RED TAPE REDUCTION ACT, 1998 LOI DE 1998 VISANT À RÉDUIRE LES FORMALITÉS ADMINISTRATIVES
ONTARIO SOCIETY OF CHIROPODISTS
CONTENTS
Tuesday 13 October 1998
Red Tape Reduction Act, 1998, Bill 25, Mr Tsubouchi /
Loi de 1998 visant à réduire les formalités administratives,
projet de loi 25, M. Tsubouchi
College of Nurses of Ontario
Ms Gail Siskind
Ms Barbara Sulzenko-Laurie
Hoechst Marion Roussel Canada
Mr Anthony Ruta
Ontario Society of Chiropodists
Ms Anna Georgiou
Mr Craig Hunt
STANDING COMMITTEE ON ADMINISTRATION OF JUSTICE
Chair / Président
Mr Jerry J. Ouellette (Oshawa PC)
Vice-Chair / Vice-Président
Mr E.J. Douglas Rollins (Quinte PC)
Mr Dave Boushy (Sarnia PC)
Mr Bruce Crozier (Essex South / -Sud L)
Mr Peter Kormos (Welland-Thorold ND)
Mr Gerry Martiniuk (Cambridge PC)
Mr Jerry J. Ouellette (Oshawa PC)
Mr David Ramsay (Timiskaming L)
Mr E.J. Douglas Rollins (Quinte PC)
Mr R. Gary Stewart (Peterborough PC)
Mr Bob Wood (London South / -Sud PC)
Substitutions / Membres remplaçants
Mr Mike Colle (Oakwood L)
Mr Tim Hudak (Niagara South / -Sud PC)
Mrs Lillian Ross (Hamilton West / -Ouest PC)
Clerk / Greffier
Mr Douglas Arnott
Staff / Personnel
Ms Susan Swift, research officer, Legislative Research Service
The committee met at 1659 in room 228.
RED TAPE REDUCTION ACT, 1998 LOI DE 1998 VISANT À RÉDUIRE LES FORMALITÉS ADMINISTRATIVES
Consideration of Bill 25, An Act to reduce red tape by amending or repealing certain Acts and by enacting two new Acts / Projet de loi 25, Loi visant à réduire les formalités administratives en modifiant ou abrogeant certaines lois et en édictant deux nouvelles lois.
COLLEGE OF NURSES OF ONTARIO
The Chair (Mr Jerry J. Ouellette): At this time we call our first presenters, if the representatives of the College of Nurses of Ontario could come forward. If you could identify yourselves for Hansard, we would appreciate it. There is a total time allocated of 15 minutes. At the conclusion of any presentation you may have, the time is divided equally between the three caucuses. Thank you for coming. You may begin.
Ms Gail Siskind: Good afternoon. I'm Gail Siskind, the director of investigations and hearings for the College of Nurses of Ontario. Joining me in making the presentation and answering your questions is Barbara Sulzenko-Laurie, the director of policy and director of external relations. Barbara will begin our presentation.
Ms Barbara Sulzenko-Laurie: The College of Nurses of Ontario is pleased to make a submission to the committee on administration of justice in the matter of the review of the health professions sections, schedules G and H, of Bill 25, the Red Tape Reduction Act.
CNO is the regulatory body for nurses in Ontario. We have approximately 140,000 nurses, registered nurses and registered practical nurses who are our members.
The Red Tape Reduction Act is a unique opportunity for the provincial government to streamline and reduce red tape in the health professions regulatory system. Our submission will focus on four sections of the bill. The first, section 13(3.1), provides discretion to a college to refuse the release of a member's business address and telephone number to protect a member's safety. The second, section 19, stipulates that quality assurance, or QA, records are not admissible in evidence in a civil proceeding except in a proceeding under a health profession act. The third provision this submission deals with is section 15(3), paragraphs 4 and 5, which gives the complaints committee the authority to take no action with respect to complaints it considers to be "frivolous, vexatious, made in bad faith or otherwise an abuse of process." We will also address a fourth provision, section 15(l), which relates to the time frame allowed for members' submissions in response to a complaint.
Members' safety regarding disclosure: We are pleased to support the inclusion in this legislation of section 13 (3.1) giving colleges the discretion to refuse information about a member's business address and telephone number in situations where to do so would jeopardize a member's personal safety. This is an important exception to the Regulated Health Professions Act's requirement for colleges to facilitate access by members of the public to the information they would need to contact an individual member. While we strongly support the objectives of the existing provisions, we have recognized that there are occasions when providing this information can put a member's safety at risk. We have expressed our concern to government through the development of this legislation and we welcome the response that section 13(3.1) provides to this potentially serious problem.
The confidentiality of quality assurance records: Section 19 of the Red Tape Reduction Act will protect QA records from being admitted into evidence in a civil proceeding other than a proceeding under a health profession act. It is our view that this protection is necessary to ensure the integrity of our quality assurance program and its role in fostering continuous improvement in nursing practice.
The Regulated Health Professions Act requires that quality assurance programs require a component that will "promote continuing competence among the members." It is in response to this requirement that we and a number of the other health regulatory colleges have developed quality assurance programs that contain a reflective practice component. This component includes the completion of a self-assessment, the obtaining of feedback about one's practice from a peer, and the creation, implementation and evaluation of a learning plan. Members who are actively practising nursing are expected to participate in all of these activities on an annual basis. Participation in reflective practice became a requirement of all registered nurses and registered practical nurses in 1998.
Earlier I distributed to the clerk and, through him to you, copies of some of our materials around our reflective practice program at the College of Nurses.
The purpose of our reflective practice program is to bring about each member's identification of and improvement upon issues affecting the quality of her or his practice. For it to be effective, nurses must be able to completely fulfill the reflective practice component of the quality assurance program without fear that their records will be used against them in a civil proceeding. This view is supported by the underlying premise of the RHPA that quality assurance programs are meant to be facilitative, not punitive, and that candid and open reflection by health professionals will result in the improvement of practice and thereby benefit client care.
I'll turn the mike over to my colleague, Gail Siskind, to complete the presentation.
Ms Siskind: In respect of frivolous and vexatious complaints, we also want to express strong support for section 15(3), paragraphs 4 and 5 of Bill 25, which give the complaints committee the authority to take no action with respect to complaints it considers to be "frivolous, vexatious, made in bad faith or otherwise an abuse of process." This provision would enable us and other health regulatory colleges to develop a process that would allow for the identification and efficient disposition of complaints which have no merit.
Under the existing provisions of the RHPA, there is no authority for the complaints committee to identify and give expedited treatment to its review of frivolous complaints. This produces consequences that are negative for the efficient allocation of resources, for the nurses who are the targets of frivolous complaints and for the protection of the public.
The process of investigating and reviewing complaints is costly in terms of both fiscal and human resources. It can provoke a great deal of anxiety for the nurse who is the subject of a complaint and who, with the college and complainant, will then participate in the process leading to final resolution. In cases of complaints that are made in good faith and reflect a genuine concern about some aspect of a nurse's conduct or practice, such costs are a legitimate part of the responsibility of the nursing profession to protect the public from unsafe, incompetent or unprofessional nursing care.
When, on the other hand, a complaint is frivolous or vexatious, the need to treat that complaint with the same weight and investment of investigative resources can divert our resources from complaints that may contain serious client care concerns. For the member, a frivolous complaint can bring a high level of stress and anxiety, as well as considerable frustration with a process that by law cannot distinguish between a serious matter and one which may be entirely unrelated to the member's conduct and abilities as a nurse.
For the benefit of the committee, we could illustrate the kinds of complaints that on the face of it would likely fall into a category of "frivolous" or "vexatious." These are examples of actual complaints we've received:
A person complained about the actions of a neighbour who was a nurse. The issue between the two parties related to the nurse allegedly throwing an object on the neighbour's lawn. The matter bore no relationship to patient care, nursing practice or public safety.
A complaint was made about an ex-spouse who was a nurse. The issues were related to child custody and other family law matters.
A complaint from a client in a residential environment concerned the colour of furniture, television and lighting. There were no issues in the complaint related to nursing practice or care.
Under the existing legislative provisions, the complaints committee had no authority to declare these complaints frivolous and unrelated to our mandate, but rather was required to process all of them as though they were complaints about the quality, competence and/or safety of nursing services.
In addition to the misallocation of resources that the work on these kinds of cases represents, their presence can have a negative effect on members' perceptions of the objects of the college's disciplinary activities. We believe that respect and co-operation from our constituent members is compromised when we are required to carry out costly investigations into expressions of dissatisfaction about members that are completely unrelated to the purposes of the complaints and discipline process as envisaged by the legislation.
In this bill, as well as in the RHPA, there are effective safeguards against any possible misuse of the provisions that will permit colleges greater discretion in relation to frivolous and vexatious complaints. These include the requirement for the complaints committee to give notice to the parties of its intent to take no action in such cases and to allow them to make written submissions on the issue. An additional safeguard is the right of a complainant to appeal any decisions of the complaints committee to the Health Professions Board, to become the Health Professions Appeal and Review Board.
Once Bill 25 is enacted, our complaints committee will begin to develop policies and procedures to follow in making a determination as to whether a particular case should be considered frivolous, vexatious, made in bad faith or otherwise an abuse of process. Through these policies and procedures, the committee will ensure that such cases are dealt with in a consistent manner and are assessed against a common set of criteria.
Our last issue to make a submission on is the member's opportunity to respond. In this section 15(l) of this bill, it would amend an existing provision of the RHPA that states that a panel "may" consider submissions from a member who is the subject of a complaint after the expiry of 30 days, changing this to one that would "require" a panel to consider submissions made after 30 days. We do not view this amendment as serving the public interest because it would likely increase the delay in the receipt of submissions from members once it became an expectation that an extension must be granted or it became known. As a result, the time period for consideration and disposition of matters would be unduly lengthened.
Our usual practice is to exercise the discretion provided in the existing legislation to permit extensions of the time for members to make submissions, if requested. We do so in order to give them the opportunity to make a full and complete response to a complaint. We're concerned, however, that making the granting of extensions mandatory would be prone to abuse. In order to ensure our continued ability to carry out the investigation of complaints in a timely and efficient manner within the 120-day legislated time frame, we would support the maintenance of the existing permissive language regarding this matter.
This concludes our presentation. We look forward to answering any questions you may have.
The Chair: Thank you very much for your presentation. Unfortunately, that only allows us enough time for one caucus to have questioning. At this time, it's the third party.
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Mr Peter Kormos (Welland-Thorold): I suppose on this last issue that you raised -- because I read the bill very carefully in juxtaposition to your comments on it -- it seems there's still discretion because the member gives reasonable grounds for his or her delay, so you can't simply abuse the process. I hear what you're saying, but this is your own membership that you're talking about, right? I would have thought, to the contrary, that you'd be advocating for your membership, that they would have every possible opportunity to respond to a complaint.
Ms Siskind: They do under the current legislation. I think where we differ is that with the inclusion of this amendment, it puts the emphasis on the need to request an extension rather than on the need to have a timely disposition of the complaint. There's no doubt in my mind that we would have a very similar process to what we do right now. Right now, we only have maybe one or two complaints every month for which we have a request for deferral that is made by the member. That's a very small number. We usually give much more than the 30 days' notice to make the submission.
When the Health Disciplines Act was in force, there was a great deal of concern related to the timeliness of disposition of complaints. It was unrealistic; it was 90 days. It actually wasn't stated in the same way. The 120 days was carefully considered as the time that it could take for an adequate investigation to take place and the member's submission to be made. The emphasis is on that because it is a screening committee. It is not necessarily a final determination committee. In order to make that process smooth and focused on the purposes of the screening committee, we want those submissions timely. We have the ability to extend the requirement for the submission to be in our hands without this amendment. Our concern is that the emphasis is on getting extensions rather than on timely disposition.
The Chair: That concludes our time. We thank you very much for coming forward with your presentation today.
HOECHST MARION ROUSSEL CANADA
The Chair: We call our next presenter, if the representative of Hoechst Marion Roussel Canada could come forward. If you'd identify yourself for Hansard, please, we'd appreciate it. You may begin.
Mr Anthony Ruta: Good afternoon. My name is Anthony Ruta. I hold the position of director, government affairs, in the province of Ontario. My employer is Hoechst Marion Roussel Canada, a pharmaceutical company of the larger Hoechst corporation.
I'd like to thank the committee for the opportunity to address it on the subject of Bill 25. Specifically, I am here to comment on schedule G, subsections (19)(2) and (19)(3) of the act in section 49 of the bill pertaining to that part aimed at amending the Drug and Pharmacies Regulation Act of Ontario. Hoechst Marion Roussel Canada, by the way, manufactures and markets products such as Allegra, Anzemet, Cardizem, Nicorette and Nicoderm.
Hoechst Marion Roussel Canada strongly endorses proposed amendments to the Drug and Pharmacies Regulation Act as contained in Bill 25, schedule G, in the subsections already mentioned. These sections of Bill 25 establish the legislative authority of the Ontario College of Pharmacists to harmonize and maintain drug schedules which govern the availability of drug products in the province without having to obtain cabinet approval first. That may be with the possible exception of the initial set of schedules that will come forward.
For the past 10 years or so, Canada's provincial colleges of pharmacy, responsible for drug scheduling in Canada, have been working to harmonize drug schedules. Harmonization simply allows Canadian citizens to purchase the same drug product under the same conditions of sale in every province of Canada. For years, with the lack of harmonization, there were discrepancies in drug schedules from province to province. A product which could only be obtained with a doctor's prescription in one province could be obtained without one in another. This causes great confusion among Canadians as they travel or relocate from province to province. It is equally confusing to physicians who find themselves having to now prescribe a drug when they used to simply recommend it.
Harmonization of drug schedules would, first, eliminate such obvious discrepancies in provincial drug schedules, but then also, and more importantly, put a system in place which, as changes to schedules are required, would allow these to be made quickly and across Canada at the same time.
Such changes are required, for example, when Health Canada approves a new drug as non-prescription. The provincial government then determines via drug schedules whether the drug may be purchased freely (in self-selection) or only through a pharmacist (behind the counter). In the past, such an approval meant the drug could be categorized differently depending on the province where you lived.
In 1995, NAPRA, the National Association of Pharmacy Regulatory Authorities was established. One of the key objectives of this association, representing the registrars of the colleges of pharmacy across Canada, was to harmonize the different provincial drug schedules into one reference standard.
The National Drug Scheduling Advisory Committee (NDSAC), a subgroup of NAPRA, reviews current drug products in Canada and recommends their placement in specific drug schedules. The main objective is to classify non-prescription drugs, as this is within the jurisdiction of the provinces. Only Health Canada determines the prescription or non-prescription status of drugs in Canada. When the latter classification is given, the provinces then have jurisdiction to determine the conditions of sale; that is, self-selection or behind the counter in a retail pharmacy only; or available for sale in any non-pharmacy outlets.
Provincial colleges of pharmacy have expressed their desire to harmonize schedules according to the recommendations of NDSAC. Subsequently, provincial governments have either proposed or passed legislation allowing the College of Pharmacy to amend drug schedules according to the reviews of Health Canada and the recommendations of NDSAC.
The need for these amendments to the Drug and Pharmacies Regulation Act as contained in the bill, giving the OCP the necessary regulatory authority to amend drug schedules without cabinet approval, is clearly demonstrated by what has happened in Ontario with a group of products called nicotine replacement therapy or NRT products, specifically Nicorette 4 mg nicotine gum and Nicoderm, also known as the patch. Despite their deregulation by Health Canada to non-prescription status, making them available for sale without a prescription to consumers seeking help to quit smoking, these products continue to require a prescription in Ontario rather than be available to consumers on a self-selection or over-the-counter basis as recommended by the NDSAC group.
In 1993 Health Canada began to deregulate NRT products from prescription to non-prescription status. The clear intent was to encourage the provinces to make these products more accessible to people who were trying to quit smoking.
Tobacco-related diseases kill 12,000 Ontarians every year, one every 33 minutes. Tobacco-related diseases kill more people in this province than traffic accidents, suicide, homicide and AIDS combined. In a report written in 1996, the Chief Medical Officer of Health estimated tobacco had cost Ontario $18 billion since 1991, $10 million every day. There are very clear and significant benefits, therefore, to any effective measures aimed at reducing the number of smokers in Ontario or reducing their consumption of tobacco products. Improved access to NRT products is widely seen as one of these measures.
The first NRT deregulation occurred in 1993 and that was Nicorette 2 mg gum. It is now available behind the counter in retail pharmacies across Canada, and across Ontario as well.
In late 1996, NDSAC reviewed and then recommended that the nicotine patches be placed in self-selection areas of retail pharmacies across Canada; that is, over the counter. Health Canada's deregulation of the patch to non-prescription status on June l, 1998, was made with the full expectation they would be placed in the self-selection area of retail pharmacies across Canada.
The only barrier, therefore, to increased consumer access to these effective smoking cessation products in Ontario is a positive decision by the Ontario government to harmonize its drug schedules as recommended by NDSAC and OCP. Increased consumer access is supported by many other stakeholders, among them the Allergy/Asthma Information Association, Canadian Council for Tobacco Control, the lung association and many others.
Ontario stands alone as the only province that still requires a doctor's prescription to access all nicotine patches and 4 mg Nicorette gum. In essence, it remains easier to buy cigarettes in Ontario than products designed to help people quit smoking.
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The specific history on deregulating these products in Ontario goes back over a year. A request for regulation changes to move NRT products from their current place in Ontario schedule F was made by the OCP to the Ministry of Health in late June 1997. The Ministry of Health gave its full support to the self-selection recommendation.
The requested changes entered Ontario's current cabinet process for drug scheduling amendments on or about late July of 1997. Feedback received by the OCP in August or early September was positive. However, after weeks of delay the OCP learned that cabinet did not approve the proposed change. Two reasons were given.
It was suggested that deregulation would cause "increased consumer access to nicotine products used for smoking cessation." Rather than a concern, this was the whole purpose of deregulation in the first place.
The second reason had to do with potential abuse by young people. However, research conducted in the US and elsewhere has shown teen abuse of NRT products is so low as to be virtually undetectable. In every country of the world where these products are available in self-selection there has been absolutely no indication of abuse by teens. Only people interested in quitting smoking have shown the slightest interest in NRT. This information was thoroughly reviewed by the Ministry of Health prior to its initial recommendation.
Now, a year later, we have been unable to obtain any specific information from the Premier's Office or other government officials as to why they do not agree with other provinces on this issue.
The proposed changes to the Drug and Pharmacies Regulation Act contained in Bill 25 would allow drug schedules to be amended by those in government with the expertise to make such decisions without getting caught up in the lengthy cabinet approval process. It would make long delays, as seen in the current NRT situation, a thing of the past. Such harmonization is good for the government, for the consumer, for taxpayers, for the retail pharmacist and for the many companies which do business in Ontario.
On behalf of Hoechst Marion Roussel Canada, I urge the government of Ontario to act without delay in allowing drug schedules to be harmonized with Health Canada and other provinces without the need for all the red tape.
I would further ask that this committee formally recommend, prior to any later implementation of Bill 25, that cabinet give immediate consideration to making NRT products more accessible to all Ontario consumers in the self-selection area of retail pharmacies. This specific action can be taken now in complete accordance with the spirit and details of Bill 25 but without any further delay.
I would be pleased to answer any questions.
The Chair: Thank you very much. That affords just under two minutes per caucus. We begin with the official opposition.
Mr Mike Colle (Oakwood): Thank you for your very informative presentation, Mr Ruta. My understanding of your presentation is that with Bill 25 it's going to be possible, in essence, to allow Nicorette-type products to be acquired or purchased without a prescription. It's possible to do that under the framework of the bill, but cabinet, just this past year, had an opportunity to do that and did not allow that to happen. Do you see it as being mechanically possible, legislatively possible, for this to happen under this bill?
Mr Ruta: Yes, that's correct.
Mr Colle: Who would make that decision under this bill?
Mr Ruta: That bill would give the authority to harmonize the schedules directly to the College of Pharmacy.
Mr Colle: Therefore, this bill would allow it to be moved into their hands to undertake whatever change might be necessary.
Mr Ruta: Whatever change might be required; that's correct.
Mr Colle: The only problem is if there's still cabinet opposition to that and if they could still, through some mechanism, stop that from happening, because it seems their intent has been, earlier this year, to stop that from happening for reasons you gave. Therefore, you're a supporter of this bill because it enables the college to allow for the over-the-counter sale without prescription.
Mr Ruta: That's correct.
The Chair: We now move to the third party.
Mr Kormos: First, I want to tell you I'm very familiar with your products. You don't manufacture the pill. What's the purple little pill that --
Mr Ruta: That's a competitor's product.
Mr Kormos: I'm telling you, the side effects are everything they claim them to be. If I'm a little edgy --
Mr Ruta: It's actually a recycled anti-depressant.
Mr Kormos: What I'm concerned about is that some of these products are very expensive, no two ways about it -- starting with Nicorette's gum through to the patch. They're not cheap products. Tell me what you have done from your industry's point of view to make sure that private drug plans -- like, quite frankly, the one we have here as members of the assembly, which is similar to many of those provided in industrial workplaces -- what has your industry done to ensure that once these products become over-the-counter drugs, they don't then fall out of the scope or ambit of drug plans. I think it's incredibly important. As I say, they're expensive products, let's make no mistake about it. If the disincentive for somebody to have to pay for them out of pocket, if they have a drug plan, is considerable, that causes me -- you say you want more access, but if they're not being subsidized for those people fortunate enough to have drug plans, then I'm saying, what are you really gaining?
Mr Ruta: I'm compelled, first of all, to point out that the cost of using these products is very similar, almost identical, to using tobacco products.
Mr Kormos: You don't have to persuade me, but you also know what I'm talking about. Cut to the chase here. They're not cheap.
Mr Ruta: No, these products have never really been extensively available on private health care plans, even when they were prescription products in other provinces. The fact that they are now going to move to over-the-counter status, as they have in many other provinces in the country, really doesn't have any impact on where they were on those plans relative to now. But what I can tell you is that the separate group within our company that is responsible for working with the private sector has been very encouraged by these people who are very willing to start adding these things to their plans in the very near future, and I know some have already done so. I don't have the names of the two big ones but I know that Blue Cross of Atlantic Canada is one such outfit and Blue Cross right across the country is looking at these. So these are being added to the private plans of many companies.
The Chair: We now move to the government members.
Mr Tim Hudak (Niagara South): Thank you, Mr Ruta, for your presentation. Just a question from your point of view at government affairs at HMR, one of the larger pharmaceuticals in Canada, on what steps the other provinces take at this time in terms of --
Mr Ruta: Essentially in other provinces this is virtually done, this type of legislation. As a matter of fact, the products I referred to specifically in my presentation are already extensively available over the counter in almost every province of the country. So many of the provinces have already enacted this kind of legislation and basically for the same reasons. They found that the transition from a ruling by Health Canada, by the time that actually became enacted in a schedule in a province, was a considerable and lengthy delay and this would speed things up very much.
Mr Hudak: So I guess the red tape that exists in Ontario and other provinces impacts your ability to market your product and reach the customers.
Mr Ruta: That's right, it certainly does.
Mr Hudak: I appreciate your support.
Mr Ruta: Thank you.
The Chair: Thank you very much for your presentation today. We very much appreciate you coming forward today.
Mr Kormos: Appreciating what has just been said, and appreciating that the parliamentary assistant may have to make enquiries, perhaps the committee could be told why cabinet, what the overlying rationale was for not putting this front of the counter. There has to be some argument that was made that prevailed.
The Chair: We can ask the parliamentary assistant to look into that.
Mr Kormos: I'd be interested.
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ONTARIO SOCIETY OF CHIROPODISTS
The Chair: I call the last presenter of the day, the Ontario Society of Chiropodists. If you could come forward and identify yourselves for Hansard we would appreciate it.
Ms Anna Georgiou: Good afternoon. my name is Anna Georgiou and I am the president of the Ontario Society of Chiropodists. I am joined here today by Craig Hunt who is the chair of our government relations committee and the past president of the society.
We would first like to thank you for allowing us to appear.
We have provided copies of our remarks and supporting documents for your consideration.
I would like to start with a brief explanation of who and what we are. Chiropodists are the largest group of foot-care professionals in the province of Ontario. We are trained through a three-year joint program of the Michener Institute and the Toronto Hospital, General Division. Chiropodists practise across Ontario but it is fair to say that the majority of us serve the smaller to mid-size communities. As a medical profession we are governed by a college in the same way as doctors and dentists. The chiropody program as it is today came into existence in 1981 to ensure Ontarians had accessible, professional and affordable foot care.
The Ontario Society of Chiropodists is the college recognized voice of chiropodists in Ontario. There are currently 307 chiropodists practising across Ontario.
We are here today to speak specifically to a matter of duplication in our profession. This duplication has led to a great deal of public confusion, extra expense for the government and a barrier to us in running successful practices.
In Bill 25, schedule G, section 25 opens up the Chiropody Act, 1991, to amendment and it is for this reason we are here today.
In Ontario there are currently two different titles for foot-care providers. We have in this province both chiropodists and podiatrists. In no other jurisdiction in the world is the term chiropodist still in use. Podiatry is the internationally recognized term for the study and care of feet, in the same way that dentistry is the recognized term for the study and care of teeth.
We are requesting that an amendment be made that standardizes the title for the care of feet in Ontario to podiatry and that practitioners be called podiatrists just as in all other Canadian provinces and countries around the world.
This standardization of title will obviously eliminate duplication. It will not confer any additional rights or privileges to practitioners currently called chiropodists. The standardization of title will not change anyone's scope of practice. Individual practitioners will practise to the extent authorized by the College of Podiatry just as the College of Chiropody does today. We have submitted to you a copy of the exact amendments proposed.
I now ask my colleague, Craig Hunt, to speak to specific reasons why the title standardization we propose is important
Mr Craig Hunt: As a practising chiropodist in southwestern Ontario I am constantly faced with having to explain to would-be patients why I am called a chiropodist when I do what a podiatrist does. I explain that back in 1981, when the then provincial government decided they wanted to have Canadian trained foot specialists, they chose the title chiropodist so as to differentiate us from the American trained podiatrists that were already practising in the province. They chose this new name because they agreed to grandfather the practising podiatrists so they would not have to change their title. The legislation stated however that after July 31, 1993, no new foot-care practitioner regardless of their place of origin or their educational background could use the title podiatrist.
As a result of the grandfathering of the podiatrist title and the use of the term podiatrist around the world becoming the norm, the title chiropodist never became known. In the spring of 1997 the Ontario Society of Chiropodists commissioned the research firm Angus Reid to question the Ontario public about chiropody and chiropodists. The results of that work are in the package we have provided for you today.
Over two thirds of the 1,002 people asked did not know chiropodists treat feet and a mere 3% of those questioned would consult a chiropodist on foot concerns. This obvious lack of awareness acts as a significant barrier to accessing health care.
Chiropodists are paid for their services directly by the patient or through an individual private health care benefits program. Chiropodists are not covered by OHIP and the proposed title standardization would not extend OHIP billing rights to us. The difficulty arises, however, that as the title chiropodist is antiquated, very few private health care insurance companies recognize it. This means they won't honour claims made for services performed by a chiropodist, while if a podiatrist performs the same service the claim is paid.
The duplicate names for practitioners in our field causes public confusion. This in turn leads to a lack of access to health care for the public. This situation is directly opposite to what the government wanted to do when they introduced the idea of Ontario-trained foot-care specialists. The duplicate names have caused an additional burden of paperwork between practitioners and the insurance industry. Repeatedly we must advise insurers that chiropody is the official government-designated title for foot care in Ontario and that chiropodists are licensed providers.
Soon after the regime of dual titles started in the province, a complaint was filed with the Ontario Ombudsman that private insurers were refusing to recognize chiropodists as professional foot-care practitioners because they were not called podiatrists. The Ombudsman's office agreed that this was discrimination based on title and agreed to consider the issue. The insurer then moved to settle this matter before a final ruling was made.
Once again chiropodists are considering launching a complaint to the Human Rights Commission due to continuing title discrimination by insurers. These complaints are costly and time-consuming for the government and all parties involved. The standardization of title would eliminate all this expense and lost time.
We want to make clear that we are not here to ask for OHIP billing privileges, nor do we want the government to direct insurance companies to incur the expense of changing all their contracts to include the term "chiropodists." Experience has shown us that chiropody is just not understood, and it only makes sense to eliminate the duplication and move to the world-accepted, standardized title of podiatry. As a matter of fact, this is what Health Minister Witmer said to us earlier this spring with her comment, "It makes sense," when she gave us support for title standardization.
We hope our comments here today have helped you realize that it makes sense to eliminate the duplication that is causing extra expense to all involved and blocking access to health care. Thank you for your attention. We'd be pleased to answer your questions.
The Chair: Thank you very much. That allows us approximately two minutes per caucus. We begin with the third party.
Mr Kormos: I come from the Niagara Peninsula, where we actually have no quarrel with you. We've been doing it for years. We have an American doctor who comes in and is peripatetic around the region, apparently because of shortage of availability. You say you're not seeking OHIP. Some of the foot work you do was just delisted. It's a very aging part of the province, and statistically it's older people who have the foot problems you deal with. Aren't you concerned about the delisting?
Mr Hunt: Those services were covered under the services that physicians provide. So that delisting is of concern to us as well. Obviously, if there's a barrier where nobody knows what you do, which is what we're speaking to today, the people can't access our services.
Mr Kormos: But you're saying essentially that if we were to ask podiatrists, they would tell us that you have the same skills and skill level and training as they do? Or is there going to be an argument there?
Mr Hunt: There might be a small argument, a small interpretation. But for the majority of services that are provided by both groups, our training provides us to provide those services to the public.
The Chair: We now move to the government members.
Mr Hudak: Thank you for your presentation. Just out of curiosity, following up on Mr Kormos's question, what do those who are currently defined as podiatrists feel about your proposed amendments? Do you have any opinions from that group of individuals?
Ms Georgiou: The Ontario Podiatric Medical Association has expressed concern that the standardization of the title would grant us OHIP coverage or that that is what we are seeking, and an automatic expansion of scope of practice. What we're clarifying here today is that we're not looking for that. We recognize that an expansion of scope of practice will involve further educational changes. This is just to standardize the title for foot-care providers. We are not seeking OHIP coverage.
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Mr Hudak: The college governs both chiropodists and podiatrists. At what stage is the college, right now, in terms of making a recommendation to the ministry or to the Red Tape Commission for a title change?
Ms Georgiou: The college has not taken a vote on this issue. There was a recent internal document, however, a discussion paper that was submitted by the members of the college council to stakeholders, which advocated standardization of the title, but that is still being discussed. It has not progressed.
The Chair: We now move to the official opposition.
Mr Colle: It seems very foolish that, in essence, we have two names for providers of the same service. It causes a lot of confusion. I agree with the Angus Reid finding that most Ontarians have no idea what a chiropodist does. I was unfortunate or fortunate enough to have their services, and my parents were too. They were just down the street at the hospital.
I think the critical thing is to get that commitment. Did the Minister of Health give her commitment in writing that she would support the standardization or was it a verbal commitment?
Ms Georgiou: It was a verbal commitment.
Mr Colle: I suggest you ask for that in writing.
I certainly think our party would support eliminating this contradiction, which doesn't serve the public of Ontario well, especially due to the fact that chiropody was a name change issued by the Ontario government. Are there still practising podiatrists or people who are podiatrists who have gone to the States to get their podiatry qualifications and then come back here to practise?
Mr Hunt: There are, but not after 1993. No new people are registered.
Mr Colle: Therefore, in order to be a foot-care practitioner you have to get your qualifications, your chiropody degree, here in Ontario.
Mr Hunt: Correct.
Mr Colle: Therefore, it's a Canadian degree and yet you can't get basically the same rights as the podiatrists, who got their education in the States years ago.
Mr Hunt: That's correct.
Mr Colle: The Ombudsman did nothing. It certainly seems discriminatory, and it especially discriminates against Canadians and Canadian schools. You've gotten nowhere with this discriminatory -- so in essence, this bill opens the door for possible amendments. The question is, who is to make the amendment to have the term standardized?
Ms Georgiou: We have included a proposed amendment in the package --
Mr Colle: I saw the proposed amendment. I guess what I'm trying to figure out is -- to change the act, it would have to still go through this government, which would have to make that amendment. I think you should make your case public because, as I said, it's the people of Ontario who are suffering from foot disorders, or whatever you want to call them, who are not being well served, because they don't know the service exists.
I know a lot of people who are suffering, especially seniors, who aren't aware that there are specialists who can help them and they don't know where to go. They're staying at home suffering with ingrown toenails, with everything under the sun. I think you should continue to make your case public. Again, it's the people out there who are literally suffering because of this complication and stupidity.
The Chair: That concludes your time. We very much appreciate your coming forward today.
Prior to adjourning this committee, I'd like to inform the committee, unless there's strong opposition, that written submissions presented to the committee are by Monday, October 19 at 5 o'clock and amendments presented to the committee by Wednesday, October 21 at 5 pm.
Seeing no opposition to that, this committee is adjourned until Monday, October 19 at 1700.
The committee adjourned at 1745.