that is there. I would think that ultimately it is the responsibility of the optician that the work done by anybody in his or her employ is appropriate and would meet all the needs you have set out.
Mr J. Wilson: May I clarify, Madam Chair?
The Chair: Yes. According to the rules of procedure of committees, members can request or put questions on the record or request questions to the parliamentary assistant. If other members of the committee are not witnesses before the committee, they cannot be compelled to answer. However, Mr Wilson would like to respond.
Mr J. Wilson: Perhaps I will clarify it, because Mr Beer points out exactly the argument. We feel very strongly that the word "dispense" needs to be defined. I think Mr Beer agrees with us that the word "dispense" means the final verification. You know pretty well whether your eyeglasses enable you to see properly or not. We do not believe the optician must be involved in every single stage of the process of filling out the prescription, but we believe very strongly that consumers should not leave the eyewear shop until an optician has given final verification that the glasses meet exactly the prescription as prescribed.
Because you point out exactly the debate that is going on, we look for support to clarify the meaning of the word "dispense." The understanding you have, Mr Beer, is not shared by everyone and yet we agree with your understanding and would like to see it clarified in the act.
Mr Beer: You make it very difficult not to agree with you and everything you have said.
Mr J. Wilson: I am doing my best.
Mr Beer: Can I ask the parliamentary assistant if he could comment on the sense of "dispense", if I can put it that way, in this section as the government has drafted it and to comment on what our colleague has said?
Mr Wessenger: Perhaps I could reiterate from memory the position with respect to the opticians. It was strongly opposed by the professional associations and the board.
Mr Beer: What was strongly opposed?
Mr Wessenger: This definition that is proposed by Mr Wilson was strongly opposed at the hearings by the professional opticians because they felt it would have an impact on the role of the opticians. They felt it would result in layoffs and reduced job opportunities for them. They also were concerned about the fact that it would reduce the quality of the programs. There was some debate with respect to the opticians and another group that took the opposing position, but they were certainly concerned about the quality of programs and felt it was necessary to not lessen the definition of "dispense."
There is a minor problem with the subsection in the term "ophthalmic appliance." It is not a correct definition, I am advised. The other aspect is that the same result that is set out in the proposed amendment could be achieved through delegation by an optician.
Mr Beer: So in point of fact, in reading the way it is worded, the optician is responsible for what goes on within his or her place of business.
Mr Wessenger: There is no question that this amendment would loosen control over the dispensing exercise by the governing body of opticians. That would be the effect of the amendment.
The Chair: All those in favour of the amendment? Those opposed?
Motion negatived.
Section 4, as amended, agreed to.
L'article 4, modifié, est adopté.
The Chair: Mr Wessenger moves that the bill be amended by adding the following section:
"4.1(1) A member shall not dispense subnormal vision devices, contact lenses or eyeglasses under the authority of section 4 except upon the prescription of an optometrist or physician.
"(2) In addition to the grounds set out in subsection 49(1) of the health professions procedural code, a panel of the discipline committee shall find that a member has committed an act of professional misconduct if the member contravenes subsection (1)."
Motion agreed to.
Section 5 agreed to.
L'article 5 est adopté.
Section/article 6:
The Chair: Mr Wessenger moves that clause 6(1)(a) of the bill be amended by striking out "at least eight and no more than twelve" in the first line and substituting "at least seven and no more than ten."
And he further moves that clause 6(1)(b) of the bill be amended by striking out "at least four and no more than six" in the first line and substituting "at least five and no more than eight."
The Chair: All those in favour of the amendment? Any opposed?
Motion agreed to.
Section 6, as amended, agreed to.
L'article 6, modifié, est adopté.
Section 7 agreed to.
L'article 7 est adopté.
Section/article 8:
The Chair: Shall section 8 stand as part of the bill? All those in favour? Any opposed?
Section 8 deleted.
L'article 8 est rayé.
Sections 9 to 14, inclusive, deleted.
Les articles 9 à 14, inclusivement, sont rayés.
Section/article 15:
The Chair: Mr Wessenger moves that subsection 15(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Motion agreed to.
Section 15, as amended, agreed to.
L'article 15, modifié, est adopté.
Sections 16 and 17 agreed to.
Les articles 16 et 17 sont adoptés.
Section/article 18:
The Chair: Shall section 18 stand as part of the bill? All those in favour? Any opposed?
Section 18 deleted.
L'article 18 est rayé.
1650
Sections 19 to 21, inclusive, agreed to.
Les articles 19 à 21, inclusivement, sont adoptés.
Section/article 22:
The Chair: Mr Wessenger moves that section 22 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
Section 22, as amended, agreed to.
L'article 22, modifié, est adopté.
Section 23 agreed to.
L'article 23 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: Shall the bill, as amended, carry? All those in favour? Any opposed? Carried.
The Chair: All members have received the information regarding Bill 60, An Act respecting the regulation of the Profession of Optometry. We have two additional amendments, one to section 3 and one to section 4. These replace the ones you have in your packet. Mr Wilson?
Mr J. Wilson: Perhaps I may request a 10-minute recess.
The Chair: We have a request for a 10-minute recess. The committee stands in recess until 5:00 pm.
The committee recessed at 1651.
1704
OPTOMETRY ACT, 1991 / LOI DE 1991 SUR LES OPTOMÉTRISTES
Sections 1 and 2 agreed to.
Les articles 1 et 2 sont adoptés.
The Chair: There are several amendments for section 3. Mr Wilson's motion is first in the order in which they were received.
Mr J. Wilson: It is a little tricky here, Madam Chair. I will agree to stand down my motions on both section 3 and section 4 if the government will stand down its two amendments. We just received today the final wording of the government's amendments. I think it would give the Ontario Association of Optometrists and all members sufficient time to study the new wording if we stood it down until next week, either November 4 or 5, because it is a little complicated. I have heard some reverberations from the association of optometrists that perhaps the government's new wording today is not an improvement upon the government amendments that were in our package prior to today. I would agree to stand down mine if the government members would agree to stand down theirs.
Mr Beer: I would like to support what our colleague has just said. There have been a number of discussions around the wording here, but as recently as this morning another possible way of expressing the scope of practice has come forward. I think we should stand down all the amendments to this section so that we can provide for the optometrists to look more thoroughly at the government's proposal and also, quite frankly, give all of us a chance to talk with them, because I think with all these different proposals coming forward and different ideas as to what they mean, it might help us. I do not think it would hurt if in fact we finalized it next Monday or Tuesday. I think we can deal with the other parts of the bill. There are two sections that are related to the scope of practice, and if we could stand those down it would be useful.
Mr Owens: I have just a quick question for Mr Wilson. Are you looking at dealing with this issue next week, next Monday or --
Mr J. Wilson: That would be agreeable. Monday or Tuesday would be fine with us.
Mr Owens: We do not have a problem with standing those issues down to give the profession an opportunity to look at the wording.
The Chair: We will stand down section 3 and section 4 until either next Monday or Tuesday, as time permits. We will deal with them at the conclusion of the package of bills.
Section 5 agreed to.
L'article 5 est adopté.
Section/article 6:
The Chair: Mr Wessenger moves that clause 6(1)(a) of the bill be amended by striking out "at least six and no more than ten" in the first line and substituting "at least eight and no more than nine."
And he further moves that clause 6(1)(b) of the bill be amended by striking out "at least four and no more than six" in the first line and substituting "at least seven and no more than eight."
And he further moves that clause 6(1)(c) of the bill be struck out and the following substituted:
"(c) one person selected in the prescribed manner from among members who are members of a faculty of optometry of a university in Ontario."
The Chair: All those in favour of the amendment? Any opposed?
Motion agreed to.
Section 6, as amended, agreed to.
L'article 6, modifié, est adopté.
Section 7 agreed to.
L'article 7 est adopté.
Section/article 8:
The Chair: Shall section 8 stand as part of the bill? All those in favour? Those opposed?
Section 8 deleted.
L'article 8 est rayé.
Sections 9 to 14, inclusive, withdrawn.
Les articles 9 à 14, inclusivement, sont rayés.
Section 15 agreed to.
L'article 15 est adopté.
Section/article 16:
The Chair: Mr Wessenger moves that subsection 16(1) of the bill be amended by striking out "in the course of providing or offering to provide, in Ontario, health care to individuals" in the last three lines.
Motion agreed to.
Section 16, as amended, agreed to.
L'article 16, modifié, est adopté.
Sections 17 and 18 agreed to.
Les articles 17 et 18 sont adoptés.
1710
Section/article 19:
The Chair: Mr Wessenger moves that section 19 of the bill be amended by striking out "college" in the third line and substituting "council" and by striking out clause (c).
Motion agreed to.
The Chair: Mr Wessenger moves that clause 19(b) of the bill be amended by striking out "number" in the first line.
Motion agreed to.
Section 19, as amended, agreed to.
L'article 19, modifié, est adopté.
Sections 20 to 22, inclusive, agreed to.
Les articles 20 à 22, inclusivement, sont adoptés.
Section/article 23:
The Chair: Mr Wessenger moves that section 23 of the bill be amended by adding the following subsection:
"(4) Despite subsection (1), section 81.1 of the health professions procedural code, as it applies in respect of this act, does not come into force until one year after this act comes into force."
Motion agreed to.
Section 23, as amended, agreed to.
L'article 23, modifié, est adopté.
Section 24 agreed to.
L'article 24 est adopté.
Title agreed to.
Le titre est adopté.
The Chair: We will hold the rest down until we complete the bill.
MEDICINE ACT, 1991 / LOI DE 1991 SUR LES MÉDECINS
The Chair: There was an amendment by Mr McClelland. Does everyone have the amendment? Are you ready to proceed, Mr Beer?
Mr Beer: Yes, if that is agreeable to everyone. I do not want to go into everything that was said yesterday by Mr McClelland but simply to note that this amendment speaks to concerns that were raised by psychiatric patients about the need to be clearer with respect to their rights and how these acts would operate in terms of the profession of medicine. In our view, this sets out additional grounds for misconduct that would better protect psychiatric patients.
Mr J. Wilson: I will be opposing this amendment mainly because I do not think it is appropriate at this time in the bill to bring forward an amendment, although it is very well intentioned. I had asked, prior to our last adjournment, why this amendment could not be discussed in the context of Bill 109 and the Advocacy Act where it is more appropriate and would cover all the professions.
Mr Wessenger: I would like to speak with respect to the proposed amendment. Certainly the principle of the proposed amendment is good, but unfortunately, for various reasons, I do not feel it is appropriate to support it at this time.
First, I think any amendment should be an amendment not just to this bill, the Medicine Act, but should apply to all professions. Therefore, it should be in Bill 43. I think that is the appropriate place for it. That is the first aspect of my concern.
The second aspect is that shortly we are going to be having hearings with respect to the Consent to Treatment Act and I know the various health professions want to make certain representations with respect to that act and want to be consulted on the whole aspect of the question of consent to treatment. I think we should listen to the professions and see what representations they make with respect to the matter.
Third, I think it is appropriate that we should ask each profession to come forward with its proposal with respect to how to deal with the problem of consent, because I think there may be variations with respect to what is appropriate for each profession. I think it is very important that we get all the input and that the professions themselves be given the opportunity to deal with this matter.
I should add that it can also be dealt with under the regulations of each act, so the matter can be dealt with in a regulatory manner. Hopefully the professions will come forward with an agreed upon language that we can appropriately incorporate into their respective regulations.
Mr Beer: With respect to Bills 108 and 109, which deal with substitute decisions and consent to treatment, they do not contain any enforcement or penalty provisions. This has been of real concern to psychiatric patients in terms of how they can proceed. They feel it is very difficult, if not impossible, to persuade a justice of the peace to lay a charge if you are dealing with the Mental Health Act and that what is important is to put it into this act, which is direct and specific, and it was for that reason we have put it in here.
I think that at this point, in terms of what is going to happen to Bills 108 or 109, they would tend to be general in application. To protect the concerns raised by the psychiatric patient advocate office, the best way of dealing with that is to deal with Bill 55. For that reason, we would continue to urge that this new motion, section 17.1, additional grounds for misconduct, be approved and placed within the bill.
The Chair: All those in favour of the motion? Those opposed?
Motion negatived.
The Chair: Shall the bill, as amended, carry? All those in favour? All those opposed? Carried.
That concludes the agenda for today. We will be dealing with the four outstanding bills tomorrow and then conclude on Monday, November 4, and Tuesday, November 5, as necessary, hopefully, all matters dealing with this package of legislation.
The committee adjourned at 1719.