Monday 6 June 1994

Chronic Care Patients' Television Act, 1993, Bill 18, Mr Ramsay / Loi de 1993 sur l'installation de téléviseurs appartenant à des malades chroniques, projet de loi 18, M. Ramsay

Lawrence Sampson; Thomas Sampson

Ontario Hospital Association

Brian O'Riordan, director, government relations

Dan Drown, senior consultant, chronic care mental health and rehabilitation division

Jim Armstrong, vice-president, operations, Queen Elizabeth Hospital


Chair / Président: Beer, Charles (York-Mackenzie L)

*Vice-Chair / Vice-Président: Eddy, Ron (Brant-Haldimand L)

*Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

*Hope, Randy R. (Chatham-Kent ND)

*Martin, Tony (Sault Ste Marie ND)

McGuinty, Dalton (Ottawa South/-Sud L)

*O'Connor, Larry (Durham-York ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

Owens, Stephen (Scarborough Centre ND)

*Rizzo, Tony (Oakwood ND)

*Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Ramsay, David (Timiskaming L) for Mr McGuinty

Wessenger, Paul (Simcoe Centre ND) for Mr Owens

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Wernham, Christopher, legislative counsel

The committee met at 1556 in room 151.


Consideration of Bill 18, An Act to permit Patients receiving Chronic Care to install their own Television or combined Television and Video-Cassette Recorder / Loi permettant aux malades chroniques d'installer leur propre téléviseur ou leur propre combiné téléviseur-magnétoscope à vidéo-cassette.

The Vice-Chair (Mr Ron Eddy): Good afternoon, ladies and gentlemen. Welcome to the standing committee on social development, discussing Bill 18.

The first order is opening statements. Mr Ramsay, do you wish to speak to the matter?

Mr David Ramsay (Timiskaming): Mr Chair, I would like to reserve my opening remarks until after the presentation that's going to be made next.

Mr Larry O'Connor (Durham-York): Mr Chair, I would like to hear some of what we're going to have presented to us; to hear some of the concerns that the Ontario Hospital Association may have with this bill, and I look forward to an open dialogue.


The Vice-Chair: The first presentation will be made by Mr Thomas Sampson and Mr Lawrence Sampson of Kirkland Lake. Introduce yourselves and proceed with your presentation.

Mr Lawrence Sampson: I'm Lawrence Sampson. Introduce yourself, Dad.

Mr Thomas Sampson: I'm Tom.

Mr Lawrence Sampson: My father has asked that I read this and give you a brief presentation and then, should you have any questions afterwards, my father or myself will be glad to answer them.

Good afternoon, ladies and gentlemen of the standing committee on social development. It's with much regret that I find myself seated here, taking up the government's time and energy in order to have a law passed so my wife Eleanor can be allowed her own television, with VCR, in the Kirkland and District Hospital.

Eleanor has been a chronic-care patient in the hospital for approximately three years and is totally bedridden. Her only forms of entertainment are reading and watching television. Both have become much more difficult due to her failing eyesight. This is partly because she is a diabetic and also due to the fact that she has had some ministrokes.

I would like to present you with a copy of the original letter sent to the hospital board of directors, from myself, requesting the option of Eleanor using her own television. You'll find that in the folders. The letter was addressed to Mrs A. Mangotich, and in that we are asking, basically, for my mother to be allowed the use of her own television. We had hoped to buy her one for Christmas and have it installed. This was denied.

I would also like to present you with another letter, giving the history of the steps taken in order to attain a favourable outcome to this reasonable request. Unfortunately, since November 1991, no successful conclusion has evolved. This is a letter that eventually ended up getting to Mr Dave Ramsay. It is addressed "To Whom It May Concern." In it, we go over the steps of what we have tried in order to get my mother a television. We tried to go through all the proper channels and do things in the right manner, going through the hospital board and the whole bit; to no avail. The hospital itself we were just unable to deal with.

We went to Sterivision themselves, asking them, could they consider even getting my mother a larger television? Sterivision was willing to do that, but the hospital itself said: "No, we don't want to set a precedent. You cannot have a larger television for your mother." We were, at that time, prepared to pay whatever the full rate may have been for that, which was, at that time, $82 a month, and it still is. We had called on Mr Webber regarding this with Sterivision.

On the monetary aspect, the present fee for television costs $82 a month. That's $960 per annum. You can buy a good 14-inch colour television for about $400. Your basic television channels are about $152.68 per annum. If you take that $450 and the $152, that only adds up to $600 per year, and you have your own television. Now, mind you, on top of that no doubt there will be some fee that will have to be paid to the hospital for electricity or whatever. I'm perfectly willing to go along with whatever charges there might be. We're also perfectly willing to supply whatever CSA-approved television might be needed, whether it be no less than a three-year-old or a two-year-old or one being replaced every three years, whatever the hospital would dictate, within reason. We could follow that.

It's been cited by the hospital authorities that safety is a major factor in the denial of this request. My question is just how important the safety factor is when at least two personal TVs have been in constant use in the present hospital since it was built about 15 years ago. The use of commercial rug cleaners in hospital rooms is a common occurrence and most certainly would draw much more power than any television or VCR. They actually use the same electrical outlets.

You'll see CSA leakage requirements. Unfortunately, I can't give you a lot of detail on this because it's just way over my head. So you may have to phone this gentleman concerned. There is a number you can reach Richard Fraser at and he can tell you a little bit more about these hospital leakage requirements. But, basically, from what I understand, this says there's no big deal. Okay?

Forgive me; I'm a bit nervous.

Mr Thomas Sampson: Take it easy.

Mr Lawrence Sampson: I'd also like to present the committee with a breakdown of present TV channels available to all cable-subscribing households in Kirkland Lake and those available at the Kirkland and District Hospital through Sterivision. You'll find in your folders that there are photocopies similar to this. In the yellow you have channels roughly from 2 to 41 -- this whole batch here -- which are all basic channels which are available to individuals in their homes. The yellow indicates the ones that are only available through Sterivision. Of these yellow, approximately three are French channels -- my mother does not speak French -- two are the parliamentary channels and two are local channels, one of which is a local television station giving advertising and the other having the local radio station on it. These channels at the bottom end are not available at all through Sterivision. Pay TV is not available through Sterivision as well, because the electrical hookups are not compatible with the black boxes that are provided by the cable outfit.

Also, you have some pictures of a personal television in my wife's room, showing how the wiring is handled, and also a picture of her TV, how the wiring is handled in hers. I refer you to this one here. You can see that the wiring has just been taped together and it's just running along the edge of the wall into a plug over here, from which the cable comes and your wiring is basically in the same spot for electricity. It comes through the television; it's tucked away towards the wall and really doesn't present that much of a tripping hazard.

This is a picture of the same television from a different angle; and these as well. They're all just showing how the cords are set up. Like I say, they don't seem to be presenting a tripping hazard, because the nurses have been working around them for years.

This latter picture is one of my mother's television, hanging from the wall, the Sterivision one. You'll notice considerable difference in the size of the screen. This is an eight-inch screen on my mother's television, whereas this is a 12-inch screen on this one here. The size of the television makes a considerable difference for somebody who can't see well.

I hope the information that I've provided will help you to seriously consider sending this bill on to the House for third reading and subsequently become law. It seems very, very sad that people have to go this far in order to have their human rights properly taken care of. Thank you for allowing me to speak on this matter.

The Vice-Chair: Thank you. Did your father wish to add anything at this time? Then we'll go to questions.

Mr Thomas Sampson: No, just that my wife has been a faithful wife and a mother over 56 years and that I figure I owe her this, to fight on her behalf, because she can't do it herself.

The Vice-Chair: Questions, Mr Ramsay?

Mr Ramsay: First of all, I'd like to thank very much the Sampsons for coming down today. It was about two years ago that Thomas Sampson came to my office to talk about this problem in, I believe, about the spring of the year. What started it was that Mr Sampson wanted to give his wife a VCR so that she could watch something other than regular programming on the television set that is supplied by the hospital at $82 a month.

Lawrence has started to talk about some of the technical problems with that, but as you know, many hospitals have contracts with various companies, though a lot of them tend to be this one, Sterivision, in Ontario, to supply at a rental fee that is negotiated between the hospital and the supplying company. As Lawrence has pointed out, these sets, particularly the ones in Kirkland Lake, are old technology that only bring in about 13 channels, not even the full basic service, let alone have the ability to provide any other, additional service if the patient wishes to purchase those. As has been pointed out, the set is incompatible with hookup to a VCR.

So what we have is a frail, sick, elderly person in a chronic situation in our hospital in Kirkland Lake. For many in a chronic ward this is their home, and for many of those in chronic wards it may be their last home. What we're seeing is that, through a lack of consistency in hospital policy across the province -- and I want to talk about that in a minute -- many of these people are denied a very basic sort of, I guess we wouldn't even call it a privilege any more but a right to have access for standard television signals.


As Lawrence has pointed out, this is just about all the entertainment that Mrs Sampson is able to get out of life because she is incapable of getting down to the TV room that the hospital supplies for people. It is a larger set. She basically is bedridden. She only has this option.

Ironically, as has been pointed out by Lawrence, there are a couple of individually owned TV sets in the Kirkland Lake hospital that were there already at the time the contract between Sterivision and the Kirkland Lake hospital came into effect, and they're still there.

But what's interesting, when I did a survey a year ago with some of the chronic care hospitals in Ontario and a sample of some of the other hospitals in Ontario, there are many hospitals that have this policy. It seems at least 50% of the chronic care hospitals have such a policy in Ontario and a smaller percentage of hospitals in Ontario in their chronic care wards have this policy.

I want to point out that I'm only dealing with chronic care wards in hospitals and in chronic care hospitals. I think that if one's in an acute care section of a hospital having some surgery and has to be in there for a few days, one can certainly pay a hefty price for the privilege of watching TV for a couple of days. But when you find yourself in a chronic care setting and this is your home, to be stuck with a bill of $82 a month to rent a TV set with a seven- or eight-inch screen that limits you to about 12 or 13 channels doesn't seem right to me.

I believe there should be an option there for the patient or the patient's family to supply proper, safe electronic equipment that can provide the basic entertainment that all of us would take for granted out in the world outside of the hospital. Really that's what this is about: having some access to some of that entertainment that we all take for granted out there. I really think that's important.

This isn't the very biggest issue in the world, but it's an issue that deals with people having some equity, people who find themselves in an institutional setting trying to make this a little more like home. I know there are varying degrees of policies with hospitals across the province of: How much of a home setting do you make a chronic care room in a hospital? How many personal possessions do you allow? Can the person have their own phone line? Can they purchase their own cable and the patient or the patient's family pay for that cable? Can you have your own equipment?

One of the reasons -- that Mr Sampson hadn't pointed out -- is that many of the folks in chronic care hospitals have family. As you know, many hospitals have a policy whereby children are not allowed to come into the hospital room. Having access to a VCR would mean that the family can video-record birthday parties and other events of the family and these tapes can be brought into the hospital and so the elderly patient can, through electronic means, start to partake and share in some of the family activities that are going on in the other home, the permanent home that's back in town. It's this sort of equity in trying to get people back to having a normal life as much as they can in an institutional setting that I'm really talking about here.

Before I was in this job, on a volunteer basis I was the chair of a hospital in New Liskeard: Temiskaming Hospital. As a politician, I particularly don't care to have Queen's Park dictating policy holus-bolus across the province. I understand the idea of trusteeship in a hospital, that we as local people in our towns get to run our hospitals. But when I see such a difference in the quality of policies when it comes to lifestyle issues such as this, I think it's important; it's important that people have the ability and the right to bring in their own television set or combination television set-VCR.

I'd like to thank the committee's indulgence for hearing me out and again thank the Sampsons for coming down.

The Vice-Chair: Thank you, Mr Ramsay. That's under the heading of opening statements, I take it.

Mr O'Connor: That's what I thought too.

The Vice-Chair: Mr Ramsay had requested that previously. We'll proceed to Mr Wilson.

Mr Jim Wilson (Simcoe West): I too want to thank the Sampsons for coming to Queen's Park and commend you for your persistence. I see one of the letters we have goes back to 1992. How long have you been dealing with this issue?

Mr Lawrence Sampson: A little over two years.

Mr Thomas Sampson: November 1991, actually.

Mr Lawrence Sampson: That we've been trying to get this.

Mr Jim Wilson: It's not the most usual thing that some members of the public would actually stick to an issue so much so as to have it come before a parliamentary committee. I commend you for that and I commend Mr Ramsay for the bill and for this set of hearings.

The bill is very short and quite general. The only limitation on TV sets will be that the sets must be CSA approved, and there's half a sentence here about they must meet other safety standards that may be set, locally I gather, although I'll have to ask counsel exactly what the implication of the phrase is.

Just after our opening statements, a little later this afternoon, the Ontario Hospital Association in its brief -- having just scanned through it -- is going to bring forward some concerns: Should there be other limitations on the size of the television or, for example, that TVs can interfere with the workers in the hospital and their ability to carry out their functions. If somebody brought in a large, 30-inch TV --

Mr Lawrence Sampson: Yes, there's no question about that. You can't expect people to try to work around a 30-inch television. That's quite unreasonable. We're talking reasonable here. A 14-inch television, in my estimation, is not unreasonable.

Mr Jim Wilson: So should we limit the size of TVs?

Mr Lawrence Sampson: Yes. I say 14-inch is reasonable.

Mr Jim Wilson: I don't know if you can answer this or maybe Mr Ramsay: It's $82 a month that you're currently paying, that the family's paying, which is a user fee in our health care system, I guess. It's like parking at hospitals and other ways of generating revenue and that's something I will ask the hospital association, because hospitals, through these fees, I think are averaging 18% or 20% of hospital revenues now coming in through various fees, TVs being I think a very small part of the revenue base, mind you. Would there not still be a fee for basic cable service? Would not the family still pay that?

Mr Lawrence Sampson: Didn't I stipulate that?

Mr Jim Wilson: I'm sorry, I missed the first part of your presentation.

Mr Lawrence Sampson: The basic cable fee at any normal household in Kirkland Lake is $17 per month or $204 per year if you pay on a monthly basis, or $152.68 if you pay on a yearly basis. If you pay ahead, you get a discount. It would be expected to pay that. Now, whether that signal is brought through by Fred Lang Television and sold to the hospital and the hospital sold it to the patient, it's up to the hospital how it handles that or if Fred Lang brings it in and we pay Fred Lang individually, so be it. I see no problem with that.

Mr Jim Wilson: I apologize again for missing the first part of your presentation. You may have already explained this, but I have to ask the question anyway. In the over two years you've been dealing with this issue, you've been through the system from top to bottom, I guess, or bottom to top, you've been before the hospital board itself, and they turned you down?

Mr Lawrence Sampson: Yes.

Mr Jim Wilson: Can you explain that and briefly give me the reasons again why they turned you down?

Mr Lawrence Sampson: Their reasons were that they did not want to set a precedent of having a person have their own individual television there because the two televisions that are presently in the Kirkland Lake and District Hospital that are personally owned are by people who were there for some 15 years, since the hospital was changed from the old hospital and a new hospital was built. They were moved there, the two televisions, under what they call a grandfather clause. They cited a safety factor like cords and grounding leakage and all this other nonsense. All we wanted to do was get a bigger television so my mother could see it, period. They just stonewalled us. They would not talk to us. It was just a flat-out: "No. I'm sorry, that's the way it's going to be. If you don't like it, too bad."


Mr Tony Martin (Sault Ste Marie): I also want to say how impressed I am with your persistence in this. I think it's certainly an issue worth chasing. Being from northern Ontario myself, I realize that television is sometimes, particularly for older people, a source of entertainment and education and different things, regardless of how old you are. Certainly I would think, given that you're placed in a facility where you're going to stay for a long time, there should be some accommodation possible re some of the issues you raise here.

You talked about setting a precedent. How many other chronic patients are in the hospital?

Mr Lawrence Sampson: Actually, we really don't have that information. There are two televisions we know of that are used by chronic care patients in Kirkland and District Hospital that are their own personal televisions. That much we do know.

Mr Martin: So there are two people in the hospital who have their own televisions?

Mr Lawrence Sampson: Yes. You have a picture of one of them there.

Mr Martin: So there is a precedent.

Mr Lawrence Sampson: Yes, in my mother's room, the same room my mother is in right now.

Mr Martin: Why are we here when they're already making accommodation of that sort? Why couldn't this have been resolved at that level? I don't understand that.

Mr Ramsay: The agreement that the hospitals enter into gives the company exclusivity to supply televisions in the hospitals. Because these patients were established with their sets before this contract was signed with Kirkland and District Hospital, they were grandfathered. That's why those sets are there today. They were partly refusing to allow Mrs Sampson to have a TV set because of the contractual obligation to Sterivision.

Mr Martin: Do you know how many other chronic care patients there are in the hospital, Dave, who would be requiring this kind of --

Mr Ramsay: I don't have the exact figure, so I'd rather not say. I'm not sure how many beds there are.

Mr Martin: Is it significant?

Mr Ramsay: Yes, it would be significant; 50 or 60 people in chronic care in Kirkland Lake.

Mr Martin: When you compare that to the whole hospital, what percentage of the hospital would that be?

Mr Ramsay: It might be about 45%. Unfortunately, it's got a very high population of chronic patients in Kirkland and District Hospital.

Mr O'Connor: Mr Ramsay might be able to help me. In the process they went through, did this go to the local hospital board? As you mentioned, hospital boards quite often could deal with individual patient circumstances. Did this go there?

Mr Ramsay: Yes, it did. It was out of frustration in dealing with the local board that the Sampsons eventually came to my office.


The Vice-Chair: We will proceed now to the next presentation to be made by the Ontario Hospital Association. Please proceed with your presentation when you're ready, giving your names for Hansard please.

Mr Brian O'Riordan: I'd just like to introduce the delegation, first of all. On my right is Dan Drown of the Ontario Hospital Association. Dan is a senior consultant in our chronic care mental health and rehabilitation division. On my left is Jim Armstrong. Jim is vice-president of operations at the Queen Elizabeth Hospital, a hospital that has been particularly monitoring this situation.

I'd also like to indicate that the OHA usually would have a presentation by our senior officers, but unfortunately this is one of those weeks where almost all of them are otherwise engaged in terms of there is a conference in Halifax of the Canadian Hospital Association, so Mr Timbrell and others send their apologies.

My name is Brian O'Riordan and I'm the director of government relations for the OHA. I believe the committee has been provided with copies of our presentation and I will be going through that. Just one other housekeeping bit of business, if I could. I'm not sure how much time we have. Myself, personally, I will be under a little bit of time pressure as we approach 5 o'clock, but my colleagues certainly can stay past that if need be.

As we appear before you today, we know that this bill enjoys considerable all-party support. We've read the Hansard on second reading. We're also aware that various groups for seniors and chronic care patients have lent their support to the bill.

The bill is summarized in the formal legislative explanatory note as giving "chronic care patients the right to install their own television or combined television and videocassette recorder in their rooms rather than having to rent the use of such equipment or to leave their rooms to watch television in a common area." This right is to be restricted only by the "relevant Canadian Safety Association standards" -- we assume this is meant to say the "Canadian Standards Association" -- "or any safety standards established by the authority responsible for the place where the person is receiving care," on the face of it, a perfectly reasonable right to enshrine in a legislative regulatory way, with appropriate restrictions on the absolute right to enjoy one's own TV or VCR.

However, when the member for Timiskaming, the sponsor of this private member's bill, first approached us about the concerns which he is attempting to address in this bill, he had already decided to introduce a bill as his chosen vehicle for dealing with the issue. That is certainly his right. He wrote to us on May 4 and the bill was introduced on May 17.

The member and his staff I would like to give credit to, because they clearly worked very hard on this issue. They clearly were doing the work of an MPP in terms of trying to address a difficult problem that one of their constituents was having. They surveyed hospitals, they generated press releases and they garnered favourable local media attention.

All of this activity is good politics but it does not necessarily add up to good public policymaking. For our part, Mr Drown and myself met with the member and his staff last June to review the issues involved. At that point, we had hoped to try to resolve some of our concerns through membership education activities and the publication of existing policy approaches.

Indeed, we have made our membership aware of Bill 18, and I think we have characterized its background and intent to them quite fairly.

I have to report, though, that many members, regardless of whether they currently allow personal television sets in patient rooms, strongly question the need for such regulation and legislative prescription. The hospital sector is already a very heavily regulated sector, subject to dozens of hospital-specific pieces of legislation and regulation as well as dozens of other labour relations, environmental and health and safety laws.

Recently, we have seen the imposition of the Social Contract Act, a massive intervention in free collective bargaining, the Consent to Treatment Act and now further long-term care policies and legislation. Hospitals are also on a day-to-day basis becoming increasingly subject to interventionist actions by the Ministry of Health and local district health councils.

You might appreciate, then, the informal reaction of some of our member institutions went along these lines: "What? Don't they even trust us to administer our TV policies?"

This is not in any way to belittle Mr Ramsay's efforts or to dismiss Mrs Sampson's complaints.

There are aspects of aging and the diminishment of capacities that challenge an individual's reserves of courage and ability to cope, and it is the responsibility of each one of us, especially those in the caring profession, to ease the burdens of illness and give comfort and security in whatever way possible to chronic care patients. Bill 18 reflects that desire, to give people in difficult circumstances a chance to make some small decisions for themselves that can make their days more pleasant and comfortable. We appreciate that. Personalizing one's institutionally based environment no doubt means a lot to certain patients in long-term care facilities. Hospitals recognize this, and at the same time they are very mindful of the needs of all patients in a given room, floor, department or wing and of the tremendous workload pressures on front-line staff, especially nurses and orderlies.

However commendable the intent of the bill, there are real problems of principle and implementation which we hope the committee will seriously consider.


First of all, many hospitals, especially those that provide chronic care, do allow patients the option of bringing in their own televisions. Logically, it would seem to follow that if some do, then they all should. This would indeed be the case if all facilities were identical. However, the hospitals that make allowances for this aspect of patient choice do so on the basis of their assessment of the particular circumstances of their facility, and circumstances do differ.

There are some hospitals that take a more flexible approach and deal with requests from patients and families on a case-by-case basis. Some hospitals prohibit the use of personal televisions as a matter of general policy but make exceptions where they feel it would be in the best interests of the patient concerned.

Bill 18 proposes that the only grounds for the curtailment of a right to instal a personal television in an institutional setting would be on the basis of safety standards -- CSA-related or those set out by an institution -- which presumably could be all-encompassing. Indeed, if this is not the all-encompassing intent, then the bill, we would submit, is even more seriously flawed.

This is because of the current situations which obtain with respect to television use in certain hospital settings.

In most hospitals now, the system of delivery of television services is customized to the hospital setting. Televisions equipped with earphones are suspended in brackets from the wall or ceiling to keep them out of the way of the free passage of patients and staff in a room. The televisions are compact, to be sure, and for some people hard to see, but this is out of physical necessity, not insensitivity. In a room with four patients, the small screen may be the only practical size if all four patients want televisions. Some hospitals are aware of the screen size problem already or are in the process of switching over to 14-inch sets, again attached to an overhead mount, and again customized.

The question arises in individual institutions as to how televisions from a variety of outside suppliers could conform to and be compatible with a given standardized system already in place. The presence of any oversized extra furniture in a hospital room can also be an impediment to other patients whose comfort and safety must also be taken into consideration.

Hospitals do charge patients on a rental basis for these customized television services. Although these rental costs have been characterized by supporters of the bill as being exorbitant or as money-making vehicles for hospitals, it's our understanding that generally the rental costs represent no more than cost recovery on a considerable initial capital outlay in terms of cable systems, special wall mounts and swing-arm units, ongoing request processing, maintenance, repair, adjustment and replacement of sets, and invoicing.

Such systems have been established for the benefit not of hospital administrators but for the direct convenience of patients and the staff who care for them. Such systems standardize the interactions of all involved. This is why they are so popular and are pervasive within the hospital system.

Certain hospitals do allow some of their longer-term patients to being in their own personal television sets, usually with the following provisions: agreement of affected fellow patients; agreement of front-line staff who may on an ad hoc basis be pressed into adjusting, repairing or controlling the use of the television; agreement by the patient or patient's family to absorb all costs of installation, maintenance and removal of set; compliance with local hospital, CSA and other health and safety standards; and patient's willingness to assume liability in case of a workplace or other injury involving the set.

Some hospitals used to allow patients the right to bring in personal televisions but have discontinued such policies for a variety of reasons: staff complaints that patients wanted staff to move sets, adjust them, make minor repairs; posing safety or comfort threats to other patients or staff; sets being used deliberately to injure or obstruct staff or annoy patient neighbours; and continuing disputes among patients over volume control, damage to sets, placement of sets etc.

In a system with over 200 institutions, hospitals and their patients have experienced a wide variety of situations and have come up with solutions that they believe make sense in their local circumstances and experiences. In our experience, hospitals do what they can to adapt to changing circumstances and evolving patient needs. Certainly, those that do not do so need to be made aware of concerns about their behaviour and there can be many ways for such concerns to be communicated, including, of course, the Legislature of Ontario.

In closing, I ask you to pause and think through whether legislative prescription and the second-guessing it implies of the patient care provided by hospitals is the way to go. Although issues of comfort, convenience, equity in treatment, liability, efficiency and accountability can also be raised, we believe emphatically that safety must be our prime consideration for hospitals and staff.

Thank you, Mr Chair, and any one of us will be prepared to answer questions from the committee.

Mr Jim Wilson: Thank you, Mr O'Riordan and others for appearing before us today. I'm sure it would have been your preference that this issue not come this far.

Mr O'Riordan: Jim, I always like to see you. You know that.

Mr Jim Wilson: Perhaps you could just give me your interpretation, though, because you do mention it in your brief, about the phrase that in part says, "or any safety standards established by the authority responsible for the place where the person is receiving care." I really don't know what that means. Does that mean the hospital administration can still make up safety regulations or something like that?

Mr O'Riordan: It's a very good question, one we really leave hanging in the brief a little bit in that I'm not going to try to put words in Mr Ramsay's mouth about what he intended there. I imagine, from the conversations we've had with the member and with his staff, that he intended to indicate that there was some flexibility at the local level in terms of laying down regulations regarding size, placement and some of the other matters you raised earlier, but I would have to defer to the member to give you a direct answer on that.

Mr Jim Wilson: Perhaps Mr Ramsay would like to take the opportunity to respond to that, because it seems to me that it's the escape clause in the bill. What the OHA has told us is that for a variety of reasons, including safety, some hospitals now don't allow personal televisions. The way this bill is worded, it seems to me that you can have a TV, but if the local authorities say you can't -- then why wouldn't they just impose some safety standards and prohibit it? I don't see how this is any different from the status quo.

Mr Dan Drown: In my understanding, what a hospital would do in terms of imposing a safety standard would be a standard that would be compatible with the operation of a public hospital.

This, while making the allowance for a personal TV, would also perhaps encompass rewiring, things like that, to make it acceptable. We're quite uncertain about whether the cost effect of that would be any different than through systems that are already set up which might well need to be made flexible and changed. As I believe the Sampsons pointed out, they did speak with Sterivision, who were willing to provide a larger-screen TV to accommodate the vision issue, within the safety regulations that apparently the hospital has, and they were willing to pay for that. That met the safety regulation.

Incoming personal-use items may have to be modified. I don't know. They are frequently designed for home use, not for the distances and the placement within a hospital room, which can be quite small, given two to four beds, as they're designed.

Mr Jim Wilson: Has the hospital association had a number of complaints about TVs in rooms now being too small? Give us your honest assessment of what the lay of the land is with respect to this issue.

Mr O'Riordan: I can't say that we have, until the matters were raised by the member. I don't think we've had correspondence on it. Dan is closer to the issue, so he may want to respond.

Mr Drown: I think it's safe to say we have not had any indication that this is a system-wide problem. As Mr Ramsay knows, there was a survey done, and there's any number of policies which across the board seem to be managed effectively within individual hospitals' purviews in providing, hopefully, what patients need in addition to their medical needs; we're now talking about comfort and support they might require. There has been no other instance that I'm aware of, in an exhaustive search of each hospital to see what's there.

Trying to impose a standard across a system as diverse as this, from smaller hospitals in northern communities to downtown, central-core hospitals, makes it very difficult to please absolutely everyone, especially over the long period of time these people are in hospital for.

Mr Randy R. Hope (Chatham-Kent): Maybe I've misunderstood some of the comments you make in reference to the member who introduced the bill, because you set the appropriate political tone but then I read the comments you make and you make political statements too.

I was listening to the presenters before you talk about an issue they have, putting in a 14-inch television. Knowing the state of technology today, that you can get a combined VCR and 14-inch television for $589 and can install that right on the mounts you're talking about, I can't understand why the people were not entitled to do this. You don't need a separate VCR and television; you can purchase it all in one. I used $589 because I was pricing them for my van. You can automatically put those on the proper brackets, which are not on the floor.

Then you come before this committee and ask, is it proper for us to make a decision on this piece of legislation? I'm saying yes, because I listened to the answer about the response to the letter, that "We don't want a precedent set" so there was no opportunity to solve the problem, and I know the technology is out there.


I take exception to some of your regulatory issues. You've clearly underlined the issue of the social contract and the Consent to Treatment Act, which I take exception to. But when I look at this as a basic issue and ask, "Do we need legislation?" the answer is yes. If somebody's not willing to make a decision, somebody has to make a decision for individuals.

I believe it can meet all standards. The questions you've raised today about health and safety -- it's in your brief about the floor space -- are inappropriate because there is the technology. I understand the gentleman's concern about providing for his wife. He's willing to spend that little bit of money, would buy a 14-inch television with a built-in VCR and would provide everything, and it would still flow out the same way the current system does.

I sat here and listened to what you said and I listened to the presentation before. Let me tell you, I understood where Mr Ramsay was coming from when he presented the bill, but I'm now becoming more clear, with more support for Mr Ramsay. By the presentation made today, I don't think we're after the best interests of resolving.

I make those statements and I do allow you the opportunity to respond, because I did take a few shots. But I now believe, just from listening to the OHA's presentation, that we are going to have to do something to ensure there is a resolution mechanism in place for people. I'm sorry, I've just got to say that.

Mr Drown: I question whether the resolution of assistance across the board requires legislation, or whether, where we have policies in place which seem to be working and potentially accommodating the needs of patients for appropriate-sized television -- in other words, we're speaking of one instance where there are problems, and we're speaking of a number of policies across the province which indeed seem to accommodate the needs of the patients satisfactorily. This bill would effectively eliminate those policies by bringing in personal televisions. I think this must be resolved at the local level as a part of administrative and hospital board management.

Mr Hope: No, what this legislation will do is set minimum standards to allow access for individuals. If hospitals say they provide bigger televisions, a 16-inch screen or whatever, in the rooms, so be it, but that becomes an additional standard of the legislation. This will put in place a minimum standard which will ensure you don't have the headache of going through this rigmarole. If hospitals want to supersede the legislative requirement, they're more than able to do so, but it does set a minimum standard, because there's no standard in place right now; it's left to the individual hospitals' policies, not a minimum provincial standard which says this is the way we go at it.

Mr Drown: I don't see the standard-setting within the policy. I see it as a bill which allows people to bring in videocassette recorders and television sets without much restriction or governance upon that.

Mr O'Connor: I appreciate your coming to address this. I agree that it probably should have been dealt with at the local level and that there should have been discussions taking place there. It's unfortunate that we had to bring the Sampsons down from Kirkland Lake to address it -- I don't think we should have had to do that -- but given that they're here and that we have this before us, there are a few things that perhaps aren't clear in the legislation. We'll talk about that later on, as we get into the clause-by-clause element of this.

I can see where there could be some problems, when we talk about people in long-term care facilities having televisions and trying to get consent from other patients in the room who might be affected. I could see why it would be important that there be some discussion and dialogue there. I know that all long-term care facilities, when they place new residents, go through a process when sometimes people don't quite get along so well, and there is a little bit of allowance made and maybe some changes made.

I wondered about the health and safety standards you talk about here. Have there been health and safety issues brought up by your membership? You've pointed that out as a reason for this and I wondered if you'd explain why you've used that as part of your rationale.

Mr Drown: I'll ask Jim Armstrong to comment from the Queen Elizabeth point of view, but I would also go back to the fundamental statement that patient safety within a hospital environment is the responsibility of the hospital and the hospital board, and it goes no further than that. You're right in asking for clarification, but what we are dealing with is a health care environment where medically necessary services are being provided that make it slightly more complicated than a home room, which indeed people sometimes come to view this as.

Jim might have some observations on the safety issues which have arisen in their experience at Queen Elizabeth Hospital.

Mr Jim Armstrong: Our policy goes back about 17 years, prior to which personal TVs were allowed. I have been there 16 years, so I can't comment too much on the distant past, but I can comment on why we went in the direction we're in now.

It was specifically because of safety concerns, the variation in how TVs were being taken care of, the various technicians who had to come into the hospital for private TVs and so forth.

We went, when we moved to hospital-owned TVs, to a rather large-screen television, about 21 inches I believe, pedestal-mounted, which at that time seemed to be the right way to go. These TVs had a lengthy umbilical cord which carried power, and strapped to that the cable signal. They went from the head of the bed down around the bed, or under the bed or whatever configuration was possible in the circumstance, to the TV generally at one corner of the foot of the bed, and they very quickly became a major problem. They were difficult in terms of care. It was difficult in terms of moving the beds for cleaning and other purposes. We found that the cables were constantly being pulled out of the wall and the plugs damaged, and with the beds running over the cable, consistently they would become damaged and broken. At times they became tangled up in the bed rails.

So having dealt with that system for a portion of the contract period, we had a reopener available and decided to get out of that particular game. We had those televisions knocked over, injuring staff and so forth. We had vases and coffee cups set on top of them and spilled into the back of the set, with resultant smoke and so forth.

What we opted for, in consideration of the safety issues, was for a more typical hospital system, a smaller-screen TV, a nine-inch TV made by Bunting Bell -- it's actually a Zenith television set -- designed more or less for the purpose of hospital use. We specified it had to be a 24-volt television set -- these particular sets had to be altered to that -- and we wanted them arm-mounted so they would be coming off the wall behind the bed. In this configuration, both the 24 volts and the cable signal are carried by one coaxial cable which runs up through the arm and down to the set, so in case there's any pinching in that arm or anything at the television end that breaks or becomes available to the patient, they're subjected only to a very minor shock, not 120 volts. It's run off a power pack mounted on the wall behind the bed, which is also fused in case of any power surges.

I wouldn't pretend these televisions are perfect, not by any means, but they do swing up out of the way in cases of patient care or the need to move a bed and so forth. They are CSA-approved sets, all the alterations are CSA approved, and we have had no incidents with them in terms of safety issues since they went in.

The theory behind a small-screen TV, which I neither defend nor acknowledge, just present, is that when a smaller-screen TV is close to your face, the visual viewing area is about the same as the larger-screen TV further off. That's why the smaller-screen TV people will tell you that's adequate.

We have somewhat newer models that we're now using that come from Granada. Both of these sets are fully capable, unlike the sets in Kirkland Lake -- ours would carry many channels -- and our newer sets are about a 10-inch set, so there's a slight improvement there.

Physically we have two sites in our situation to have ceiling mounts, and other individual considerations would be very difficult. For us at least, this particular consideration is clearly the way to go. Our costs are not nearly what Kirkland Lake's are either, because we own the television sets.


Mr O'Connor: Yes, and it's also a very large hospital, in comparison.

Very early in your opening remarks, you mentioned that when the member for Timiskaming introduced this bill and sponsored it -- I don't know if it was an inference or what -- you wished there had been more opportunity for dialogue then. If you'd had the chance for more direct input into what Mr Ramsay would bring forward -- he felt this was the only way of remedying this situation -- what else would you have suggested he include in the bill?

Mr O'Riordan: First of all, the OHA is of course not a regulatory body. We don't have that kind of power over our members. It's still a voluntary association. All hospitals do belong, but it's not a closed shop. But we would in the circumstance have attempted, if we could have, to try some mediation of the situation. Once the bill was introduced, I guess on the one hand it appears like a solution, but on the other hand it tends to polarize the situation a bit in terms of the individual hospital member that may have felt they were being spotlighted by this.

Mr Drown: We've consulted with some of the chronic care task force, which represents both acute hospitals that have chronic units and the freestanding hospitals, and they do see this as an individual hospital matter. We don't have the power to enforce or control what individual hospitals do. On occasion, there might be the opportunity to mediate an individual situation, if it's called to our attention, in terms of trying to help something. In this case I don't know if that would've been helpful.

But what we are seeing is that over 200 hospitals, about 145 of which have chronic care beds, do not seem to have difficulty administering at the local level policies which try to recognize a patient's needs in the various configurations of the units we find, which range from about eight beds in some facilities to as many as 200 in the large size of Queen Elizabeth Hospital. We see the range of things. We concluded that we can't write the perfect policy perhaps; we can only do what we can to ensure that the fundamental concept of patient safety is given the sensitivity of following patient comfort needs as well.

Mr O'Connor: If that resolution couldn't have been found up in Kirkland Lake, do you think there was the possibility that this could have been dealt with in a regulatory fashion within the hospitals act? I don't know; I'm asking for your thoughts on this. Do you think this could have been dealt with in a regulatory fashion if the dialogue had ended in Kirkland Lake?

Mr Drown: Again, the issue of going before a hospital board and the use of those vehicles one would have thought would have remedied or found some compromise. I can't comment on what happened. It's obviously been some period of time and they feel their policy is correct. I don't think there's an enforcement of that, as there isn't in many other instances, in terms of patient comfort needs contained in the Public Hospitals Act.

Mr Jim Wilson: I just want to get the witnesses' opinion about something before they have to leave us; that is, I think the explanatory note in this bill doesn't match the contents of the bill, given that it talks about that patients have a right to install their own television.

But it would be my opinion, and I'm just wondering what the hospital association has to say, that the way the bill is worded in clause 1, the Kirkland Lake hospital administration or board still wouldn't have to allow personal television sets and VCRs, given that they could simply pass some safety standards policies and, at the end of the day, this bill doesn't do what it is billed to do because it's not an absolute right prescribed here. Would you like to comment on that?

I gather from your presentation that it's: "Why put us through these hoops when we have policies in place in local hospitals now? If you want us to go back and make up some safety standards..." All you would need is a letter from the staff, for example, or the nursing staff saying, "These TVs are in the way." That would be enough excuse to not have them, the way this bill -- it says, "any safety standards." This is the most wide-open piece of legislation I've ever seen. So what's your opinion on what I think this bill does, which is good politics?

Mr O'Riordan: I guess we're getting into a very speculative area. But clearly, as you say, if a joint workplace health and safety committee identified this as a difficulty, if there was smoke coming out of the back of the TV, as happened at the Queen Elizabeth Hospital, or Mr Sampson, I think, talked about "there was not much of a tripping hazard" involved with the wiring -- that would not be sufficient for a joint workplace health and safety committee.

I think in their analysis and in their view of the situation, their goal, as we know, in workplaces is to eliminate the hazard, to prevent the hazard, not to just simply ensure to the staff that there's "not much" of a hazard.

I would think that hospitals would not frivolously put in place safety standards, but I think those that currently prohibit the use of personal televisions, in our view, are doing so for good reasons, are doing so for sound reasons, and would likely continue those policies through the creation of safety standards or the enforcement of current standards.

Mr Ramsay: I'd like to come to that question before I make some other comments.

The reason for that provision, to talk about local safety standards, was that the Kirkland Lake hospital cited as one of their reasons for not allowing individual televisions in the rooms that they have their own safety standard policy. The reason given, which I felt was valid, is that there may be some interference given off by older model TVs to some of the new, sophisticated monitoring devices that are installed in some hospital rooms. Obviously, that would cause a health and a safety hazard, and there would have to be some standards set in each hospital as to the type of equipment they have and the compatibility with residential-type electronic equipment. That's why that provision is put there.

If I could just sum up, we've had a lot of highly technical discussion here and a lot of discussion based on institutions. Obviously a hospital is an institution. You will notice in the very first sentence, in the first clause, I have only talked about one part of the hospital, and that's the chronic care part. because I think the chronic care part of the hospital is not necessarily business as usual. Really, this is a home for people. I think we have to strive to try to make a chronic care setting in health care more of a home setting.

I know there's a tension here between running an institution and trying to make sure the institution runs effectively and efficiently. At the same time, it is a caring business. I think that's got to be uppermost.

These things don't move along unless you have advocates. I know you haven't been absolutely overwhelmed with complaints at the OHA and, quite frankly, I don't expect you to mediate on my behalf with an individual hospital, because each hospital is free to make up its own policies and it's probably not your part in the piece to be representing me or my constituents at the Kirkland Lake hospital. They have the perfect right to set their own policies.

But it's for advocacy, such as a private member's bill as a medium, to try to bring the issue to light and to try to strike some advance for patients' rights. It's not about televisions; it's about patients' rights in chronic care wards and about trying to make it more of a home for people, more of a humane setting.


I guess in everything we try to do there's always a balance. We wish hospitals could generate all their revenues to ease the tax burden. That would be nice to do, but we have to find a balance between the taxpayer's contribution and what the hospitals can generate through their own cash-generating revenues. That's why I bring this forward, and I ask the committee to support this bill.

Mr O'Riordan: I think what we have here is to a certain extent a collision of rights. There are certainly the rights of the patients; there are also the rights of fellow patients and their families and the rights of workers in the hospital and administrators, and I think we do have a classic sort of collision that way.

I don't envy your task in sorting it all out this afternoon, but I do want to indicate that we are very sensitive, and I think Mr Ramsay has achieved his purpose in some ways in that I think he has sensitized a number of people in the community and within our sector to the importance of the issue. I think he's to be commended for that.

We cannot agree with his solution, necessarily, but I think if this is the purpose of a private member's bill, to a large extent that probably has been achieved.

Mr O'Connor: I would like to ask one further to what I was asking earlier about long-term care, some of the regulations that will be coming about as a result of legislation around long-term care and chronic care and what not, if you could see an area where this could be regulated in that fashion that would achieve the results Mr Ramsay would like to set forth as a way of providing some reasonable way this could be dealt with so that the patients do have some choices here. I don't know whether there is or there isn't; I just pose that as a question to you.

Mr Drown: I would only say the hospital environment as we know it is one where safety and comfort have to be paramount, I think, bearing in mind, as you said, that the whole chronic care role study which has been supported for change will introduce a very different kind of patient obtaining chronic care services over time.

These people will be more medically unstable than they are at the moment, and I think perhaps we'll need different technologies than we have right now to attest to and attend to their comfort needs, along with the fundamental reason why they're in a public hospital, and that's to receive fairly complex medical treatment. This issue needs to be, obviously, attended to using the best of technology in the best way that can be implemented.

However, we can't stray from the fact that increasingly the delivery provided in chronic care beds will become much more to medically complex patients as government initiatives are taking their place to do that. These have been changes that have been supported by all parties of the government for a number of years, and I think that this issue exemplifies where, to cast in legislation something that has to be modified, I don't that will correct it. It will be corrected by attending to the patient needs the best way they can in the local circumstances.

Mr Hope: I was listening to the presentation, and being one who plays with electronics, I believe that a normal TV can be converted to be adaptable to the packs that they were talking about. Just a general question: Are we done with this bill today or is it on longer?

The Vice-Chair: We're proceeding to clause-by-clause now to complete the bill.

Mr Jim Wilson: Before we do that, I have a question for legislative counsel, if counsel would like to join us.

The question is similar to the one I posed to the Ontario Hospital Association in my latter comments, and that is, can you just give us a clarification of any safety standards established by the authority responsible for the place where the person is receiving care? In my reading of that, this bill may not do what the Sampsons want it to do, and I don't want anyone to get any false hopes here.

Mr Christopher Wernham: For the record, Chris Wernham, legislative counsel. Would you mind repeating the last part of your question?

Mr Jim Wilson: First of all, here's my opinion. Tell me if I'm right or wrong. There's not an absolute right established here to install your own personal television or VCR, because that right is limited by CSA standards or any other standards that may be set by the local authority, I gather being the administration of a hospital.

Mr Wernham: That's correct.

Mr Jim Wilson: What type of local standards would be acceptable? Mr Ramsay talked about electronic interference. I could see if some of the staff complained to administration that so-and-so's TV set is very often in the way of the staff performing their duties. I know we're in the area of speculation here, but would that be something then that the board or the administration of the hospital then could say, "Well, okay, so-and-so doesn't get a TV," or, "We're going back to our old policy of just using the TVs that the hospital provides and not your personal TVs." It seems to me it's a very flimsy and open piece of legislation here.

And the thing is, I should just comment, Mr Chairman, that this thing very well could pass, so we want to be careful it's acting on what we're voting on here.

Mr Wernham: I'm sorry, but I can't comment on the policy aspects of the bill. I don't know what is involved with respect to interference with other patients.

Mr Jim Wilson: It says, "or any safety standards." Does anybody know what the heck that means?

Mr Wernham: As the bill states, these would be standards established by whoever is responsible for the chronic care place.

Mr Ramsay: I'd like to try to give an answer to Mr Wilson. You're right, there is no absolute right through this piece of legislation, because I feel it would be irresponsible to disregard safety standards that might have to be accounted for in varying institutions.

As the Ontario Hospital Association had stated, we have an incredible variety of chronic care institutions in Ontario. Some are very modern and some are very old. We have wards with six or eight people. We have private rooms. There are all sorts of different things that have to be taken into account in an individual hospital.

Each hospital has its own safety requirements based on the plant that they operate and I would not want to override through a piece of provincial legislation the individual safety concerns that a hospital would have.

I bring this forward in good faith, that hospitals do have their safety policy and would not invent safety policies in order to circumvent the law in Ontario that people in chronic care wards be allowed to have their own TV or combination TV-VCR. But to be responsible, there are very different circumstances in different hospitals and safety standards have to be paramount in delivering this sort of service or any service.

Mr Jim Wilson: I agree with Mr Ramsay. In good faith, I don't think they will, but say they just want to stick to their guns and not allow personal TVs and VCRs and they brought forward a set of safety standards to justify that position. Then this bill would at least give chronic care patients the right to go to court and argue that in front of a judge.

Mr Wernham: I would think so, yes.

Mr Jim Wilson: Then the courts could decide whether it's frivolous or not on behalf of the hospital.

Mr Wernham: Correct.


Mr Hope: Good Lord, I wouldn't want to go to court over a television, and I think this is what we're trying to get at. I agree with Mr Ramsay.

I listened to the conversation the OHA just made, that they would have loved to have been involved in the discussions or have been a mediator. Well, this is a perfect opportunity to do that. If we were to amend this bill by adding a section which puts into place a provincial, regulated standard, it does meet the electrical aspect you're talking about, making sure the wires are off the floor and all that. You can look at a hang-up approach, where the individual can do it.

A simple amendment in this bill will give the regulatory power to develop a provincial standard, and then the OHA, as the representative body of all the hospitals, the government and Mr Ramsay can sit down, and people will not have to go to court because there will be a set standard that will deal with the hospitals' health and safety issues. What I heard from the brief was wires on the floor, tripping, in the way. I didn't hear much about technical interference with machinery used in hospitals. You can simply develop it.

What puzzles me the most is why this thing's even here. The TV the individuals went to Mr Ramsay about can be put on that same mount, right into the same box and everything. They would have their TV and VCR and it would still swing off to the side out of the way and the person would be able to see what was on television. It just puzzles me that this is here.

I'm asking, how can I guarantee that without some individual having to go to court -- which lawyers just get rich from. The process is to put a amendment into this act which will allow a provincial regulatory standard that will take in the health and safety concerns of the workers and also of the hospital, so you don't get into whether a hospital can try to play games with this issue. We're not talking about playing games. We're talking about providing a basic thing for individuals, called a TV and a VCR, a little bit of pleasure they have left in their lives, trying to make their days worthwhile.

Good Lord, we can do it very simply by putting in an amendment which gives the regulatory power. The OHA -- I heard them; I'd have to check Hansard -- was very clear about working this thing out. Come to the table and let's develop those regulatory standards and let's get them in place so we never have to deal with this issue again, nor do we have to see any individual go to court to challenge whether they can have a 14-inch TV with a VCR in their room to provide comfort.

Ms Jenny Carter (Peterborough): I'm a little puzzled by this whole issue. It seems on the one hand we've got a specific instance and on the other hand we've got a law that's going to apply to all of Ontario. I have the feeling that the best solution to this is going to be hospitals making a decision on the spot about whether a particular case warrants an exemption from the general provisions. I should have thought that was the way to deal with it.

I'm also a bit puzzled about the fact that you may have safety standards laid down in the act but the objection to a particular person having a particular TV may be that it's annoying other people in the room or something of that nature, in which case the right to have it would override those objections, according to what we have here. It just doesn't seem to add up.

Mr Ramsay: I can answer that and other questions about why we would need a law by giving some quotes, both for and against, from Ontario hospitals to show you the divergence of view out there.

On the against side, this is a quote: "Listen, we're not running an entertainment centre here. We're trying to run a hospital." This is from a northern Ontario hospital.

Another quote: "We've never had anyone ask us for their own personal TV, and we don't encourage it. If one gets it, they'll all want it."

Another one: "Are you kidding? This place is looking for every penny it can get." That's a Toronto hospital.

So that's how extreme some of it is.

On the pro side: "Of course they are allowed the choice to use their own television or VCR, as long as the equipment they bring into their rooms is CSA-approved. Our policy is that exceptions are made for our chronic care patients. The cable company comes in and hooks it up" etc and they even have their own phone lines. That's a hospital in Guelph.

A hospital in Toronto: "Our three-year contract with the TV rental company expires this year, at which time we will change our policy. Chronic care patients will then be allowed to bring in their own equipment. We have discussed the matter and feel that this is a quality-of-life issue. It really is ludicrous that some of our chronic care patients must pay a significant portion of their income to rent a small-screen television."

Another one: "The people on our chronic care floors are not considered patients; rather, they are residents who have made their hospital room their personal home. Thus, we allow TVs and VCRs as long as they are deemed to be safe by our maintenance staff." Again, this is why local regulation. "A safety log is kept on the equipment, and if the resident shares a room, we request that they use earphones."

Another one: "We make every effort to turn chronic care rooms into homes. That would include TVs and VCRs, if requested, and even personal furniture and wall hangings, but with some minor restrictions with respect to size and safety."

I've got another one here from Thunder Bay, but it's the diversity of the view in this that makes it quite a concern to me that there really are some people who are tremendously caring about these patients and others who say, "Forget it."

Ms Carter: I can see there's a problem, but I'm not sure this law is going to solve it. I also wondered why, in the specific instance we're talking about here, the suggestion that a 14-inch television would be provided by the company was turned down by the hospital.

In the letter, "To Whom It May Concern," Sterivision was receptive to the suggestion that arrangements could be made for a TV with a larger screen. It was agreed, providing the hospital administration would allow it, that they would supply a 14-inch TV with remote control at no extra charge. This proposal was brought to Mr Girkey and this was refused as well. There has to be a reason behind that and I'm wondering what that reason was.

Mr Lawrence Sampson: The same reason I told you initially. He did not want to set a precedent, period. That's the only answer I can give you because that's what I was given.

Ms Carter: It seems to me that what we need is for hospitals to have their own regulations, but be able to make an exception where it seems to be warranted and make that stick.

Mr Lawrence Sampson: If the hospital in Kirkland Lake is allowed the option of making its own regulations, nothing will come of this bill, nothing. We're here for nothing and you're here for nothing.

Ms Carter: We're going round in circles on this.

Mr Lawrence Sampson: These people have to be shown that other people besides the hospital administration have concerns in their life as well. We're not talking money here, we're talking my mother's rights, and I feel she is really being denied. She spent a whole lifetime raising her children. This is her last stop. Let's give her a chance, for crying out loud. That's how I feel.

Mr O'Connor: It seems to me that we're now coming to the point, in terms of chronic care, long-term care in these facilities, that we're looking at the residents therein as consumers and trying to be easy to get along with and cooperative in order to please the consumer. If the hospital is providing a service and has a consumer, would you not think they would want to try to please the consumer a little more?

Mr Lawrence Sampson: Actually, the hospital really isn't supplying the television system. Sterivision is supplying the consumer.

Mr Thomas Sampson: This is just for chronic care people who are not able to look after themselves.

Mr Lawrence Sampson: In Kirkland Lake we might be talking another two, three or four individuals who might want their own television. Maybe the rest of them are not capable of watching television or whatever. We're not talking a whole major deal here; we're talking a few individuals.

The Vice-Chair: Thank you very much for your presentation. We appreciate it.

The committee will now proceed to clause-by-clause consideration of the bill.

Mr Hope: Mr Chair, it's Mr Ramsay's bill, and I want to point something out to him. I mentioned an amendment to section 1 that would give a regulatory standard, and I'd have to check the record, but the OHA clearly indicated that to put in a provincial standard -- even you said it -- some will supersede that provincial standard, but at least you will not get into that complicated area. If you were to amend the order in council, or whoever has an opportunity to regulate a provincial standard, it might be more appropriate to deal with the legal aspect of making sure this thing can move ahead versus just another roadblock. With an amendment in section 1 of the bill to allow order in council or whatever to have regulatory standards put in place, that way the OHA can be a partner in the standards, which will be a minimum standard for the province.

Mr Ramsay: I appreciate the friendly amendment coming from the member opposite. I'm not sure that's the OHA's real concern with this thing. To them, there shouldn't be an Ontario directive to this principle at all. I think their point of view is that each individual hospital board should make its own policy when it comes to this sort of item, and that's where we certainly disagree. I'm not sure that amending the bill to place more details with regard to safety standards is going to make it more palatable to the other side.

Mr Hope: At least they can't say you closed the door on them. It does allow an opportunity to put that standard in place, and that's what I heard, that they were willing to play a mediated process. They clearly made a statement about when you notified them and how much time you gave them. I'm just saying here's a little more time to make reality come true, and you don't get caught up in a legal process or a hospital playing games, if some regulated powers are there. I'm saying there's still opportunity.

Mr Ramsay: I appreciate that. What I've tried to do is to still respect individual hospitals' needs to set their own standards, and that's why I've set the tone of the bill the way I have. Unlike other comments that were made here, I certainly have faith that the hospital trustees will set their own standards in regard to safety and for no other intent.

Mr Hope: We can always refer back to Hansard in the future when we have to figure it out. I would love to see the amendment put in place, but if Mr Ramsay is not willing to do so, I can still support the bill as put forward.

Mr O'Connor: In the wording of the bill, should it not be "Canadian Standards Association" instead of "Safety Association"? Is that what you were referring to there?

Mr Ramsay: That's right. I'll so move that amendment, Mr Chair.

The Vice-Chair: It's been moved by Mr Ramsay that section 1 of the bill be amended to change the word "Safety" to "Standards" in the sixth line. Is it agreed that the amendment carry? Carried.

Shall section 1, as amended, carry? Carried.

Shall section 2 carry? Carried.

Shall section 3, short title, carry? Carried.

Shall the title of the bill carry? Carried.

Shall I report Bill 18 to the House, as amended? Agreed.

That completes the bill. Thank you for your time.

The committee adjourned at 1724.