HEALTH DISCIPLINES AMENDMENT ACT
REGIONAL AND METROPOLITAN MUNICIPALITIES AMENDMENT ACT (CONCLUDED)
The House resumed at 8 p.m.
CENTRAL TRUST COMPANY ACT
Hon. Mr. Elgie moved second reading of Bill 97, An Act respecting Central Trust Company and Crown Trust Company.
Hon. Mr. Elgie: Mr. Speaker, as I indicated when this bill was introduced on October 21, the purpose of the bill is to substitute Central Trust Co. for Crown Trust Co. in respect of Crown Trust agency and trust business, and thereby vest in Central Trust all real and personal property held by Crown Trust in its estates, trust and agency business so that the rights and obligations of those who have had such business dealings with Crown Trust can be clearly determined. This general purpose is set out in section 1 of the bill.
The remaining sections of the bill carry out in specific detail the intent and purpose as spelled out in section 1. Section 2 of the bill makes it abundantly clear that nothing in the bill affects the rights of any person having a claim against Crown Trust in respect of that company's agency and trust business.
Mr. Nixon: Except the preferred shareholder.
Hon. Mr. Elgie: No, it does not. This bill is aimed at maximizing returns for the preferred shareholders.
Nor does it impair, modify or affect the liability of Crown Trust Co. to any such person. This section also provides that all such acts as may be enforceable in Ontario may be asserted against Central Trust, which shall be responsible for all debts, liabilities and obligations of Crown Trust with respect to Crown's agency and trust business.
The bill would not apply to property held by Crown Trust for its own use or to property held by Crown as trustee situate outside of Ontario for which Crown Trust is not subject to an Ontario court. The bill will also not apply to funds received for guaranteed investment by way of guaranteed investment certificates which have previously been transferred to Central Trust Co. under the authority of the Crown Trust Company Act.
Section 4 of the bill is the primary operative provision which carries out the purpose set out in section 1 of the bill. Sections 6 and 7 are transitional provisions preserving the rights and status flowing out of the existing trusteeship and agency business of Crown Trust.
This legislation will provide in a very clear and detailed manner for the transfer of the trusteeship and agency business of Crown Trust to Central Trust and will preserve the rights of those persons in Ontario who have had relationships of this kind with Crown Trust. For this reason I urge that the bill be considered expeditiously by this House so the rights and interests of those people may be provided for as set out in the bill as soon as possible.
Mr. Boudria: Mr. Speaker, our party does not intend to delay this bill unduly, but that does not mean we are for the bill as we see it at present. The bill has been introduced in this House as appearing to be one merely of housekeeping, but in effect the information we have at present is that it will be giving away one of the very last business assets of Crown Trust, the value of the estates, trust and agency business.
As the minister stated on first reading, Central Trust makes certain payments of compensation to Crown Trust for the lucrative privilege of managing these estates, trusts and administration portfolios. But to permit this bill to go forward, in the words of the investment broker representing the thousands of Crown Trust preferred shareholders, is in effect permitting the theft of a very valuable asset, and I am quoting words he used in a conversation he had with us.
It must be remembered that as it stands now, the only hope those preferred shareholders have of recovering any of their nearly $20 million investment is if there is money left with Crown at the end of Central Trust's five-year period of management. It would seem obvious that if the estate, trust and administration portfolios were to remain with Crown, their sale, according to usual business practice, could yield something for these terribly abused and totally innocent investors.
Although the government may have been too busy to consider the situation of preferred shareholders, we cannot permit another occasion of abuse as potentially exists in Bill 97 without some restitution being made to the investors. Most are seniors, and their preferred shares yielded dividend income; for many, it was their only source of income beyond a meagre sum from the Canada pension plan. Since this government seizure, not one dividend has been received. The hardship created by this government neglect does not receive much attention.
I would like to tell this House of one of many cases of financial ruin created by the treatment of preferred shareholders. In the early 1960s, a farmer lived in the area near Brampton. He retired and sold his farm, receiving a sum of some $500,000. On broker's advice he invested this in Atlantic Acceptance Corp. Remember them? All members know the story of that government-created disaster.
Hon. Mr. Elgie: On whose advice?
Mr. Boudria: On a broker's advice, I would trust that the minister's government had something to do with the regulatory process governing that particular agency as well.
All members know the story of that disaster. Nearly 10 years later, the farmer recovered a sum of $150,000. That is all he could salvage from his original $500,000 investment. Having learned his lesson, this farmer went to see another broker to get much better advice on a more prudent investment.
Mr. Nixon: I think he went to his provincial member for advice.
Mr. Boudria: It is quite possible that he went to his MPP as well. I am sure he, along with everybody else, would have thought investing in Crown preferred shares was as safe an investment as any in North America.
Just last week, the same farmer had all his household furnishings seized for debt. He has binder twine on his shoes. He has applied for welfare and now lives in Hamilton. He started off with $500,000, and he never spent a cent of it. This is the result of the regulatory fiasco for this gentleman. It is a very sad case.
What, then, is the value of the very significant assets of Crown Trust which have been handed over to Central Trust? We have yet to be told. At the very least, they are worth two to three times the annual income yielded to the trust company collecting the commission. No information is currently available on this as Crown has had no published audited statement since the government took it over.
A huge range of questions emerge when the value of the assets and the consequence of their giveaway are considered. It is imperative that a committee of this Legislature have the opportunity to ask those questions and to hear from those affected, to hear from the seniors and all the other people who had money invested in Crown Trust.
There are witnesses who should and could come to this committee, such as Crown Life-Extendicare, a losing bidder for Crown Trust, that possibly could have protected those preferred shareholders. It will be interesting to see what everyone has to say on this issue if we can get this bill in front of the committee.
8:10 p.m.
My colleague the member for Kitchener (Mr. Breithaupt) spoke extensively on Bill 215, the predecessor to this legislation, earlier this year. He spoke eloquently on the forgotten Crown preferred shareholders and their plight and suffering. The member for Waterloo North (Mr. Epp) also spoke on property rights in this Legislature and proposed a resolution all of us will recall.
We should all remember there is a very serious issue at stake when the people of this province see their life savings disappearing before their eyes. To own a very large retirement account portfolio and to see it totally disappear overnight and have nothing left is a very unfortunate thing. I am sure the minister would agree this is a very sad event. Each and every one of us has to bring the concerns of those people to this Legislature through the mechanism of having those people address our committee.
That concludes my remarks. I think the member for Kitchener will be in later and will be commenting on this bill as well. The way the bill stands at this point, we intend to oppose it. If we can get the amendments we are looking for in committee, we will decide at that point what will happen to it on third reading. But it is offensive the way it appears to us at present.
Mr. Nixon: On a point of order, Mr. Speaker: I know you will want to recognize the presence in your gallery of Dr. Donald MacDonald of Atkinson College at York University and some of his proteges. Don can pick the active nights in this chamber to bring his class down and we would like to welcome him. The interesting thing is they actually pay him to do this. I do not know whether members noticed that I referred to him as Dr. MacDonald. York University honoured our former colleague with an honoris causa degree. In his case, I think it was fully merited.
Mr. Speaker: It is very nice to see the former member. Seeing him around here on a fairly regular basis, indeed a very regular basis, I did not think it was necessary to draw attention to him, but we are always happy to recognize his class. We are very happy to have him, and I advise all honourable members I shall be meeting privately with the group a little later.
Does any other member have anything to say on this bill?
Mr. Swart: Mr. Speaker, I want to make some very brief comments on this bill. There are two immediate thoughts that come to mind. One is that I think from our point of view and a caucus point of view it would be rather absurd to oppose this bill at this stage some 10 months after the decision was made to take this step. More than that, we think the bill probably provides as much security as is possible by transferring these assets and liabilities from Crown Trust to Central Trust.
The second thought that comes to mind when I read over this bill is that it sure makes a mockery of the principle of the resolution that was introduced by the member for Essex South (Mr. Mancini) and passed, that all agreements and documents should be worded in simple language and in short sentences.
When I look over this bill I notice on page 3 that the first subclause runs for 21 lines, contains more than 200 words and is all in one sentence. Many of the other paragraphs are similar to that, although none of them are quite that length. However, it has been written by lawyers and therefore I presume that everything that is in these wordy paragraphs is very necessary to provide the safety and security that is necessary in this bill.
Having said that we will support it, there is one question I would like to ask the minister. That question relates to the mandatory provisions of all the transfers and what opportunities trustees would have if they wanted to take their assets or business to some trust company other than Central Trust. Do they have this opportunity in any way through the courts, or in any other way, or is everything tied up there as it would be tied up if Crown Trust was still in a position to honour the commitments it had made?
The other qualification I want to make was referred to by the member for Prescott-Russell (Mr. Boudria). Because of the very real likelihood of substantial losses for too many of these people, there should be the opportunity for the committee to delve into the negligence that surrounds this whole matter, and perhaps at some stage, as was the case with the Re-Mor Investment Management Corp., some reimbursement should be made to these people for any losses or losses they will sustain.
However, we are not going to hold up the bill because of that. We believe the committee consideration this winter of the reports that were tabled by the minister today will give members of all parties the opportunity to examine the degree of negligence or at least to push for a fuller examination of the degree of negligence on the part of the government. That certainly has not been established yet.
There certainly is reason to believe there is gross negligence on the part of the government as was indicated by the leader of my party and other members of the opposition in the House today. If the same kind of negligence shows up a second time, as it did with Re-Mor and Astra Trust Co., then this government must accept its responsibility for reimbursing the investors of Crown Trust and these people who, through no fault of their own, are losing substantial sums of money.
Those are the comments in brevity which I wanted to make on this bill. I want to say once again that we will be supporting it because we think it is one step that will not preclude any other opportunity the investors may have of getting recompense, and provide in the meantime, perhaps, the fullest degree of security for what assets they may have until further steps may be taken by the committee to determine the degree of negligence on the part of the government in this whole trust fiasco.
Hon. Mr. Elgie: Mr. Speaker, I am a little disappointed, because the member for Prescott- Russell indicated the member for Kitchener wanted to speak on this, but I will respond by telling him, and I say this with respect, that there is some honest misunderstanding of the purpose of this bill.
8:20 p.m.
If I am not mistaken, the information I have now received is that the preferred shareholders' representative now has a better understanding of the purpose of the bill. But I understand the reasons the member put forward reflect the views of the preferred shareholders. I want to assure him that this is not in any sense a bill that is giving away a remaining asset of Crown Trust.
The member will recall that with the passage of the Crown Trust Act last February, all of the assets, including the estates, trust and agency accounts, were transferred to Central Trust Co. to be managed by them.
Because the estates, trust and agency accounts have to be dealt with on a province-by-province basis, each of the involved provinces, British Columbia, Alberta, Manitoba, Saskatchewan and Quebec have been contacted, as they were when Royal Trust reorganized and as they were when, I believe, Montreal Trust reorganized for exactly the same type of legislation. It is legislation which simply transfers the obligations and the rights with respect to those who have claims against Crown to Central Trust.
Let us understand that in that sale, if one wants to call it that, of the assets of Crown to Central, it was agreed that each of them -- the intermediary business, the fiduciary business and so forth -- had a value. The contracts, far from being hidden, were tabled in this House. The contracts clearly reflect that there is to be some payment for each portion of the assets, including the estates, trust and agency accounts.
In order to finalize that in a way that is meaningful for the benefit of the creditors and shareholders of Crown Trust, it now has to be enacted in legislation so that the rights that people have against Crown will become rights against Central Trust. Without that, let us be very frank about it, there could well be some with estates, trust and agency business who choose to apply to the courts to withdraw that from Central Trust to the detriment of the preferred shareholder. I say that very deliberately because I want the member to clearly understand what we are talking about.
We all understand the plight of the preferred shareholders. I do not want to be argumentative in any way, particularly with Dr. Donald MacDonald in the gallery. He never argued with anybody in this House. He was always open, sincere, nonpartisan, nonprovocative -- or was that the same Dr. MacDonald? I cannot recall.
Interjections.
Hon. Mr. Elgie: You mean he was on occasion a little provocative. Of course, the member for Brant-Oxford-Norfolk (Mr. Nixon) would know far better than I. I remember him only as a friendly, giant teddy bear who was always willing to co-operate and help in all ventures. He was a remarkable man and we all miss him very much.
We all understand the plight of the preferred shareholders. I understand, in this important game we play in this Legislature, that it is nice to say there was negligence in this. But let us analyse the Crown Trust situation. Crown Trust was acquired by the new owner on October 7 and within virtually one month an investigation was commenced into its business. That eventually led to legislation in December, which led to possession and control on January 7.
I do not think anyone seriously looking at this issue would consider there was any negligence in any way by anybody by the wildest stretch of the imagination. The government's actions in Crown Trust were aimed at preserving something in the interest of creditors and shareholders.
It is nice to talk about Crown Life Insurance Co. as a bidder, but Crown Life was not a bidder for the assets of Crown Trust. Crown Life negotiated with Mr. Rosenberg for the acquisition of his shares, with an amount of money going to Mr. Rosenberg as a result of that proposal.
I clearly stated in this House on January 17 that this government would not be involved in any transfer unless all the depositors, all the preferred shareholders and all the creditors, including the Canada Deposit Insurance Corp., had their obligations met first. So it is really misleading to say that. I do not mean that in the sense that we are trying to kid anybody, I understand that.
It is not the centre of the experience, as Governor Jerry Brown used to say, to talk about Crown Life because Crown Life was negotiating with Mr. Rosenberg for his shares. They were not involved in the five applications received with respect to acquiring the assets because they were not a trust company. They do not have a trust company licence, therefore they could not. They were trying to acquire shares which would have given them ownership of the trust company.
The member for Welland-Thorold (Mr. Swart) asked what the options are with respect to trustees removing any estate, trust and agency accounts. This does not change the ordinary rights one would have against an operating company in good standing. In other words, whatever legal rights one has with respect to Crown Trust can now be exercised with respect to Central Trust just as they could in the ordinary course of business.
In other words, a beneficiary can still go to court at any time and apply for a change in trustee under circumstances that have to be proved in court. They could do this before this bill was enacted except that now, with Crown Trust standing as the possessor of only soft assets, it is in a vulnerable position. Recoveries with respect to the preferred shareholders and creditors are therefore at jeopardy in some degree.
The member for Welland-Thorold also talked about a committee to delve into the negligence that surrounds Crown. I have tried to deal with that pretty honestly in my remarks to the member for Prescott-Russell. I think it would be far-fetched to suggest that if there was any negligence anywhere, and I honestly have serious doubts about that, it occurred in the case of Crown Trust.
I appreciate the points members have made. With the greatest of respect, I think it would be a tragedy to delay passage of this bill. I understand from the House leader it is the wish of that party that it go to a standing committee. I will not oppose that wish. But I do hope some option is available to allow this to go to committee of the whole to resolve it in a more expeditious manner. This is not because there is any reason it should not go to a standing committee, but because I think members will find those wishing it to go now have a better understanding of the bill.
I do not know how one handles that, Mr. Speaker, I will be honest about that. My experience in matters between House leaders is not that extensive.
Mr. Conway: I would not move an inch without calling Bill Macdonald myself.
Hon. Mr. Elgie: That is the member's problem, but then he has relationships with a number of people in the province, of whatever religion. He always has to phone someone to make certain what they are and whom they are with. As a matter of fact, I recall there is some interest by some members of this House in having a provincial bird. Some might think the blue jay. I am interested the member thinks the cardinal should be the provincial bird. Is it true the member has made that suggestion?
Mr. Speaker: Has this anything to do with the bill? Back to the bill.
Mr. Conway: You are the judge of that, Mr. Speaker.
Hon. Mr. Elgie: Mr. Speaker, I have concluded my remarks.
Mr. Nixon: Mr. Speaker, on a point of order: The minister has indicated there are concepts in his own mind about whether or not this should go to a standing committee or the committe of the whole House. I suppose it is possible that it go to both committees. However, it is true he has an understanding that the official opposition has requested that it go to standing committee. I do not feel it would needlessly hold up clause-by-clause consideration of the bill. I am sure it could be arranged that one of the standing committees could deal with it expeditiously.
The minister may have cleared up the matter, through his colleagues and assistants, with those people who have registered their objections with us. We are not aware of that, although we are quite prepared to accept the minister's explanation. We do feel a reference to the standing committee would be in order. Since, in the minister's view, there would be no one objecting to the specific provisions it certainly would be a very short reference indeed. We appreciate the fact that he is not seriously standing in the way of such a reference. We would hope he would allow the bill to go out to standing committee.
8:30 p.m.
Mr. Speaker: Hon. Mr. Elgie has moved second reading of Bill 97.
All those in favour will please say "aye."
All those opposed will please say "nay."
In my opinion the ayes have it.
Motion agreed to.
Hon. Mr. Elgie: Mr. Speaker, I am content to have the bill go to a standing committee of the Legislature.
Mr. Speaker: Does it matter which committee, or are you going to name a committee?
Hon. Mr. Elgie: I am not going to name it. I am going to let the House leaders decide.
Mr. Speaker: Somebody is going to have to say something. General government?
Mr. Nixon: Justice.
Mr. Speaker: Justice? Will somebody please give me some direction?
Hon. Mr. Elgie: It can go to the standing committee on administration of justice.
Mr. Speaker: There was no doubt about that at all. Everybody has agreed. Okay?
Bill ordered for the standing committee on administration of justice.
Mr. McClellan: What happens now?
Mr. Martel: What do you want to do with this now?
Mr. Speaker: Orders of the day.
Mr. Nixon: How about a little budget debate?
Mr. Conway: Mr. Speaker, is it possible, with 26 ministers, 18 parliamentary assistants and 69 Progressive Conservative members in their majority, that we have no business?
Mr. Speaker: There are 125 in all.
Mr. Martel: Mr. Speaker, we cannot order the business of the House, if you want us to do that.
Mr. McClellan: I would be happy to call an order, Mr. Speaker.
Hon. Mr. Elgie: Mr. Speaker, I think there was some understanding by my caucus that this bill of mine might well go to committee of the whole. I suspect this is the reason we are not ready at the moment.
Mr. Speaker: Obviously, that has been decided otherwise.
Mr. Nixon: Mr. Speaker, that is true, but if one looks at the business for Tuesday, when we complete second reading of Bill 97, which has just been completed, we go on to second reading of Bill 92, An Act to amend the Health Disciplines Act.
Mr. Speaker: I have called the orders of the day and nobody --
Mr. Nixon: I see the former Minister of Health is down at the door there. Perhaps he would -- oh, no, I guess not.
Mr. McClellan: Mr. Speaker, are you saying the government has lost control of the House?
Mr. Martel: Mr. Speaker, if I might make a suggestion: if the Conservatives have a budget speaker they want to put up until the acting Minister of Health (Mr. Wells) comes, he might want to talk about anything.
Mr. Conway: Frank, give us your leadership pitch.
Mr. Martel: Frank, talk about anything.
Mr. Nixon: Tell us about your liaison with the New Democratic Party.
Mr. Speaker: Could we adjourn for 10 minutes?
Mr. Conway: Mr. Speaker, who is running the shop?
Mr. Martel: Bill Davis is sure going to be mad at this.
Mr. Speaker: Order.
Mr. Conway: I am almost tempted to make a motion of adjournment. With 26 ministers --
Mr. Speaker: Is it the pleasure of the House that we suspend proceedings for 15 minutes?
Mr. Mancini: No, it is not the pleasure of the House. We should be debating issues of concern in Ontario.
Mr. Conway: Donald MacDonald might favour us with a speech.
Mr. Speaker: I am going to suspend the proceedings for 15 minutes and I shall return at that time.
Mr. Nixon: Is this grave disorder?
Mr. Speaker: No.
Mr. McClellan: It is grave incompetence.
The House recessed at 8:34 p.m.
8:49 p.m.
HEALTH DISCIPLINES AMENDMENT ACT
Hon. Mr. Wells moved, on behalf of Hon. Mr. Norton, second reading of Bill 92, An Act to amend the Health Disciplines Act.
Hon. Mr. Wells: Mr. Speaker, first of all I apologize for the inconvenience the House has been caused.
Mr. Nixon: Never apologize, never explain.
Hon. Mr. Wells: I assumed the last bill would cause the Liberal Party to burst forth in five or six speeches, but I stand speechless at the fact that it went down to committee so quickly.
Mr. Conway: Unlike Lester Pearson you were not in Bermuda.
Hon. Mr. Wells: Never, never. In moving second reading of Bill 92, An Act to amend the Health Disciplines Act, I would like to explain to the House specifically what the bill is all about.
It does two things. First, it gives to the College of Physicians and Surgeons of Ontario the authority to suspend --
Mr. Conway: Do not read the notes.
Hon. Mr. Wells: We have them all ready here. It gives to the college the ability to suspend or restrict a physician's licence on an interim basis pending a hearing by the college's discipline committee, when the college's executive committee is of the opinion that the continuing practice of that physician might bring harm or injury to a patient. That is the first purpose of this amending bill.
The second purpose is it gives the college's current peer assessment program the needed regulatory authority. It gets that authority, of course, through this statute.
Currently, the College of Physicians and Surgeons can suspend the licence of a physician suspected of being physically or mentally incapacitated until the matter is determined by final decision of the college's fitness to practice committee or by the courts. However, this provision does not apply to physicians who are suspected of professional misconduct or incompetence and are consequently referred to the discipline committee.
It often takes six to 18 months between the time an allegation is made against the physician and the time a decision is reached by the discipline committee. If there is a subsequent appeal to the courts by the doctor, then the time of delay is extended, of course, even further.
The college, therefore, considers interim orders to be essential for the protection of the public. But this necessity would be used, and I emphasize this, in only a very small number of cases each year, cases where it definitely is needed for the protection of the public.
The peer assessment program, a section of these amendments, refers to the regular review of a physician's practice by other physicians to ensure that the quality of patient care is being maintained. The college's program began on a voluntary basis as a pilot project in 1979.
Standards of patient care among 100 physicians were reviewed by physician assessors. In this project, patients' records were examined and an interview conducted with each doctor who was under assessment. In 1981, 197 physicians were assessed. Of the 15 physicians whose standards were judged deficient, none was considered to be neglectful or dangerous to patient care. I think that is very important to emphasize.
Physicians whose standard of care is considered to be deficient are, however, interviewed by the peer assessment committee and the process is considered to be an educational one. The committee does not have the right to revoke the physican's licence.
In the event the assessor discovers what is believed to be incompetence or misconduct, this would be reported to the registrar of the College of Physicians and Surgeons, who then has authority to appoint investigators. The result of the investigation could lead to the physician being tried by the discipline committee or being reviewed by the fitness to practise committee.
Mr. Conway: Could you amplify on that?
Hon. Mr. Wells: I will as we get into the debate. Currently, the peer assessment program is being run under the authority of a regulation. This regulation is now being challenged in the courts by the Association of Independent Physicians of Ontario which claims that the regulation affords no statutory authority to the program and that it violates patient confidentiality.
The college reports that the conduct of the assessors was acceptable to 98 per cent of those whose practices were assessed. Approximately two thirds of the physicians visited reported that the assessment was beneficial to their practices. The college and the Ministry of Health also believe the program is especially helpful in monitoring the practices of physicians in solo practice who have little or no hospital exposure and who are thus seldom subject to the professional scrutiny of any of their colleagues.
One of the important issues in this program that has been raised by some members of this House and members of the public is the whole issue of confidentiality. We believe we have accommodated the concerns of, for instance, the Association of Independent Physicians of Ontario which has raised this as a major criticism of the peer assessment program. The names of the patient records selected for assessment may be withheld from the assessor if the physician believes this to be appropriate. Any patient information gained during the assessment must likewise be kept confidential and records may not be removed from the physician's office.
Mr. Conway: Or left in a parking garage.
Hon. Mr. Wells: I hope they would never be left in a parking garage.
Mr. Conway: You find them there every six months.
Hon. Mr. Wells: No. not these kinds of records.
Mr. Nixon: No. The doctors' records are much more carefully guarded. Heaven help us if they ever found out --
Mr. Speaker: Order.
Hon. Mr. Wells: I believe this gives the members of this House a very brief description of the two amendments in this bill. I think they will clearly understand the reasons behind these amendments and that these amendments are obvious safeguards to patient care in this province. I would urge the members to pass Bill 92.
Mr. Nixon: Mr. Speaker, in the continuing and unfortunate absence of the minister because of ill health, I for one feel quite confident that the member for Scarborough North (Mr. Wells) has added the duties of acting minister to his roster of heavy responsibility. I notice his friend the member for Muskoka (Mr. F. S. Miller) is hovering near him. Since his friend from Muskoka is a former Minister of Health as well, we have a sort of double whammy here tonight to try to force through the Legislature this departure in the governance of the medical profession.
There are those who feel I have developed a somewhat jaundiced view of the legal profession. Normally, I am quick to say that some of my best friends are lawyers. I really never met an individual lawyer I did not like and respect, but taken as a whole, they tend to be an overcharging group of people who are ripping off the community right and left.
I have to say that somehow or other that same attack of jaundice is transferring itself to the medical profession. I do not intend, under the discussion of the principle of this bill, to pursue that unduly because I see the frown on the minister's face is deepening. I do feel, however, that the ministry is not going beyond the bounds of reason when it gives the power to the college to effect interim orders removing from practice a medical doctor who is going to come under the general review provisions. I do not think this idea is unnaturally or unhealthily intruding on the rights of individual medical practitioners and it provides little enough protection for the consumers of medical care.
As a matter of fact, I think this House had better seize upon this expanding problem in a jurisdiction such as ours which is overserviced with medical practitioners. The acting Minister of Health has not made any pronouncements about that, being the careful man he is, but his predecessor has frequently indicated that Ontario has too many doctors. In their efforts to live according to the income to which they would like to become accustomed, I have a feeling their services are perhaps more generally thrust upon the public than is generally acceptable.
9 p.m.
This House must concern itself more with the quality of medical practice. My experience with the royal college has been that while they respond to complaints, it is a major case indeed that leads the college to take any sort of mild disciplinary action. There has always been a feeling in my unprofessional, and I suppose therefore unwashed approach to most professions, that they spend a lot of their time in mutual protection. That is true of doctors and lawyers and, as we have seen in the past few days, it can sometimes be attributed to politicians.
Mr. Conway: I enjoyed that pay raise, short- lived as it was.
Mr. Nixon: You always have to say the obvious, but we will let it pass.
Mr. Conway: I am just an ordinary, little old member.
Mr. Nixon: How ordinary we all know.
The peer assessment provision is one that ought to be strengthened and made much more general than it is at present. The same criticism can be directed toward teachers, lawyers and other professionals. But so often this tendency towards professional self-protection leaves incompetence in the field to the detriment of consumers of professional services. Peer assessment is one way whereby we might improve the quality of medical practice across the province. My experience is that the quality is variable in the extreme. At the low end of the spectrum there seems to be very little remedy other than the old remedy of the buyer beware. Quite often, particularly in the case of the acquisition of professional medical assistance, it is a bit late for that kind of assessment when one puts himself or herself in the hands of a professional medical practitioner.
We support the bill. My colleague the member for Hamilton Centre (Ms. Copps) has extensive and important public duties tonight that she is hoping to perform and so be back in this House before the debate has concluded. If we are all lucky, that will be the case. I know she would want to add the benefit of her careful and in-depth research to this bill. The acting minister knows to what extent she, as our official critic in these matters, does do her research and brings her views to the attention of the minister's staff, which often result in improvement of legislation and certain administrative decisions associated with the ministry.
Mr. McClellan: Name one instance.
Mr. Nixon: With anything to do with doctors and medicine, everything is pretty well in camera. We have to protect the professional stance of the doctors. As has already been pointed out, all the official documents associated with them are guarded with the care that would normally be given to the plans for Fort Knox.
In general we feel this is an essential step forward but a very small one in a jurisdiction and circumstances where we, as members of the Legislature, in the future will be called upon to reinforce the processes of self-administering, discipline and review through the offices of the royal college and the procedures of peer assessment that are included in section 2 of the bill.
Mr. McClellan: Mr. Speaker, about the scientific research contributions of the member for Hamilton Centre to the Ministry of Health, the less said the better. She makes many exceptional contributions to the life of this Legislature, but solid research is not among them.
Mr. Mancini: If Sheila was a man, you wouldn't have said that.
Mr. McClellan: I will try to be brief. We also support the amendment to the Health Disciplines Act that is before us this evening, although I do have some questions I hope the minister will respond to with respect to part I of the bill.
As has been pointed out, the bill gives the executive committee of the college the power to suspend the licence of a practitioner or to impose such restrictions on the licence of a practitioner as the committee so designates. The criteria invoked in either suspending a licence or imposing such restrictions on the licence of a member as the committee so designates are the likelihood of the practitioner exposing the patient to harm or injury.
I seem to have lost the attention of the minister. I am hoping he will respond to this question when he replies.
If a practitioner, in the view of the executive committee of the college, is likely to impose harm or injury on one of his or her patients, why would there be an alternative to the simple suspension of the licence? I do not understand what is meant in the language of the bill when it says the executive committee may impose restrictions on the licence. Does that mean a doctor may continue to practise in some way, even though that doctor is likely, in the language of the statute, to expose his patient to harm or injury?
I think the minister needs to give the House some explanation about what those restrictions will look like. What are the kinds of limitations on the powers of a practitioner who is liable to harm or injure his patient? If the minister can reassure us that the government is finally giving the college the power effectively to discipline practitioners who are -- in simple language -- quacks who could be exposing their patients to injury or harm, that is eminently supportable. I suppose the only question is, why has it taken so long for the government to give the college precisely this kind of power?
I had not expected to participate in the debate this evening. My colleague the member for Windsor-Riverside (Mr. Cooke), who is our Health critic, is also being detained at other important public functions. He is expected back imminently. I left my extensive file, based on meticulous research I accumulated over the years when I was Health critic, in my office.
I seem to recall the case of a certain doctor in this community who was suspended from practice by the royal college and yet continued to pop up year after year in various offices, usually in the west end of Toronto strangely enough. It was further west, of course, than the boundaries of the great riding of Bellwoods. He continued to practice surreptitiously. The college and the ministry seemed to have enormous difficulties in dealing with this character. I assume this statute is designed to remedy that deficiency.
Again, if the minister can explain to us what is meant by the option of imposing restrictions on the licence, in addition to the suspension, I think that would go a long way towards reassuring those of us who intend to support the bill anyway.
Secondly, I want to make a few comments about the peer assessment section of the bill. I think the peer assessment provisions that are being added to the Health Disciplines Act are an important and significant move, if I may say so, towards a solution to the extra billing problem in this province. It has always been argued by representatives of the government that it is impossible for them to put an end to the practice of extra billing on the grounds that there is no other way for doctors of exceptional competence and merit to be remunerated for their exceptionality, for their enormous skill, for the extraordinary contribution they make to the practice of medicine.
9:10 p.m.
We are talking about a number of specialists in various fields of practice who, in everybody's estimation, exceed the skill, capacity and competence of their colleagues. They are in a league by themselves. The argument is always made that the only way to acknowledge their exceptional skill is to permit them to charge over and above the Ontario health insurance plan fee schedule.
In practice, this is not what happens. In some communities, 60, 70 or 80 per cent of the specialists are opted out, so this fact rather shoots that argument full of holes. Nevertheless, I think there is a kernel of truth in the argument that is made. It makes sense that a practitioner who is recognized as a world expert in his or her field of practice may be entitled to an additional remuneration over and above the OHIP fee schedule. If this is one way out of the extra billing which is threatening to destroy universal medical insurance, I for one am prepared to look at it.
It seems to me peer assessment offers one possible solution. There is nothing to stop the Royal College of Physicians and Surgeons from instituting a kind of peer assessment program. Such a program would permit exceptionally skilled and competent practitioners to receive the assessment of their peers that they are entitled to additional remuneration on the basis of these extraordinary skills.
One possible development of the reform in section 2 of Bill 92 might be the development of an exceptional category of payment under the OHIP fee schedule. This could be provided to practitioners who, in the opinion of their peers, following a peer assessment, are entitled to additional remuneration because of the exceptional contribution they make to the practice of medicine.
I put this forward as a suggestion -- I think in good faith to the minister for his consideration, perhaps not even for an immediate response. I think there is precedent in Great Britain for precisely this kind of procedure. There are opportunities in Great Britain for the medical profession to sit in judgement on the performance of their colleagues and to make decisions about who of their colleagues are entitled to additional remuneration under the National Health Service.
Amazingly enough, it seems to work reasonably well in Great Britain, despite all the propaganda we read in North American newspapers. The medical associations in Great Britain are remarkably united in their support of the National Health Service. One of the reasons this is true is precisely that the peer assessment program has permitted members of the medical profession to acknowledge the exceptional merit of certain practitioners and to reward them financially in accordance with that recognition.
I think it is simply not good enough for the government to continue to say, "The only way an exceptional specialist can be recognized is to permit him or her to charge 40 per cent above the OHIP fee schedule." I do not think this is fair. I do not see why the hapless patient should be forced to bear the burden of remunerating an exceptional specialist. It does not make any sense. It seems to me that if one wants to build the merit system into the OHIP fee schedule, one can do it by adjusting the fee schedule on the basis of this peer review mechanism.
Mr. Conway: What is your proposal again? Just repeat the essence of your proposal.
Mr. McClellan: I have been asked to repeat the essence of my proposal. The essence of my proposal is to take the peer assessment provision that is being established in section 2 of this bill and to permit a second level of payment under the Ontario health insurance plan fee schedule for practitioners who, in the opinion of their peers, are entitled to what one might call merit pay on the basis of an extraordinary contribution that the medical profession itself acknowledges an individual practitioner has made to the practice of medicine. This is not an original notion at all. This is what is done in the United Kingdom under the National Health Service.
If the government is serious in the arguments it uses to justify extra billing -- and when we come right down to the bottom line, that seems to be the principal argument; practice obviously belies that, but the principal argument, at least in theory, is that doctors must have some way of recognizing in financial terms the contributions of exceptionally talented practitioners. If that argument is being put forward seriously, it seems to me this proposal is one way of addressing that argument and at the same time protecting and preserving the integrity of universal medicare.
At any rate, I put it forward as a modest proposal. We intend to support Bill 92, but I invite the minister, when he makes his reply to those of us who have participated in the debate, to be so kind as to attempt to explain the meaning of subsection 58a(1), which permits the executive committee of the college to impose restrictions on the licence as well as to suspend the licence.
The Deputy Speaker: I thank the member for his remarks. The member for Renfrew North.
Mr. Conway: I will expect you to know my riding next time, Mr. Speaker, without referring to your master list.
Let me start at the end by saying that we Irishmen are always nervous about modest proposals. I must say, though, in this case my illustrious colleague the member for Bellwoods (Mr. McClellan) makes an extremely good point, and I commend him for it. I am not aware of its existence elsewhere, but I think he has recommended to the attention of the acting Minister of Health a very worthwhile consideration, which I have every confidence the acting Minister of Health will digest in a positive sort of way.
I am surprised to learn parenthetically that the member for Bellwoods is no longer the Health critic for the New Democratic Party.
Mr. McClellan: We all move on; even you moved on.
Mr. Conway: I note that with a certain sense of loss, because he was such a --
Mr. McClellan: You are deputy leader now, I believe.
Mr. Conway: Oh, but that is a mere title, I say to my friend; his is a real responsibility.
I want to say that Bill 92 invites us lay members of the Legislature to reflect upon the whole issue of self-governing professions, a matter about which I have been developing some real concern in recent months. It is not so many weeks ago that I happened by the standing committee on procedural affairs to hear a presentation made by the Law Society of Upper Canada, a self-regulating body that looks after its members from Parry Sound through to Brantford.
I am concerned, quite frankly, as are many people in the public, about the way in which the self-governing professions go about protecting the public interest as it relates to their mandate. I recall, for example, that the Law Society of Upper Canada was apparently quite indignant about being summoned before a committee of this Legislature to give an accounting of its performance regarding its mandate.
"What right does the Legislature have," it was reported to have said, with the aid and comfort of the Attorney General (Mr. McMurtry), "to inquire into our administration?" I say the self-governing professions in this province have every right to expect that they can be called on for an accounting of their responsibilities.
9:20 p.m.
When I look at Bill 92, I say to the acting Minister of Health, the most impressive observation that passes through my mind upon reading this act is that the College of Physicians and Surgeons of Ontario has not long had this authority. It is amazing to me. I, like the member for Bellwoods, know of situations where the college has expressed a private concern, if not a public concern. People have been disciplined. Bad actors have been reined in on previous occasions. Their practice is the subject of ongoing review and, of course, they continue to practise with apparent immunity.
I think for a lot of people it is a great surprise to find out that the College of Physicians and Surgeons has not for a long time had the power we are going to give it with Bill 92. I certainly join with the member for Brant-Oxford-Norfolk (Mr. Nixon), the member for Bellwoods and other members in offering my wholehearted support to the acting Minister of Health for the quick passage of Bill 92.
I say again that if self-governing professions are going to have any credibility in terms of the discharge of their public mandate, they are going to have to be seen to be more vigilant than they have been on previous occasions. I want to be specific here about the College of Physicians and Surgeons. The public literature of this province in recent months is replete --
Interjection.
Mr. Conway: The public literature of this province in recent months, as the member for Hastings-Peterborough (Mr. Pollock) well knows, is replete with example after example of cases where the College of Physicians and Surgeons has not appeared to have been either evenhanded or very consistent in the way in which it went about protecting the good people of Madoc, Marmora, Bancroft, Stirling, Roseneath, Port Hope, Cobourg and the people beyond those great communities. I say to the acting Minister of Health, I would hope --
Mr. Pollock: Look after it, Sean.
Interjections.
Mr. Conway: The mineral water at the Royal York must have been very good indeed. I want to say to the acting Minister of Health --
Mr. McClellan: Things are a little soggy on the back benches.
Mr. Conway: The member for Bellwoods reports a sogginess on the government back benches, and I would not touch that line with a 10-foot bar pole. I want to say to the acting Minister of Health, through you, Mr. Speaker, if I might have your attention --
The Acting Speaker (Mr. Robinson): Change of command.
Mr. Conway: A change of command; I understand a change of command.
I hope the acting Minister of Health, when he goes forward armed with tripartisan support of his Bill 92, will convey to the College of Physicians and Surgeons the sense that many of us have in this Legislature, as have our constituents beyond this place, that the college would do well to be more vigilant in the way in which it goes about protecting the public interest. As I said earlier, there are many of us who are not very pleased that, with recent accounts of incidents under its jurisdiction, it has been doing what the public expects a self-regulating professional body of that kind to be doing.
I do not have my file of these cases because I did not come prepared to debate Bill 92 tonight, but I have conveyed this concern to my friends in the medical profession. I do not mean to offer this as a broad-brush criticism of the medical professon, because I think by and large as a profession it is composed of well-intentioned professional men and women. But the public expects a high standard of discipline and self-regulation from that self-regulated profession.
I certainly want to encourage the acting Minister of Health to convey the concern I have about its recent performance. We have heard cases of people on the operating table being talked to about their billing, and we have heard a variety of other cases which, unfortunately, I cannot document because my file is not at hand this evening.
I consider it passing strange that this kind of provision has not been long within the purview of the College of Physicians and Surgeons. Therefore, I have no problem at all in supporting its inclusion at this particular point.
The acting minister, as members will recall, was an earlier full Minister of Health way back when Allan Lawrence was almost Premier of Ontario -- think what would have happened had the acting minister's man made it to the top in the 1971 leadership race. When the acting minister reflects upon the water that has passed under the bridge of this ministry since he left its helm some 11 years ago, he will want to share with the member for Bellwoods and myself the need to clarify that part of the first section of the bill which talks about the imposition of "such restrictions ... as the committee designates." I would like to have a better picture of what is intended, as would the member for Bellwoods. What are the possible restrictions in that particular case, short of a full suspension of the licence?
I also want to express a concern about subsection 64a(3) of this bill: "The committee on peer assessment may appoint members of the college or other persons as assessors for the purposes of a peer assessment program." I would like the acting minister to help me understand who might be involved as "other persons." Does that mean people might be involved in a peer assessment who are not members of the College of Physicians and Surgeons? That clarification would be helpful.
In his opening statement the acting Minister of Health took some pains to point out, as does the legislation, that a member has the right not to have information given by a member in the course of a peer assessment program --
Interjections.
Mr. Conway: The member for Sudbury East (Mr. Martel), whose tender sensibilities forced an earlier vote today, seems to have been restored to his more traditional conviviality. I would only beg his indulgence for a few moments more, by talking briefly to the point of how a member might not have information given in the course of a peer assessment used against the member in any proceeding before the discipline committee, except for knowingly giving false information.
That provision interests me, because I can well imagine that a lot of members of the college are going to feel there is an instrument of intimidation here that will have to be very carefully applied, and I am not so sure that a lot of the good doctors in this province are going to be satisfied that the information so procured in the peer assessment will not be turned against them otherwise or elsewhere.
I note the minister's painstaking efforts to indicate that this will be so, but I must say from my knowledge of many in the medical profession that it is not likely, on the basis of past conversations with me at least, that those people will feel very protected by subsection 64a(6) of this bill.
9:30 p.m.
Again that part of the bill reminds me of what we found in the Morrison special examination about the performance of lawyers in the trust companies affair. We heard from the leadership of that self-governing profession that they were very capable of rooting out the bad actors and disciplining those bad actors within that self-governing profession.
Mr. Speaker, my attention has been drawn to that quizzical look which just crept across your face. I do not have total confidence that the self-governing medical profession will apply itself as vigorously to the --
Interjection.
Mr. Conway: Well, I do not know. I think the member for Sudbury East made a point earlier. I seem to be endlessly distracted tonight.
I support Bill 92. I am surprised it was not included in the act a long time ago. I strongly support the government in closing this particular gap. I strongly encourage the government and the self-governing medical profession to be more vigilant and more vigorous, more even-handed and more consistent in the application of its self-governance in the public interest than recent incidents would have the general public believe. They ought to know that there are some sceptics, including myself, who feel they have fallen some distance short of their promise in terms of their self-governance.
On that note, I am pleased to resume my seat to await the acting minister's amplification on the points raised by myself and others.
Mr. Cooke: Mr. Speaker, I will be very brief. I start by saying that I agree with whatever the member for Bellwoods said. I was not here to hear him, but I understand he said it on behalf of the party and therefore I agree with whatever he had to say.
We will be supporting this legislation. On the two amendments, I agree with the previous speaker; one must wonder why these kinds of amendments were not brought forward previously.
I would like to compliment the minister for the compendium of information. In my previous portfolios, I have never had legislation explained in black and white and English for those of us who are nonlawyers. It was made very easy to understand and the rationale of the legislation was included. Therefore it was very easy for the government to convince us that in this particular case, this legislation was worth while.
I do have some problems with the system that is currently used in which one first goes through the College of Physicians and Surgeons of Ontario and then to the discipline committee. Eventually, if one is still not satisfied, the complaint can be taken to the Ombudsman in this province. But one has to go through those first two steps before the Ombudsman will accept the complaint.
I just want to illustrate with one case my concern with the process. Numerous cases have come to my office. More often than not, the process is so difficult and usually unsuccessful that most of my constituents who have had complaints about doctors would rather avoid the system than go through the system and try to get things corrected.
One particular case I had demonstrates the problem with the system. This individual in my riding had a three-year-old daughter who had an operation performed. She had actually been born with a physical problem and had to have surgery. Two operations were necessary. This individual went to Dr. Stecko in Windsor, who could perform one of the operations. The other operation was going to have to be performed at the Hospital for Sick Children in Toronto.
After scheduling the operation, the parents thought about it and said: "This is kind of silly. She has to have two operations, and both of them could be done in Toronto. Let's have them done by the same doctor." They were done in Toronto. The child returned to Windsor and a complication developed.
The family returned to the Children's Rehabilitation Centre in Windsor where Dr. Stecko is the staff physician. I emphasize "staff" because it is a Ministry of Health facility. They made an appointment to deal with the complication. They got to the clinic. They waited for an hour and a half to see Dr. Stecko.
After waiting for an hour and a half, the nurse came out. Dr. Stecko said: "Since I did not perform the surgery I will not even take a look at the complication that has developed. You are going to have to travel 240 miles to Toronto to see if there is a serious problem or not."
The family had to do that. We did take the case to the College of Physicians and Surgeons. The college said, "Strictly speaking, under what is defined as professional misconduct, the doctor did not do anything wrong and, therefore, we cannot reprimand him." We then took it to the health disciplines board. The health disciplines board said exactly the same thing. Now it is before the Ombudsman.
The point is that at both of the hearings that have been held so far, Dr, Stecko was there with his lawyer and my constituent was there with my legislative assistant. The doctors have all the cards on their side and, for something I think is a moral question in this particular case, the college and the health disciplines board followed strictly what in this case was not defined as professional misconduct and, in my view, let the doctor off the hook.
I think the system is such that it does not protect patients adequately. It does not provide for adequate hearings, it is a system controlled by the profession and it pays little attention to the patients and their concerns. It is primarily in place to protect the profession.
I realize the piece of legislation before us does not deal with the global problem. I really think it is something with which the profession must come to grips.
One should consider that this government, when it came to extra billing, at one point had negotiated with the Ontario Medical Association and agreed there would be prior notice for extra billing. But the only way the government could actually get the profession to implement it -- which seems to be a very humane, a very considerate agreement; that if one is going to extra bill patients one has to notify them ahead of time -- the only way it could get the profession to accept that was to put it in the provisions or regulations for professional misconduct. That, to me, indicates there is something very seriously wrong with the profession, if this is the only way of dealing with it.
I think it is something the government is going to have to come to grips with and I think it is something the profession is going to have to come to grips with.
I think the makeup of the various bodies is going to have to be more representative of consumers, reflect public concerns and take into consideration the fact that this is not simply a profession, it is not simply a business for individual business people but in fact it is a social service. It is a social service that is, by and large, funded with public funds and therefore should be operating in the public interest and not in the interest of only the profession.
We will be supporting these two amendments. I note one of the amendments on the section deals with the peer assessment program. The only reason the amendment is being brought forward is because a group of doctors is challenging the legality of that process now, which again indicates something with the profession.
I also would like to make one point on confidentiality, which is one of the concerns of this particular group of doctors. If doctors are sworn to confidentiality, as professionals are -- and I remember as a former social worker that was one of the things we had to take an oath on when we became social workers with the children's aid society -- there are some areas where we simply have to accept that responsibility on the part of the profession.
I know it is one of the concerns of the Health critic of the Liberal Party. I think building in any kind of a process whereby confidentiality is guaranteed by wiping out the names and so forth would be very difficult to implement. The response of the profession in this case is to accept professional responsibility.
I assume that if confidentiality by the people who are part of the peer supervision committee is not respected, there will be remedies open to consumers or patients and I would expect those would be used. If a problem developed, then a further amendment to this legislation would have to be examined. At this point, the amendment before the Legislature this evening is satisfactory to us without any further amendments.
9:40 p.m.
Mr. Roy: Mr. Speaker, I want to make a few brief comments on this amendment to Bill 92. It has been some time since some of us were involved with the original Health Disciplines Act. Some of my colleagues, such as the member for Renfrew North (Mr. Conway) and others, were talking about who was the Health critic when the Health Disciplines Act was passed around 1974.
At that time the Minister of Health was the member for Muskoka (Mr. F. S. Miller) and I was the Health critic. We spent a considerable amount of time reviewing the legislation then and hearing submissions from a variety of health professionals and so on. In reviewing Bill 92, like many of my colleagues who spoke earlier, I was surprised that the existing Health Disciplines Act did not encompass the powers that are given to the committee by the amendments proposed by the acting minister.
As I have heard from other members, I suspect the reason for the legislation is that there is some court challenge to the existing legislation. But in reviewing section 58 of the Health Disciplines Act, I would have thought the section was wide enough to encompass the powers currently given in Bill 92. What the bill proposes is to give power to the executive committee to suspend or impose restrictions on the licence of a member pending the commencement and completion of discipline proceedings. So the power of suspension or the power of imposing restrictions is only given pending the completion of the discipline hearing.
In reviewing clause 58(2)(c), I see there are quite extensive powers given to the committee. It states the committee had power to "take such action as it considers appropriate in the circumstances and that is not inconsistent with this part or the regulations or bylaws."
That is quite wide. Given the wide discretion under that section, I would have thought the powers given under Bill 92 already existed. Apparently the minister does not feel such to be the case. Obviously the legal advisers within the ministry do not take that position. The powers in Bill 92 give the power to restrict or suspend a licence pending the hearing. That is given under very limited and stringent conditions.
I suppose what the acting minister and the ministry have in mind is simply that they want to checkmate any court action which will challenge the powers of the committee now and they want to spell out clearly in Bill 92 exactly what those powers are.
Sometimes it is a good idea to do that. Some of us are concerned about excessive and superfluous legislation that is not necessary when the powers are already given in a present statute. Here they are spelled out in minute detail in Bill 92.
I see the power given to the committee to suspend and restrict the licence is given under fairly restrictive conditions, and so it should be. With the new Charter of Rights, all legislation must now reflect a sense of natural justice. The acting minister and the ministry obviously have been advised of this.
I see the restrictions put on the power to suspend pending a hearing are restrictive indeed. For instance, it requires a report in writing from the registrar about the conduct and actions of the member. It requires proper notice to be given, etc. I applaud these initiatives. The minister will understand that when such wide powers are given over the livelihood of individuals, one wants to ensure that a system of natural justice is in place.
I am sure the Minister of Consumer and Commercial Relations (Mr. Elgie) will understand when I speak about a system of natural justice. It has not always existed in legislation we see coming before the House. He knows what legislation I refer to. He knows why we oppose that legislation. He knows why the Premier (Mr. Davis) today distorted in some way the reason we oppose the legislation. We opposed it on the basis that there was a lack of natural justice in the process.
Even though we applaud initiatives taken by the ministry and have no sympathy with the individual who might try to take advantage of the process, the system of natural justice must apply to everyone. A system is only good when it has application even in the most offensive situation and sometimes to the most despicable individuals. That is our system of democracy. It must apply equally to all. So I applaud this initiative by the ministry.
Like my colleagues, I have not been overly impressed by the initiatives taken by the health discipline committee against some members in the past. The members for Renfrew North and Bellwoods and others have talked about their concerns in that regard. I think it is important that we who represent the public put it on the record that when self-governing bodies such as these -- lawyers, doctors, accountants or others -- are given the power to discipline themselves they must act responsibly and in the public interest.
Like many of my colleagues, I have been amazed by some of the leniency against some of the members shown by the committee on the health disciplines process. The most recent example was the doctor who managed to get a cheque signed while a lady was being wheeled to the operating room and under anaesthetic. As I recall, there was no discipline against that individual.
I recall another situation a few years ago where a doctor was suspended for having sexual relations with a patient, but another doctor who had absconded and defrauded the Ontario health insurance plan of thousands of dollars was given a very light sentence indeed. There was a lack of equity in the two cases. I mentioned those cases because they appeared at the same time. There seemed to be a disproportionate amount of punishment in one case as opposed to the other. I am not suggesting the punishment in the first case was not adequate, but certainly in the second case it was totally inadequate.
9:50 p.m.
I mention this because my colleague from Renfrew North talked about lawyers. Lawyers traditionally deal very harshly with members who are involved in fraud, playing around with their trust funds and so on.
Mr. Speaker, you as a member of the assembly will know that not a week or two go by but one gets a report from the Law Society of Upper Canada with a whole list of lawyers who have been suspended, disciplined or whatever. I say to my colleagues in the medical profession that they may have something to learn.
Mr. Cooke: There are volumes of lawyers.
Mr. Roy: The member is not suggesting there is more reason to do it to the lawyers than the doctors. It is just that the lawyers traditionally have had no compunction about dealing severely with members of their own who are delinquent in a variety of areas. They are not afraid to say so. Every week we publish those who have been reprimanded, disciplined, suspended or whatever.
Interjection.
Mr. Roy: The member is not going to tell me. I say to my colleague the Minister of Consumer and Commercial Relations, who happens to be a member of both professions -- some people would say he is incompetent in both but he happens to be a member of both professions -- he will understand that his colleagues the doctors have traditionally taken an attitude of self-protection, while the lawyers on the other hand have been a bit more vicious towards each other. They have been more aggressive and savage towards each other. There has not been that sort of self-protection.
As one member representing the public, I say to the minister that the message must go forth from any of us here that we expect that if powers are given to these discipline committees they are enforced with a measure of natural justice. However, they must be enforced with a measure that inspires public confidence in the process. I am not convinced that has always been the case in the past.
The last thing I want to mention is the section dealing with this question of peer assessment. Perhaps the minister made a statement and I do not know what the purpose of this is. I suspect, if I can speculate, it is not a bad idea to have a process by which the profession reviews from time to time the performance, the work record, etc., of a variety of members because, in a profession as important as that of the doctors, it is important to keep a level of competence. I suspect that is part of the process. If this is what it is, I am surprised that system has not existed in the profession before.
Hon. Mr. Wells: It has.
Mr. Roy: The minister is saying it has, but we are codifying the process here. We are giving it the necessary power. Given that situation --
Interjection.
Mr. Roy: Mr. Speaker, what did the minister say there?
The Acting Speaker: I did not hear what he said. I really do not think it will produce anything if you hear it either.
Hon. Mr. Wells: It is being challenged.
Mr. Roy: It is being challenged.
Of course, the lawyers will do their job. If they see an injustice some place in this province they will come to the rescue and they will challenge it. This is the vocation of the profession. Mr. Speaker, you understand that. The minister has enlightened me. He says --
Mr. Conway: They will bill everybody with equal vigour.
Mr. Roy: That is the other thing. I want to tell the House this. As my colleague gets older, he is trying to give the member for Brant-Oxford-Norfolk competition in being nasty towards my profession. Is it a matter of cynicism towards the profession? Is it a matter of envy? I really do not know. However, I will have to talk to him. I think that fellow can still recuperate. I have given up on the other one over the past years.
I understand now. The minister said it is being challenged and therefore we have to codify to make sure we know the parameters and the guidelines under which this peer group or this peer assessment will be given the necessary powers. Given that situation, I think it is a good idea. As my colleague said earlier, we certainly are in favour of it.
The last thing I want to say is we wish the Minister of Health well. We would like to see him back. It is not that we do not like the acting minister, but I could see from my question to him today that he has lost his touch in Health. He is not up on the thing. He has too many other priorities.
Mr. Conway: He is running too.
Mr. Roy: No, he would not be running.
The Acting Speaker: Why do we not address our remarks to the bill?
Mr. Roy: We are just having a bit of gossip here. What do you think? Do you think he is going to run?
Mr. Conway: Ask him about that radioactive Scarborough soil.
Interjections.
Mr. Roy: The other thing is he has had distractions recently. I must say that for the record. I saw the minister the other night talking about radioactive soil out there -- where is that?
Mr. Conway: Beare Road.
Mr. Roy: He was facing an irate group of taxpayers. We have great respect for the minister. He always has a way of charm and a way of compromising, but somehow that sort of effectiveness was slipping on him with these people in front of the television cameras.
Mr. Conway: They ruffled his silver feathers.
Mr. Roy: Yes. That white mane of his was tingling somewhat.
The Acting Speaker: I caution the member that we are wandering rather far afield from the bill.
Mr. Roy: You are quite right, Mr. Speaker. Maybe I spoke too long and too loudly. I might have distracted the assistant clerk.
Having made these brief comments about Bill 92, I want to say we are fully in support of it. If the intention is to spell it out clearly to frustrate these court actions or these challenges, we are in full support and the minister has our blessing.
Ms. Copps: Mr. Speaker, first, may I apologize and thank my colleague for holding the fort for me. I was out playing hockey with the colleague of the member for Ottawa East, the Attorney General. I found myself in a rather awkward position because I was dropping the puck in a hockey game between McMaster and the Toronto Varsity Blues. The only thing I could wish the Varsity Blues is that the same fate befall them tonight that will befall the Toronto Argonauts on Sunday.
The Acting Speaker: I am not sure what that has to do with Bill 92 either.
Ms. Copps: Nevertheless, Mr. Speaker, I am sure you will accept that apology.
Interjections.
Ms. Copps: Mr. Speaker, as was mentioned by all of my colleagues on this side of the House, we recognize the need for this legislation. I think it behooves all of us to recognize that the vast majority of physicians have co-operated with the informal peer assessment review. The court challenge is being launched by a very small minority who have a number of concerns they wish to address and in that respect have actioned a court challenge.
We believe the statement issued when the acting minister introduced the bill made it quite clear that the peer assessment program has been working effectively within Ontario. As long as there are guidelines developed to ensure that each physician has an adequate and ample recourse in terms of the speedy and due process, then we intend to support the bill.
We will, however, be interested in calling for certain amendments speaking to one of the issues which was addressed by the independent physicians' group that is launching the court challenge, and that is the issue of patient confidentiality.
The Speaker will no doubt remember that when the minister launched Bill 92 in the House, he did so with a compendium of notes which suggested that each physician would have the opportunity, when he or she so chose, to have the records made confidential prior to the peer assessment team's carrying out its responsibility. When I had a chance to see the bill, it was with great interest that I looked for the actual legislation that would guarantee that kind of confidentiality. I found that within the context of the amendments that have been presented the one glaring omission was the issue of patient confidentiality.
I do not speak particularly to the court challenge that has been launched by the independent physicians' group, where patient confidentiality may have been introduced as an ancillary rather than a central issue to their objections. In a society where information is becoming ever more available from many more numbers of sources, it seems to me that it is incumbent upon us to stress the right of the patient. I speak now not of the right of the physician to have his or her files made confidential, but the right of the patient to be guaranteed confidentiality in the peer review process. In fact, that right was alluded to in the statement made by the minister when he introduced the amendment, but it is glaringly absent from the legislation presented before us.
10 p.m.
Naturally, our party will rise in full support of the bill because it does address the issue of self-regulation of a body that is covered under the Health Disciplines Act. I am only sorry the government has not been in a position to respond as quickly to certain other organizations. I am thinking of the Society of Medical Technologists which was guaranteed more than a decade ago by the then twice-removed Minister of Health inclusion in the Health Disciplines Act. To date we have not seen anything in legislation.
I am happy that when the government discovered the potential for legal difficulty relating to peer assessment review, it acted immediately with this amending legislation. I am sorry, however, that at the same time the government was not prepared to put forth a full package of amendments to the Health Disciplines Act, which would include provisions for self-regulation for many and varied health bodies across this province that now are either voluntarily self-regulating or have virtually no regulation whatsoever.
It would seem that with the kind of input we have had from many medical and health team professionals over the last couple of years, it would have been a real feather in the cap of the new minister if he had brought in a major package of amendments on the Health Disciplines Act, not merely the housekeeping legislation we see before us.
I know the member for Windsor-Riverside expressed some concern about the issue of patient confidentiality, but he added that, as professionals, doctors would be bound among themselves by the oath of confidentiality. I think, however, the minister expressed concern on the part of the ministry in his opening remarks. He said if a physician so chose, he or she could have patient confidentiality guaranteed in the process.
But not including such an amendment in these housekeeping revisions speaks very clearly to the fact that patients' rights are not given our full attention. They are not allowed the full detailed examination we often accord in this Legislature to the right of physicians and to the right of peer assessment for self-governing purposes.
It seems to me we have waited many years for implementation of recommendations regarding the Kreever commission that have not been forthcoming. If the House would accept a minor housekeeping amendment we will be suggesting with regard to the issue of patient confidentiality, I feel we would be responding to the desire for delivery of a first-quality service that would be subject to a peer review which would be supported by the majority of physicians. I believe a majority of patients across this province support that too. At the same time, we would build the first bridge towards a guarantee of patient confidentiality, which has been given rather short shrift in the past.
I would urge, then, that members not only support the spirit of this legislation, but also that we would all support the inclusion of patient confidentiality. Then all patients across this province can rest assured that when they have a very private medical relationship with their own physician, the physician will not be allowed to make those medical files available to other professionals, quasi-professionals or others involved in the peer assessment review.
I think the process can certainly be carried out. The Minister of Education and Colleges and Universities (Miss Stephenson), an expert on all other matters, will no doubt be aware that it was the Minister of Health who first suggested that physicians should have the possibility of nullifying or deleting the identities of their patients if they so choose. What we are asking for is that this amendment be carried a little bit further and, instead of leaving the responsibility for making that choice with the physician, all patients rights across this province be protected by incorporating in the legislation a clause which would guarantee patient confidentiality, so that a matter of choice would not simply be left to the whim of each physician.
We believe this is an important and integral component in a package that we hope, with the new health disciplines review, will lead to a more effective protection of patient rights in this province. We certainly urge the support of all sides of the House not only for the amendment but also for the amendment to the amendment we will be proposing.
Hon. Mr. Wells: Mr. Speaker, I would like to thank all the members for their participation in this debate tonight.
Mr. Conway: Got you through the hiatus.
Hon. Mr. Wells: Actually, we had a number of people ready for budget debate, and here we are just going to finish right on time. I will answer some of the questions that have been raised and comment on them.
The first question that was put was about the meaning of subsection 58a(1) in section 1, "The executive committee, in the circumstances set out in subsection (2), by order may suspend the licence of a member or may impose such restrictions on the licence of a member as the committee designates."
The purpose of that subsection is to allow the discretion with the executive committee either to fully suspend the licence of a doctor to practice in these circumstances or to bring about a partial suspension of some of the privileges of that doctor.
What would be an example of that? In one of the cases given to the members in the compendium, for instance, from October 1980 the college received information that a physician was prescribing narcotics and controlled drugs to addicts and other drug-seeking individuals on demand and in massive amounts. The physician's licence was revoked in June 1982. In the interim, he continued to prescribe narcotics. In that particular case, at the discretion of the committee, they could prevent him from prescribing narcotics or using narcotics, but they could allow him to continue in practice.
Mr. McClellan: Why would they do that?
Hon. Mr. Wells: It gives them the discretion to do that, if they wish. It may be they would find he did not have to be completely cut off from practising. At the present time, not only is he not cut off from practising, but he is not cut off from prescribing narcotics.
Mr. McClellan: Why not just suspend his licence?
Hon. Mr. Wells: My friend says why not just suspend his licence. We are always talking about being as careful as possible not to take rights away that should not be taken away from someone. In this case, in the opinion of the executive committee, it may be that a full suspension is not necessary.
Mr. McClellan: What is an acceptable level of harm or injury?
Hon. Mr. Wells: That is something the committee will have to decide. If the person so affected does not agree with that, there are certain remedies he can take under the legislation. He can go to court and achieve certain ends through those remedies.
Mr. McClellan: It sounds like a loophole.
Hon. Mr. Wells: No. I can assure my friend it is not a loophole. It is merely an avenue to allow a partial suspension of certain duties if that is adequate in the particular instance.
10:10 p.m.
Mr. McClellan: He is a drug pusher, so you give him an opportunity to practise.
The Acting Speaker: Order.
Mr. McClellan: We are not allowed to ask questions. I am just trying to help the minister to clarify his thoughts.
Hon. Mr. Wells: I think the member will find it allows a degree of flexibility that this House will be very happy we put in. It may be, for instance, that a person would have his surgical duties suspended. He could still practise medicine as a family physician or in some assisting capacity until the hearing has been held, but he could not practise surgery. That would be another instance of a partial suspension.
Mr. McClellan: That is a better example.
Hon. Mr. Wells: If we thought long enough, we probably could think of other examples. This section is in there to allow both eventualities to be put into effect.
Mr. McClellan: Your drug pusher is a bad example. Your drug salesman is not a great example.
Hon. Mr. Wells: The next section we were talking about was the peer assessment program. I listened to my friend's comments about the use of the peer assessment program to provide some new avenue to approach the idea of extra billing.
Mr. McClellan: To replace extra billing.
Hon. Mr. Wells: Or to replace it. It certainly is an interesting idea.
Mr. McClellan: Eliminate it. Just think about it.
Hon. Mr. Wells: The member has suggested two levels of remuneration under the OHIP fee schedule, a sort of merit pay for doctors, something which has been very difficult to establish in many other professions. We have tried over the past 20 years to achieve a really good merit pay program in the teaching profession and we have never been able to achieve it. Ultimately, what happens is the higher schedule becomes the schedule most people get. But it is an interesting idea, and I am sure it will be considered along with a number of others over the next little while as we look at ways of improving the system.
Mr. McClellan: Over the next 30 or 40 years.
Hon. Mr. Wells: I think the other question that was raised was about confidentiality. As I emphasized in my opening statement, we must be sure that confidentiality is not breached and that there is no feeling by any patients of doctors who are being assessed that confidentiality is going to be breached.
I would like to say to the member for Hamilton Centre I am not sure her amendment completely does that. I am not sure whether we should not amend section 65. I think we need to do something. In the next little while, in the next few days, I am going to look at the best way to ensure that the confidentiality we all want to be sure is in the bill, the confidentiality that will guarantee to patients that their records are not going to become public and that doctors are going to be protected as they make available their patient records to assessors and so forth, is all taken care of. I am not sure whether that amendment does it, so I will give her my assurance we will look at that. We will send the bill to committee of the whole House today and bring it back in a few days and have some amendment that I hope will remedy that situation.
The Acting Speaker: I draw the minister's attention to the clock.
Hon. Mr. Wells: Let me just quickly conclude, Mr. Speaker. Subsection 64a(3) in section 2, which deals with the peer assessment, may appoint members of the college or other persons. That was meant to mean doctors from other jurisdictions, but I think perhaps it should be clarified to a greater degree. I am going to see if we cannot amend that. I think it is a little open there, and certainly doctors would be concerned that someone might appoint nondoctors to carry out the peer assessment, which would destroy the whole program.
I will bring those amendments back when the bill is in committee of the whole House. I would urge everyone to pass this bill on second reading.
Motion agreed to.
Bill ordered for committee of the whole House.
House in committee of the whole.
REGIONAL AND METROPOLITAN MUNICIPALITIES AMENDMENT ACT (CONCLUDED)
Resuming consideration of Bill 86, An Act to amend certain Acts respecting Regional and Metropolitan Municipalities.
Mr. Chairman: The members will recall that the committee agreed to stack the three amendments for 10:15 p.m.
10:27 p.m.
The committee divided on Mr. Swart's amendment to section 8 of Bill 86, which was negatived on the following vote:
Ayes 30; nays 55.
Section 8 agreed to.
The committee divided on Mr. Swart's amendment to section 9 of Bill 86, which was negatived on the same vote.
Section 9 agreed to.
The committee divided on Mr. Renwick's amendment that a new section 10a be inserted in Bill 86, which was negatived on the following vote:
Ayes 11; nays 74.
Bill ordered to be reported.
On motion by Hon. Mr. Wells, the committee of the whole House reported one bill without amendment.
The House adjourned at 10:31 p.m.