Legislative Assembly of Ontario

SAVINGS AND RESTRUCTURING ACT, 1995 / LOI DE 1995 SUR LES ÉCONOMIES ET LA RESTRUCTURATION

CONTENTS

Wednesday 24 January 1996

Savings and Restructuring Act, 1995, Bill 26, Mr Eves / Loi de 1995 sur les économies et la restructuration, projet de loi 26, M. Eves

STANDING COMMITTEE ON GENERAL GOVERNMENT

Chair / Président: Carroll, Jack (Chatham-Kent PC)

Vice-Chair / Vice-Président: Maves, Bart (Niagara Falls PC)

*Carroll, Jack (Chatham-Kent PC)

Danford, Harry (Hastings-Peterborough PC)

Flaherty, Jim (Durham Centre / -Centre PC)

Grandmaître, Bernard (Ottawa East / -Est L)

*Hardeman, Ernie (Oxford PC)

Kells, Morley (Etobicoke-Lakeshore PC)

Marchese, Rosario (Fort York ND)

*Maves, Bart (Niagara Falls PC)

Pupatello, Sandra (Windsor-Sandwich L)

Sergio, Mario (Yorkview L)

Stewart, R. Gary (Peterborough PC)

*Tascona, Joseph N. (Simcoe Centre / -Centre PC)

Wood, Len (Cochrane North / -Nord ND)

*Young, Terence H. (Halton Centre / -Centre PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Caplan, Elinor (Oriole L) for Mr Sergio

Clement, Tony (Brampton South / -Sud PC) for Mr Kells

Ecker, Janet (Durham West / -Ouest PC) for Mr Stewart

Johns, Helen (Huron PC) for Mr Danford

Lankin, Frances (Beaches-Woodbine ND) for Mr Marchese

McLeod, Lyn (Fort William L) for Mrs Pupatello

Phillips, Gerry (Scarborough-Agincourt L) for Mr Grandmaître

Sampson, Rob (Mississauga West / -Ouest PC) for Mr Flaherty

Silipo, Tony (Dovercourt ND) for Mr Wood

Also taking part / Autre participants et participantes:

Cooke, David S. (Windsor-Riverside ND)

Curling, Alvin (Scarborough North / -Nord L)

Wildman, Bud (Algoma ND)

Ministry of Health:
Czukar, Gail, legal counsel
Finkle, Peter, director, central region, institutional health group
McKeogh, Carole, legal counsel

Clerk / Greffière: Grannum, Tonia

Clerk pro tem/ Greffier par intérim: Decker, Todd

Staff / Personnel: Baldwin, Elizabeth, legislative counsel

The committee met at 1000 in room 151.

SAVINGS AND RESTRUCTURING ACT, 1995 / LOI DE 1995 SUR LES ÉCONOMIES ET LA RESTRUCTURATION

Consideration of Bill 26, An Act to achieve Fiscal Savings and to promote Economic Prosperity through Public Sector Restructuring, Streamlining and Efficiency and to implement other aspects of the Government's Economic Agenda / Projet de loi 26, Loi visant à réaliser des économies budgétaires et à favoriser la prospérité économique par la restructuration, la rationalisation et l'efficience du secteur public et visant à mettre en oeuvre d'autres aspects du programme économique du gouvernement.

The Chair (Mr Jack Carroll): Good morning, everyone. Welcome back to the hearings on clause-by-clause analysis of Bill 26.

Mrs Lyn McLeod (Fort William): I, as you know, have tabled a motion and would like to place that motion before the committee as we begin our deliberations.

The Chair: Okay, Mrs McLeod, since we're in the middle of debating a motion, you will have to wait until you can have the floor.

Mrs McLeod: May I place that immediately after the next motion is voted on then?

The Chair: Yes.

Mrs McLeod: Thank you.

Ms Frances Lankin (Beaches-Woodbine): Mr Chair, sorry, I couldn't hear.

The Chair: Mrs McLeod has a motion she wanted to put before the committee and I just advised her that since we were in the middle of debating a motion, she would have to wait until such time as we were finished with that particular debate.

In order to alleviate some of the congestion we've had at the front, we offered the parliamentary assistant and any staff people she wanted the option of sitting at the witness table at the back. It makes it a little easier for the Chair, who seems to be accumulating more and more books and paper up here. He needs to spread out.

Ms Lankin: We're all having that problem.

The Chair: We're all having the same problem.

Mr Gerry Phillips (Scarborough-Agincourt): Mr Chair, just so I understand the timing, we will deal with the one amendment and then we'll deal with Ms McLeod's motion. Is that correct?

The Chair: When we vote on the amendment, Ms McLeod can request the floor and introduce her motion at that particular point in time.

We were in the middle of discussing a proposed amendment by the government to schedule F, section 1 of the bill. The speaking order that had been set up last night was Mr Clement, followed by Mr Cooke and Mrs Caplan. So Mr Clement, you have the floor.

Mr Tony Clement (Brampton South): I wanted to state for the record that I agree completely with the thrust of Ms Johns's comments respecting this particular amendment and its effect with respect to the issue of the Health Services Restructuring Commission. I agree with her that there has to be adaptability that is built into this legislation to allow the minister and the government, which is ultimately accountable to the people and accountable to the Legislature, to choose the best available persons, who may or may not fit the criterion which Ms Lankin wished to set out in her version of this particular motion.

There was some discussion yesterday afternoon about whether this in fact reflected some or none of the testimony that we heard during our three weeks of public hearings. To that issue, I wish to remind the committee and draw to the attention of those on this committee who were not part of the health care portion of our little road trip and our session in Toronto some comments by hospital persons as well as district health council persons. Ms Johns quite correctly mentioned Mr Labelle, CEO of Ottawa General, yesterday afternoon, but I've got some interesting words to share with the committee from Tom Closson, who is the CEO of Sunnybrook Health Science Centre. We saw him closer to the beginning of our process, so perhaps it is opportune to remind the committee at this time of some of the things that he said.

He said, "Given the enormous debt this province has, this is a critical emergency." He goes on to say that the debt "needs to be addressed with radical measures." I'm quoting him now: "I think this legislation is radical, but I think it's necessary if we are going to protect the public and ensure that they have good access to health care in Ontario."

I would draw the attention of the committee to Ken Ferguson's comments that we heard in Sudbury. He is a part of the Manitoulin-Sudbury District Health Council. "Generally, we support the establishment of the commission. Implementation of hospital restructuring is chaotic" -- those are his words, not mine -- "throughout Ontario because the...legislation impedes the sweeping changes that are needed" -- further evidence, I would submit, from some of the deputations that we were privy to that there is a recognition of the need for far-reaching change and restructuring within the hospital services that are offered to the public.

Indeed, that was a common refrain. I hope it would not be too much of a shock to the former Health ministers who serve on our committee to see that change. There really has been a sea change of attitude within the hospital sector on the need for change. It's almost too bad that we didn't have such a change of attitude 10 years ago. Perhaps more could've been done at that point, rather than today. But the fact of the matter is that today there is a general recognition within the hospital sector that real change, and some even termed it radical change, is needed to restructure the hospital sector and then to reinvest the savings that accrue from such restructuring to those areas in the health care services that are genuinely needed in the communities.

I'm reiterating somewhat what Ms Johns said, but it does bear repeating that we did get a lot of recommendations during the hearings to keep the mandate of the Health Services Restructuring Commission as broad as possible. In fact, they were concerned that we were going to narrow it in our amendments. I respectfully remind the committee of some of the deputations of nurses who came forward, those involved in long-term care who were concerned that they were going to be left out of the restructuring and left out of the impacts of the restructuring. They see the real need to be part of that restructuring so that long-term care is not forgotten.

The community care, community health centres: We heard a lot from them about how this is more than just a hospital restructuring issue, this is a whole health services restructuring issue. The skills that are required for that go far beyond, perhaps -- not necessarily in every case -- simply what was contemplated among the district health councils or some of the mandates of the district health councils that have been extant to date.

All of that is to reiterate that there is a broad mandate that is required if this job is going to be successful. My point of view is there is no point in doing this, no point in setting all this out, no point in starting this process unless we have confidence that we can be successful at the end, because it is a quite substantial change in our health care system. We have to be sure that we have the tools necessary to get the job done; otherwise, we'll have wasted another four years. Quite frankly, the people of Ontario cannot afford another four-year wait on this.

My final point is this: There were a number of suggestions from my friends across the way during Ms Johns's presentation of this amendment that somehow we were missing accountability mechanisms for the Health Services Restructuring Commission.

Firstly, the Minister of Health, as we all know, is accountable for anything that takes place in his ministry. That accountability is part of our democratic and parliamentary tradition and I see nothing in this legislation that derogates from that.

Secondly, and I put again on the record, just as I have done over the past two weeks, the fact that section 8.1 of the Ministry of Health Act is still in existence. Section 8.1 is the section that recognizes and creates district health councils, gives them the power to analyse, to search out information and to plan and to make recommendations to the Minister of Health respecting the health services in that district.

Nothing in this legislation, nothing in Bill 26, nothing in schedule F derogates from the roles, responsibilities and duties of the district health council in any particular region. Those councils have local representation, they have community representation, they have experts in the field, no question about it, and they continue to have their role. I foresee that once we get the Health Services Restructuring Commission rolling, there will be a very visible, inextricable link between the role and work of the respective district health councils and the role and work of the Health Services Restructuring Commission. That is a point that Ms Johns has already made. I reiterate it and I support her on this amendment.

The Chair: Mrs Caplan.

1010

Mrs Elinor Caplan (Oriole): I'm going to yield my time to Ms McLeod.

Mrs McLeod: Mrs Caplan yields her time because she knows that I have been watching the committee hearings over the last couple of days and I am appalled at the continued efforts of the Conservative members of this committee to selectively distort the public views that have been offered to this committee over three weeks of public hearings. So let me respond very directly to the distorted views which Mr Clement has just attempted to put on the record as reflecting the public input that we've had over the last three weeks.

I suggest to him that we have indeed heard from many people in hospital administration who have been trying to cope with the stresses of bringing about a hospital restructuring, which everybody knows is needed. They have seen a role for government, and all would agree that there's a role for government in that process, but with one possible exception, who I think has been cited but does not represent the restructuring efforts of the Ottawa-Carleton region. They have all said that the role of government and the role of the Ministry of Health and the minister should be a facilitating role, not a role where the minister steps in and unilaterally makes decisions in what he deems somehow to be in the public interest. We have heard concern after concern expressed about the fact that there is no indication of what will guide the minister in determining what is in the public interest of that community.

We have also heard very clearly on the issue of delegation that again, with one possible exception, there have been unanimous views that there should not be the ability of the Minister of Health to delegate such important decision-making powers to a commission or to any other individual. If you check the record, Mr Chairman, that will come through loudly and clearly, including in the initial submission from the Ontario Hospital Association.

I thought it was reprehensible on the part of the government, when they tabled amendments on this issue in Kitchener, to hold back amendments which strengthened the ability of the Minister of Health to delegate his decision-making powers until later on in the day, after they had attempted to appease the people who were concerned about the provisions on hospital restructuring by saying they would be sunsetted after four years, and, "Don't worry, if we're going to come in and shut down your hospital, we'll give you 30 days' notice." The fact that the minister can delegate even more extensively than was originally in this bill was left to amendments that were tabled later in the day.

I would also want clearly on the record that presentation after presentation said that they were concerned about the ability to delegate any powers to the commission and that the role of the commission had not been clearly set out. People asked that the role of the commission be defined in legislation, that there be clarity as to what this commission's role would be in the restructuring process, and that has not been set out in this legislation, nor has it been clarified in any attempt by the government to help us all understand exactly what the commission's role will be.

This takes me to my last point, in response to the last point of Mr Clement, which is the role of the district health council. Again, presenter after presenter said to us, "We want the local planning capacity respected. We don't want decisions made by the Minister of Health in Queen's Park imposed on our communities without good community planning," and repeatedly members of the government side said: "Don't worry. The DHC will be there. We're going to build on the recommendations of the DHC."

The DHC reference that Mr Clement cited is in an advisory capacity only. It is not given the kinds of potential powers that the restructuring commission is given under Bill 26. The minister cannot delegate to the district health council the powers that he could delegate to the restructuring commission, and therefore there is no guarantee that the planning process of the DHC or any other local body will be respected in the work that is done by the restructuring commission or the decisions that are imposed on a community by the Minister of Health. I just wanted that clearly on the record because I think it is a more accurate reflection of the public concerns that were expressed to this committee.

The Chair: Any further discussion on the amendment?

Shall the amendment proposed by Mrs Johns to schedule F, section 1, subsection 8(7) of the act, carry?

We'll continue with our agreement for recorded votes.

Ayes

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

Nays

Caplan, Lankin, McLeod, Phillips, Silipo.

The Chair: The amendment carries.

Mrs McLeod: I would like to move that the Premier be requested to appear before the standing committee on general government on January 24, 1996, or January 25, 1996, to answer questions regarding Bill 26, the Savings and Restructuring Act, 1995, which forms the government's major legislative agenda.

Mr Chair, I think you will appreciate my earlier intervention that my frustration level in watching the proceedings over the last two days has been building, and I have been equally dismayed to realize that as we began these proceedings there would be no minister responsible for carriage of any portion of this bill, or for the future implementation of any portion of this bill, who was prepared to come before the committee to answer questions that have been raised not only by committee members but in fact by members of the public day after day in public hearings.

I would have thought it was a minimum of responsibility for the ministers to be prepared to come and answer questions. I thought it was irresponsible for those ministers to expect that their parliamentary assistants would have to respond to those kinds of detailed questions, and questions which would affect the future accountability of the ministers themselves. I thought that was putting the parliamentary assistants in a rather difficult position. It was also clear they were not being given the kind of information they needed in order to be able to respond to those questions, and in fact I thought it was quite significant that in the vote that was missed it was because the government members were out in the hall rather desperately trying to figure out what was the correct message to give.

I think the public who have made presentations to this committee, who have put tremendous effort into getting hold of this bill, trying to understand it, and then raising the concerns that emerged -- every piece of this bill that you read raises new questions -- were looking to the government to give the correct answer. I think they wanted actual answers to what the impact of this bill would be. Clearly, the parliamentary assistants and the government members of this committee have not been given those answers to respond in the absence of their ministers.

I feel it is only appropriate that the Premier, who has accountability and ultimate responsibility for all the legislation that is before the House, and in fact for the implementation of this legislation as well as for the agenda that is the basis for bringing forward these measures, should appear before this committee and answer the questions directly. I think it's also important he do that because it has become apparent since his return that the Premier continues to have a different view of the impact of parts of this legislation than appears to be the reality of the legislation itself. Perhaps that's because the questions that have been raised as more and more people have examined the legislation have brought to light many implications of the legislation which weren't apparent when the legislation was first presented. I think it would be important, so there is not continued public confusion, for the Premier to either respond according to his view of what this legislation means or, again, to be held accountable and responsible for the actual content of this legislation and its future impact.

I understand that the ministers have said they can't be present because of scheduling difficulties. I would think that if it's difficult for several ministers to arrange their schedules to appear even over the course of an entire week, it might be possible for one individual, the Premier of this province, who is ultimately responsible for the effect this legislation will have on this province, to appear before the committee to answer not just our questions but the questions the public has raised.

Ms Lankin: We will be supporting this motion and I want to indicate that in reviewing the news coverage of the Premier's comments over the last day, I have grave concern on the part of our caucus about whether or not anyone in the government actually knows whether this bill is going to be able to allow municipalities to implement tolls on roads, whether or not doctors are going to be responsible for reviewing files of chiropractors -- on and on and on; issue after issue. The Premier has made it very clear that he holds certain views with respect to this act that are absolutely contrary to what we have heard from presenter after presenter over the course of the weeks of hearings, and in fact what we've heard from government members of the committee in terms of their interpretation of sections of the act.

We had the amazing spectacle, when this bill was first introduced by the Chair of Management Board -- when issues were put to him, it was very clear he had no understanding of various aspects of the bill. We had the clear and amazing spectacle in the House of the Minister of Municipal Affairs who couldn't answer questions put directly to him about parts of the bill, who then swore that his bill did not allow for municipal taxes to be implemented in the likes of poll taxes and others and that he'd resign if he was wrong and that the bill didn't need to be amended and that at some point in time, about two weeks ago, if the opposition wanted clarification he'd look at that. The opposition didn't put any amendments forward. In fact the minister came forward and amended it himself to prove that he was wrong about his interpretation to begin with. We haven't had an answer from him yet about whether he's going to resign.

1020

The Minister of Health responded to questions early on about the $150 administration fee in the section of the Health Care Accessibility Act dealing with hospitals and tried to defend why it is that a patient might have to pay that $150 when the administration fee applies to doctors and to the procedures with respect to a hospital and doesn't have anything to do with patients, yet he was defending it, bravely I might say, but he had it wrong.

And now we have the Premier making statements that absolutely contradict what those of us who have spent all this time examining the bill and listening to the public coming and giving us their interpretation of the implications of aspects of this bill in their jurisdiction have told us and what we've come to understand. The Premier has a different understanding and reassures the people of Ontario, "That's not my understanding of the bill."

I'd like to know who in the government does understand this bill. If it's not the Premier, then perhaps it's Mr Long who should be coming before this committee with a team of whiz kids and explaining what the heck is going on here. There are four seats there; we could get all four of them there. Or they could accompany the Premier and answer the questions and advise him.

I don't mean to make light of the motion, because I think it's quite serious. I think this bill, as I've said many times, has been put together in a very hasty fashion with departments of ministries all writing different sections of it with nobody cross-referencing the various wish lists that have come forward from departments of ministries, no one understanding the overall effect, and even some of the very specific effects that we keep uncovering day by day by day as these hearings continue. I think the Premier should come and should explain his understanding of the bill and should be accountable for some of the amazing problems that this bill will create for the public of Ontario and for the government, quite frankly.

I think he should explain, for example, what Mrs Johns was unable to explain yesterday. Why would you be setting up a commission just taking broad powers to be assigned to the commission and not be able to explain what powers it is that that commission is going to be able to exercise, what powers it is that the minister is going to delegate to that commission? Every time she was asked we got one answer: section 6 of the Public Hospitals Act. Well then, make that clear.

This is bad law. This has been poorly put together. It's clear that there is no one in government who has an understanding of the full impact of this. If there is anyone, it should be the Premier. He has ultimate responsibility, ultimate accountability. We've heard members opposite talk about the absolute accountability of ministers of the crown and members of the executive council to the Legislature through question period, through the opportunity to answer questions. Well, we're asking for that opportunity here during the course of these hearings, for the Premier to come forward, for him to give us some indication whether or not he actually understands this bill. Quite frankly, I suspect we'll find out he doesn't, and that being the case, I think the only consideration after that is, how do we amend the process to in fact give the government enough time to get itself under control and to get an understanding of the bill and to proceed with those aspects that it believes it actually needs and to give the other aspects the appropriate time for public debate and consideration and legislative debate and consideration that from day one we have been calling for?

Mr Phillips: This whole bill has turned into kind of comedy hour in that originally the government presented this thing as if they had actually thought about it and said: "Listen, this is so good we don't even need a debate on it. We're going to pass this thing in two weeks. It's the perfect bill." As we peel it back a little bit, it's clear that the government has no idea what's in it. Certainly I feel badly for the members who are trying to defend it because every day we hear -- we had the spectacle here two days ago of the explanation being given on toll roads that it's permitted and then the Premier 24 hours later saying: "Well, I don't know. Is it? I don't know." It is absolutely clear that nobody in the government understands what is in this bill and there's only one way to clear it up. The Premier has to come and tell us what in the world he intends with this bill because every day he says one thing out there and a different thing's happening in here. It's undeniable.

Yesterday he expressed some amazement that the Thorold fire department was planning to charge a few of fee of $900 an hour. Well, we were told weeks ago that it was the intent of this bill to permit that. In fact, the government, when they originally briefed us -- these are your notes; this is your own briefing document, "The legislative amendments will generally provide unlimited flexibility, thereby overriding all existing limitations on user fees." So why in the world would the Premier be surprised yesterday when the Thorold fire group said, "We are going to charge $900 an hour to put out a fire"?

On one hand, you're telling us that's what the intent is -- in fact, I'm sure that Al Leach went to the municipalities and said: "You keep quiet on the cuts to grants. Keep your mouth shut on that and we'll give you what you've been looking for, and that's unlimited flexibility on user fees, on licences." Frankly, I think the deal was to allow taxes too because we had three mayors come before us very quickly after the bill was tabled saying: "Thank you. Thank you for the opportunity for gas tax." It was only when public pressure built that you were forced to back down on it.

I just want the public to be aware of what's going to happen when this bill passes because every municipality's back is to the wall. Here's what we heard when we went around the province. North York: A false alarm fee of $300. The mayor is quoted as saying, "We're going to put a fee on just about everything that moves."

We were in Kingston and I found one of the most interesting ones was the Kingston council. They say they can save two jobs out of 99 that they're going to have to eliminate. They're going to have to cut 99 jobs, but they can save two because of this great bill, because they're going to jack the rate up on death certificates and marriages. So to pay for your big tax break, the people who die in Kingston -- the estate will know. They probably won't recognize it, but the estate will know that they've helped to pay for your tax break. They go on to say that this is great because it allows the police to set up some safe-driving seminars at a cost of $100 each, a really good new revenue source.

It goes on to say, "We're of the opinion the provisions would enable us to charge landlords and residences that provide student housing, including the university. We can charge property standards enforcement so that an additional user fee could be instituted through the universities directly to the students living in residence."

We heard the mayor of Guelph talk about taking a licence fee from $20 to $500. We heard the other day about this permits toll roads. Believe me, we were about ready to talk about technology here that will permit toll roads. First, it now will be legal to put a toll road in a municipality and, secondly, you are putting in place the necessary law to permit toll roads through technology. So it will be very simple for municipalities to say, "That lane there is designated only for those who pay the toll," and that'll be the express lane and the technology's there.

My point of this is this: People in Ontario should recognize what you've promised the municipalities. You've essentially said: "We are going to cut your grants in half. We are not going to allow you to take property tax up." In fact, the public would be in an outrage about that. "But we are going to allow what you call unlimited flexibility for fees."

For the Premier yesterday to be surprised when someone raised the point about the fire fee in Thorold is incredible. It can only be one of two things. He doesn't know the bill or somehow or other he was trying to be misleading on it. That's the only one of the two explanations because it's clear, as the members across know, that this bill not only permits it, it encourages it. You have told the municipalities that this is how they can make up the revenue shortfall. You've told them that. We've had dozens of examples around the province; I've just quoted a few here. Come January 30, the fee door opens and the pen is open and we have runaway fees in Ontario. The municipalities have given us fair warning that that's what's intended.

So why should the Premier come here? Very simply, what does he intend by this bill? Is he saying he doesn't want those fees? By the way, when you're in opposition you tend to keep these old clippings. This is what the Premier said at one time: "Fee Hike Called the Same as Tax Hike." I guess that was in the Taxfighter days.

1030

Ms Lankin: That was then.

Mr Phillips: That was then, as someone said. "Fee Hike Called the Same as Tax Hike." But what is one of the cornerstones of this bill is that municipalities have said, "Please, please give us the right for unlimited flexibility on fees," and you are giving them that right. I think the Premier owes the people of Ontario an explanation.

We now have fewer than three days to get what is the government's intent around this bill. He needs to come here and say: "Here's what I intended. If the bill isn't doing what I intended, we can amend it." But he owes the people of Ontario at least the courtesy of coming and saying what he intends. If he intends unlimited flexibility for fees, then when someone asks him about the $900 fee for the Thorold fire department, he should say: "Yes, that's my Ontario. Yours to discover. You'll discover these fees, but that's my Ontario and don't be surprised by it." If he didn't intend the fee, then surely it's in everybody's interest to change the bill.

I've taken just one small part of the bill, but I think it's symptomatic of the way the government tried to do it. They didn't want people to know what was in here. You really didn't. Now we've got from you I think 139 amendments proving that you didn't know what was in the bill, and you've been caught on some things that you're so embarrassed about you've got to change. You were caught on the gas tax -- no question of that.

Perhaps if we'd had the ministers here earlier and an opportunity to explain, but the clock is running, this bill is going to be passed on January 29, and there is only one person who can clear the air, and that's the Premier. He's around. He's got time. Have him in and have him explain what he intends. Otherwise he'll play this game of, whenever there's a hot thing, he'll say, "I didn't know it was in there," and try and duck the responsibility. There's only one way to hold him accountable, and that's for him to show up here and give the public an opportunity to find out what in the world he intended with this bill.

Mr Clement: I would speak against this motion.

Mrs Caplan: Why?

Mr Clement: I'll tell you why. As we know, it has been the parliamentary assistants who have been involved for three weeks of public hearings.

Mrs Caplan: That is not true.

The Chair: Mrs Caplan, Mr Clement has the floor.

Mrs Caplan: But he is not telling the truth. The parliamentary assistants did not have carriage. No one had carriage of this bill.

Mr Clement: In fact, it was Ms Caplan who insisted that parliamentary assistants start to have carriage of the bill. Starting on Monday we have done precisely that.

Interjections.

Mr Clement: Mr Chairman, could we have some order? I respectfully listened to their points of view even though I disagree profoundly with them.

Mrs Caplan: As long as he tells the truth, I'll stay quiet.

The Chair: Mrs Caplan, you will have your chance to speak when Mr Clement is finished. I expect you to wait till then, please. Thank you.

Mr Clement: Thank you, Mr Chairman. The parliamentary assistants are in the unique position to have heard the presentations throughout Ontario, 12 different cities, and to have the perspective of their respective ministries to put forward why this legislation is critical as a first stage. I disagree that it's the government's major legislative agenda as found in Mrs McLeod's motion, but it is the first stage of getting Ontario back on track. It is perfectly normal and habitual for the parliamentary assistants to have carriage of this legislation in this forum. That is how Mr Wessenger, who was the parliamentary assistant for Health under the previous regime, operated, and Ms Lankin knows that very well.

The ministers and the Premier will be in the House on January 29. There is a question period that will be available for the opposition. There is accountability built into our parliamentary system, and there's nothing we are doing today that derogates from that accountability -- nothing.

Ms Lankin made a reference -- and I hope I don't misquote her; it certainly would not be intentional. I gathered from her comments that she felt the parliamentary assistants thus far have not given the straight answers she was looking for and that consequently we need the Premier here to do that.

My take on it is that they did give straight answers, but she didn't like the answers. She didn't like the answers we gave her respecting why the Health Services Restructuring Commission is characterized the way it is. She didn't like those answers, which is fine. That is the way democracy works. The opposition is not going to agree with the government every minute of every day. It is her right and her responsibility as a member of the opposition not to like our answers, but answers we have given and answers we are giving.

May I say this with respect to what Mr Phillips has said, and I've said this before and I guess I risk howls of protest by saying this again: If there is any confusion being sown with respect to the nature of this bill, I believe the opposition bears some responsibility for that because of the myth-making that has been going on over the last month.

Mrs McLeod: This is ludicrous. Just let it pass without asking questions and there won't be any --

Mr Clement: For a party that cherishes democracy so much, Mrs McLeod is not giving me an opportunity to speak, and I find that offensive.

I find that the myth-making that has occurred has been both dishonest and misleading.

Mrs McLeod: There would have been no opportunity for anybody to be heard.

Mr Clement: For example, Mr Phillips talks about the Thorold fire charges when he knows full well or should know that those charges had been possible prior to Bill 26 being a twinkle in the Finance minister's eye. He knows that.

For example, we have heard over the past three weeks from the opposition and their friends that we are destroying DHCs when the opposition knows full well that DHCs are continued in the Ministry of Health Act under section 8.1.

Mrs Caplan: They have no role in this bill.

Mr Clement: For example, we have heard continually over the last three weeks that we are threatening personal medical records when there was a deemed --

Mrs Caplan: The privacy commissioner said that was so.

The Chair: Mrs Caplan, you will get your chance to speak.

Mrs McLeod: Mr Chairman, on a point of order, and I ask this in all honesty: I did not place the motion in order to bring about a substantive debate on portions of the bill. We know that debate is going to go on re the amendments. It was a question on whether the Premier can be requested, simply requested, and I would hope we could, in the interests of time, focus our debate on whether the Premier appropriately would come to the committee.

The Chair: Basically, Mr Clement's comments are germane to the argument.

Mr Clement: I believe I was mentioning how I felt personally, that the opposition's arguments which have created the myth-making have been dishonest and misleading.

Mr Phillips: Point of order.

Mr Clement: I mentioned --

The Chair: Excuse me, Mr Clement. Mr Phillips.

Mr Phillips: Mayor Lastman --

Mr Clement: Mr Chairman, I am not yielding the floor to Mr Phillips at this time.

The Chair: Are you raising a point of order, Mr Phillips?

Mr Phillips: Yes. He's not telling the truth. He said the bill does not allow people like Mel Lastman to put a fee on false alarms.

The Chair: Mr Phillips, that is not a point of order.

Mr Clement: I believe I was talking about the Thorold fire charges. I also went on to mention the district health councils, and that under the current legislation there are deemed-to-disclose provisions re personal medical records, which the opposition seemed to deny existed in the first place.

Mr Phillips also has been going on about how we have admitted that there's unlimited flexibility for municipalities when in fact, when I checked the Hansard, it was his term, "unlimited flexibility."

1040

Mr Phillips: On a point of order on that, Mr Chair: This is a government briefing, your own government briefing. You can't get away with this. The compendium on schedule M has those words in it. You cannot get away with that. You can't get away with that. That's your own compendium.

Mr Clement: Mr Chair, I'd like to read from the Hansard, if I may, just to clear up this point for Mr Phillips. I'm reading from December 18, 1995.

"Mr Phillips: Okay, so there's unlimited flexibility here.

"Hon Mr Leach: As much as they can, knowing that they'll act responsibly and also knowing that if they don't act responsibly" --

Mrs McLeod: Point of order.

The Chair: Mrs McLeod, is it dealing with this point of order?

Mr Clement: -- "there are methods within the legislation to limit their ability, if need be."

My only point, Mr Chair --

Mr Phillips: Mr Chair, I am quoting from the government's compendium, the schedule M compendium. You handed this out. It says here, "This legislative amendment will generally provide unlimited flexibility, thereby overriding all existing limitations on user fees." If I can't believe what you give us in writing, how can we possibly trust you on anything?

Mr Clement: I'm quoting Mr Leach from the hearings, Mr Phillips. This is the record.

Mr Phillips: Well, who's lying? Is this a lie, or is what he's saying a lie?

Mr Clement: Mr Chairman, to perhaps wrap up my remarks, I find it incredible that I have been listening patiently over the last few minutes to their point of view --

Mrs Caplan: But you're telling lies.

Mr Clement: -- which is their point of view. That's what opposition is for, to have a particular point of view which is different from the government. I respect them for that. We were in opposition for 10 years and I understand --

Mrs Caplan: Nothing coming out of your mouth is truth.

Mrs Janet Ecker (Durham West): So your opinion is truth and our opinion is a lie. Is that what you're saying?

Mrs Caplan: What he's saying is misrepresenting the facts.

Mr Clement: The public will decide, not Elinor Caplan, and I'm quite willing to put my faith in the public on this point. I just want to make it clear I understand why the opposition always has to oppose what the government is doing, always has to say that I'm a liar, I'm a fascist, I'm a jackbooted Nazi. I understand why they have to do that. But I'll let the people decide, not Mrs Caplan.

Mr Phillips: On a point of privilege, Mr Chair, if I might: He has said that I have misled. I want to read into the record what I quoted from. Mr Chair, it's very important to me, and I've never called him any of the names he said. The compendium, Savings and Restructuring Act, schedule M: This was the briefing the government gave to us. Under "User fees," this is what they said, and I could read the whole thing, but I'll just read a quote: "This legislative amendment" -- this is the instruction they gave to us -- "will generally provide unlimited flexibility thereby overriding all existing limitations on user fees."

I would ask the member to withdraw the comments about me misleading on the user fees. I am simply quoting from your own document. I would ask him to withdraw that.

Mr Clement: Mr Chairman, I understand his point. I understand why you're upset. I understand that you tried to get a clarification from the Honourable Mr Leach regarding that point, and you got that clarification and I read it into the record. That was the point I was trying to make.

Mr Phillips: So have you now said the compendium was wrong when you set that out?

Mr Clement: I'm quoting Mr Leach, who was before this committee.

Mr Phillips: No wonder we don't trust you.

Mr Clement: I'm sorry you feel that way, and I'm sorry if I'm offending the other side. That really is not my intention. But I listened to them for 10 minutes talk about what an evil empire of a government we are, and I wanted to set the record straight from our point of view that we are not being misleading. There is a lot of myth-making going on about what this bill is about. From our perspective, the bill is about giving us the tools and giving the municipalities the tools to --

Mrs McLeod: Mr Chair, on a point of order: Your ruling, as I understood it, was that the discussion of the motion should be relevant to the motion. The question here was not evil empires. The question was, will a person who is responsible for carriage of the bill appear before the committee?

The Chair: Mrs McLeod, I ruled once already that that is not a point of order. Mr Clement's comments basically relate to comments that had been made by other members. It's not a point of order, Mrs McLeod.

Mr Clement: In all honesty, Mrs McLeod, I'm responding to your motion and the way you presented it; that's all I'm doing. You're the one who was talking about how we don't have an agenda other than the way you characterized it, and I just want to correct the record.

Perhaps I should finish up my remarks, Mr Chairman. Obviously, I've hit some raw nerves, and I apologize for that, but I did want to set the record straight from our perspective.

Getting back to the main motion, we have confidence in the structure of these committee hearings, we have confidence that the parliamentary assistants who have carriage of this bill this week will be able to put forward the government's position. We'd like to get on to the amendments so we can discuss them -- in full view of the time, which is ticking away -- so we can fulfil our responsibilities to the people of Ontario.

Mrs Caplan: I want to begin my remarks by asking that Mr Clement correct the record. I never said he was a jackboot Nazi, I never said he was a fascist, nor did I suggest that he was part of an evil empire. I did say he was misrepresenting this bill; I said that he was not telling the truth; I said that he was not categorizing it correctly; I said that he had lied to the people and I did call him a liar, but I did not use the words that he said I used and I think it's very important that this be on the record and corrected.

I don't take back any of the words that I actually used, because that is what he has done consistently at these hearings and that's why we need to have the Premier here. We need to know if the Premier knows and approves of what has happened at these hearings. We need to know whether Mr Harris knows that this bill removes all of the due process or most of the due process and natural justice that was put in place by Premier Robarts following the McRuer commission reports. Rights of appeal, rights for hearings, due process, access to the courts -- this bill removes that. Those democratic provisions that were put in place by a previous Conservative government are gone. I want to know whether Mr Harris understands that that is in this bill.

We have not had a minister of the crown willing to come here and answer those questions. Those ministers are accountable to the Premier; he appoints them. If he doesn't think they are doing a good job, he can fire them. I think what you have done to the parliamentary assistants is tremendously unfair, Mr Harris, and to the members of this committee, including Mr Clement. The parliamentary assistants have been given a mantra, which is one response. It's not an answer; it is a response that is repeated over and over again until they start to look foolish. It is clear that the parliamentary assistants do not understand substantially what this bill can do and they cannot defend the decisions that the ministers have made.

Let me tell you something. It is the ministers who get the approval of cabinet; hopefully they have that approval. They must have the approval of the Premier for the policy and they must defend the policy decisions they have made and the implications of those policy decisions, and we haven't had a policy debate or discussion. We have parliamentary assistants here who are ill prepared to tell us what was in the ministers' minds when they made the decisions affecting substantive policy. They were not at the cabinet table when this was approved, and it is unfair to put them in that position of looking foolish because they simply were not there when the decision was made, they cannot defend the ministers and the ministers have refused to come here. I want to know if the Premier knows these things.

I'm not talking minute detail of the bill; I'm talking broad policy considerations such as the policies and issues Mr Phillips has raised on the ability to levy new taxes and fees and licences and all of those things that Mr Harris, the self-styled Taxfighter, said he didn't support. I want to know if he realizes this bill does that.

On the health side, Jim Wilson stood in the House and said to the people of Ontario: "Don't worry. This bill doesn't have any impact on access to your records or will affect personal privacy." The commissioner of privacy said, "Oh, yes it does." The commissioner of privacy confirmed my worst fears and my concerns when Mr Wilson had the nerve to say to me: "Stop pestering the commissioner. You're just pestering him." I want to know if Mr Harris says that's okay for a minister to do: Stand in the House and say, "Don't worry"; then when he's told, "You're wrong; you're dead wrong," the Premier says, "He'll fix that."

We haven't heard anything from the Premier about whether or not he thinks it's okay to remove all of the natural justice provisions that are removed from this bill. We want to know from the Premier if he thinks it's okay for government to go back and say to a court decision, "It is of no effect."

What that means is that any citizens who sue the government because they think they've been dealt with unfairly stand the risk, if this precedent passes, of then having the government come in with a law and say, "You went to court, you made your case, you said, `The government treated me unfairly,' you got an award from the court," and the government tables a bill that says that court case is deemed to have no effect and the government doesn't have to treat you fairly.

1050

Does Mr Harris think that this broad policy implication in Bill 26 is okay? Does he even know about that? Does he know that every presenter -- with the exception of one who does not represent mainstream hospital administrators in the Ontario Hospital Association -- every other one, every presenter from the hospital sector, from the district health councils, individual representatives, doctors and nurses and everyone else, has said the commission should not have actual powers delegated to it? They said: "We support a commission. We think that it should be able to implement, we think it should be able to facilitate, but we think the minister should make those decisions."

Does the Premier think that after this committee has heard that over and over again, the minister should be able to bring in an amendment that allows him not only to delegate powers under the Public Hospitals Act, but powers under the Independent Health Facilities Act, the Health Insurance Act, the Mental Health Act? And you know something? I'm not even certain that you couldn't delegate powers from any act across government, because of course there are going to be labour adjustment policies that are going to be required. None of that is in this bill. So the potential for the delegation of powers to this commission is enormous.

Does the Premier think that it's okay for the Minister of Health to be able to delegate ministerial powers to an individual -- unaccountable, unelected -- to be able to go into a community without any assurance of due process? There's no defined role for the district health councils. I'll agree that Mr Clement and the others have rightly said that the section that says the DHCs are advisory to the minister remains, but there's nothing in this legislation that requires them to be involved at all. Because the minister says, "Oh, they'll be involved," that is no assurance in this legislation that this will happen, because he can delegate his authority to any commissioner, who can override what the DHC has said, who doesn't even have to hold a public hearing, who doesn't have to have an implementation plan.

In fact, we don't even know what the mandate is. We don't know what the mandate of the commission is. We don't know what the intention of this policy is except that it's a tool. In the name of restructuring and tools, this commission and an individual commissioner can do anything unrestricted. Does the Premier of this province think that's okay and that's good policy and that's good law? Does he think it's okay for the government to get to coerce medical practitioners, to tell them where they can practise, under what conditions they can practise? Does he think the Minister of Health, without any consultation with anyone, including the public or the College of Physicians and Surgeons of Ontario or anyone, should be able to determine what they're going to pay for, what they're not going to pay for, what price they're going to set? Does the Premier think that's okay? Is that good policy? Is that the way he wants to run his government?

Does the Premier of this province think that it is okay for the cabinet to determine what is medically necessary? Does he think that the Ministry of Health -- and it can under this bill -- should be able to contract with a US managed-care company to come in and provide US-style managed care, centrally administered and centrally controlled in the province of Ontario? Is that the policy that Mike Harris thinks is okay? It is permitted in this bill. Does he know that?

I'm prepared to say I don't think he knows that and I want to be able to ask him those questions. If he says he doesn't know it, then it is the best argument for why this bill should not go forward on the 29th, next Monday. If he does know it, then we have an opportunity to finally understand what he wants to do in this bill.

The last thing I want to address as to why the Premier must be here, and yes, Mr Chairman, I got exercised when Mr Clement misrepresented what happened -- from day one I asked, "Who is carrying this bill?" Do you know what I was told? "No one is carrying this bill. It is an omnibus bill. No one carries omnibus bills. No one is responsible." When I said, "For the different sections of the bill, can the parliamentary assistants take carriage of this bill, as is tradition when it comes to policy?" the answer was: "No. If you have any questions, place them on the record and they'll be answered in writing."

I've asked dozens of questions. I still don't have the answers. Some have been answered, but not all. The answers provoke an additional question. We have not had the opportunity to have our questions answered. We have not had the opportunity to question anyone who has carriage or responsibility of this bill until this week. This week there was a whole kerfuffle at the thought that parliamentary assistants should lay out broad policy direction and then answer, at the beginning of the discussion, just a few questions. That threw the government into an absolute tizzy.

I want to know from the Premier, is that the way he thinks this bill should be taken through the Legislature? No one has carriage. No one is prepared to speak to the bill. No one's prepared to talk about the broad policy implications. Parliamentary assistants are put in an awkward position and given a mantra to just repeat over and over again until they look silly. I mean, at times I feel very badly, not only for Mrs Johns but for the other parliamentary assistants who have been put in the position of having to defend the indefensible and who have been unable, by virtue of their position, to answer the questions. They never made the decision. How can they defend a decision that they were not part of? They weren't at the cabinet table when the debate occurred. How can they be asked to defend those decisions?

The Premier should be here because no one has had carriage of this bill, no one has discussed the broad policy implications of this bill, no one has given us the vision of where this is going to take us and no one has confirmed the policy implications that are possible. No one can do that except for the leader of this government because this, we are told, is going to implement his policy, the Common Sense Revolution document. We've been told that this is the cornerstone of his government's legislative agenda.

We also know, and I was at the meeting when Mr Eves informed the House leaders, that this bill would be passed before Christmas without any public hearings. That was the original intent of the government. This bill was so perfect and it was so important to the government that they were prepared to see it passed before Christmas with no public input. That meant no time for even one amendment, no time for anyone to be heard on this. That was position number one of this government.

If you check Hansard, because I see Mr Clement shaking his head, I will say to him that immediately following that meeting I went into the House, and on the record in Hansard I stated my concern about that intention. I tell Mr Clement -- I always tell the truth -- I was at the meeting. Mr Cooke said it yesterday. We were there, and in front of witnesses Mr Eves said that it was his intention to have this bill without any public hearings. Don't shake your head no. You may not like it. You weren't there, but that's the truth. Frances was there, Dave Cooke was there, Jim Bradley was there, I was there, staff was there and that's what he said. We were there; you were not. He said that was his intention, and we immediately alerted the Legislature to our concern. I stood in the House and said: "We're prepared to stay here and debate this bill and give it proper public scrutiny. Democracy requires that we have public hearings on major, important government bills."

I want to hear the Premier on that. You know, we've heard a whole lot of excuses for how the bill was tabled and all that, and frankly I had some concerns about the haste this bill was put together with. I think that the Premier could, at this point in the public hearings, I would say, not only answer the concerns that I have, but perhaps by his coming here and giving that kind of a reasonable explanation, help us and help the people of this province understand what this is really all about and what the government's intention is.

1100

From the beginning, we made the very reasonable suggestion that the bill could be split: Take out the parts that were really significant, identify those that the government had to have quickly. Those could be dealt with. The rest, that have these kinds of broad public policy implications that people are just beginning to really understand and that -- we are daily finding new things to be concerned about, as in the issue of tolls yesterday. And the thing is, people say, "Oh, they can't do that." The truth is, they can. The technology is there.

We need to hear from the Premier if this is acceptable to him, if he knows what the bill contains, or if, as the rumours say, this bill was put together by bureaucrats who were told: "Government needs the tools. Come in with a bill that will give us the tools and let us get on with it." In that process, that hasty process, of talking about tools, these powers are so broad-sweeping and have such enormous implications, they affect everything from rights, natural justice, every aspect of life in Ontario: taxation, environmental protection. I think the Premier has to come in and tell us if he knows the implications of this bill and if in fact this is his vision for Ontario. This is a reasonable motion; this is just saying, "Let's request." The Premier can turn us down, but let's request that he come and help this committee that is struggling with this bill because of its enormous impact on the province of Ontario.

Mr Tony Silipo (Dovercourt): I'm going to resist the temptation to redebate every section of the bill under this motion, but let me just say a couple of things. In fairness to the government members, I will make one comment about a couple of other comments specifically on the motion.

I think we've heard a lot of discussion in this motion and in other motions about the question of carriage of the bill. I do want to be clear, and Mr Sampson, I think, is going to appreciate this, as will Mr Hardeman, that on our half of the committee, while the two of them never formally said they were carrying the bill, I think it's fair to say they acted as if they were carrying the bill, and whenever I had questions or any other colleagues on the opposition side, they never hesitated to answer them. So I wanted to make that clear.

Mr Phillips: That's enough, Tony. Get on to the rest.

Mr Silipo: No, no, but the interesting point is that I know that Mr Sampson would have wanted to put that on the record, but given that Mr Clement is the government whip, is running the show with an iron fist, he wasn't allowed to.

Mr Rob Sampson (Mississauga West): I've been muzzled again.

Mr Silipo: I want to correct that for him. I find it interesting, since that was so possible on our half of the committee, that the other half of the committee dealing with health issues seemed to have such a difficult time with the question of who was carrying the bill.

But the essential and really important point that I think this motion for me addresses is really that one of the things that has been really striking throughout this whole process, above everything else or beyond everything else or in addition to everything else, really has been the enormous contradictions in which the government members have found themselves.

If we have, as we had yesterday, the Premier of the province, the leader of the government, denying that a certain action can come about as a result of this bill, saying, "No, it's not possible for firefighter charges to be applied as a result of this legislation" -- "That's news to me" was basically his attitude -- then I think it calls into question fundamentally the very essence of this bill. Because if the leader of the government is contradicting or showing that he doesn't know one significant aspect of the bill, then I think all the questions that people have raised about, "Does he know about the other parts of the bill?" are very legitimate questions.

Even at the very best, if one can say that he just simply didn't know, that in and of itself is quite scary, because it says to us that there may be many other sections of this bill that the Premier, as the leader of the government, on what is clearly their most important piece of legislation to date, is unaware of the impact of this legislation. If he is aware, he's giving us a different answer in public than his own government representatives are giving us here in this committee.

That, I think, is really the underlying problem that we have, because one of the things we have seen time after time after time really has been the ongoing series of contradictions. We hear first from the Minister of Municipal Affairs, to give but one example, that this bill does not allow a variety of taxes to municipalities, but we then discover it does. Many municipal leaders point out to us that it does. A number of municipal lawyers point out to us that it does and, lo and behold, the minister himself comes to the realization that it does, and so has to backtrack, a major backtrack, and bring in amendments that clearly say certain taxes, those powers, will not be given to municipalities. That's just one example, and I'm not going to belabour the point by giving you a series of others, but we have seen that approach and we have seen that constant series of contradictions come through from government members. And to have the Premier now contradict his own members on the committee, contradict his own minister, contradict the parliamentary assistants, who now we hear are being given full carriage of this bill, well, I think that's just a bit too much.

If the government doesn't have the decency to send its ministers here, which I think on this, their most important piece of legislation to date, would have been the minimum they could have done, it leaves really no other alternative but for us to call upon the Premier. So we will support the motion from the Liberal caucus because that's really the only course left at this point.

The Chair: Any further discussion on Mrs McLeod's motion?

Mr Phillips: Recorded vote.

Ayes

Caplan, Lankin, McLeod, Phillips, Silipo.

Nays

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

The Chair: The motion is defeated.

Mrs McLeod: I have a second motion to place, and I place this motion given the defeat of the previous one.

I move that Tom Long, Leslie Noble, and Guy Giorno be requested to appear before the standing committee on general government --

Mr Phillips: Author, author.

Mrs McLeod: -- on January 24, 1996, January 25, 1996, or January 26, 1996, to answer questions regarding Bill 26, the Savings and Restructuring Act, which forms the government's major legislative agenda.

Mr Chair, I do not place this motion lightly and I want to make it very clear -- my colleague earlier said that this whole bill has become comedy hour. It would indeed be a complete farce if it weren't for the fact that this bill involves huge and significant changes that will affect the lives of every citizen in this province. That's why I don't place this motion lightly.

I don't know whether or not the individuals named in this motion are the right individuals to name, and I would be absolutely delighted if whoever wrote this bill and knows what's in the bill would step forward to answer our questions about what the bill is and what it's intended to do and how it will be implemented and what its impact will be. I'd be delighted to have those people come forward, but we have been unable through three weeks of hearings, and now in the amendment process, to get anybody to come forward. Apparently now even the Premier can't be asked to come forward. We can't find anybody who is prepared to actually appear before this committee who is responsible for presenting the bill in the first place, let alone anybody who will have responsibility for implementing it once it becomes law.

We have tabled questions, as my colleague Mrs Caplan has indicated, because we were told that was the route to go to get answers, and there are outstanding questions to which we have not had answers from the Ministry of Health or other ministries we've tabled questions with.

As Mr Silipo has said, we have had continued contradictions. Mr Chairman, I submit to you that this is a serious concern as we approach the point at which debate even on amendments will be over and we will be forced into a position of having to vote on this bill. The contradictions that we have consistently found between what is in the bill, what is in the compendium to the bill, what is the ministers' statements outside of this committee about what the bill means and what they understand it to mean, contradictions with press releases that have come out accompanying the amendments, contradictions with statements that have been made by members of the committee representing the government -- these contradictions have made it impossible for us to know and for the public to know exactly what is in this bill and what it will mean.

1110

I suggest to Mr Clement that that is not the result of opposition myth-making; it is the result of continued contradictions in a bill which is from the very outset complex and confusing.

Mr Chairman, I place this motion, again, and I don't place it lightly, because of our frustration that we can't seem to find anybody who actually knows. As you know, Mr Chairman, as this committee has gone and its subcommittee has gone across the province, every day we find something new about this bill. Even yesterday there was something new that was learned about this bill that even the Minister of Municipal Affairs and Housing was not apparently aware of, and we're not sure the ministry was aware of, in the ability of municipalities to place tolls.

So I place this motion simply because I'm hoping that perhaps somebody who knows what is in this bill will come forward and answer questions directly for members of this committee and therefore to the public.

Mr Alvin Curling (Scarborough North): I would be happy to participate in this motion as it's put forward by Mrs McLeod.

The frustration that is being shown by the committee members and people in this province at the Scarlet Pimpernel role that the ministers are playing -- we can't find them anywhere. We seek them all over the place. They were so visible in the election, and when they bring this major piece of legislation before us to be debated, we thought then that somehow somebody would take some responsibility.

Mr Chairman, sometimes I've seen some frustration in your face when you see that neither of the ministers appear before this committee to be accountable, to defend, to support, to explain this legislation, and I understand why they don't come to explain. The demonstration of the Minister of Municipal Affairs having no understanding at all of the legislation, if I were in his position, there are two things I would do. I would step down from that position, seeing that the incompetence was showing up so much, and maybe try another portfolio. And because this is so important, they refuse to appear.

I think too that when they appointed parliamentary assistants, in our attempts over the time for them to explain this legislation, they failed miserably. As a matter of fact, I wouldn't go so far as to say they failed; there were no attempts at all. As a matter of fact, they refused to even answer questions in that regard.

We took it that they had some instructions, maybe from higher-ups, maybe from the Premier, where we don't see him, maybe from Mr Eves, since the bill is in his name, and maybe from the whip himself, who seemed to have taken on all the answers at one stage. And when he found out that he himself was defending something that was not defendable, none of the parliamentary assistants, with that high-paying amount of extra money they get to justify their existence, could do so.

So maybe we should attempt to get the other gurus, the Tom Longs and the Leslie Nobles and the Guy Giornos or whatever his name is, if I could be able to pronounce it properly --

Mr Silipo: Giorno. It means day.

Mr Phillips: It's in here somewhere.

Mr Curling: We hope that at least we'll get some answers out of them. I think they could give us some answers too, because I am quite sure that they are behind this legislation that they want to be passed.

We saw it coming for a long time, the way this bill was introduced, the manner in which it was introduced, the ramming through, the unparliamentary, undemocratic way in which it has been done, and if you feel that this is not so and that the people are not upset about this, just last night my colleague and I were at a meeting. We had about 300 people there. They came concerned about housing, and you know that 50% of the time, they were asking questions about Bill 26. They were upset about the process, the democratic process. They wanted to know if their lives will be changed dramatically, negatively, on this bill and what they could do. We asked them, of course, and we say to people out there, "You call your members of Parliament and you call the provincial members of Parliament." I even insisted they should call all the mayors around, because of all this wonderful power, this new power, that is going to be given to these mayors. They were rubbing their hands. Hazel McCallion came in here rubbing her hands, and Mel Lastman was so happy to get some of those powers to levy some taxes on those people, the same taxpayers this Premier complained about. There's only one taxpayer. Then what he has done is pass it on to someone else to give some tax.

My colleague, I heard, eloquently, efficiently, spoke about the fact that they are taxes that could be charged on the highways which the minister denied, said he would resign if all these things would come about. He said it wasn't in the bill. Then he had an amendment to something that wasn't in the bill, which we said we know, we saw it in the bill.

So we want some explanation. We will do anything. We will try to get any of these gurus who come in to find out if they can explain what this law is about. What we're trying to do, Mr Chairman, and you appreciate this very much, is to bring back some democracy into this whole play, so that the people believe that they have a part in this in a way that this law that affects them can be explained to them; just explained to them. They may not agree with it, but they want an explanation.

We can't get this out of this government. It's shameful. It's very shameful. People are calling names of the government. They said, "Is this fascism?" And my colleague said, "Listen, there are many names that are called to the type of way these people are behaving." We just feel it's very undemocratic and something must be done. We will do anything to bring -- and when I say "anything," we will try in even these motions to say to the people, "You have an opportunity now to tell your Premier, the Premier of this province, to send someone to explain this law."

I'm telling you, on the 29th you will ram this thing through, you will not listen to our amendments. We are trying our best to make something bad even look a little better. You will not listen to the amendments. You don't want to listen to the amendments. And the people should understand that when the time cometh, when the time runs out on Friday, you will not be able to do the massive amount of amendments when you, Mr Chairman, will consider this as being read. The people should understand what it meant is that we will ignore everything else that the opposition has put forward and ram through the amendments that you have, as taking it as the gospel, as the law. That's bad. That's awful.

The people are asking what they can do, what we can do. And we're doing our best from this side. I'm telling the people to do your best from your side. Call the mayors, call the Premier, call even the chairman here. His name is on there, Jack Carroll. Call him. Call anyone. See if something could happen. Because, Mr Chairman, you have been at every hearing and you can't deny the fact about democracy and the process. Respond to them and don't dodge behind the title. These parliamentary assistants who are getting all this pay dodge behind that. Call Tom Long. Call anyone to see if they will listen and to see if they will explain. So I'm in strong support of bringing forward those individuals to explain, even those. We will talk to clerks. We will talk to machines. Bring something to explain it.

With that, Mr Chair, I rest my case today, just so far. I will be back here every day if I can to see if I can get some sense -- I wouldn't even say common sense, because they've put a new definition to that word now -- to put some sense into this government.

The Chair: Thank you, Mr Curling. Mr Clement, followed by Ms Lankin.

Ms Lankin: Don't provoke me, Tony. I actually was going to be very short.

Mr Clement: Okay, I'll try to live up to that. In ancient Roman times, there was, when they had --

Interjection: When they had emperors.

Mr Clement: Perhaps it was in the republic as well, not just the empire, but they had a form of entertainment where Christians and lions would be in the amphitheatre and they would battle it out. I think we have disagreements in modern times, in the context of this hearing, as to who represents the Christians and who represent the lions. But the fact of the matter is we have viewers at home who read the papers of the fourth estate who are here and want to look at our process and they want to see debate of the bill. That's the price of admission in terms of watching the TV or reading the newspaper; they want to see debate of the bill, just like the ancient Romans when they went into the amphitheatre wanted to see the Christians and the lions debating in the form that they debated in those days.

The fact of the matter is, the opposition has every right to present this motion. The opposition certainly has that right under our democratic process. I would draw the attention of the mover -- actually, thumbs down meant that you stayed on Earth rather than going to heaven. It's a very picky point, but the point that I'd like to make is that Mr Curling is quite right, that people want to debate the substance of this bill. That's why we are here representing the people of Ontario. We have waited 12 hours of committee time, Mr Chairman, just to get to schedule A. That's how long it took us to get to schedule A.

You have every right to move any motion at any time. I do not deny you that right, but I simply plead with you, for the viewers who are waiting for the Christians and lions to get back at it, to debate please the substance of the bill so that, according to Mr Curling, we can get to the end of schedule Q, because we have spent one hour, and almost a half an hour on top of that one hour, an hour and a half, debating the motions, which is your right, to move any motion you want, but I think that people want to see the substance of this bill. It is a disservice to the public to continue without having the substance of the bill debated.

The persons mentioned in the motion, two out of the three of them are private citizens who are not in the employ of the provincial government or the Premier's office. Quite frankly, as I've said before, we have acknowledged that the parliamentary assistants are here to debate the bill and I would just as soon cede the floor to Ms Johns so that we can get on to the next amendment. So I will vote against this motion.

Ms Lankin: That's certainly an amazing analogy. I'm in awe of Mr Clement and his Christians and lions and his story of gladiators and empires and emperors who give the thumbs up or give the thumbs down. I guess we're just saying we'd like to see the emperor here.

Basically, the reason these motions are continuing to be put forward is because quite frankly the government continues to contradict itself day in and day out with respect to what's in this bill and what the implications of this bill are. Parliamentary assistants either don't have full answers or they give partial answers or they give an answer which then a minister of the crown contradicts the next day or the chief minister, the Premier, in fact contradicts, so it is reasonable for us to say, "Who knows what's in this bill, and let's get those people there."

I think I must be prescient, because I mentioned earlier about calling Tom Long here. I didn't know Mrs McLeod actually had a motion to that effect, but then I actually think she's prescient because the next motion we were going to move is, if there's anyone who wrote the bill and knows about the bill, would they come forward?

Everyone seems to be ducking this process. Minister Wilson, for example, won't come forward and defend the health sections and won't explain the amendments to us. Quite frankly, I read in the paper today with interest that he had a meeting set up with a group of people from the public and public meetings.

Mr Phillips: The public found out about it.

Ms Lankin: Someone sent the public notice to Ellie Tesher, who printed it in her column, because she's been following these hearings, as you know. Lo and behold, when he thought the public might actually show up at the public meeting, he cancelled the meeting. Where is the minister?

We continue to ask questions about this and let me say, perhaps with a little jest, in our caucus room when we talk about it, it's, "Where is Waldo?" But I actually think that the question has changed, because now we can't figure out who knows anything about the bill. Perhaps the appropriate question is, "Who is Waldo?" Who is it who wrote this bill? Who is it who can explain it and would you please bring that person forward, because, boy, we've got a lot of questions that we'd like some answers to. Thank you very much.

Mrs McLeod: I'll be very brief. I just want to say that I do think that debate is important and I think it's an important part of the democratic process, but I think on this bill the public's looking for answers and that's why I posed the motion.

Ayes

Caplan, Lankin, McLeod, Phillips, Silipo.

Nays

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

The Chair: The motion is defeated.

As per our instructions, we will now have a 15-minute recess.

The committee recessed from 1125 to 1143.

The Chair: Welcome back. Just a little housekeeping while you were away. The New Democrats have replaced a motion of theirs, page 18, with a new page 18, so you can make that change in your book. Destroy the old one and substitute the new one.

Mrs Caplan: We're past that already.

The Chair: But that's back in section E that we stood down.

The NDP has also replaced page 25 is replaced with a new page 25, of which you have a copy. The government has put forward a new page 162, so you can replace the old 162.

Mrs Caplan: While the committee was in recess, I received a fax that I'm assuming is from a constituent, although it's not someone I have ever met, who is watching the proceedings. I was asked if I would deliver this message to Mr Clement. It says:

"Mr Clement: As a member of the viewing public to which you just referred, please be advised that honourable members opposite are not wasting my time by attempting to defend the democratic process heretofore lacking.

"Patricia Marson."

I'd like this placed on the record.

The Chair: The next order of business is a Liberal motion under subsection 8(7), page 24A.

Mrs Caplan: I move that subsections 8(7) and (8) of the Ministry of Health Act, as set out in section 1 of schedule F to the bill, be struck out and the following substituted:

"Duties

"(7) The function of the commission is to carry out and implement plans proposed by a district health council and approved by the minister to restructure hospitals or groups of hospitals in the jurisdiction of a council and to ensure the efficient delivery of an integrated health care system in the council's jurisdiction.

"Dissolution

"(8) The commission shall be dissolved three years after the Lieutenant Governor establishes it."

This motion does what the government has said it wants to do in terms of the duties of the commission. The restructuring commission, as proposed by the government, has no mandate enshrined in the legislation, has no duties or responsibilities set out in the legislation. We want to be clear that if you're going to go ahead with a commission, its function and its duties be clearly defined as to what that commission will be able to do.

We've set out duties in subsections (7) and (8), and subsection (8) says "three years." We think all the decisions and the implementation should have been set in process within the next three years and that is well within the government's mandate. We think that is more appropriate than the four years. However, I suggest that if the government is willing to accept the first part of the amendment, we would be willing, as a matter of being helpful, to live with the four years if they insist, although, from what we heard from the deputations and from what we know about time lines of government, we think three years is adequate time to put these plans in place.

We're very concerned about any minister having these absolute powers any longer than required for the planning to be completed and the implementation to be well under way. That's why we tried to shorten that. But if they will accept the first part, which defines the duties of a commission clearly so everyone understands what the duties are, and is also very clear that the duties and responsibilities relate to hospitals but also to an integrated health care system -- that has not been clear at all in this legislation and it's our hope that the government will support this amendment.

Mrs Helen Johns (Huron): I'd like to thank you for the motion. Basically, we as the government have decided we need four years to be able to implement the hospital restructuring, so from that standpoint we will not be supporting the motion.

The Ontario Hospital Association has sent out a release that says it is pleased that the amendments are very close to those the hospitals have been recommending to the minister and his staff and to the standing committee on general government, which is reviewing the bill.

We believe we need four years to be able to work through restructuring. That allows the next government to campaign on that aspect, if we need to have restructuring one more time; to go forward if we haven't completed all the restructuring that needs to be done.

Because you have talked about standing down subsection (8), I will talk about subsection (7) also. We believe that in most cases, what will happen is that the commission will hear from the district health council, they will hear the plans of the community, they will implement the plans of the community. The commission will carry that process through and will implement it. We believe that process will take approximately four years.

What we are concerned about in this motion is the area where a community doesn't have a district health council report, where they may have just a group of people who come together where it's not a district health council; or where there is some other reason to move forward on restructuring where there is no district health council report. This motion stops us from moving forward. We can only move forward with restructuring if we have that district health council report. We know that in some areas we will not be having a district health council report and we will have to lean on other factors in the community to decide what the best health care system is for Ontario. That's why I'm recommending that this motion not be supported.

1150

Ms Lankin: I'm disappointed. I can tell from your argument that you will also vote against my next proposed amendment. It's quite clear that you couldn't support mine, based on the arguments you've made, in spite of the fact that you may be getting some advice to take a look at it. That's disappointing, because I think there is room in the legislation to make reference to plans of district health councils.

I take issue with always being assured that you believe the commission will carry out its work in light of district health council reports but that you refuse to have anything written into the legislation that even builds a linkage between the two. I'm disappointed that you're going to vote against this, and because of the arguments you've made, it's very clear to me that you will not be able to support my motion that's coming up next.

Mrs Caplan: To be helpful to the parliamentary assistant, we would like to amend the motion to delete everything from "dissolution." That would take out any of the sunset timing, and hopefully the amendment would then be acceptable to the government. We will delete everything following the word "dissolution," and that would just leave in place a definition of the duties of the commission, which certainly the parliamentary assistant and the minister can support.

Mrs Johns: Can I clarify that? Are you basically saying you'll take out subsection (8) and leave in (7)?

Mrs Caplan: Yes.

Mrs Johns: Maybe you missed part of my argument, so I'll just reiterate that.

Mr Phillips: If we take out (7) too, maybe they'll support it.

Mrs Caplan: I'd just make the point that (7) is enshrining in the legislation what you've been saying. There's nothing in (7) that's inconsistent with what you've been saying about the duties of the commission. It just makes it clear, and clarity is important; this legislation has no clarity. I've now amended this motion so that it will be acceptable to you.

Mrs Johns: I understand that. Ms Lankin says I did answer it, but I want to answer it again so you can hear it. For once, someone says I did it right -- maybe not, just said it properly.

The intent of the commission: We believe that the commission will, in most circumstances, take the district health council report, implement it and move forward with the recommendations of the district health council report. There are some cases where there will not be a district health council report because there isn't a district health council process going on. For example, in my riding there's not a district health council process going on at this time. There may be places where there is not consensus on the district health council report. Recently, we received a recommendation from a district health council where we have a dissenting opinion from the DHC. We have problems with being able to move forward on just the issue of a district health council report being the start of the process for the commission.

Mrs Caplan: Now I'm very concerned, because what we've just heard from the parliamentary assistant is contrary to everything we have heard from the ministry and from the parliamentary assistant and from members of the government caucus to this point in time. It's exactly what our fear was. The fear was that there would be no process in place and that the minister could unilaterally and arbitrarily go in, without any process that involved the district health council, and make a decision. What I hear the parliamentary assistant just say has confirmed that.

Until this point in time, all we've heard about are the 60 reports that are out there. We've heard about the important role that the district health council has to play. Now, we're not arguing that there may not be a need for further debate and discussion on those DHC reports, but to have the parliamentary assistant tell us today -- let me read you again what we're proposing:

"Duties

"(7) The function of the commission is to carry out and implement plans proposed by a district health council and approved by the minister."

So between the recommendation by the district health council there can be changes until the minister approves it, so there's your check and balance. It's not automatically what the DHCs have to say. They advise the minister, he takes their plans, he makes whatever changes he wants and then he approves them. These are for the purpose of restructuring hospitals or groups of hospitals that are in the jurisdiction of that council, and the purpose is to ensure the efficient delivery of an integrated health care system in that council's jurisdiction.

Mr Chairman, I am alarmed that we now hear it is the minister's desire to have the powers to go in where no study has been determined and where there's been no participation by a district health council, where he can just walk in and unilaterally make a decision that's going to have dramatic implications on a community. He can do that with this legislation without so much as a public hearing and with no due process, and he doesn't have to involve a district health council and he doesn't have to establish a district health council. He doesn't even have to establish any kind of community process.

The concern we have is that he can delegate all of the powers he is granted here to a commission or to an individual commissioner to do all of those things that I have just said. All that this reasonable amendment does is to scope that a little bit to ensure that there is some process, and I don't understand why we at this late date are now hearing a different tune sung. It's not that you got it right; it's that we haven't been given the information from day one. This is new information. We were never told that that was the intent.

Mrs Johns: I just want to clarify, if I may. All we want to do is recognize that there may not be consensus within a district health council, and if there isn't consensus and we don't have a report from the district health council, the whole system can be held up for ransom because of the way this has been set up. What will happen is that we cannot proceed with restructuring if we don't have a report, so therefore the system will not be restructured.

Mrs Caplan: I would disagree completely with what I've just heard from the parliamentary assistant, because in fact this does not require a consensus. All this requires is a report from the district health council. The minister can then make whatever changes he wants because they're only advisory to him. All this does is ensure some process in the community. It does not demand consensus.

It says the minister can make the decision and then the commission implements the minister's decision. It also does not require that the district health council has to come in with a unanimous report. They can have a report from the district health council that lays out to the minister what the concerns are in the community and asks the minister to arbitrate, make the final decision.

So this is not something that's going to in any way fetter the minister or stop the minister from taking action. All this does is require community participation and ensure the involvement of district health councils.

Mrs Johns: I disagree with your interpretation of the legal ramifications of that, so I'd like to get Ms Czukar to comment on the legal ramifications, all that this does, so that we both understand.

Ms Gail Czukar: I think that the way the motion is written, it states that the function of the commission would be to carry out and implement plans proposed by a district health council. So this would restrict the commission to that function alone and would require the minister to approve those plans. But if there is no plan, the commission essentially can't move forward, according to the wording of this motion. I think that some of the things that were said about the minister being able to write a plan that the commission could move forward with are not incorporated in the motion as it's written.

Mrs Caplan: Ms Czukar, the role of the district health councils is to do what? Legally, what can they do?

Ms Czukar: There are functions set out in section 8.1 of the Ministry of Health Act which refer to advising the minister, making plans with regard to the health within a geographic area and that sort of thing.

1200

Mrs Caplan: Do the district health councils -- I know the answer to this; I just want to get it on the record -- have any power to do anything other than recommend to the minister?

Ms Czukar: They have the power to make plans and advise the minister, but the way this motion is written, it requires that plans proposed by a district health council and approved by the minister be the ones that the functions of the commission are to carry out. If there is no plan, then the minister can't make a plan on his own under this section.

Mrs Caplan: That's exactly what we're trying to accomplish. We don't think the minister should be able to do a plan unilaterally on his own. We think there should be community process and participation and a plan developed by the community that the minister then has to approve. We are also aware that under the existing law without this amendment, the minister can unilaterally go into a community, whether or not there is a district health council, and do as he pleases. So, in fact this bill requires some process. I don't believe it fetters the minister; I still think that because DHCs are advisory to the minister, they don't have any statutory power to do anything except recommend. On that we can further debate. But I think you've said very clearly that this legislation would require community process.

Mrs Johns: I'm not disagreeing with community process. What I'm saying is, if there is no report from the district health council for any reason, it would hold the restructuring process up for ransom. We want to expedite, to move forward in hospital restructuring. We believe it's an important part of reforming health care in Ontario.

Mrs Caplan: Look, Mike Harris stood on a platform and said, "I have no plans to close hospitals." What he is now saying is, "Give my minister the authority to close hospitals without a community plan." That runs totally contrary to the promise that was made to the people of this province. I'm telling you this bill does not require any community process, and you have just confirmed that the reason you won't support this is that you want the minister to be able to go in and act unilaterally and develop his own plan.

Mrs Johns: I have confirmed that there are not just district health councils that are making plans about the restructuring in Ontario. There are local planning processes between hospitals and other agencies that are not directed by the district health council. These recommendations are local.

Mrs Caplan: The history of this province's --

The Chair: Excuse me, Mrs Caplan, I think we basically heard most of the arguments on this question. Is there any other discussion on this particular amendment?

Ayes

Caplan, Lankin, Phillips, Silipo.

Nays

Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

The Chair: The amendment, as amended, is defeated.

The next one we will consider is a New Democratic amendment. Ms Lankin.

Mrs Johns: Can I just ask for this to be stood down? We just got it this morning and I'd like to have a look at it and talk about it with Ministry of Health officials.

Ms Lankin: Maybe you just got it this morning but it's exactly the same as the one we took out, except it makes it consistent with the motion you just passed setting out powers. This becomes sub 7(1). It just makes it consistent with the motion you passed. The content of it is exactly the same.

If I may, it's not read into the record yet, but we had functions set out in the old one and you've now put --

The Chair: Is that explanation satisfactory? Are you prepared to proceed, Mrs Johns, or do you still want unanimous consent to stand it down?

Mrs Johns: I'd like unanimous consent to stand it down.

The Chair: Everybody, unanimous consent to stand down this particular amendment? Agreed? Okay.

The next amendment is a government amendment, page 26.

Mrs Johns: I move that the French version of subsection 8(8) of the Ministry of Health Act, as set out in section 1 of schedule F to the bill, be amended by striking out ", auquel cas" in the seventh line and substituting "et, si le règlement le prévoit,".

Pardon the French. To anybody who is French, I apologize.

The Chair: Is there any discussion on this particular amendment?

Mr Phillips: Why don't you give us a few of these to move just so we can have something to do.

Mrs Johns: That's a good idea.

The Chair: Shall the amendment carry? The amendment is carried.

The next amendment we will consider is one from the New Democrats, page 27. Ms Lankin.

Ms Lankin: This is schedule F to the bill, section 1, subsection 8(8) of the Ministry of Health Act.

I move that subsection 8(8) of the Ministry of Health Act, as set out in section 1 to schedule F of the bill, be amended by striking out "or that only specified members of the commission are to carry out that duty within a specified geographic area" in the fifth, sixth and seventh lines.

The Chair: Discussion?

Ms Lankin: Generally, I guess I would start by saying I'm a bit perplexed as to why the minister or the parliamentary assistant believes this section is necessary. It would be helpful, when you are responding to my proposed amendment, if you could give some rationale for the section, particularly given some of the regulatory powers that you've set out in the sections to follow in this particular act.

But I'm concerned about this section, just to explain it so you don't have to go back and take a look, allows where the commission has been set up, for duties to be assigned to individual members and for them to be carried out in specified regions of the province. I don't know if there's any other elaboration you would like to make to that, but it gives me the sense -- you know how concerned we are about the powers and duties that you have given to the commission and that are being delegated from the minister -- that this could be delegated to one person to carry out whatever those duties are going to be. We've not had -- excuse me, Mr Clement -- an adequate explanation from you, I would say, at this point in time as to what those duties are. They can be carried out by one person in a region or an area of the province, which can truly lead to a bizarre situation of an individual being able to override local planning processes.

I'm not sure (1) why you need that section of the act, and (2) what it is you want to accomplish. I think yesterday when we had this discussion in general around the commission it was drawn to people's attention that when you put all these sections together, you can have one person essentially walk in and take over all the decision-making with respect to the delivery of health care services in a region of the province.

Given that you won't let us define who's going to be on this commission and we don't have any assurances of what the membership and the makeup of the commission are going to be, giving these kinds of powers over a region is very worrisome, particularly to some of my colleagues who come from parts of the province where they have gone through local restructuring exercises and have a consensus they've arrived at, and find themselves unable to continue to implement that consensus because of the Ministry of Health, or in this case the minister, taking a different position than previous ministers had taken.

I've moved the amendment because I worry about those kinds of powers being carried out by a single individual in regions of the province. You might be able to allay my concerns with your explanation; I don't know. But I'm also not sure why you need that section of the act.

Mrs Caplan: Can I speak in support of the motion?

The Chair: There was a question asked of Mrs Johns, I believe, so we'll give her the opportunity to answer the question.

Mrs Johns: The intent of this section in the act was to say that the representation on the commission would not be all centralized, if you will, that there would be people from different areas who would bring a broad perspective to the commission. So, for example, my feel was that with eight to 10 members of the commission we may well have one with a rural perspective and one with a northern perspective. I was quite surprised by your amendment also when I saw it, because I was unsure where you were coming from.

We were saying that of the members on the board, there would be some who would be chosen for different reasons, maybe because of district health council experience, maybe because of their ability to work on amalgamations, and people with geographic differences too, to be able to bring a wide perspective to this commission about what the needs are in Ontario.

I want to make sure I say this: We're still going to use the local planning and we're going to be saying, "Hey, if you have a solution that's working in your community and it's proceeding forward, we're not stepping in to do something about that." What we want to do, though, is have a broad base of interest on this commission, because we believe it's important. It's not only interest by profession, but it's by geographic area also.

1210

Ms Lankin: I appreciate you explaining what it is you want to do by this section. May I read the section to you? "Where a regulation is made assigning a duty to the commission, the Lieutenant Governor in Council may provide that only specified members of the commission are to carry out that duty or that only specified members of the commission are to carry out that duty within a specified geographic area, and where the regulation so provides, any action or decision of those members shall be deemed to be an action or decision of the commission."

With all due respect, Ms Johns, it says nothing about the makeup of the committee. You missed your chance on that when you voted against my amendment yesterday, which talked about the commission having to reflect the diversity of the population of Ontario, which in fact was your opportunity to ensure that you had geographic, regional and other issues of concern in terms of diversity reflected on the commission.

This section of the bill has nothing to do with the makeup of the commission and your answer to me only spoke to the makeup of the commission. So I suspect if that's what you're trying to accomplish, that you've written it incorrectly, unless you're trying to accomplish something different. So maybe I'll ask you to give me one more answer in terms of what this section is supposed to be doing.

Mrs Johns: I'll add something else to it, if you'd like me to.

Ms Lankin: Do you still stand and say that this section is to ensure that there is geographic representation on the commission? That's what you told me it's for.

Mrs Johns: We need to add people to the commission or designate members of the commission who can provide a local or a regional perspective, one way to help achieve the goals that you've been trying to put forward so far.

Ms Lankin: So this section allows you to add someone to the commission? Is that what you're saying?

Mrs Johns: Add people to the commission who have a specific --

Ms Lankin: Let me read it to you again: "Where a regulation is made assigning a duty to the commission, the Lieutenant governor in Council may provide that only specified members of the commission are to carry out that duty or that only specified members of the commission are to carry out that duty within a specified geographic area, and where the regulation so provides, any action or decision of those members shall be deemed to be an action or decision of the commission." It doesn't say anywhere that you can add a member to the commission. So let's give it a third try to answer what is your intent with this section.

Mrs Caplan: Just to be helpful --

The Chair: Mrs Caplan, we're having an exchange here between Ms Lankin and Mrs Johns.

Mrs Johns: Ms Czukar would like to answer that for you.

Ms Lankin: Ms Johns, my point here -- quite frankly, I understand what this is; I understand. These are very clear words. I understand. My point is that we are here in a system where we have someone presenting and carrying the bill and explaining amendments to us -- and I am sorry and I apologize; with all due respect, the minister should be here because the minister is the person who should be accountable for this. The minister shouldn't put someone forward who wasn't involved in the development or the rationale behind this. It's not fair to other individuals and it's not fair to us as committee members.

Let me tell you what this section does. You have a commission that you appoint. Under this section, you can give certain of the powers that you've just passed in your amendment to any individual, and an individual can carry them out.

Mrs Johns: On a regional basis.

Ms Lankin: Not only on a regional basis. Again, look at it, Ms Johns. I'm sorry, you're wrong. There are two sections contained within there; there are two powers. Any individual can carry out the powers of the commission as they are assigned, or any individual can carry out the powers of the commission on a geographic basis. So there are two sections; there's not just one.

Quite frankly, we are worried about having the opportunity or the situation where one individual is given all of the powers of the minister of the crown to go into one specific geographic region, can override what local planning processes and local individuals have said. I think this is badly constructed. I think it's pretty clear that it has at least not been well presented and explained to us. I would suggest that my amendment is helpful in the sense of not having one, single arbiter walk in and make decisions in communities, overriding community consultation and community consensus.

The Chair: Mrs Johns, did you have any further comment on that? No. Mrs Caplan.

Mrs Caplan: I'd like to be helpful, if I can, because my reading of this part of the bill is not as you've described it, Ms Johns. In fact, this is where the minister has the power to designate any one member of that commission to act as an independent commissioner. As we've discussed before, that is a provision of this bill, and I believe this is the section that gives effect to that.

It says that the minister could appoint somebody from Toronto to go into Huron and make a decision, because that would be within the geographic region, and that they could do that without a district health council report, without any community process, without any community input. That's exactly what this legislation says -- any individual member of that commission can be given all the powers of the minister and all the powers of the commission and be appointed to a geographic area -- but it also says that it doesn't have to be geographically specific.

The concern I have with the amendment that's been placed is that, frankly, I don't think that any individual should be able to be given all of the powers of the minister, even if it is confined to a geographic area, because if you want to start a war in a community, just try and send someone into that community to dictate to them what's going to happen in their community. And this does not require that the individual come from that region. This has nothing to do with the makeup of your commission. It doesn't say that people have to come from different geographic regions. It doesn't do that, and I'm going to read it to you again so that you can understand it as I understand it.

It says that "the Lieutenant Governor in Council" -- that's the cabinet -- "may provide" -- the cabinet can decide -- "that only specified members of the commission are to carry out that duty" -- as set by regulation at some point behind closed doors about what the responsibility of the commission is going to be and-"that only specified members of the commission are to carry out that duty or" -- and that was an "or" by the way, not an "and"-that those "specified members of the commission are to carry out that duty within a...geographic area." Then it goes on to say that "any action or decision of those members shall be deemed to be an action or decision" of the whole commission.

What this says to me, on my reading of the legislation of your law, is that the minister will be able to decide -- it'll be an order in council cabinet decision, but it'll be on the advice of the Minister of Health -- which individual of the commission will be able to go into a community and tell them what they have to do. That's what this says.

This does not require that they come from that area. It doesn't say what their credentials have to be. It doesn't require any due process. This is about giving any individual member of the commission, to be selected by the minister, all the powers of the commission, and when they make a decision, there's no appeal. There's no appeal to the courts, there's no appeal to the minister, because the decisions of those members who've been given this extraordinary power to dictate to communities what's going to happen in their community "shall be deemed to be an action or decision of the commission."

And the commission's decision is not appealable, and there's no due process following a decision by the commission, and there's no access to the courts. That's what this says. This isn't about where people on the commission come from, Mrs Johns. That's why we need the minister here. This is a very frightening clause. This is the clause that lets the minister decide who's going to walk in and tell communities what's going to happen and the communities have no right of appeal. That's what this is about.

Frankly, with due respect to Mrs Lankin, I don't think your amendment solves the problem.

Mrs Ecker: I think Mrs Johns has been quite clear about the intent of why the restructuring commission is needed. The minister has been very clear that local planning groups, whether it's district health councils, which are usually the groups that are making local planning recommendations to the ministry -- that that process is important, that process will be there and that process will be the process we will be using to restructure, as much as possible. If there's a district health council process there to restructure, those are the recommendations that the ministry would like to be able to consider and to implement.

Mrs Caplan: She didn't say that.

Mrs Ecker: Yes, and that's what the commission is all about.

Mrs Caplan: That's not what she just said.

The Chair: Mrs Caplan.

1220

Mrs Ecker: Thank you, Mr Chair. There are many areas where that local planning process has been working very well. We've also heard there are areas where that local planning process had difficulties and problems and where they thought they needed some assistance from the Ministry of Health.

The opposition has complained that they believe Bill 26 gives the minister all these powers that he shouldn't have, yet Bill 26 is clearly saying there will be a commission to remove any attempt to make allegations that somehow or other this is a politically driven process. You will have a commission of individuals who will be making decisions about the restructuring based on whatever and as much local input as they can have. I think that is very clear and very necessary in the system.

Mr David S. Cooke (Windsor-Riverside): I just have a question, if I might, of legal counsel from the ministry. I understand what Ms Ecker is saying and what the purpose is, but I want to know, in the proposed law, if the ministry wanted to, would it be able to send one commissioner in who does not come from the region to be the decision-maker for restructuring of health care in that particular community?

Ms Czukar: The answer to that is no, not without a regulation that's been passed which specifies what duties that particular commissioner has and with respect to what geographic area. The ministry can't do it unilaterally.

Mr Cooke: No, but -- all right.

Ms Lankin: So the answer is yes.

Mr Cooke: The answer is yes.

Mrs Caplan: Can they write a regulation?

Ms Lankin: Come on, Gail.

Mr Silipo: The question is, can it be done with a regulation?

Mr Cooke: Under this framework law, it could be done by the government.

Ms Czukar: What this section says is that a regulation could be made that would allow certain members of the commission to carry out those powers in certain geographic areas.

Mr Cooke: So the answer then is that if the Minister of Health decided that he, in his wisdom, wanted to send one commissioner down to be the arbiter, say, in my home community of Windsor-Essex to restructure that health care system, he could take somebody from Metropolitan Toronto and send that person down after the regulation had been passed and that person would basically be the health care czar for that area.

Ms Czukar: I don't think I can characterize it that way.

Mr Cooke: Well, it would be the commissioner who would be making the decisions, based on the regulation.

Ms Czukar: He or she would be carrying out whatever duties have been assigned by the regulation under this section.

Mr Cooke: The only point being that if in fact the purpose and the procedure is as Ms Ecker outlines it, then why wouldn't you be more specific in the legislation so that it would not allow, under any circumstances, a person who doesn't even come from the community to go down and be the single decision-maker on health care restructuring? Why wouldn't you say that in the law?

Mrs Caplan: Could I just restate Mr Cooke's question in a way that we could elicit a yes or a no answer from the counsel at the ministry? As I understand what you've just said, this is the process -- and I won't use words like "czar." The minister could draft a regulation appointing any individual from any part of the province a member of the commission, assign them duties and responsibilities for any area of the province, whether they come from there or not, and they could receive all of those powers by regulation, go into that community and make a decision. Then in the next section of this bill, section 9, any decision that they make, if it's done in good faith, is not appealable.

Is that the regulatory authority that the minister would have under these sections? Is that a fair categorization of what this permits?

Ms Czukar: Yes, I think that probably describes it.

Mrs Caplan: Okay, that probably describes it. So for the members of the government caucus, let me tell you what that means. I want to be fair, so that we all understand that section 8 and 9 together would permit this. If I'm wrong, okay. It would permit the Minister of Health, by regulation, to appoint someone from Ottawa to go into Windsor to make a decision on what's going to happen in Windsor. The duties and authorities and powers would all be set out in regulation behind closed doors, the cabinet. They would decide; that's order in council. The decision that person would make, if it were made in good faith -- so they'd have a little report that showed they acted in good faith -- nobody could appeal that. That's what this does.

What this does is it says he could appoint a bureaucrat, he could appoint a civil servant to do this. There's no restriction on who the commissioners could be. It could be anybody. That's how I read this. Could that scenario occur, Ms Johns? Yes or no? I'm trying to be fair. I've debated something. Yes or no? I didn't hear you.

Mrs Johns: Yes, although my lawyer's saying it isn't a yes or no answer and I should probably hear the whole reason why it's not a yes or no answer. What we believe is -- oh, I guess it's not my turn to speak.

Mrs Caplan: Sure, go ahead.

The Chair: Mrs Caplan asked you a question.

Mrs Johns: What we believe is happening is there are 60 studies coming in in the next two years and we know that we have to work on those, implement them, expedite them along the process. All of the commission will not work on every study that comes in. We've agreed to that. We agreed yesterday that they will not work.

This commission or these people will be tied with duties and powers that will be set up by the cabinet so we will be able to say, "Implement a district health plan," and we'll be able to make the requirements that tell them what to do. They won't just be going out and saying, "Hey, I'm going to do this." They're settled by regulations. Their mandate is set up in regulations in the bill.

Mrs Caplan: If that answer was designed to give the people watching these hearings any comfort, let me tell you, you have now sent a very clear message of what your intention is. You can appoint anybody you choose, whether it's a bureaucrat in the ministry, well-meaning as they are -- it could be anyone -- to this commission. We don't know what the commission's going to look like. We don't know even what duties and powers you may or may not assign. We don't know what direction. Because that's all done behind closed doors in the cabinet.

You can appoint individuals, send them into a community, tell them to make a decision defined by the regulation. Do you think the communities are going to accept that as reasonable? Now that we understand -- it's taken us all this time to understand that that is your intention -- do you think the people think that's what this bill does? Do you think anybody understands that? A minute ago you were telling us that section 8 had to do with the composition of the commission.

Mrs Johns: I believe that people understand that hospital restructuring has to be done. They want it to be done. They want it to be done in the best way that it possibly can, so that they maintain their health services in the community.

Ms Lankin: What's that got to do with section 8?

The Chair: Ms Lankin --

Ms Lankin: Well, it's a legitimate question. What's that got to do with section 8?

The Chair: Mr Phillips is the next person to speak.

Mrs Johns: And this just expedites the process. That's all we're doing.

Mrs Caplan: "I have no plan to close hospitals," Mike Harris said. "Now we're expediting. We're sending one person in who will have absolute power and you can't take him to court. You can't appeal it."

Mr Cooke: Now do you agree it's a czardom?

Mrs Caplan: You know what? I can't think of a better word.

Mrs McLeod: It's imperial Rome heading for a republic.

Mrs Caplan: I don't know what you're going to call this person, this person filled with all power and wisdom to go into a community and dictate to them what's going to happen. And their words can't be appealed. That's it; it's done. You're not going to get away with this. Communities will not stand for this.

Mr Phillips: To the parliamentary assistant, just so I'm clear on this, and I run the risk of repeating what my colleagues have just said, but yesterday we heard that the commission has provided -- the regulation covers this. But the commission has the authority to determine -- you mentioned hospitals, but it's well beyond hospitals. The commission has the authority to make a determination for a community on, we heard yesterday, nursing homes, home care, long-term care, hospital structuring, ambulance service, community health centres, independent health facilities. I gather the commission has the authority to restructure virtually all of those areas, provided the regulation gives them that authority. Have I interpreted that properly?

Mrs Johns: The commission, yes.

Mr Phillips: I'll use Windsor as an example.

Mr Cooke: Quit picking on us.

1230

Mr Phillips: All right. Scarborough or Kingston.

Mr Cooke: Liberals advocate Windsor be number one to be restructured.

Mr Phillips: Where's Sandra? That's right.

Just so I and we and the public are clear, this is not just about hospital restructuring. The second thing is that the cabinet some day will pass -- and I gather you said there are 60 of these studies going on, so we just assume this will be a one-person, many one-persons commissions, because these eight or nine people are going to be extremely busy.

But at some stage a regulation goes to cabinet, is passed and the public finds out that there's a restructuring going on in Windsor through what we call the Gazette on Saturday. Am I right on the second point, that the cabinet, the Minister of Health, will direct through regulation this commission on their terms of reference for restructuring in Kingston?

Mrs Johns: Yes.

Mr Phillips: That's correct. And that regulation -- maybe you can just describe what might be in the regulation. Here's what I think could be in the regulation. Tell me if I'm wrong. This instructs the commission to go, let's say, to Essex county, and to put forward a final plan for restructuring the hospitals, the ambulance service, and I assume -- you're shaking your head, but yesterday you got the authority, through your amendment, to do that. You've always talked about community; you've said this is well beyond hospitals, so I assume that, if you are restructuring hospitals, it is your plan to be restructuring, for Essex county, the whole system.

The regulation might say, this authorizes you to go to Essex county, to restructure the health system there, including the determination of how many hospitals, how many long-term-care beds, how many community services are provided, how the ambulance structure should work with that and the community health services. That regulation would give them that direction and, once they've finalized their report, the report is final. No one else need approve it other than the commission, and I gather the commission's report is approved by the commission. Am I right there?

Mrs Johns: No, I wouldn't say that. What I would say is that the local community would come up with a plan of how the system should work, taking into effect all the needs they have in their health services. What they would then do is submit the plan, the plan would then be approved, and what would come about then would be the restructuring, with a focus on hospital restructuring.

But we have to maintain, we have to ensure that there's a continuum of care, so we can't leave holes in the system and we may have to look at other areas that would also be discussed by the local planning committee. The difference between what you said and what I've said is that I believe the local planning in the community will be the incentive to drive the process.

Mr Phillips: Yes, but --

Ms Lankin: That's what you refused to put into legislation.

Mr Phillips: Yes, just so the public is aware, there have been motions by the opposition proposed to implement what you said you were going to do. You've rejected those motions, and the reason you have rejected them, I can only conclude, is that you have no intention of holding the commission to implementing the local plan. You want the commission to do whatever you want the commission to do and you've told us you want that flexibility.

I think the public should recognize that you may or may not accept their recommendations. Frankly, the commission will do whatever you direct it to do. Why would you not, if you believe what you just said, have accepted the motion calling for the commission's role to be to implement a locally developed plan?

Mrs Johns: What I said when that motion was before us was that there are some communities which will have different visions within the community, not one plan from the district health council, maybe different views, and we have local planning that's not district health council planning. That's why we didn't accept the motion before.

We believe that local communities will have input into the hospital restructuring. We will set that up in the terms and conditions for the commission. But we believe we have to have flexibility in case there isn't a district health council report, that there is only a local plan or that there is only a group of people who come together to decide what's best in community health care.

Mr Phillips: I think you understand the scepticism we have, which is that we think you want the authority to do whatever you want to do. But perhaps you could help us here. Would you be prepared to entertain a motion that says that if there is a locally developed plan that has clearly been widely consulted on, if there is such a thing, you would then hold the commission responsible for implementing that? Are you prepared for that amendment?

Mrs Johns: I would suggest you submit it and we'll have a look at it.

Mr Phillips: But you've rejected everything else so far. Are you prepared to accept an amendment that embodies that?

Mrs Johns: I'd have to see it first.

Mr Phillips: Sure, yes. This is so phoney. Are you prepared to draft an amendment that would encompass that? You've rejected every single one of our amendments. Will you have your counsel draft an amendment that embodies what you just said you would accept, or I presume you would accept?

Mrs Johns: Can I suggest that we have a motion somewhat like that, I think, on page 25, which the NDP set up that we're considering at this moment?

Mr Phillips: Do you want to stand this down till we deal with that then?

Mrs Johns: No, because this section is not something we will be supporting.

Mr Phillips: I know that. But I assume that the thing that you say on page 25 --

Ms Lankin: I want to speak to that point to clarify.

Mr Phillips: Ms Lankin, maybe you can clarify things, and then I can get back on.

Ms Lankin: I just want to respond to Mrs Johns on that point with respect to the New Democrat amendment, which has been stood down. It essentially is a very weak motherhood amendment trying to get them to even put the words "district health council" into this bill. It does not embody what Mrs Johns just said was the government's commitment with respect to respecting the work and utilizing the work of district health councils.

I think Mr Phillips makes an excellent suggestion. She's made a commitment. Is she prepared to draft an amendment and bring forward an amendment that would embody that commitment?

Mr Phillips: I'm trying to find a solution to this. Are you prepared to draft such an amendment that we can deal with?

Mrs Johns: As I said, if you submit an amendment, we'll have a look at it.

Mr Phillips: Please. You spend $17.5 billion over there. Mr Wilson, if you're prepared to accept what your parliamentary assistant just offered, can't you have one of the thousands of people over there draft that amendment and bring it forward? Are you prepared to do that? I'm waiting for an answer.

Mrs Johns: I guess from my perspective, I'd like to see what you have in mind, so I'd like you to submit the amendment.

Mr Phillips: I have in mind what you said you would do.

Mrs Caplan: Draft an amendment that is consistent with what you have put on the record that you're willing to do. We'd like to see that amendment.

Mr Phillips: Rather than us trying to guess what you might accept, you put down on a piece of paper what you will accept that embodies what you said you would do, and that is that where there is a community plan developed with the support of the community, you will instruct the commissions that that's the plan. You've said that's what your intent is. Don't let us go through the exercise and then you find one word you don't like. Will you undertake today to bring forward that amendment?

Mr Cooke: Is that something you support?

Mrs Johns: I said when I was talking about it, and I will have to check Hansard, but what I said basically was that the community would prepare a report, we would look at it and have it approved and we would go forward. I'm not saying that every local planning report will be approved. If they want to spend $45 million, we're not saying that's okay.

Mr Phillips: Will you draft for us the terms that you would agree to a local plan? I think what the public is frightened to death about is that this government, in my opinion, has shown that it will implement its will on anybody. We're trying to provide some safeguards in this legislation that you're not going to come in and trample on their rights.

I think most communities in this province recognize that it is your intention to send somebody in to restructure -- is the assistant finished? This is important to us.

1240

Mrs Johns: It's important to us too. We want to have the best restructuring system in Ontario.

Mr Phillips: Then maybe you could tell the assistant to keep his mouth quiet while you listen to what we're talking about, if you don't mind.

You've indicated that you're prepared to entertain, incorporate in your bill, that where's there broad community support and where it's a reasonable -- you shake your head. What are you prepared to accept? You said you would prepare an amendment for us. Are you prepared to bring forward an amendment --

Mrs Johns: I didn't say I would prepare an amendment. I suggested that you prepare an amendment and we would approve it. I don't believe that the communities across Ontario are worried about this. I believe that they believe we will do the best for restructuring that we can. We will give them the best health care possible --

Ms Lankin: "Trust me. Give me a blank cheque. Trust me."

Mrs Johns: Yes, they should trust us. It's been 10 years and the system is getting worse and worse and worse. There is no good health care left in Ontario.

Ms Lankin: "We won't give you any agreement. Trust me. We know best. We're the fathers of the whole province. We'll decide everything that's best for communities. Trust me."

Mrs Johns: I think it would be better for them to trust us. The waiting lines in a lot of hospital areas have gotten worse and worse. It's time for them to trust somebody.

Ms Lankin: Oh, please. "Nothing's been done in this province in health care." Here we go again. "Nothing's been accomplished." You know best. You're not going to give any guarantees in legislation.

Mr Sampson: A point of order, maybe: I believe we're debating the NDP proposed amendment. My suggestion, if we can get ourselves out of this logjam, is that we deal with this particular one. We've stood down a previous NDP motion which, until it's dealt with, will preclude us from dealing with section 8 anyhow. There is another government motion relating to section 8 that perhaps we could move to, subsequent to dealing with the item here. Then, after lunch, we could deal with the stood-down motion to be able to complete the review of section 8, if I could suggest that to get us out of this logjam.

The Chair: Mr Sampson has requested unanimous support to stand down 27. Is that what you're saying?

Mr Sampson: Right, that we proceed with the motion that's on the table and deal with that one --

The Chair: Basically, that's what we are doing.

Mr Sampson: Right. I'm just saying that we're not going to be able to deal with section 8 anyhow, because we've stood down a prior motion, so we can continue the process here and section 8 is still open until that prior motion has been dealt with, the one we stood down that was moved by the NDP earlier.

The Chair: I'm having trouble understanding your point of order.

Mr Sampson: Let's continue. But my point is that we will not be able to close off the matter as it relates to section 8 until we've dealt with the stood-down motions proposed by the NDP people.

Ms Lankin: He's making a procedural suggestion. It's actually quite rational.

Mr Sampson: Then can you guys help me out over there?

The Chair: It is escaping the Chair.

Ms Lankin: Would you like me to explain it to you, Mr Chair?

The Chair: Mr Phillips, did you have something to say on this particular point?

Mr Phillips: I think he's asking me to proceed, so I will.

Ms Lankin: To a vote, Gerry.

Mr Phillips: Oh, to a vote. I'd just make the point that if there's one thing communities feel perhaps most deeply about, it's their local health system, and the thought of somebody coming in from outside -- it will be an outsider; there's zero doubt about that -- and imposing a complete health care system on them, with no assurance of public input -- you say, "Trust us, we will," but the authority is completely ignored.

It's just reinforced by the fact that the assistant has indicated that the government will perhaps be prepared to look at amendments but they are completely unwilling to do their own amendments, and then when we bring forward amendments, they turn them all down. This is a very frustrating exercise, because rather than the government coming forward with language it could accept, they say, "You go away and draft it, opposition, with your limited staff." Then when we bring forward an amendment, you say, "We don't like that because it's got three years instead of four years, or it has 7 am instead of 9 am, so we're going to turn that down."

It just makes the point that rather than the parliamentary assistant being here -- I have no difficulty with the parliamentary assistant, but if the minister were here we would have somebody who has some authority to make some decisions. Clearly the instructions to the parliamentary assistant are, "Agree to nothing the opposition says, reject their motions and you'll be rewarded, come Friday afternoon, with a pat on the back." It's not a very useful process.

Mrs McLeod: I concur. If the committee and the parliamentary assistant are interested in expediting, I don't think we'll achieve that by standing down. We'll stand down every section of this bill until we can get clarification.

But it's equally clear that the parliamentary assistant has raised a concern that is in direct contradiction of assurances that have been given by her and by other members of the committee, which is that there is a guarantee that the local input, the local planning process and indeed the role of the DHC will be respected in any involvement of the restructuring commission. The parliamentary assistant has now said that these powers are needed particularly where there is no report of the DHC, which raises the concern of what local planning process will be put in place.

You've said, "Bring in amendments." We've brought in amendments which do no more, as my colleague has said, than put into the legislation what you've stated repeatedly in committee, which is that the planning process will be in place and indeed that where there is no agreement the Minister of Health would have a role in resolving the disagreement. Since you cannot undertake to bring in an amendment yourself, do not have that authority -- and I don't think we're achieving anything by prolonging it -- will you at least undertake to directly ask the Minister of Health if he will bring in an amendment that will acknowledge in this law the local planning process and the role of the DHC?

Mrs Johns: I just want to draw to your attention that I never said that all local planning would be accepted carte blanche. I said that if they came out with a process that did not meet the needs of the community or that cost a lot of money or that didn't cover specific diagnostic areas or something we needed -- kidney dialysis or cardiac, whatever -- we may in effect turn down a local planning process, as we have in different areas asked them to go back to the planning board to look at it again. I never said that the local planning process was the only basis we were going to look at for hospital restructuring, but it will certainly be an integral of us deciding on how we should proceed.

Mrs McLeod: All we're saying is, please bring forward an amendment that recognizes in law exactly what you've said.

The Chair: Shall we move on and vote on this particular amendment?

Mrs Caplan: Mr Chair, could I for just one minute or less? As much as I respect what this amendment is trying to do, I can't support it because I don't support having any one individual of the commission being able to go into any part of the province and act individually, where their decision cannot be challenged. I think that's bad law and I don't think this amendment fixes that major concern I have. I don't think it makes it even slightly better. The whole thrust and ability of the minister to be able to give powers to one individual, who is not accountable and can't be challenged, is a wrong premise, wrong policy. That's why I'm not supporting the amendment.

The Chair: An amendment has been proposed by the New Democratic Party.

Ayes

Lankin, Silipo.

Nays

Caplan, Ecker, Hardeman, Johns, Maves, McLeod, Phillips, Sampson, Tascona, Young.

The Chair: That motion is defeated.

Is it your pleasure that we proceed to the next one or that we break for lunch?

Ms Lankin: Keep going.

The Chair: Okay. The next one to be considered is a government amendment.

Mrs Johns: I move that section 8 of the Ministry of Health Act, as set out in section 1 of schedule F to the bill, be amended by adding the following subsections:

"Mandate of commission

"(8.1) The commission shall be established for a period of up to four years and, at the end of that period,

"(a) the appointments of all the members of the commission are revoked; and

"(b) the commission shall cease to perform any duties or to exercise any powers assigned to it under this act or any other act.

"Review

"(8.2) The minister may, at any time during the existence of the commission, appoint one or more persons to review the activities and operations of the commission and to report on them to the minister."

We have asked that the commission cease to be in existence after a four-year period. Existing members' appointments would be revoked. It allows for the minister to require review of the commission at any time in that period.

1250

Mr Cooke: I just have one comment on this. When I first heard that the government was going to be introducing amendments on this and other parts of the bill that have sunset clauses, I thought this is the most manipulative thing a government can do. You give all the powers you want, and you try to set people's concerns aside by saying: "Look, we're going to sunset this after four years, at the end of our first term in office, after we've closed down dozens and dozens and dozens of hospitals, after we've sent commissioners into communities to design plans that don't reflect the community desire at all. After we've abused power by giving ourselves this kind of power for four years, just before we go to the people for an election, we're going to sunset those provisions." This is absolutely the reason why people in this province are cynical about governments and politicians, and it's just baloney. You're not going to get away with this.

The Chair: Ms Lankin. I'm sorry -- yes, Ms Lankin.

Ms Lankin: We are sure it's this Ms Lankin? Okay. I just wanted to be sure.

Mr Phillips: Are there two?

Ms Lankin: On some days with this Chair there are.

My colleague has made a very good point. A lot of groups came forward and said, "We want to see these power sunsetted," because they're very concerned about those powers being in place and they don't want them in place forever. In fact, it was a last-ditch plea to say, "Let's get some control over this, that at least after this government these powers won't continue to be in place." I believe this is the absolute wrong way to go about it. The intent of the powers you want to utilize with respect to health care restructuring should be set out in the act, and that's the point I've been trying to make all the way through this.

The blank cheque approach is not good law, not good governing, and there are very real reasons for the people of Ontario and the members of the opposition parties to be concerned, particularly when we hear some of the responses from the parliamentary assistant that seem to suggest one thing in one breath and something else when pushed and asked to clarify.

I have no confidence at this point that there is a framework for health care reform within which this government is going to operate. You've not articulated any principles of a framework of determinants of health, for example. You've not adopted any policies with respect to a shift from illness treatment to illness prevention. We don't know, other than bottom-line fiscal dollars -- that's the only thing we hear from you.

People have a right to be concerned if they think you're going to let the Treasurer run the health care system in this province, which seems to be the direction you're going. All we hear from Mrs Johns is: "Sixty reports are going to come in and we have to do something with them, but we don't know what. One moment we're going to listen to them, the next moment we may not. We may like what they say, we may not like what they say." Based on what criteria, on what framework of health policy, are you proceeding? You have not told us. Have you adopted the framework of health policy that the previous government adopted, based on determinants of health, based on the shift from institution to community, based on the continuum of health care through the community?

There was a complete document set out that gave a framework for how health care reform and restructuring was going to proceed and the policy framework within which that would be implemented. We haven't heard from your government, so how can we have any trust in the direction you're going to take? Well, it's not a question of trust -- we don't know; you haven't told us.

I think this is a real failing with respect to proceeding with a bill like this that gives such wide powers into the minister's hands and for the minister to delegate to individuals, and for everything else to be set out in regulation, done behind closed doors around the cabinet table, 18 people raising their hands and saying, "Yes, sounds good to me," with the ability to completely override what local planning processes have recommended. There's nothing in here and you won't even come forward with an amendment to tie yourself to having regard for local planning studies. You won't even put in that kind of language.

I heard Mr Sampson talk about the fact that this section's stood down because of an amendment we brought forward. I'm tempted to withdraw it. I don't know why we should continue to waste time. You're voting against everything we put forward anyway. That was such a motherhood amendment, so simple. It simply says that this commission, when it's exercising these new powers and duties, will do so with the goal of restructuring the health care system and providing adequate health care in the province and having regard to local district health council reports. It amazes me that we hear the parliamentary assistant in one breath commit to something much stronger than that, but refuse to bring forward an amendment to embody that in the legislation. Of course, the next time a question's asked, the answer gets changed.

I have a significant problem with this particular amendment before us. For a government that talks about wanting to do away with regulation and layers of government and layers of bureaucracy -- when we've said the accountability should rest with the minister, you felt a little bit touchy about the fact that maybe there was a lack of accountability if the minister was assigning all his powers to this commission, so to deal with that you add a clause that says, "The minister may, at any time during the existence of the commission, appoint one or more persons to review the activities and operations of the commission and to report on them to the minister."

Let me get this right. We have local district health councils that are going through the whole process of trying to develop a plan for the delivery of health care services in their geographic area. They submit that to the ministry, presumably. We don't know which process this is going to go through. Ms Johns at one point in time said the commission will take that and look at it, and at another point in time said the minister will take it and approve it or not approve it.

The commission then is another body on top of that, which may not take the advice of the local district health councils and which may, as an individual or a group of individuals on this commission, go into an area and essentially throw out all the local work that's been done and do it over again -- and presumably without talking to the minister, because the minister has given his powers to this commission; the minister doesn't retain the powers. It appears that the minister isn't even going to talk to the commission, because if the minister wants to talk to the commission, he's going to have to appoint one or more other people to come in and review the activities and operations of the commission and then report on them to the minister.

There are only eight to 10 commissioners, as I remember you were saying. Can't the minister go and talk to the commission and find out what it's doing? Can't they report to the minister what they're doing? Why do you have to appoint another group of people, a commission over the commission, to talk to the minister? This is a bureaucratic nightmare. Come on, you reformers over there, where have you all gone to? How have you allowed the bureaucratic tentacles of the octopuses in the ministries to come up with all these convoluted processes of commissions over top of councils and review groups over top of commissions to talk to the minister? What the heck is going is going on?

The Chair: On that note, it is the lunch break, so --

Ms Lankin: I will wrap up. I don't need to hold on to the floor for when we come back. Let me simply say that it is a cynical move to put forward this kind of sunsetting of the powers of the commission when there are other sections where powers are vested in the minister that aren't sunsetted. While I agree that this commission and some of the other areas should be sunsetted in four years, I think they should not exist at all, so I am having a problem with the whole section and our caucus will be voting against this whole section.

Mrs McLeod: Mr Chair, on a point of order just before we break: It's my understanding that a little earlier this morning, when the Premier was asked whether he would come to the committee -- obviously not by members of the committee but by members of the media -- he indicated that he was not familiar with all the parts of the bill but that the ministers would be speaking to it. I'm not sure, Mr Chair, whether that gives licence to place again the motion that the ministers appear before the committee, but if either I consider that motion to be in order after we return or the government members consult with the Premier and find out if that's what he was recommending, I would appreciate it.

The Chair: Thank you, Mrs McLeod. We're recessed until 2 o'clock.

The committee recessed from 1300 to 1401.

The Chair: Welcome back. Where we left off this morning, the order of speaking was Mrs Caplan, Mr Phillips and Ms McLeod. In view of the fact that Mrs Caplan isn't here, Mr Phillips, did you want to go ahead?

Mr Phillips: Yes, I did, Mr Chair.

The Chair: Just while Mr Phillips is getting organized, there have been some more submissions that have come through various members' offices that were asked to be circulated, so you have those at your desks.

Mr Phillips: Yes, I did want to speak, Mr Chair, if I could. Just to refresh our memory, we're debating a government motion that essentially sunsets the commission, which is the language used to mean that after, I believe it's four years -- yes, the commission may be established "up to four years" -- the commission would then be dissolved.

The problem we have with this is, pardon me for the extreme language, but there's no such thing as a temporary dictator. We find the mandate for the commission frankly too extreme.

I guess from the government side, if you believe this commission is a good idea, if you really believe that, and it's fairly structured -- the challenges in health care aren't all solved in four years. As a matter of fact, it's probably a huge mistake, if you think this is a good idea, to put a deadline on it, because if you think this is a good commission for restructuring of health, a community may require the services that you think it does, not in four years but in five years or in six years. If you believed that this thing was really well structured, you wouldn't be sunsetting it. You would say, "This is a permanent part of managing our health care system in Ontario."

Clearly, the only intent of this is, you know the powers you are giving this are extraordinary. I personally don't accept that the debt-deficit problem is so great that you have to turn over extraordinary powers for a short period of time to some group or individuals to execute your authority. Surely we in a democratic society can put together a way of handling these matters of dealing with our debt and deficit that aren't so draconian that even you acknowledge this thing should be sunset in four years and gone. Maybe it makes the Ontario Hospital Association feel better. I don't know. They think you're going to do all your dirty work in four years and then go away.

But I repeat: If this commission makes sense and is sensible and is effective, then why would you not want it around permanently? If, on the other hand, it is, as we believe it to be, an abuse of power, one that you're embarrassed to keep around, one that you know you shouldn't have and therefore you're imposing this sunset provision, we can understand that. But if I were in your shoes, if you want to get rid of it in four years, it should never exist.

I know the government members had no idea what was in this bill. You were as much in the dark as we were about the bill. You were just as surprised by it, and now you've got no choice. You have to defend this thing. We know that.

Mr Bud Wildman (Algoma): Not even the Premier knew that much.

Mr Phillips: Mr Wildman, how are you?

You have to defend this bill. But if you think you should be rid of this thing in four years, my advice to you is, get rid of it right now and design this thing properly.

Obviously, we'll be voting against this and asking the government members to kind of consider their own conscience. As I say, I don't believe there is any such thing as a temporary dictatorship.

Mrs Caplan: I listened very carefully when we had representation, delegations, come before this committee, and I heard them say they were very concerned about the powers that the minister was taking unto himself. They were very concerned about the powers that the minister could delegate to a restructuring commission. They did say they supported a restructuring commission with duties and responsibilities, as we have discussed and suggested that this bill would be amended to permit.

I thought a lot about that, and I don't think that this government amendment would give any comfort to all of those groups and presentations who came and said, "Don't delegate ministerial responsibility to a commission." They said, "Sunset the commission," and the reason they wanted it sunset was because they were concerned that the voluntary governance, which has been such an important aspect of the delivery of hospital services in the province, would be threatened by having a commission in place.

I understand that, because this bill potentially threatens voluntary governance, but it's not just through the restructuring commission; it's through the powers of the minister to micromanage, through the appointment of a supervisor and all of those other aspects of the bill in ministerial powers. It's the complications of the different parts of this bill all put together that I think people were very uncomfortable with.

What this amendment does is say: "We haven't responded to those concerns that were raised by the presenters to this committee in any of their areas of concern except one, and that is that the commission will cease to exist after four years. But during those four years, we will suspend democracy. We will delegate" -- the government is saying -- "all of the extraordinary powers. We'll do it by regulation. We can do it not only to the whole commission but to any one individual." That is still permitted during this four-year period, and every group save one, every presentation save one, and there were hundreds of presentations that we had before the committee, said that the minister must not delegate his authority to a commission.

So I can't support the establishment of a commission. I therefore can't support the sunset of a commission that I don't think should be established in the first place.

What we have tried to do to respond to those presentations that said a restructuring commission without those powers but with duties and responsibilities, clearly framed in the legislation, a mandate that is clear, whether it's in legislation or not, is supportable, is that I have proposed an alternative way for the minister to do that without it being part of the bill.

1410

The minister could establish a restructuring commission under the Ministry of Health Act, just as the district health councils have been established. He could, by virtue of his confidence in the recommendations that commission would give to him -- by accepting their recommendations, they would have all the authority they would need to see that plans were implemented in the community, because people would have the right to appeal to the minister and the minister would say, "I've decided what the commission is doing is good," just as the minister can say, "I've decided what the district health councils are doing is good and I support them." By the weight and the virtue of the support of the office of the minister, district health councils for 20 years have played an important planning role.

But beyond just their planning role, they have done implementation work. They have recommended where dollars should be spent. It was called rationalization in those days. They have recommended rationalization plans to the minister that were implemented when the minister said, "This is good work, go to it." And it was done.

So the minister, in order to respond to the Ontario Hospital Association and others who say, "Set up a commission, but set up a commission that does not have the powers of a minister and that is accountable and can be appealed to the minister" -- that's the accountability, that the decision of a commission can be appealed to the commissioner -- that can all be done without this legislation. It can be done under the Ministry of Health Act. The powers under that act, as a former minister I tell you, are significant enough to be able to establish a restructuring commission.

What I'm saying to those people who came before this committee and said, "We support a restructuring commission," my answer to them is, the minister can do that today, and he can do that and respond to your concern about that commission not having the broad sweeping powers that this bill takes unto the minister and which the minister can delegate.

I will not be supporting this amendment, because to support this amendment would support a commission where individual commissioners would have the power of a minister with no opportunity for communities or for individuals to have any recourse to decisions made by that all-powerful body. In effect, we would be suspending democratic rights and democratic process for the period of time that this commission was in place.

The other reason I'm not going to support this is that it sets a terribly bad precedent. In the 10 years that I have been here, and I have participated in all kinds of sunset reviews, I have never seen -- I have never seen -- government ministers, government cabinets, give up powers. Once the precedent is established for a commission such as this, if my colleague Mr Phillips is correct and the work is not finished, it will be very easy to see the sun rise, as opposed to the sun set, on this commission, and potentially future commissions, because you'll be able to argue: "You see, we had a commission. It was there. We still need it."

So while I said that I was prepared to consider a limited time frame on a commission whose duties and powers were scoped and whose mandate was clear in order to give some comfort to communities that if it was truly for that kind of restructuring, as long as it didn't have those kinds of powers -- and that could be done without this legislation -- I am very concerned that this amendment will enshrine forever and a day the opportunity to just not enact or to repeal the sunset provision of the legislation and that all of our worst fears -- all of our fears about the suspension of democracy and the suspension of due process and the suspension of rights of appeal, all of those things that we hold so dear -- will change Ontario forever, simply because for the next four years, under this legislation, you will have an all-powerful commission that nobody will be able to appeal its decisions whatever. I think that's a very dangerous precedent. I don't think it's necessary. I think you can have a commission without this. I cannot support this amendment.

Mrs Johns: I just want to remind the committee, the people who were on the health committee, that a number of groups came forward and asked for this sunsetting provision. We had the Sisters of St Joseph of Sault Ste Marie.

Mrs Caplan: They said, "Don't delegate power."

Mrs Johns: We had the Sudbury General, we had the Ottawa General and we had the OHA come forward. The OHA suggested a time frame of three to five years, and we of course have chosen four.

In the past, previous governments have set up planning processes for us to be able to restructure, but they have never come up with a process to be able to implement, to be able to move forward with this structure.

I have a clipping from the Sudbury Star that says:

"Inevitably the goal of improving cost-efficiency in the delivery of hospital services fell by the wayside as individual hospitals were too concerned with preserving their own turf and separate agendas. Finally it appears that hospitals will no longer be able to prolong their turf wars as the provincial government puts an end to this intransigence that has reigned in the local system. It is hoped that the local hospital officials will see the light and finally cooperate to ensure a voluntary restructuring of services."

We believe that if we have an independent group to review the activities and the operations of the commission, what we will have is a strengthened accountability to the minister. We believe that this is the right way to proceed to deal with four-year sunsetting and to deal with increased accountability with the minister.

The Chair: Any further discussion on the motion? Shall the motion, as proposed by Mrs Johns, carry?

Ayes

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

Nays

Caplan, Lankin, Phillips, Silipo.

The Chair: The motion carries.

Mr Wildman: Mr Chair, I'm not a member of the committee, but I would like to ask a question on the procedures, for my benefit and for the benefit of all of us, I guess -- I hope. I understand that this number represents 141 amendments that have been put by the government. How many amendments have we dealt with? Is the 28th?

The Chair: We've dealt with 23.

Mr Wildman: Okay. I'm very interested in debating amendment 102. I would like you to tell me when we would likely get to that on this committee so I would know when to come back.

Mrs Ecker: Ask your colleagues.

The Chair: Mr Wildman, I have no idea.

Mr Wildman: You anticipate that it will be debated before Friday?

The Chair: If it is to be debated, it will be debated before Friday at 1 o'clock.

Mr Wildman: And all of the amendments will be debated.

The Chair: The amendments that we get to by Friday at 1 o'clock will be debated.

Mr Wildman: You would not put amendments that haven't been debated?

The Chair: That's not my decision, sir.

Mr Wildman: Oh, dear, that's not very democratic.

The Chair: As you know, Mr Wildman, the orders under which this committee is operating state that all amendments will be deemed to have been moved by 1 o'clock on Friday.

Mr Cooke: For Mr Wildman, could we move to amendment 102?

The Chair: We will be considering the amendments, as we agreed, in order.

Mr Clement: Fine with us over here if you want to have unanimous consent, Mr Chair.

Mr Wildman: If that's the case, 141 amendments indicate very well-drafted legislation, obviously, as well as sincere concern for the people who have been able to make representations to the committee, I'm certain. But if you would like to go to amendment 102, that's fine with me.

Mr Phillips: It's not a problem.

Ms Lankin: Mr Chair, again, just for clarification of this issue, I would like to make sure we are talking about the total number of amendments: 141 are just the government amendments, and of course we know that by and large the government -- well, so far -- has voted down every opposition amendment, but there are actually I think 340-odd amendments in total. Is that correct?

The Chair: I think the regular members of the committee, who have had the book for a couple of days, know that there are 340 pages of amendments.

1420

Mr Wildman: I meant 141 government amendments. I didn't realize there were a number of other amendments.

Mr Phillips: Oh, there are.

The Chair: Mr Wildman, can we get on with the proceedings?

Mrs Ecker: Have you not been meeting with caucus on your amendments?

Mr Wildman: I assumed that our amendments were matters that would be debated prior to the end of the committee work. I didn't assume that you would just deal with government amendments and not allow opposition amendments to be debated.

The Chair: Mr Wildman, would you mind explaining to us, as it's your first visit in here, exactly what your purpose is?

Mr Wildman: To find out what was going on.

The Chair: Did we not explain it to you?

Mr Wildman: I beg your pardon?

The Chair: Did we not explain it to you?

Mr Wildman: Well, thank you very much, you've explained very clearly that you don't intend to deal with all these amendments and that you're going to deem some of them to have been passed even though they haven't been debated.

Mrs Ecker: Check with your House leader.

The Chair: On section 1, that is the last of the amendments that we've been asked to --

Interjections.

The Chair: Are there any additional amendments to section 1 of schedule F? There is the one that we stood down. Mrs Johns, you requested that we stand down the NDP amendment; I believe it was number 25. Are you prepared to deal with that now?

Mrs Johns: I think it's been agreed to, thank you.

The Chair: Okay. Ms Lankin.

Ms Lankin: The amendment that has been tabled, which was a new motion, was to schedule F to the bill, section 1, subsection 8(7.1) of the Ministry of Health Act. Am I on the right one? Yes.

I move that section 8 of the Ministry of Health Act, as set out in section 1 to schedule F of the bill, be amended by adding the following subsection:

"Function of commission

"(7.1) The duties and powers assigned to the commission under this or any other act shall be duties and powers with respect to the development, establishment and maintenance of an effective and adequate health care system and the restructuring of health care services provided in Ontario communities having regard to reports of local district health councils."

There has been some discussion with respect to this, and there is a minor change in the wording which Mrs Johns has indicated would make this motion acceptable to her. I have a replacement motion that is prepared, but it's not officially tabled yet. So I'm not sure in terms of the procedure if I just read the change into the record. Legislative counsel has it.

The Chair: Is it a replacement for this one, Ms Lankin? So you're withdrawing this one?

Ms Lankin: Yes.

The Chair: Okay. Thank you.

Ms Lankin: So this hasn't been circulated, but it's very similar. People can follow along with the one they have in front of them. You'll see the differences.

I move that section 8 of the Ministry of Health Act, as set out in section 1 to schedule F of the bill, be amended by adding the following subsection:

"Function of commission

"(7.1) The duties and powers assigned to the commission under this or any other act shall be duties and powers with respect to the development, establishment and maintenance of an effective and adequate health care system and the restructuring of health care services provided in Ontario communities having regard to district health council reports for those communities."

You can see the wording is very specific; it just relates the reports to those communities.

If I may, may I say that while I am moving this amendment, I am very distressed that an amendment as watered down and as weak as this is the only thing where we were able to get the government to agree to build some linkage between the work of the commission and local district health councils. This language, as you can see, attempts to say that these unprecedented powers that are going to be handed over to the commission at least have some reference to the delivery of health services in this province, because people who have been following this will know that as the bill is set out there is no definition to the commission, what the terms of reference are, what the mandate is other than the length of time it will be in existence, what the powers are, what the limits on the powers are. It simply says that there shall be a commission, that it shall have powers and duties as assigned by the minister and as set out in regulations.

Quite frankly, it, to me, is very, very poor legislative form to establish such an all-encompassing body as this that is going to be so key and critical to the future of health care in this province and not provide any sense of what the conditions are attached to that, what the terms of reference are, what the limits on the powers are, what powers specifically are going to be given to it. I'm very sorry that through the course of this we've not been able to get the government to give definition to any of those areas.

This amendment I fully admit is very weak, very soft, but it at least says for this commission that can have powers and duties assigned to it under this or any other act, any other law in the province of Ontario, at least we specify that they're going to be dealing with health care and not highway construction or something like that. That's how badly your bill's drafted. You could assign powers to that commission under any act in the province of Ontario.

It also, which I think is important, makes reference to reports from district health councils. Again, I believe it should be a much stronger reference. This just says "having regard to" those reports. But I'm placing this motion because later, and I will invite you to look ahead, there are amendments that I'm proposing which have some accountability for the commission in tabling reports with the Legislature of what they intend to implement and how they are using these powers, and accompanying those reports must be the reports of the district health councils that they had regard to, at least.

This does not, obviously, tie them to those district health councils reports. We've never suggested that the minister in the end didn't have to make a decision of whether to approve a report or not. And it doesn't in this case tie it to a district health council plan for restructuring. We obviously hope that in those communities where there is a consensus that's been arrived at, the report that comes forward is actually a plan for implementation, but we've heard often from the parliamentary assistant her concern about communities where there wasn't a consensus.

At the very least, I believe there should be a report from that district health council about what the state of affairs is in that community and what the issues are, and that the work of the commission and the minister in reviewing this should at the very least be informed by a report of that nature that lays out the local landscape. It would be horrendous to have a situation where that procedure wasn't followed.

I don't move this amendment with a great deal of pride in terms of thinking that it addresses some of the very serious concerns I have with the commission and the unprecedented powers being given to it and the lack of definition in the legislation, but it is the last-ditch effort and the only thing we could get the government to agree to, to build any kind of linkage between the work of this commission and the work of local district health councils. So I move it because I think it is essential that there at least be some linkage built into the legislation, and while this doesn't accomplish nearly what I believe needs to be done, it is the only thing that I was able to get the government to agree to. So for that reason we put it forward and our caucus will be supporting it.

Mrs Caplan: I'll be very brief. I think Ms Lankin is quite correct in not wanting to take any pride in having this amendment put forward. It is minimal. It doesn't change or fix, it just makes slightly better, that which is seriously flawed. It's in that spirit I take no joy in supporting this. I don't support the commission as it is constructed, but at least here there is a link to the important work that's being done by district health councils in the community. I believe the legislation should reference that. If this is the only thing the government will permit, I will be supporting it.

But I offer no comfort to those who think this is going to improve a very bad approach, bad concept, because this commission will not have to take anything other than "have regard," will not have to take seriously the work that's done, and will be able to ride roughshod, override and in fact pay no attention whatever to the important work that is done in communities. An individual can go in and do whatever he or she wants to do in a community and there will be no recourse or action that can be taken. I think that's undemocratic, but at least the legislation will now say that they have to pay due regard, even though if you think they didn't pay due regard, you're not going to be able to do anything about it.

1430

Mrs Ecker: I think Ms Lankin has argued very forcefully about the need for an amendment such as this. We certainly heard from many deputations as we went across the province that the local planning process was very important to them. In some areas it had worked very well, in some areas it hadn't, but they all said they thought that local link was very important. We felt that we had made it very clear that the district health councils were still there in the mix, because we hadn't amended section 8.1. I think it's interesting to note that in the previous legislation there was nothing there that caused or forced ministers of Health to listen to district health councils, but past governments and past ministers of Health have quite seen the wisdom of consulting district health councils on many issues, and in fact have assigned them many tasks to do.

So that authority, that power, that ability to advise, to recommend and to plan was still in the legislation because we felt that it was important to maintain in the legislation. We heard from many deputations and we asked them, would they feel more comfortable if there was a more specific link between the commission and those district health councils? Many of them said that would indeed ease their mind. So I think we have an amendment here to the legislation that helps put that link in place. I think it's a good amendment to do that and so I would be very pleased to support this motion.

Mr Phillips: I too will be supporting it, really out of self-interest almost. It's my hope that maybe you can find one of our motions --

Mr Sampson: We're looking awful hard, Gerry.

Mr Phillips: -- and change one or two words so that in the years ahead when I have this bill, I can say, "Frankly, we spent four weeks on it and nothing changed other than that word," and there will be one or two words that you've agreed to change as a result of the opposition. So I'm pleased to support it. It does actually, I think, improve the bill, and that's what we're all about. So I'm pleased you've changed a couple of words and now we have one amendment. I hope before we're through there may be three or four of our amendments you may be able to massage enough that you can finally agree to them.

Mr Clement: Dare to dream.

Mr Maves: Just quickly, the amendment says that the restructuring can occur if the commission is having regard to DHC reports of local communities. We had previous discussion about how in some communities these types of DHC reports were unavailable. I just want to ask, if there is a community where DHC reports are unavailable, does that mean the restructuring process can occur with this amendment? If they're not available, then the restructuring process can occur anyway?

Mrs Johns: Yes.

The Chair: Did you have your question answered, Mr Maves? I'm not sure who the expert would be on it. Mrs Johns?

Mrs Johns: Yes. That's the answer.

Mr Maves: So we wouldn't need to put having regard to DHC reports of local communities "where available"? That's not necessary in this?

Mrs Johns: We had it looked at by our legal counsel over lunchtime, and they're happy with that.

Mrs Caplan: I just want to put this on the record, because frankly I'm sick and tired of hearing the rhetoric from perhaps well-meaning -- and Janet, I think it is well-meaning, but I was at a meeting where I heard Jim Wilson very clearly say he intends to revert the mandate of the district health councils back to what it was 20 years ago. He was very clear that he does not support the work that's happening in the communities by the district health councils. I heard him say that personally.

The Chair: Does this have anything to do with this motion?

Mrs Caplan: Well, it does, because this motion for the first time references the role of the district health councils, and for the government to have said this isn't necessary because we support the DHCs, the minister hasn't said that. There's no assurance. The section you referred to that establishes district health councils is at the pleasure of the minister. This bill, until this point in time, had no mention whatever of the important work that's been going on in communities by district health councils.

The Chair: Any further discussion on this amendment? Recorded vote.

Ayes

Caplan, Clement, Ecker, Hardeman, Johns, Lankin, Maves, McLeod, Phillips, Sampson, Silipo, Tascona, Young.

The Chair: The amendment carries unanimously.

That being the end of any amendments we have --

Mr Cooke: Let's pack it in and report the bill to the House.

The Chair: That being the end of amendments to section 1, shall section 1, as amended, carry?

Ayes

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

Nays

Caplan, Lankin, McLeod, Phillips, Silipo.

The Chair: Section 1 carries.

We now move to section 2. The first amendment I have listed for section 2 is from the government.

Mrs Johns: I move that clause 12(c.1) of the Ministry of Health Act, as set out in subsection 2(1) of schedule F to the bill, be struck out and the following substituted:

"(c.1) assigning powers and duties to the Health Services Restructuring Commission and respecting any conditions with respect to the assignment of those powers and duties."

This is a regulation-making power which permits the commission to receive the powers of the minister to issue directions to a hospital to facilitate restructuring, either the closing or amalgamating of a hospital. The Ontario Hospital Association in its report when it came to us on December 18 suggested that it will assist the government in making these regulations.

Mrs Caplan: The Ontario Hospital Association also said you shouldn't delegate the powers to the commission. Does this amendment allow for the delegation of ministerial powers to the commission?

Mrs Johns: Yes, it does.

Mrs Caplan: So don't you think it's unfair to say that the Ontario Hospital Association asked for this when they told you specifically, "Do not delegate ministerial powers"?

Mrs Johns: No, I don't think it's unfair.

Mrs Caplan: This does not do what the OHA asked you to do. This still allows for the delegation of powers to the commission, so I object to you suggesting that this solves the concerns the Ontario Hospital Association and every other presenter had that came here and said, "Do not delegate ministerial powers." Mrs Johns, I expect a higher level of performance when answering those questions. If you want to say what this does, do it, but don't give as your defence the fact that this satisfies the Ontario Hospital Association when it clearly does not. They don't want you to be able to have the minister delegate his authority and powers. They don't mind if the commission has duties, but they don't want powers delegated to an unaccountable, dictatorial commission. Don't you get it?

The Chair: Any further discussion on this amendment proposed by Mrs Johns? We'll take the vote.

Ayes

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

Nays

Caplan, Lankin, McLeod, Phillips, Silipo.

The Chair: The motion carries.

The next amendment to section 2 is a Liberal motion. In view of the fact that it is the exact opposite of what we just passed, I rule it out of order.

1440

Mrs Caplan: I would point out, as you rule it out of order, that in fact this motion would satisfy the concerns of the Ontario Hospital Association.

Mrs McLeod: Mr Chair, could you point out in what way it's in direct opposition to the previous amendment?

The Chair: The motion that was passed by the government added the word "powers" and this particular motion doesn't make any reference to the word "powers." That was the only change from the previous motion.

Mrs McLeod: Quite clearly, the focus of the government amendment was to make it clear that power could be delegated, and therefore it is contrary to our motion, which would say power should not be delegated.

The Chair: As I understand it.

Are there any further amendments to section 2? Shall section 2, as amended, carry?

Ayes

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

Nays

Caplan, Lankin, McLeod, Phillips, Silipo.

The Chair: Section 2, as amended, carries.

Ms Lankin: Mr Chair, just before we go on to the next motion, because that moves us into section 3, I have one question I would like to place -- it's an interpretation I'd like to ask for -- that deals with sections 1 and 2 that we've just passed. It'll be brief. It's a clarification.

Ms Johns, could you explain to me, under subsection 8(7) you'll know that the government members carried a government amendment which added the word "powers": "The commission shall perform any duties and powers assigned to it by or under this or any other act." And in section 2, the government members just passed an amendment which in the regulation-prescribing section set out that you can make regulations assigning duties or powers, the same sort of language.

Could you tell me why, in subsection 8(8), where you make the regulation assigning a duty to the commission that can be done on a geographic-specific area, not powers? In all the questions we asked you earlier about an individual commissioner being able to go into a geographic region and exercise the full duties and powers of the commission, you responded, "Yes, that's the case." In fact, as I look at this, when you didn't amend (8), you can only assign duties to those individual commissioners to act on their own and not powers.

Mrs Johns: I'm going to defer that to Mrs Czukar.

Ms Czukar: We don't believe it's necessary to assign powers under subsection (8) of that section because the commissioners would get those powers assigned under subsection (7). Assigning duties with respect to particular areas or particular kinds of tasks would only apply to duties; they would already have those powers assigned. So we don't believe that language is necessary.

Ms Lankin: Then I do have to ask the question, because I asked this the first time, why you needed subsection (8). Now you're telling me that the commission overall has powers and duties assigned to it. In (8) it seems to be something that is giving greater specification, that "where a duty has been assigned to the commission" a regulation can be set out that a specific member or specific members can carry out the duty in a specific geographic area. Presumably, you can't make a recommendation that a specific member or specific members could carry out powers that have been assigned to the commission in specified geographic areas. Is that correct?

Ms Czukar: Powers and duties are different, which is why we need to use both words.

Ms Lankin: I realize that.

Ms Czukar: Duties are mandatory. If the commission is assigned duties, that's their mandate from cabinet and that's what they're expected to do. In order to carry out those duties they may need certain powers, and if those powers aren't explicit, they only have the powers that a corporation has normally in law. That's why we have to have the powers assigned from particular acts that may be different kinds of powers from ordinary corporate powers.

What I'm saying is that they already have the powers to carry out duties, so with respect to sub (8), which allows for the assigning of particular duties such as carrying out a particular restructuring report or a district health council report, or with respect to a particular area, that commissioner would already have had the powers assigned to it in order to carry out that duty in that area.

Ms Lankin: I have a real problem understanding why you needed (8) at all, then. If you had to specify that an individual member had to be given the duties of the commission by regulation in order to carry it out as a sole member and not as the commission overall, why do you not have to specify the same for that individual member to carry out a power which has been given to the commission overall and not to an individual member? What is the difference there?

Ms Czukar: Without subsection (8), the duties that were assigned by the regulation, passed by cabinet, under the other subsections, would have to carried out by the whole commission. All the commissioners would have to meet and would have to make a joint decision about any particular aspect of a restructuring activity implementation. This allows for one person to work on one report or with one community without having to have the whole commission make those decisions together. But they already have the powers.

Ms Lankin: Presumably to exercise a power, the whole commission is going to have to give approval before the individual member can exercise that power, because you didn't include power in subsection (8).

Ms Czukar: I suppose it's open to interpretation.

Ms Lankin: I think so.

Ms Czukar: Our view would be that the commissioners have the powers, once they're assigned by regulation under this act, in order to carry out their duties.

Ms Lankin: Collectively, not individually. Section (8) you needed to give individuals powers, otherwise you wouldn't have said, in section (8), that's what you told us you needed it for.

Ms Czukar: That's not our view, but people may differ in their legal interpretation.

The Chair: Okay, we now move on to --

Mrs Caplan: I assume you're going to vote on this amendment.

The Chair: We already did. We just finished voting on section 2.

Mrs Caplan: I thought you were on the section 3 amendment.

The Chair: Ms Lankin asked for the opportunity to ask her question first.

Mrs Johns: Mr Chair, can I ask permission for Mrs McKeogh to come forward? She is the legal representation from the ministry for the public health act -- Public Hospitals Act, I'm sorry.

Ms Lankin: Mr Chair, shall I get on with the next amendment?

I move that section 3 of schedule F to the bill be amended by adding the following subsection:

"(2) Section 1 of the act is amended by adding the following definition:

"`Commission' means the Health Services Restructuring Commission established under section 8 of the Ministry of Health Act."

Essentially this is the kind of amendment that is of the category of a technical amendment. It gives a definition to the use of the word "commission" in the Public Hospitals Act.

As you know, the sections we just passed in Bill 26 that create the commission are under the Ministry of Health Act. Some of the further amendments I will be putting deal with the way in which powers are exercised under the Public Hospitals Act, including things around closures and mergers of hospitals, and those amendments make reference to reports or recommendations or actions of the Health Services Restructuring Commission, so it's necessary in the definition section of the act to define what is meant by "commission" in those further amendments.

Mrs Johns: Mr Chair, can I ask that this be stood down until we decide if we need to have the definition of "commission" in the public health act? It will depend on whether some of the motions being presented by different parties are approved.

Mrs Caplan: Public Hospitals Act.

Mrs Johns: Am I saying it still? I'm sorry. The PHA.

1450

The Chair: Do we have consent to stand this amendment down? Okay.

We go on to section 4. Are there any amendments to section 4? Shall section 4 carry?

Ayes

Clement, Ecker, Johns, Maves, Sampson, Young.

Nays

Caplan, Lankin, McLeod, Silipo.

The Chair: Section 4 is carried.

Are there any amendments to section 5? Shall section 5 carry?

Ayes

Clement, Ecker, Johns, Maves, Sampson, Young.

Nays

Caplan, Lankin, McLeod, Silipo.

The Chair: Section 5 carries.

Are there any amendments to section 6? I believe the first one we're going to deal with is a Liberal amendment.

Mrs Caplan: I move that section 5 of the Public Hospitals Act, as set out in section 6 of schedule F to the bill, be amended by adding the following subsection:

"Limitation

"(2.1) A condition imposed under subsection (2) shall not restrict the administrator or the board in the management or operation of a hospital but may require that the grant, loan or financial assistance be dedicated to the provision of specified hospital services."

I believe this would respond to some of the concerns about micromanagement. It would avoid micromanagement of the hospitals by the minister through the condition of financing from the minister. While I believe that the minister should have the authority to fund or not fund -- and that would be a new provision, because right now the minister is restricted as to the conditions under which he cannot fund -- I don't believe that as a condition of funding the minister should be able to micromanage and direct the hospital services. That's the intention of the motion, to respond to the legitimate concern of the Ontario Hospital Association.

Also, I have a quote here from Premier Harris when he answered the Ontario Hospital Association questionnaire about his party's policies on health. I'm not going to get into all the ones we've heard already, but there is a new one. This was the PC response to the OHA 1995 campaign questionnaire. He says: "A Harris government will not micromanage the health care system but is committed to ensuring that efficiencies and cost savings are identified so that resources can be reinvested in the front lines," and so on and so forth.

They made a very specific commitment not to micromanage, and this amendment is one step. There will also be other amendments forthcoming, but I think it is important that we start putting some restrictions in place so the minister cannot micromanage the system. We know there are many ways that can be done in this bill.

Mrs Johns: Subsection 5(2) of the act gives the power to the minister to set terms and conditions on grants, loans and financial assistance. The limitation being put on in this motion would cause us great concern. One of the terms and conditions a minister could put on would be that there needed to be an annual operating budget they would stay within, and if we weren't allowed to put those terms and conditions on and restrict the administration to follow through, we wouldn't have the control we need for the taxpayers of Ontario. We will oppose this motion.

Mrs McLeod: I would like the parliamentary assistant to clarify in what way there are any limitations on the Minister of Health's ability now to control the dollars and therefore the total operating expenditures of any hospital in this province.

Mrs Johns: Maybe I didn't express it clearly. We can put a term and condition on a grant, for example, that they have to meet an operating budget. In your amendment it says "shall not restrict the administrator or the board in the management or operation of a hospital...." We may well want to restrict them to follow an operating budget. If they had money left over -- here's another example of what could possibly happen -- they may be able to transfer surplus funds into a foundation account as opposed to keeping it within the operating funds of the hospital. We're concerned about that and we want to make sure we have that ability to control the terms and conditions and to make sure they're enforced.

Ms Lankin: Again I find myself amazed at some of the interpretations we are receiving. Ms Johns, if you look to the amendments you are making to the Public Hospitals Act as part of Bill 26, under subsection 5(3), "Security for payment," you have the ability to require the repayment of funds; if you believe there are surpluses, you have the ability to do that. Under sub (4) you can lower the amount of the grant or "withhold payment in whole or in part of any grant, loan or financial assistance with respect to a hospital if the minister considers it in the public interest to do so." You have every control at your fingertips.

All this amendment is saying is that we're going to let the minister step in here, and in a whole lot of other sections of this act which will we come to, and take over the micromanagement of a hospital. That is not the intent here. If the minister is so concerned about what's going on in the hospital, we know -- and we'll come to sections like section 8 where he has the ability to appoint a supervisor to completely take over the day-to-day operation. If the grounds are so severe that he has the belief he can exercise the powers under that section -- there's very little limitation on him there other than public scrutiny when he does it -- then he has that power.

What we're suggesting in this section of the act with respect to varying the amounts of loans and grants and those sorts of things is that the conditions you place on the moneys when you give those moneys forward be related to the use of the moneys and not to the individual terms and conditions of how a management of a hospital is undertaken by the board or by the CEO of the hospital.

You can't micromanage the health care system the way this bill suggests you will. People need to have some assurance that there are protections against a minister stepping in. Believe me, there are times from time to time when folks in the hospital branch, for example, of the Ministry of Health would like to be able to step in and micromanage, and there shouldn't be that ability.

This amendment simply puts a limit on the conditions you can attach to the money. It doesn't change 5(3), which allows you to have ability to secure repayment. It doesn't change 5(4), which allows you to withhold or lower or vary the amounts, if you think it's in the public interest. You still have all those powers. If they won't give you an operating budget, you can withhold your grant. All the things you said you need to be able to do, you still can accomplish. This simply puts limits on the nature of the conditions you can place on it, to prohibit you from micromanaging the hospital.

Mrs Johns: I'd like to ask the ministry staff to respond to this, because we seem to be at odds here, and see what implications there are for this so that we all understand them.

Mr Peter Finkle: There may be elements here of a technical nature which Carole can jump in and clarify, but in terms of setting terms and conditions, which I think 5(2) in the act -- the change anyway -- addresses, we have in place now an annual operating plan process where we have policy regarding that. The approval of those operating plans is fundamental to the operation of a hospital and gives us some comfort that there's a range of services that the hospital's going to provide for the funding that's delivered. We still intend to fund hospitals on a global basis, and that's a term and condition which we apply right now by policy, which may be an example.

1500

We have a lot of volume-based provincial programs, cardiovascular surgery, dialysis, lens implant programs, where we have for years been funding hospitals to provide a specified volume. That's a term and condition on that funding. They cannot reallocate that funding to other activities of the hospital, and we make year-end adjustments on that.

They're also to allow certain policies to be implemented that are currently under discussion and development, rates-based funding being the most significant one through the joint policy and planning committee process with the Ontario hospitals. That's still in the very early stages of development and it may require some terms and conditions around it.

Also, there's a lot in restructuring that's not micromanagement per se, but it's a lot of movement of programs between hospitals. There may be terms and conditions that are required to facilitate that process and to be fair to the physicians and employees associated with those programs, because quality in patient care is very important in making restructuring work effectively. Other than that, Carole, is there --

Ms Lankin: Peter, the problem I'm having -- I understand you're just explaining the technical aspects of this and can't provide defence for it, but once again the answer I just got is that virtually everything you said up until the last point you have the ability to do under this amendment, because this amendment talks about the financial assistance, the conditions that it be dedicated to the provisions of specified hospital services.

All the issues that you raised with respect to the volumes of service, the nature of the services, the types of the services, that's all there. The only one that you contemplated as something that might happen in the future, you're not exactly sure what the terms and conditions would be. So once again this is a blank cheque the government is asking us to sign, because you're not telling us what those terms and conditions might be.

Presumably if you thought there was going to be some kind of workforce adjustment plan that you were looking at, you could withhold payment of funds if you thought it was in the public interest if that wasn't lived up to, but it should be the hospital that determines what the elements of the workforce adjustment plan are, or there's a provincial agreement and then everyone's in agreement anyway.

I continue to have a problem when the answers that we get almost universally either are already powers that exist in the current system or are for unknown needs in the future. You can't answer this. I'm sorry, I shouldn't put you on the spot. Ms Johns, let me say again that that's not an appropriate legislative process or use of legislative power, to write yourself a blank cheque for the future.

Mrs Caplan: Am I up finally? Actually, I'm very concerned about what I've heard, both from Peter, who I know well, and from the parliamentary assistant. Because I think your intention, as the bill stands right now, one, is a threat to voluntary governance, and that is because of the powers it will give to ministry bureaucrats who really would like to be able to interfere in a more direct way in what's happening in the day-to-day management of hospitals. Two, I think many of the things you referred to, Peter, are already happening today, so you don't need the powers of this new legislation to be able to do them.

If my memory serves me well, we implemented equity formula funding that had been negotiated and discussed without these powers. It was done under the existing Public Hospitals Act through consultation with the Ontario Hospital Association. I support rates-based funding. I think it can be done in exactly the same way that equity funding was put into place. I don't think you need these powers for anything other than unwarranted intrusion and possibly micromanagement.

What concerns me is exactly what Ms Johns just said when she gave her answer as how this could be used. Her answer said this could be used where hospitals have a surplus at the end of the year, so the ministry could take that away. That runs contrary --

Mrs Johns: And put into a foundation.

Mrs Caplan: And put into a foundation. It would stop hospitals putting surpluses into a foundation. I see the legal counsel is nodding and saying, "Right." Well, the principles of quality management are not that you say to everybody, "We're going to penalize you if you manage well and have a few dollars extra left over that you're going to put into your foundation which the next year you can draw on to fund a piece of equipment or fund something that your hospital is going to need without having to come to the ministry cap in hand." The principles of quality management in fact allow reserve funds to be established should there be a surplus.

But I'll tell you, I don't think, given the fact that you're taking $1.3 billion out of the hospitals of this province, that very many of them are going to have the problem of surpluses. Your worry that they're going to scoop those surpluses and stick them into their foundations and use them for something that you don't approve of sends a chill, an absolute chill, to voluntary governance and to the people who work so hard to run the hospitals of this province. Because that's an attitude problem. It says: "We don't trust you. We don't think you have the interests of your community at heart, and in fact we want to be able to get in there and micromanage."

There are sufficient powers in the existing Public Hospitals Act to be able to fund the hospitals. This new power in Bill 26, without my amendment, has raised fears in the hospital community as expressed on their behalf by the Ontario Hospital Association and echoed by every one of the presentations here about the ability of the ministry to begin micromanagement.

This amendment scopes that. It doesn't take away your ability to fund. It doesn't even take away -- let me read again what this says. The limitation on your right under Bill 26 is that, "A condition imposed under subsection (2) shall not restrict the administrator or the board in the management or operation of a hospital but may require that the grant, loan or financial assistance be dedicated to the provision of specified hospital services."

That allows you to enter into whatever agreement you want with the hospital and then lets them manage it, the people on the front line. It says: "Ministry, we can make an agreement with you, but you cannot send in Peter or any of the other nice guys at the ministry to manage our hospital. If you have concerns about how we're managing it, you've got to send in an inspector or you can wipe it out and send in a supervisor. If you think we're being fiscally irresponsible, you have those powers under other sections of the Public Hospitals Act as it stands today." You can send an inspector in where you think that patient care is in jeopardy or where you think that a hospital board is acting irresponsibly. Then you send in your inspector. Under this act you can send in an inspector; in fact you don't even need an inspector, you can send in a supervisor immediately.

Your objection, if you do not pass this amendment, what you're saying is, "Watch out, our real agenda here is Ministry of Health control and the ability to micromanage." Clearly it runs contrary to everything you ever said, that your Premier promised during the election, to the Ontario Hospital Association, and if you do not support this amendment you're saying to the Ontario Hospital Association: "We heard you, but tough. We're worried about your hospital boards, the voluntary governance of this province. We don't trust them. We need to be able to micromanage those hospitals." Well, let me tell you something. You do that and you will destroy voluntary governance in this province.

Mrs McLeod: I think almost accidentally we start to find out in the responses what some of the intent of the government is. Let me be sure I have clearly understood the answer of the parliamentary assistant as to why this incredible section of this bill is necessary and can't be amended even in this very simple way that we've proposed.

The section of the bill that we're concerned about does give the power to the Minister of Health, as my colleague has said, to step in and essentially take over the day-to-day management of a hospital -- incredible power to have. The ministry people have made it absolutely clear that currently the Minister of Health and the ministry determine how much money a hospital gets. They can set terms and conditions on how that money is used.

Our amendment doesn't restrict that power in any way at all; in fact it says clearly that terms and conditions can be set out. The only thing our amendment does is say the Minister of Health can't step in and take over the management of the board, and in future parts of the act, as you know, there are places where, if there is mismanagement, the Minister of Health has powers to be able to step in. But just in terms of the allocation of dollars and how the dollars are spent, the Minister of Health does not need the power to actually manage the board on a day-to-day basis.

1510

Let me understand your answer as to why we can't make that clear. You've said there's a danger that hospitals might have money left over in their operating budget at the end of the year that could be put into a foundation. I raise the question because I think it is a serious concern about your view of voluntary governance.

My understanding of what voluntary boards of governors, people who are volunteers -- that's what "voluntary" means -- try and do is look at what their hospital needs, look at what people in their community need, try and take the dollars that are given them by the Minister of Health and stretch them to be able to meet the needs in their community. If they feel the dollars aren't going far enough, they make application, as the ministry representative has said, for additional funding and sometimes that's granted and sometimes it's not. It's totally under the control of the Minister of Health.

Are you telling me that there is such a danger in the way the Ministry of Health gives money to hospitals that some hospitals are struggling for funds to meet their goals and other hospitals have extra money that they're going to be able to put into a foundation? And if you've mismanaged the allocation of dollars to the hospital so badly that this would actually occur, when the dollars are restrained everywhere, you want the Minister of Health then to be able to step in and manage the hospital so they don't put the money into a foundation? Is that what you've told us today?

Mrs Johns: We're not suggesting we want the minister to step in and manage the system. What we're objecting to in this is "shall not restrict the administrator or the board in the management or operation" of the firm. These are terms and conditions we're setting to the granting of taxpayers' money. We're saying that in some cases we may have to restrict what they do with it. We're not micromanaging; we're saying there may be restrictions on this money.

Mrs McLeod: Our amendment says that: The minister can set terms and conditions but in exercising those terms and conditions shall not restrict the ability of the board to manage.

Mrs Johns: We want to be able to restrict the --

Ms Lankin: It's on the record now.

Mrs Johns: Yes, and I might have got that backwards too. I'm sorry about that. In some cases we need to have control over how the money is being put in. We need to be able to say that money has to be used for operations.

Mrs McLeod: Ms Johns, you have those powers now. What else do you need?

Mrs Caplan: I would like Ms Johns to read the amendment into the record, slowly. Just read the part that starts "Limitation."

Mrs Johns: It's already read into the record.

Mrs Caplan: I read it. Would you read it, please?

Mrs Johns: I've read it, thank you.

The Chair: Mrs Caplan, it wasn't your turn; it was Ms Lankin's turn if Mrs McLeod is finished.

Mrs McLeod: Let me put Ms Lankin's question again, because I think that was why Ms Johns called on a representative of the ministry. As I recall, it was: What is the limitation now on the Minister of Health in order to be able to manage the total dollars to the hospital -- I'm paraphrasing you, Ms Lankin; please don't hesitate to correct it -- and what limits the ability of the Minister of Health to set terms and conditions, and why does he further need the powers that are set out in Bill 26? What are you trying to do with this?

Mrs Johns: We're trying to make sure that the money we give to hospitals is being given for uses that are needed. We're trying to make sure that the taxpayers' money is being best utilized within the system.

Mrs McLeod: You can do that now, Ms Johns. I'm asking, what do you need Bill 26 for, and why isn't this amendment adequate to ensure that you have those powers unrestricted except for the ability of the Minister of Health to take over the management of the hospital?

Mrs Johns: I think we're at an impasse, so I'll ask the legal counsel to talk.

Mrs McLeod: That's actually where we started, at an impasse.

Ms Carole McKeogh: I'm Carole McKeogh from the Ministry of Health legal branch. The current provision in the act states that the minister may pay provincial aid to hospitals in such amount, in such manner and at such times as the regulations prescribe. So there are only three things you can deal with in the current act: amounts, manner and times. I think the intent here of this wording is to permit the imposition of additional terms and conditions which would be more than amounts, manner and times; different types of terms and conditions.

Mrs McLeod: Can you tell me what else is left besides amounts, manners and times? It's a fair public question. Volunteer members of boards of governors are saying, "What is it you plan to do to us if you thought you needed the power to do it, which is what Bill 26 gives you?"

Ms McKeogh: When we were working on this section, the program area indicated to us that, for example, the requirement for operating plans currently in place is purely a policy requirement. There is no legal authority to require annual operating plans, because they're not amounts, manner or times of payment.

Mrs McLeod: I think the requirement is that the dollars don't come unless you give us an operating plan. It's pretty straightforward: He who pays the piper calls the tune.

Ms Lankin: I didn't quite get the gist of your answer, because in a sense it's consistent with what we heard earlier. The only example we're being given is operating plans. Under subsection 5(1), payment to hospitals, "The minister may pay any grant, make any loan and provide any financial assistance to a hospital if the minister considers it in the public interest to do so."

If I were the Minister of Health and a hospital refused to give me an operating plan, I may think, then, it's not in the public interest to give them any grant or loan or financial assistance. Isn't it possible I would interpret that requirement for an operating plan as something that would be in the public interest before I gave money?

Ms McKeogh: Other examples would be --

Ms Lankin: We didn't get an answer to that on the record. I'm sorry. You answered me but it wasn't on the record. But the answer is yes?

Ms McKeogh: You could withhold payment under subsection 5(1).

Ms Lankin: So you don't need to be fearful of the limitation being put under subsection 5(2) on terms and conditions in order to get your operating plans. You do have other mechanisms under subsection 5(1) to get the operating plan from the hospital.

Ms McKeogh: The mechanism in subsection 5(1) would be to withhold payment of the grant.

Ms Lankin: That's a pretty big term and condition: You don't get your money unless you give us an operating plan.

Let me talk to the members of the committee here and ask you to think this through. I don't think you really believe in the micromanagement of the hospital system. But put together the kind of language you have in section 5, together with the language in section 8, which is the appointment of supervisors, where you can now appoint supervisors after 14 days' notice without any due process. You don't have to put an investigator in first. You don't have to listen to the report of the investigator. You don't have to give the hospital any hearing. While you're putting an amendment in and giving them 14 days' notice, there's no process for hearing the hospital's response to that.

You've changed the language so that in the past, where the voluntary governance -- the hundreds of volunteers who run our hospital system in our communities, who have the day-to-day operations on their plate in terms of the running of hospitals, where they would in the past, if it was under a supervisor, have to check major decisions with a supervisor, you've even taken that away and you've said the supervisor can take over the day-to-day operations of the hospital, totally undermining all those hundreds and hundreds of volunteers.

You didn't put any sunset on those powers. Those powers are going to be there forever. You've sunsetted section 6, the powers to merge and close. You've sunsetted the commission. You didn't sunset the extraordinary powers of the supervisor. Particularly for those members who were not on the health section, may I tell you, when your minister appeared before our committee on the very first day of hearings, he went to great lengths to tell us that the existing section dealing with supervisors had hardly ever been used in the history of the province. He said maybe only a couple of times. When I asked him why he wanted even greater powers then, he couldn't answer that question. There was no answer to that question.

Yet you've put in place a whole series of amendments to the existing legislation under Bill 26 which allow the ministry departments to step in and take over the running of hospitals and totally undermine the volunteers who run our hospital system. If I were Jim Wilson, I could be much more eloquent about governments taking over the role of volunteers and destroying volunteerism in our communities. He's pretty good on that issue, let me tell you. I know.

Look at what you're doing. The amendment that's here is simply saying, if you're going to put terms and conditions on the money that's coming in, relate it to the services that you want the hospital to provide and not the day-to-day management issues. You have all sorts of other mechanisms to get at day-to-day management and to either negotiate agreements or to influence or, if you think there are problems, to send in an inspector or a supervisor or whatever. You don't need, in every section of the act, to have the power to step in and run things, which is what you're doing by this section.

1520

Again, if in fact it's not your intent every step of the way to undermine the role of legitimate volunteers, hard-working volunteers in our communities, who are dedicating their time and energy to helping run the hospital system of this province and delivering health care in this province, if it's not your intent to be able to undermine them at the whim of the ministry or the minister, then listen to the recommendations that you're hearing from Mrs Caplan, a former Health minister, saying: "Limit that power. Put some limits on it."

Every argument we hear back from you is that you want unlimited flexibility, to use some words that were being bandied around earlier. Again, I suggest to you that's not good legislation. Governments need to have limits placed on their own powers, and in this case, you need to have limits placed on you in terms of how far you're going to go to undermine the work and dedication of volunteers in the province of Ontario.

Mr Clement: Can I just ask the legal counsel, firstly, when was section 5 originally part of the legislation? How many decades does that go back?

Ms McKeogh: Probably 1931.

Mr Clement: Thank you, 1931. I'd like to speak to this, because I think there's an important point that has to be made, that section 5 of the Public Hospitals Act is a very archaic device for 1996. Here we are in 1996. We're dealing with legislation that was created for the times in 1930, 1931. I see nothing wrong --

Mr Cooke: You remember it well.

Mr Clement: In a former life. I'm still paying for the sins of that life, Mr Cooke.

Ms Lankin: Until the next time, Tony. It's going to be even worse.

Mr Clement: Yes, I think so.

Mr Sampson: You'll come out as a patch of grass or something.

Mr Clement: Yes, I might be an NDP supporter or something in the next life. We'll see what happens.

Mr Cooke: You mean to tell me the Almighty has made this mistake twice?

Mr Clement: No, no. He's infallible; I'm not.

Getting back to the issue at hand, if I can, I look at the sections found in Bill 26 and compare it to the Public Hospitals Act. The language is archaic. We're talking about public money here and how that money is spent. I see nothing wrong, when we are the custodians of the taxpayers' dollar that is going into the system, to impose, if necessary, some terms and conditions on how that money is spent. Maybe that's a 1996 concept. In 1930-31, maybe it wasn't such an issue, but it certainly is an issue in 1996.

We have a responsibility to the taxpayers and to the public to make sure that their money is spent wisely and, quite frankly, at the other end, at the output end, we have a responsibility to Ontarians, all of whom at some point in their lives are going to be in the health care system, to ensure that we have properly run hospitals, allocating the resources in the first instance as they determine them, but we've got to have some accountability in this.

I hope I'm not speaking out of turn. I mean no disrespect to the former government, but we're getting this lecture on volunteerism. That was a government that enacted Bill 173 on long-term care that gutted volunteerism in a very important area that touches on the health care issue. We had Mr Kormos in Niagara Falls standing up talking about electing the boards of hospitals, for gosh sakes. What does that say to the volunteer? That somebody can go to a meeting or go to a ballot box and blow away the volunteer? Is that where that's coming from? Is that what's coming from the NDP?

Mr Sampson: The future leader of that party.

Mr Clement: A future leader of the party saying that. I know Ms Lankin wants to defend Mr Kormos, but in all seriousness --

Mr Cooke: You don't like elected hospital boards?

Mr Clement: Read the record. In all seriousness, I think that we need a law respecting public hospitals that does give the government of Ontario, the custodian of the taxpayers' dollar, some level of authority to make sure that dollar is accountable when it is spent by the hospitals, and so I would support the section as it stands now.

Mr Cooke: I found part of this discussion interesting. You know, nobody can disagree with what Mr Clement just said. I think the debate is whether or not there are already sufficient powers within the acts and whether this is going that one additional step that's not required. But I think what we've seen is an explanation from legal counsel, Ms McKeogh, where the comment was, "When we sat down to draft this section, the program people said, `We'd like to have this power.'" That's fine for people in ministries to make those judgements. They make those judgements and recommendations all of the time. That's appropriate. What is appropriate for the elected people and the minister and then the Legislature is to say whether that recommendation, whether that additional power coming to the ministry, to the bureaucracy is an appropriate power or whether the existing powers are quite adequate to protect the public purse.

When we had the second reading debate on this bill, I believe there was a very good argument put forward by my leader, who said that there's always going to be a tendency within a large bureaucracy, in the public sector or the private sector, to try to accumulate more power and control over the system within the ministry. That's exactly what's happened here, and it's been confirmed that that's exactly what happened. This isn't being driven by politicians, by the publicly accountable people; this is being driven by the ministry. It's not a necessary power. It's not something that the political process has approved. It's something that somebody said when they were putting Bill 26 together: "Hell, we've got an omnibus bill. We're going to be centralizing more power." The people in the ministry, the program people said: "We'd like to get this additional power. It's probably been raised with previous ministers and been rejected, but let's do it. We've got this huge bill going forward and we'll take this additional power unto ourselves."

Here we are, and now we've got a rationale being made up by the politicians on the government side to justify something that they know darn well they would never justify in any other previous life. So I think this afternoon's debate and the comments by the elected people and the non-elected people are very illuminating, and not just on this section but on this entire bloody mess.

Mrs Caplan: I will try to be brief. I don't agree with all of what Mr Clement had to say, because I think there needs to be update in laws from time to time. In fact, we're not saying, "Strike out section 5." We're supportive of section 5, which would update the funding powers of the minister. We've agreed that those have to be updated. All we're saying is, impose a limitation that doesn't allow the minister to go in and interfere with the day-to-day operations of the hospital or administration as it relates to the work of the hospital board and the administration of the hospital. That's micromanagement. That's the only limitation we are placing on the updated funding ability of the minister.

Frankly, I can understand the program branch wanting this and I can also understand why the Ontario Hospital Association and every hospital hates this. The hospitals hate this because this means potential micromanagement by program branch staff in the ministry. If this is in place, they can walk into any hospital and they can restrict the administrator or the board of management on the operation of that hospital. That's micromanagement. Why anyone in their right mind would want to sit on a hospital board as a volunteer, knowing that at any time someone from the ministry could come in and interfere with the day-to-day operations of that hospital, beats me. That's where it will undermine volunteer governance. This is exactly what the Ontario Hospital Association was referring to. The case analysis, both from Mr Clement as well as Mrs Johns, portrays a lack of trust of that voluntary governance.

1530

The Public Hospitals Act already permits, where a minister has concern about that governance or the administration of that hospital, action to be taken. Bill 26 enhances those powers dramatically. Where you are worried that board is not acting in an appropriate way, you can send in a supervisor and direct the board, if it's serious.

But on the basis of your funding power and the need to update that old, archaic law, surely a reasonable limitation that does not give total and absolute control to the minister, and thereby well-meaning ministry bureaucrats -- sometimes maybe not so well-meaning -- to be able to go in, who knows? You know, sometimes there are personality conflicts and tensions and so forth that occur.

This is a very reasonable limitation on that funding power, and if you don't support it, then your message to every hospital board, to every hospital administrator, to the Ontario Hospital Association is (1) you don't trust them and (2) they'd better not trust you. That lack of mutual trust will undermine everything that we believe in and it will undermine voluntary governance.

Think about it before you vote against this. You all have hospitals in your local communities. Do you want somebody from the ministry to be able to come in and direct your administrator on the day-to-day operation of that hospital? Do you want them to be able to come in and direct the board on the day-to-day operation of the hospital, or do you want them to be required to sit down and negotiate any problems that they might have? If you can't come to a mutual and satisfactory agreement following those cooperative negotiations, you've got Bill 26 and you can send in a supervisor and you can have your way.

But this limitation that we're trying to put into section 6 simply requires those negotiations when it comes to the day-to-day operation of the hospital and it limits the ministry's ability to micromanage. Think of all those hospitals in the local communities. Do they want a bureaucrat from Queen's Park coming in and telling them how they have to manage the day-to-day operation of their hospitals? Do you want that in your communities? If you do, then you vote against this amendment. If you don't, if you don't think that the ministry should be able to micromanage and if you support what Mike Harris said, and if you heard the concerns of the Ontario Hospital Association, you'll support this amendment. It'll do everything you want, Mr Clement, but it will stop the program branch, which wants this, from being able to come in and micromanage. That's what it will do.

Ms Lankin: I agree with Mrs Caplan's explanation of what her amendment would accomplish and with the reasons to support it, and I also agree with Mr Cooke's version of how this bill got drafted. I think we've seen time and time again that there is much truth to that scenario.

I have only one point I want to address and it's very directly in response to Mr Clement's comments, and I am so glad that he finally understood the parallel that I have been making as I have been arguing about voluntary governance. You brought up the long-term care legislation, because that's exactly why I've been making this point. I appreciate your opening the floor in the debate on that so that I can make the point even clearer to you.

I'd like you to take a look at what in fact the previous government was doing with respect to that legislation and the delivery of community services to seniors who are living in their homes, who are in receipt of long-term care services in the community. That legislation provided for the creation of an agency called the multiservice agency, which essentially was a merger of all of the different community agencies currently delivering.

You might argue, in your fiscal terms, merger and closure so that you could have more fiscal efficiency. You might argue that was rationalization of services. You might argue a lot of things. In fact, I suspect, given all the powers you've given yourselves, you'll be doing it in lots of areas, but you won't be as explicit in setting it out in the legislation as the previous government was.

In any event, what it did was it merged a lot of community agencies delivering a similar nature of services to seniors into one agency. And do you know what? It maintained volunteer boards for that agency. They still had volunteer boards.

But it is very true that your now Minister of Health went across this province and told everyone that that was the gutting of volunteerism in this province, that that would destroy volunteerism in the health care sector. Those were his words. They were very extreme. I think very rhetorical, but they were very extreme words.

That was just merger of community agencies that would still have a community board. But instead of five agencies and duplication of services, it would be brought into one agency. Instead of five boards, there would be one board, hopefully ways of maintaining all those volunteers. But that was going to gut volunteerism.

Now let's look at what you're doing in this bill. You now have a section in which you're going to put terms and conditions on any financial grants that you make to the hospital, which allows you to actually restrict -- in the words of the parliamentary assistant: "We want to be able to restrict the day-to-day operations. We want to be able to have that power" to essentially micromanage -- she didn't use those words, those are my words -- the hospital system out from underneath the voluntary board. You have the ability to send in a supervisor, without any due process, to take over the operation of the hospital from that voluntary board. You, by the way, give yourself the powers we know to merge and close hospitals irrespective of what the voluntary board wants you to do.

If you want to talk about undermining volunteerism in this province, please take a look at what your bill does and what you will be accomplishing and the way in which you are saying you don't trust volunteers in the system. It is absolutely appalling that you could even attempt to make the comparison to Bill 173. It took me long enough to goad you into it. I've been trying for a couple of days here and you finally did.

Mr Sampson: Well done.

Ms Lankin: Take a look, just take a look: For anyone out there who understands what the Conservative Party railed against as the end of volunteerism in this province, the merger of some community agencies still under a volunteer board -- that was the end of volunteerism -- to a bill that allows the minister to close any hospital he wants, merge any hospital he wants over the objection of any hospital board; that allows him to set up a restructuring commission and gives him the powers to go in and do anything he wants over the work of volunteer district health councils and not listen to them; that allows him to send in a supervisor to take over the day-to-day operation of the hospital and pull the rug out from underneath the volunteer boards; and in this section, a government that won't even allow a slight limitation on the language that says the terms and conditions have to be related to the services, as opposed to restricting the day-to-day operations of the decision-making of the board. And you want to say that other people were gutting volunteerism?

Look. Look at your bill. Look at what you're doing. Look at the message that you're sending to the hundreds and hundreds of volunteers in this province. Bill 173 pales in comparison to what this Conservative government is doing and it runs absolutely contrary to everything you ever said you stood for.

I believe Mr Cooke's scenario and I believe Ms McKeogh, who said it very accurately. This is a desire of the program branch, and you're now trying to defend it with lovely flowery language. It would be very interesting to know -- a surprised look from a couple of members -- if you believe that Mr Wilson actually said to the people in the ministry who were drafting this bill, "I need this power and I want this power to put terms and conditions on the grants and the loans so that I can restrict the day-to-day operation of the hospital around the wishes and desires of the perhaps democratically elected hospital board" -- because we do have elected hospital boards in this province, Mr Clement; you might acknowledge that there's a mixed system out there -- "or the hospital board that has been just brought together from the membership of the hospital corporation."

If you believe Mr Wilson gave that direction, I suggest you continue to defend this. Otherwise, you should perhaps take a second look at it, because all you're doing at this point is giving in to the wishes of the department that had put forward a wish list. You are voting to undermine voluntary governance in this province and you are putting together a string of amendments that will indeed gut volunteerism in the hospital sector in the province.

Mr Bart Maves (Niagara Falls): I'll be very brief, not being a former Minister of Health. As I look at the amendment, the limitation is that the government may require that a grant, loan or financial assistance be dedicated to the provision of specified hospital services. My fear, and admittedly it may be unwarranted, becomes that if translated literally, the amendment might preclude the government from giving grants, loans or financial assistance to hospitals for the purpose, for instance, of purchasing equipment and things like that. It may be an unwarranted fear, I admit, but if translated literally, that's something that comes to my mind. I just wanted to put that out there.

Mrs Ecker: I'm having some difficulty understanding why our friends from the NDP are having difficulty with this particular phrase in this legislation. If the bureaucrats are supposed to have pulled one over on us in 26, they certainly pulled one over on the former government in Bill 173, long-term care, which has an identical section in it, with terms and conditions on grants and terms and conditions imposed on funding.

Ms Lankin: That's the legislation you said gutted volunteerism, remember?

Mrs Ecker: I have the floor, Ms Lankin, please. What our esteemed Health minister was talking about, and I can go by the numbers of individuals who talked to me from agencies out there in the long-term-care field, wasn't that the terms and conditions on the funding were the problem. As Mr Clement has said, as the people who are the custodians of the taxpayers' money, I don't object to amendments in legislation that are going to help us have better control of taxpayers' money. What we objected to, Ms Lankin, was that they were going to restrict the powers of the volunteers on the board, they were going to restrict who they could hire. I heard from a lot of individuals out there doing the Meals on Wheels and all those other programs who were terrified about what was going to happen under long-term care to their volunteer efforts. It had nothing to do with the restrictions on the funding.

Mrs Caplan: I think Mr Maves raises a good question. As a former Minister of Health, I'll tell you that when the Ministry of Health and the minister decide to give money to hospitals, whether it is for capital or operating, it's for the provision of services to the community from that hospital. I don't think you need have any concern that the restriction or limitation I am proposing would in any way restrict services. They could provide capital for equipment so that they could then provide service. They could provide capital for a building, the purpose of which is to provide services. It would not be a problem.

The Chair: Is there any further discussion on the amendment proposed by the Liberals? Seeing none, shall the amendment pass?

Ayes

Caplan, Lankin, McLeod, Phillips, Silipo.

Nays

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

The Chair: The amendment is defeated.

Since this is a convenient break in the action, we will take our 15-minute recess for the afternoon.

The committee recessed from 1543 to 1601.

The Chair: Welcome back. In case anybody's lost track, we are more than halfway through our time. I had to throw that in -- just a little levity.

Ms Lankin: Mr Chair, I have a query and I'm not sure whether Ms Johns can answer it for me -- a couple of questions. First, are there further amendments to the health schedules that you will be tabling with us this afternoon or tomorrow morning?

Mrs Johns: It's a possibility. I'm sorry, I don't really know, yes or no, or what the holdup is. I guess we're looking at a few.

Ms Lankin: Could you give us some sense of the number of those?

Mrs Johns: Three.

Ms Lankin: Specifically, this morning in the newspaper, I saw a reference to an amendment the minister said he was working on with respect to CMPA. I found it interesting that he was being quoted. You haven't seen that one and you don't know whether or not we'll see that amendment.

What about with respect to the medical review committee process? Are there amendments coming with respect to that?

Mrs Johns: I think the practitioner, chiropractor issue is one you will see, what we've been talking about. That's the only one I know of at this particular point, but I understand there'll be two more.

Ms Lankin: Perhaps, if more information becomes available before the end of the day, you could share that with us. Mr Chair, we are moving our way slowly through the health sections, but I am informed that there are several areas where the government is contemplating tabling amendments to their amendments. I know the one area around "practitioner" that we've talked about, but there are some other areas. I'd like to know whether that's the case, because I find myself not sure whether to react to the amendment I have in front of me with respect to the positions I take on amendments we table, or whether to hold off and wait, because I've been informed that there are other amendments coming to these amendments in other areas.

As you just said, Mr Chair, we're more than halfway through the time. By the end of today there will be one and a half days left to debate amendments, and tomorrow is the last time they can be tabled. Is that correct?

The Chair: Tomorrow at 4 is the deadline for tabling of amendments.

Ms Lankin: I'm quite concerned about a situation where in the last two days -- we're going to be receiving more amendments to amendments that aren't being fully discussed with us or shared with us in advance in any way so we can have an appropriate response. It really is driving it right down to the wire. I just plead for a little better process, as bad as this has been all along. Don't leave it right to the last, on the last day for amendments, to table your amendments.

Mr Phillips: Was that a question to the government? Are they actually planning more amendments, or have we got the final amendments?

Mrs Johns: I said that in health I know of at least one more amendment, the one we were talking about earlier in the week with the chiropractor versus the doctor situation. That amendment is coming. That's the one I know of.

Mr Phillips: I'm aware of another one, I think, where we need all-party agreement to have it tabled, so that would be the second one, I guess.

Mrs Caplan: I'm assuming it's not going to just deal with chiropractors but will deal with dentists and podiatrists and all of the other --

The Chair: Mrs Caplan, let's not get into talking about an amendment that might come forward.

Mr Phillips: I gather we're talking one or two amendments, not 10.

Mr Clement: Not a whole forest.

Ms Lankin: I'm glad it's not going to be a whole forest. That's helpful.

I appreciate your confirmation that an amendment dealing with the amendment to Bill 26 that you tabled that caused a problem with respect to practitioners and OHIP billings and review of such will be forthcoming. Would you please undertake to inform me by the end of the day, if you can, whether there are amendments to any other section of the health bills that will be coming forward? That's quite important for us to know. Some of us actually were expecting some other amendments, and I'm surprised that you're indicating they may not be coming forward. I'd like to know that by the end of the day.

The Chair: The next amendment we will be dealing with is to section 6, and it's a Liberal amendment.

Mrs Caplan: This is a significant amendment that, from what I have heard, the government will likely not accept, but I hope they will because it's very important. Let me just read it and then give you a very short rationale for it.

I move that subsection 5(4) of the Public Hospitals Act, as set out in section 6 of schedule F to the bill, be struck out and the following substituted:

"Reduce or terminate grants

"(4) Upon the recommendation of a district health council, the minister may reduce the amount of any grant, loan or financial assistance, may suspend or terminate any grant, loan or financial assistance or may withhold payment in whole or in part of any grant, loan or financial assistance with respect to a hospital located in the jurisdiction of the district health council.

"Notice of reduction or termination

"(5) The minister shall give a board notice of a decision to reduce, terminate or withhold the payment of all or part of any grant, loan or financial assistance at least 30 days before the decision takes effect.

"Content of notice

"(6) A notice of a decision shall state the reasons for the decision and shall inform the board that it is entitled to submit a notice of objection to the decision to the minister within 10 days of the receipt by the board of the notice of the decision.

"Right to object

"(7) Within 10 days of the receipt of a notice of a decision, a board may submit a notice of objection to the decision to the minister which shall set out the reasons for the board's objection.

"Response by minister

"(8) Within 10 days of receipt of a notice of objection under subsection (7), the minister shall give the board a written response which shall either confirm or revoke the decision and give written reasons therefor."

This deals with the rights that hospitals and hospital boards must have in relation to the reduction of financial assistance by the Minister of Health. Our amendments have to do with restructuring. It says there has to be some due process and some natural justice, all of which is missing from the legislation. Our amendments say that for the purposes of restructuring, reduction in financial assistance by the Minister of Health can only be done when it's recommended by a district health council, where the hospital has received 30 days' notice, where the hospital has been given written reasons, and it adds that the hospital is entitled to object within 10 days. It also says the minister must respond with written reasons either confirming or revoking original notices.

We know that what this act is going to be doing when it comes to restructuring is shifting funding and moving services around. We believe that before the minister should have the absolute and uncontrolled powers to be able to do that, there should be some process: The local district health council should be involved and have made recommendation to the minister of the plan that's going to see services move around; the hospitals have to receive notice this is going to happen; if they are concerned about it, they have to be able to know they can have a hearing; and the minister has to provide reasons, even if the reason is "the restructuring of."

This is part of putting some terminology around "in the public interest." The minister right now can make any decision if he thinks it's in the public interest, and that's undefined.

1610

This puts in some process, some natural justice and some definition of what's in the public interest. Without that, the minister can do as he pleases, without any process, without any right of appeal, without any public hearings and without any reason. He doesn't even have to say why he's made that decision.

We think this is a reasonable amendment and we hope the government will support it, although I am not optimistic. Say I'm wrong, Mrs Johns. You're going to support this, right?

Mrs Johns: You shouldn't be optimistic. The government will not be supporting the amendment. Mrs Caplan probably explained why. In "Reduce or terminate grants," it's been suggested that we wait for a recommendation of the district health council before we reduce the amount of any grant. This has never been part of the policy before, so this is a serious problem for us in being able to operate the ministry on the day-to-day basis.

Never before has notice of a decision and notice of objection been required on day-to-day funding. That's a second issue within it. The ministry gives, in practice, reasonable notice about changes in funding, and we believe tat that's all that's necessary.

Ms Lankin: Why is it that whenever you want to change something and there's an objection, you say, "We can't support the status quo," but when you don't want to change something, you say, "It's always been done this way and it's okay"? I don't quite understand your logic in your arguments.

Mrs Johns: We believe in this particular case that for the district health council to recommend a change in funding every time would be a very time-consuming, duplicative process, and we don't think that's in the best advantage to being able to provide funding to hospitals.

Ms Lankin: So in this case the status quo is best.

Mrs Johns: Is that a question?

Ms Lankin: Ms Johns, in this case, do you believe the status quo is best?

Mrs Johns: That's correct.

Ms Lankin: Thank you very much. I just want to make sure we've got that on the record so the next time you accuse someone of wanting to protect the status quo, we can show equally that where there is a good, rational reason to continue something that is working, a process that is bringing about reasonable, considered reform of the health care system within a framework of principles that have been arrived at through consensus-building in the communities -- we can point out that that's the status quo and not everything about the status quo is bad. I appreciate, on a serious note, having that on the record, because you have rhetorically used that comment in many circumstances in a way that really undermines the work that's been done by a lot of people to reform the health care system.

Mrs Johns: As you well know, we have had the discussion around this table a number of times that each one of the people at this table wants the best for health care in Ontario. No one's suggesting that one of us or another is better able to decide what's best for health care. We're all looking at ways that we could implement a good health care system for Ontarians.

Ms Lankin: If I thought that was the case and the position of the government members, I would be much more comforted.

Mrs Johns: You should be comfortable.

Ms Lankin: But all the recommendations being put forward by the opposition are being dismissed out of hand by you. Any time arguments are put forward, we hear catcalls about opposition defending the status quo. We hear a defence of your change because nothing was working in the health care system, nothing was changing. You know how many times I've taken exception to that, because a lot of good work is going on in communities to reform the health care system.

In any event, it was a political point to be made, and I've made the point.

Mr Phillips: Just so I'm clear, I gather that the minister makes this decision. What are the areas of public interest that he can consider here? How does the minister define "public interest" here?

Mrs Johns: The minister defines "public interest" under section 9.1, which we'll be coming up to. What it says is that he "may consider any matter they regard as relevant including, without limiting the generality of the foregoing,

"(a) the quality of the management and administration of a hospital;

"(b) the quality of the care and treatment of the patients in the hospital;

"(c) the proper management of the health care system in general; and

"(d) the availability of financial resources for the management of the health care system and for the delivery of health care services."

Mr Phillips: But I gather the intent is "or anything else he wants to consider." Is that right?

Mrs Johns: Considering "any matter they regard as relevant including...."

Mr Phillips: So those four things and anything else he wants to consider.

Mrs Johns: And "without limiting"; that's correct.

Mr Phillips: So whatever he wants to do, he can do, I gather. Is he required to publish his decision in the public interest? Is he required to give written explanation of how he reached -- I keep using "he," but the Health minister.

Mrs Johns: Can you tell me under what section you're talking about?

Mr Phillips: I'm back under the section we're talking about -- that is, reduce or terminate grants -- and you're saying if the minister considers it in the public interest to do so.

Mrs Johns: No, he's not required to --

Mr Phillips: So he just does it, is never required to tell anybody why he did it, and it's unfettered in terms of how he can make the decision. Have I got that right?

Mrs Johns: As you know, the term "public interest" is used in many pieces of legislation. I don't think that a minister would use it unfettered. Is that your definition?

Mr Phillips: That's what I interpreted, that there is no definition of "public interest" here. The minister can just pretty much decide and never have to tell anybody. He just decides.

Mrs Johns: There is a definition of "public interest" which we've gone through in 9.1, but he doesn't have to outline the reasons why he's made a decision in the public interest. That's correct.

Mr Phillips: Your definition lists four things but says "and anything else." So it's the ultimate in openness.

Mrs Johns: That they regard as relevant. It can't be an irrelevant detail.

Mr Phillips: No wonder the public are worried. This truly essentially means the minister makes any decision he wants and doesn't have to tell anybody the basis on which he reached the decision.

Mrs Johns: It has to be in the public interest.

Mr Phillips: But he never has to tell anybody why he did that.

Mrs Johns: I'm sure there have been different challenges to make sure that ministers are using "in the public interest." I'd have to check that with legal counsel, because I'm just assuming that.

Mr Phillips: I gather that this decision can be taken to court, then.

Mrs Johns: Can it? Has public interest ever been tested in court?

Mr Phillips: No, this decision can be taken to court.

Ms McKeogh: We are on to a funding decision?

Mr Phillips: I think what you just said was that it can be challenged.

Mrs Johns: No. I said I think it must be able to be challenged. I'd like to get an opinion on that, though. I don't want to say something that's probably incorrect.

Mrs Caplan: Guess what?

Mr Phillips: I'll just wait here for that.

Mrs Johns: Is that incorrect? It has never been tested, "in the public interest"?

Mr Phillips: I'm waiting for an answer, that's all.

Ms McKeogh: It could be challenged on the basis, I believe, if the decision was made in bad faith.

Mr Phillips: So this can be challenged in the court.

Ms McKeogh: But on very limited grounds of bad faith and patently unreasonable.

Mr Phillips: Can you give me an example of when that's been done before? I gather that we're giving the minister essentially unlimited powers to make this decision. He may consider anything that he considers relevant. So it probably is a little difficult to challenge him when the law says you can consider anything you want and then make the decision. Can you give us some help here how this would be challengeable?

Mr Cooke: What's an example of bad faith?

Ms McKeogh: I'm just relying on a Metropolitan General Hospital decision which dealt with a funding cut, a challenge to a funding cut by the Minister of Health. The court held in that case that the decision was not reviewable, that the expenditure of public funds was a policy decision entrusted in the minister. I believe this case mentioned grounds for review if there was bad faith or an unreasonable decision, but I'd need a minute to review the case to try to find that.

1620

Mr Phillips: The way I read this is that the minister can make the decision any way he wants. I'm wondering why you even want to put "in the public interest," because it seems that the scope is so far-ranging that he and he alone makes the determination of the public interest. I will await the answer.

Ms McKeogh: We have it here. The court report stated here: "He," meaning the minister, "cannot perhaps use a statute designed for one purpose for another, nor can he can exercise his statutory power under extraneous or irrelevant considerations. But where his decisions are pursuant to and in the course of his duties to advise the government in the conduct of the affairs of the province, they are unimpeachable in the courts."

Mr Phillips: That gives me the answer that I expected. Thank you.

Mrs McLeod: This is an incredibly important issue, because the powers given under this act to the Minister of Health are sweeping, the powers given in this particular section are absolutely unprecedented, and when I hear the ministry's legal adviser indicate that under existing legislation there has been very little power to hold the minister accountable for decisions made, I would suggest that there is virtually no power for there to be any appeal of ministerial decisions made under this new legislation. It is so unfettered and so unchecked, as my colleague has said; there are no limits. There are very wide-sweeping factors that the minister can take into account, but as you've said, Ms Johns, he's not limited to that.

All that exists as a safeguard for the public's access to health care under this section of this act is the minister's consideration of the public good, the public interest. It seems to me that to be even suggested that he would be acting in bad faith, he'd almost have to stand on a rooftop and say, "I could care less about health care and that's why I'm doing this." Anything short of that, clearly he's going to say, "I'm acting in what I believe to be the public interest."

It's my understanding that under current legislation the Minister of Health is at least fettered or checked by having to act within regulations under the law, under the Public Hospitals Act, that that at least is a measure of check on his personal, individual judgement being exercised. This takes that away.

I agree with the statement you just made that no one alone can decide what is in the best interests of health care. I would ask you whether or not you believe, and therefore your government believes, that it is appropriate for any one individual, including the Minister of Health, to have unfettered, unchecked, individual power to determine what is in the public interest in the delivery of health care. There's no question that's what this bill does. Unamended, that's what it does. Do you believe it is appropriate for one individual to have that power?

Mrs Johns: I guess this is a personal call you're asking me to make?

Mrs McLeod: I'm asking you as parliamentary assistant, as the minister is not here.

Mrs Johns: Obviously, our government believes that cabinet and ministers, as elected officials, have the ability to be able to make decisions in the public interest.

Mrs McLeod: Ms Johns, that is not the question that's before us with this section, which gives the Minister of Health the power to act in his personal opinion. This is unprecedented. This is a huge power to give to one individual. That individual minister can operate without reference to cabinet, without reference to the Legislature. It is a sole, individual power to act in the public interest.

I ask you not for an individual opinion, because it has been made very clear to us that you are the representative of the Minister of Health. So do you, as the representative of that minister and of your government, believe it is appropriate to give that power to a single individual to operate even outside of cabinet control or check?

Mrs Johns: The only thing I want to clarify before I comment is that you said "in his opinion," but it's "in the public interest."

Mrs McLeod: In his opinion of what constitutes the public interest.

Mrs Johns: Which is challengeable in a court, but I believe, yes, he should have the ability to be able to decide on payments to hospitals.

Mrs McLeod: So a single individual should be able to make the determination of the public interest in health care without any regard to executive council, to the Legislature or to any existing law other than the one that gives him the power to act unilaterally, and it is not, as I've heard the response from the ministry legal adviser, truly appealable in a court, because there is nothing written in law that could hold him accountable. That is an astounding statement to make on behalf of a government, Ms Johns.

Mrs Johns: If he acts in bad faith, he's held accountable.

Mrs Ecker: Ms Johns has put very well the fact that this government was given a mandate to act and to try and restructure within the health care system, and that this was very much needed. It's also important to note that there is legislation which gives ministers of Health significant power, legislation which the two previous governments and our party at the time supported.

The Regulated Health Professions Act does give a minister the power to require a council of a regulatory college -- that's the council, the 21 colleges that govern our health professions out there -- to do anything that in the opinion of the minister is necessary or advisable to carry out the act. So I suggest this is not an unusual power that has been put forward and I think there are many checks and balances within the system of this government to ensure that it will be exercised appropriately.

The Chair: Any further discussion on this amendment? Shall the amendment carry?

Ayes

Caplan, Lankin, McLeod, Phillips.

Nays

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

The Chair: The amendment does not carry.

The third amendment we will consider is also from the Liberals.

Mrs Caplan: I move that subsections 6(1), (2) and (3) of the Public Hospitals Act, as set out in section 6 of schedule F to the bill, be struck out and the following substituted:

"Direction to cease operation

"6(1) Upon the recommendation of a district health council and subject to subsection (6), the minister may direct the board of a hospital in the jurisdiction of the council to cease to operate as a public hospital on or before the date set out in the direction where the minister considers it in the public interest to do so.

"Direction re specified services

"(2) Upon the recommendation of a district health council and subject to subsection (6), the minister may direct the board of a hospital in the jurisdiction of the council to do any of the following on or before the date set out in the direction where the minister considers it in the public interest to do so:

"1. To provide specified services to a specified extent or of a specified volume.

"2. To cease to provide specified services.

"3. To increase or decrease the extent or volume of specified services.

"Direction to amalgamate

"(3) Upon the recommendation of a district health council and subject to subsection (6), the minister may direct the board of two or more hospitals in the jurisdiction of the council to take all necessary steps required for their amalgamation under section 113 of the Corporations Act on or before the day set out in the direction where the minister considers it in the public interest to do so."

Speaking to the amendment, and I will be brief, this amendment simply requires the recommendation of a district health council, where one exists, before the minister can take any action. The truth is that the minister can ignore what the district health council has to say, because they are advisory in nature. What this will do is stop the minister from acting unilaterally. If the minister is truly going to do what we've heard from Mrs Ecker and the government benches time after time, and that is have a process that involves the district health council, then this amendment should be accepted, because all it does is put in place a little bit of process.

It requires the restructuring commission to do a human resource adjustment plan. It requires district health councils to publish notice of recommendation and to have the minister hold hearings, and I believe it would also require the district health council to do a number of studies as set out in section 6.1. This is purely process. It's make sure you have the human resource adjustment plan so you can consider the concerns of nurses, doctors and other hospital workers, that the district health councils have been involved where there is a district health council. All this is some comfort to the community that the minister or the restructuring commission, which could be just one person, can't walk into their community without some process. That's all this is, a little bit of the due process that we're so concerned has been eliminated from this bill.

1630

Mrs Johns: I'd just like to first of all draw attention to the fact that this amendment has in three occasions "in the public interest." That was one of the debates of last time, what was the matter with the process that we had suggested in the previous section, which was "in the public interest."

Mrs Caplan: So you will support the amendment?

Mrs Johns: What we have here is the minister in a reactive mode. He has to wait; he can't react until he gets a district health council recommendation or approval. We believe the restructuring process has to be expedited and in some cases it has to occur quickly, and it certainly puts the minister in a position where he has to wait for a recommendation or a report from the district health council.

Mrs Caplan: I agree that we have heard all along from you that the intention is to be reactive and to have process and to have communities. We've heard there are 60 reports out there and that it's the minister's intention to respond to those reports. What I'm hearing from you now is that you don't want to have to wait until you have a report, that you want to be able to go in unilaterally, without a report from the district health council, without community process, and dictate what is going to happen in that community without any process. That's what I heard you say, Mrs Johns.

Mrs Johns: We've been through this debate before. There are other circumstances; ie, local planning, people in district health councils who have different opinions. We have a number of different circumstances where we would need to react quickly without necessarily a report from a district health council.

Mrs Caplan: We know you have 60 reports out there. What this says is that the minister would have to receive those reports and have some community process before he can move to close hospitals in a community.

Mike Harris said, "I have no plan to close hospitals." Surely, if he is not going to be accused of another broken promise, what he meant was the district health councils are doing these plans, and "I would never walk into a community that hadn't developed their own plan." Surely that's what he meant when he said, "I have no plan to close hospitals." Obviously, Bill 26 gives massive powers for closing hospitals. Surely he wouldn't do that without having the local planners, the eyes and ears of the community, as Health Minister Wilson described them, the local planning body, the district health council -- certainly you would want to have that process where the local district health council would be involved and had developed a plan for the minister's approval before he could move in. Certainly that's what was contemplated when Mr Harris said, "I have no plan to close hospitals." Wouldn't you say that's a reasonable expectation of what those words meant, Mrs Johns?

Mrs Johns: As we said earlier today in the amendment we approved that the NDP put forward, if there is a plan, we will consider the recommendations of the plan. But if there is other planning that may come out of the local community, we may consider that process too. We'll be looking at many different methods of deciding the ability to provide the best health care in Ontario.

Mrs Caplan: What I've heard you say is that you do not respect the role of the district health council in communities. What I have just heard you say is that you want the power to unilaterally walk in and tell communities, "I'm going to close your hospital." If you do not support this amendment, that's the message they're going to receive. I have nothing further to say.

The Chair: Any further discussion on this amendment? Shall the amendment pass?

Ayes

Caplan, Lankin, McLeod, Phillips.

Nays

Clement, Ecker, Hardeman, Johns, Maves, Sampson, Tascona, Young.

The Chair: The motion is defeated.

The next amendment that we'll entertain is one from the New Democrats.

Ms Lankin: Let's try this again. This is virtually the same wording as is in Bill 26, and I point out to Ms Johns, when you were attempting to make a point with Mrs Caplan about the reference to "in the public interest," that's in fact from Bill 26. All Ms Caplan's amendment did was instead of saying "the minister may direct," to say, "upon the recommendation of a district health council the minister may direct." So it's your words. It's not words that we're putting forward and recommending.

My amendment actually is very similar, and I'll read it into the record, but it is virtually word for word what is in Bill 26 but it substitutes the concept "upon the recommendation of the commission." If you remember, I earlier wanted to get in the definition who the commission was. This is the Health Services Restructuring Commission.

I move that subsections 6(1), (2) and (3) of the Public Hospitals Act, as set out in section 6 to schedule F of the bill, be struck out and the following substituted:

"Direction to cease operations

"6(1) Upon the recommendation of the commission, the minister may direct the board of a hospital to cease operating as a public hospital on or before the date set out in the direction.

"Direction re specified services

"(2) Upon the recommendation of the commission, the minister may direct the board of a hospital to do any of the following on or before the date set out in the direction:

"1. To provide specified services to a specified extent or of a specified volume.

"2. To cease to provide specified services.

"3. To increase or decrease the extent or volume of specified services.

"Direction to amalgamate

(3) Upon the recommendation of the commission, the minister may direct the board of two or more hospitals to take all necessary steps required for their amalgamation under section 113 of the Corporations Act on or before the date set out in the direction."

In this particular motion, what we do is try and address two things: one, the fact that in Bill 26 as it proposes to amend the Public Hospitals Act and give the minister the power to close or merge a hospital or to direct the ceasing of operation or the ceasing of provision of certain services, we try to do two things. One, we try to give some definition or some sense of process to what "in the public interest" would mean. So we delete those words "in the public interest" and we say to the minister, before "the minister may direct," that it has to be upon the recommendation of the commission.

Now if you'll recall the debate we've had so far, the reasons that Mrs Johns argued that we needed to have the commission established was so that the commission could in fact get out there and implement the health care restructuring that needed to be done. She argued that they needed to have the powers of the minister given to them in the legislation so that the minister can delegate his powers. Quite frankly, when I asked what powers, the only section that she could actually identify for me was section 6 under the Public Hospitals Act, which is this section.

So what we do here is we try and tie it back the other way and say, okay, we have a health care restructuring commission. We have some minimal ties to the fact that they have to at least have regard to reports from district health councils. We did that amendment earlier. So we know that they're going to at least see whatever reports come from a community, whether they're full plans for implementation with consensus or whether they are a report of a lack of consensus. At least that is provided to the commission.

The commission, which has been delegated the duties and the powers of the minister to implement restructuring plans, is the group that will be making the decisions as they have set out in the act and passed further amendments. So the minister in this section, if he's going to exercise these powers, surely it isn't going to be independent of the commission. Where else will the minister get the information from that the minister is in fact going to close a hospital or direct to cease the provision of certain services if it's not from this commission that he's delegated all of this authority to earlier on to make these decisions with respect to implementing hospital and health care restructuring?

1640

So we set it up this way because we felt that it was too broad and unfettered the way it was, that there were no linkages again to any of the earlier provisions that the parliamentary assistant has argued were necessary, the powers of the commission and the establishment of the commission, or to the district health council reports, which we were able to get a minor amendment which starts to link this. So we're starting to try to weave a process here that at least we know that the pieces -- it's like connecting the dots, you know? We're trying to connect the dots.

And I will also be fair in my presentation of this and suggest that it is a helpful amendment because some of my further amendments that come forward will try to give a process of public scrutiny to the work of the commission, that the report of the commission, the recommendation of the commission, needs to be tabled and that there should be some opportunity to have a response to that -- not prolonged; I'm talking about one month. Those amendments will come up.

If in fact what we've heard all the way through the debate so far is that we need to be able to move quickly, the Health Services Restructuring Commission is the one that's going to do this, that's going to implement this, needed to have the powers that are going to make this happen, and particularly the powers under section 6, then surely the minister, if he's going to delegate the powers under section 6 to the commission, if he's going to use the powers himself, at least he should listen to the commission about where he's going to use those powers.

Mrs Johns: Commenting on this section, I would just say that I am surprised that the NDP would want to duplicate the role of the district health council --

Mrs Caplan: What role?

Mrs Johns: -- and make the minister subject to the commission.

The commission is not an advisory board. The commission is a decision-making organization. This takes all the decision-making away from the commission, makes them report back to the minister, as opposed to just going out, implementing the process, expediting the process, moving on.

Ms Lankin: Excuse me, no, but that's wrong.

The Chair: I know, Ms Lankin, but we'll let Mrs Johns finish, and then you can make a comment.

Ms Lankin: That's dead wrong, Helen.

Mrs Johns: No, I don't think so. That's how I read it.

Ms Lankin: Well, then explain that to me, please.

Mrs Johns: You say, "Upon the recommendation of the commission, the minister may direct the board of the hospital to do any of the following" type of operations: "To provide specified services.... " "To cease to" direct -- the commission can make those decisions themselves. We don't need to get the minister back involved in it again. The commission has those powers.

Ms Caplan: Everyone's worst nightmare.

Mrs Johns: Did I say something wrong?

Ms Lankin: This is just amazing. Yes, in my argument I made it quite clear that the commission has those powers. Your section that you're trying to pass unamended says, "The minister may direct the board of a hospital to cease operating." Are you suggesting that that takes the powers away from the commission? No, you've given yourself the ability to delegate those.

What I'm saying here is that the minister is going to exercise them, right, as opposed to delegating them? If at any time the minister chooses to exercise them, it should be in relationship to somebody out there, not just Jim Wilson's personal whim; somebody should advise him. And here, I'm using the body that you've established, that you've said is going to be implementing, that's going to be making the decisions, that's going to be doing all of this, and suggesting that if the minister ever does choose to use this section himself, as opposed to delegating it -- which he is fully able to do, you're quite right; this and anything else he wants to, to the commission -- then he should at least have the recommendation of the commission upon which to base his actions.

Mrs Johns: Well, he has the recommendations of the district health council reports, if there is one, if there's a local planning, he has all those kinds of recommendations that he can draw upon, he can use to make his decisions.

Ms Lankin: I find this mind-boggling. You are sitting there and trying to suggest that you'd be amazed that I would try and duplicate the process of the DHC. You've refused on every count to build in strong linkages to the DHC. You've refused to be bound by DHC plans where they exist and where there is a consensus. You've refused all the way along. The only thing you agreed to was a minor reference that the commission has to look at and read and think about any report that comes out of a local community. That's the only thing that you agreed to.

Now you're arguing that the minister shouldn't take the recommendation of the commission, your commission, the commission you've been arguing with us for the last two days is the body that's going to do all of the restructuring and make all the decisions about what hospitals should close. And all I'm saying is, in your section, where you give the minister the power to close a hospital, he should do it with the recommendation of the commission, which is the body that you've given the power to to make all these decisions.

Mrs Johns: I'm saying that the commission is not an advisory board. It's an implementation board.

Ms Lankin: This doesn't change it. I'm not taking away any powers from the commission. I'm not changing their role or function. The minister can still give them any duty he wants to assign them or any power he wants to assign them, but if the minister himself is going to exercise the power under section 6, if the minister is going to direct the closure of a hospital as opposed to delegating the powers under section 6 to the commission to do, that he at least have to have the commission telling him it's a good idea, that he can't act unilaterally. It doesn't change the role of the commission.

The Chair: Maybe we can get a couple more people in on this discussion; it might wend its way through a little bit more.

Ms Lankin: Mr Chair, I think that's a helpful suggestion, but I, at this point, would like to hear an answer from Ms Johns because I have to say that so far it has been quite circular, her logic, and has not addressed the point of this amendment. So if I could get an answer from her then perhaps we could go into debate.

Mrs Johns: What I believe will happen, as you know, is that a district health council report will come, the minister will approve it, decide how it should go forward and the commission will implement. What you're saying to me, and maybe I'm missing something and I'll get another interpretation as we go through here, is that then the commission comes back to the minister and says, "Okay, this hospital should cease to operate." We're not going circular. The commission can implement the policy.

Ms Lankin: Yes.

Mrs Johns: So why do they need to come back to the minister?

Mr Silipo: Why do you need section 6 at all then?

Mrs Johns: Because we need to restructure hospitals within Ontario.

Mr Silipo: But if the commission is going to do all that, you don't need section 6 at all.

Ms Lankin: Section 6 of the Public Hospitals Act says the minister may direct the board of a hospital to cease operating. Do you ever envision the minister doing that? I know the minister can delegate that power to the commission and that the commission will be doing that. That's fine. Is there ever any time that the minister will do that?

Mrs Johns: That calls for speculation; I don't know. It's possible.

Ms Lankin: If it wasn't possible, I would suggest that you do away with that section or that you say the commission may direct the board. Let's figure out who is making the decisions, but if it's possible that at some point the minister may not want to delegate that authority and he may want to exercise that authority, do you not think it's reasonable, given all of what we've talked about in terms of trying to build linkages, that the DHC report at least be looked at by the commission, and the commission's the one who you're assigning the duties to to do all the work, to figure out what hospitals should close? Is it not reasonable that the minister should at least have a recommendation from the commission if he's going to exercise those powers himself?

Mrs Johns: I believe that the district health council could give him a recommendation and he could proceed from there.

The Chair: I think it's time now to let somebody else in on the discussion because it doesn't seem to be going anyplace. Ms McLeod, you were next on the list.

1650

Mrs McLeod: It follows directly from Ms Lankin's concerns. I find one of the advantages of having a parliamentary assistant here is that perhaps almost inadvertently she tends to reveal the truth of the intent of the government, and that can be sometimes very helpful to the committee. I think in this case, by suggesting that Ms Lankin's amendment somehow suggests a duplication between the restructuring commission and the DHC roles, and her clarification of what the difference is is that the commission is a decision-making body -- it will make the decisions -- brings it home absolutely clearly that the intent of this government and this minister is to use those delegation powers, the powers that the minister says he would only use in rare exceptions. You need a commission that is not making recommendations to the minister but that is going to be the decision-making body.

Mrs Caplan: The puppet of the minister.

Mrs McLeod: The debate's over. I don't want to reopen the debate about the delegation powers. We've obviously lost that, as has every single presenter who wanted a limitation on the ability of the minister to delegate those kinds of decision-making powers to any other individual or body which has no electoral accountability. I would simply suggest that no minister and no government can duck the responsibility by simply delegating his authority to somebody else.

We tried very hard to get some way, in the most simple amendments we could present, of recognizing the role of the district health council because our concern is that the government, in this bill, has not spelled out the role of the commission and the way in which it differs from the district health council or is complementary to the role of the district health council. Where is the requirement that either the commission or the minister has to take into consideration the planning of the district health council? Yes, it exists. Yes, it advises. But it certainly isn't as powerful as the commission and there's nothing that directs, that requires either the minister or the commission to act on the advice, or even to take into consideration the advice, of a district health council.

We will support the NDP amendment. It's getting to the point where we are really basically trying to do some damage control on a piece of legislation that we think is really intolerable. We're hesitant to support "acting on the recommendations of a commission" when the roles and responsibilities of the commission have not been spelled out, when the minister still retains the ability to delegate his authority to that commission. But, having said that, we need at least some kind of minimal damage control and this is at least a step forward.

Mr Clement: One other reason why I think the amendment proposed by Ms Lankin does not meet with approval from my perspective is the elimination of the phraseology "in the public interest." I understand her point of view on this. She's made it evidently clear over the past three weeks of public hearings that she feels that this phrase is unduly broad and gives the minister undue power with respect to the decisions that have to be made. But I would remind Ms Lankin and the committee that there are in fact a number of statutes under the Revised Statutes of Ontario that have similar wording.

I would draw to the attention of this committee that under the Business Corporations Act there is language where there is a cancellation of the certificate of the business corporation if it is in the public interest. Under the Commodity Futures Act the commission body can recognize a self-regulating body if it's in the public interest. In the Conservation Authorities Act we're talking about water here -- water, the sustenance of life -- where the minister or his or her representative, if he considers it in the public interest, issue instructions --

Ms Lankin: On a point of order, Mr Chair: Just to try and facilitate things here, I'm quite willing to put the words "in the public interest" back in. Now Mr Clement can tell me why he's going to not vote for my motion upon the recommendation of the commission. That's the point really to be made in this.

Mr Clement: I'm a bit confused because that is at variance with what Ms Lankin was concerned about in our proceedings over the past weeks. I'd have to see the wording for that. Actually, quite frankly I said --

Ms Lankin: Mr Chair, on a point of order: If I could facilitate it, the exact same wording that is in Bill 26 except where it says "the minister may direct." In front of each of those words, you add the words "upon the recommendation of the commission." That's the point we would like to try and make here. That is the very last effort at damage control.

The Chair: Are you proposing an amendment to your amendment?

Ms Lankin: Yes.

Mr Clement: Thank you for trying to accommodate me. I believe I said at the outset that another reason I could not support the motion was the following --

Ms Lankin: I thought that's what you would do.

Mr Clement: I'll go back to the first reason then that I cannot support the motion as read. I think it comes back to that there's a dissonance between what we heard from the opposition -- and I'm not trying to paint Ms Lankin into a corner. I can't remember precisely whether she was on this point or whether it was Ms Caplan. Sometimes it blends together and I do apologize if I'm misspeaking your particular point of view. But there was a suggestion made by one of the opposition parties that in fact the minister should take responsibility for the actions of his ministry under this legislation and not delegate that power, and it seems to me that the language contained here is the exact opposite of that point of view. You have not convinced me. I understand your argument and I listened closely to your cross-examination of Ms Johns, but from my perspective you have not convinced me that this is not completely at variance with the position taken on the road.

Ms Lankin: What's wrong with this language?

The Chair: Mr Clement, are you finished?

Mr Clement: I am finished, sir.

Mr Phillips: Actually, just for the record, I did get elected to a hospital board. Mr Clement said earlier that -- I think he was sort of laughing about election --

Ms Lankin: That means you weren't a volunteer then.

Mr Phillips: Well, I was even a volunteer and I was paid every cent I was worth, of course. I think the public know you get no money for it. I actually ended up as chair of a hospital.

The only reason I say all of that is I think if you want to define an organization where the community feels strongly about it, it's a hospital, and that normally they're born -- in the particular case of the hospital where I was, there was an order of sisters who decided they needed a hospital in the community and from the ground up built it with the help of a lot of people.

I'm just saying that we have to be really careful in this process. I understand there are all the empty beds and we can do all the number tumbling here around, "There are 5,000 empty beds. That means we close 10 hospitals." Bang, bang, bang. Every single hospital that you plan to close, the history of it is such that it's there for a reason, people have put their hearts and souls into it, and this cannot be and should not be, and in the end will not be I think, a simple numbers game here. I think it's in everyone's best interests that we try and put together in this bill a process where, in the final analysis, the public are astute but they want to make sure this process is fair.

As I read the bill, the minister gets it every which way here, every way the minister wants it. If the minister thinks there's going to be a lot of heat, you get it off to the commission and you get the commission to do the dirty work and the minister cannot touch it: "Sorry, it's their recommendation. Don't blame me." But in this section, as I read it, the minister can completely bypass the commission and just decide that he is going to take the decision on the hospital. I don't know why the minister might do that, but I can speculate on some reason, and there is no public input into that. The minister may direct the board of a hospital.

I think what Ms Lankin was doing with her motion, and listening carefully I don't think it's inconsistent with what she said before, is saying the commission should look at this before the minister makes a unilateral decision. Let the commission make the recommendation to the minister. Maybe I'm misinterpreting the intent of the motion, but that's how I read it.

If we approve section 6 as it is, without this amendment, it seems to me the minister -- well, I'll ask Ms Johns; maybe that's the best way to get an answer. The way the bill is currently written, am I correct in assuming the minister may make that unilateral decision, that it would not be a recommendation of the commission -- 6(1), page 49 of the bill?

Mrs Johns: We have said, though, that the minister will take into consideration district health council reports or programs or --

Mr Phillips: Where do I find that language here?

Mrs Caplan: What section is that?

Mrs McLeod: It's not there.

Mr Phillips: Get the lawyer.

Mrs Johns: Oh, I see. It was in the commission that we talked about it. Okay.

Mr Phillips: But can you help me with where that --

Mrs Johns: But yes, the minister could make a unilateral decision if he so chose.

Mr Phillips: That's what I thought, and Ms Lankin's recommendation is that that not take place. We all know that there are some tough decisions by the minister, but I think what people are definitely worried about is that -- and the government's already told us -- this deficit is such a problem that you couldn't even wait. This bill was wanted to be passed by December 14, because it's such a desperate problem. We know how you feel about things. We know you are anxious to get some hospitals closed. We know that, you've said that. But why would you not want to adopt Ms Lankin's proposal that simply ensures that you have the commission to prepare the recommendation for the minister?

Mrs Johns: Because we want to move forward as quickly as possible with hospital restructuring. We want to be able to implement the process as quickly as possible to maintain health care in Ontario. If we don't move forward, some of these choices we won't be able to make because there's a demand for dollars within the whole health care system. We need to reallocate funds from the hospitals to other areas that people want in Ontario.

Mr Phillips: I appreciate that. I appreciate that's what you're saying. So of the hospital restructuring plans that you've got under way, how many would you see using these powers where you've got to move very quickly? How many of them would you see the minister making the unilateral decision on?

Mrs Johns: We would perceive that in almost all cases the decisions would go to the commission.

Mr Phillips: Why would you not then, if it's virtually all the cases, incorporate Ms Lankin's recommendation into your legislation? The only reason you would object to that is that the minister has up his sleeve wanting to move without the benefit of any commission.

1700

Mrs Johns: I feel like we're going around in a circle and I'm not sure where we are. Let me go through the whole process again. Maybe I've missed the point of this. The district health council will do local planning. It will come up to the minister. The minister will decide or approve a plan. It will go to the commission and the commission will implement the process. The commission is a body that needs to expedite the process and move forward with it. That's the way most of the 60 reports, or more than that by the time we finish, will proceed. Have I answered your question now?

Mr Phillips: No, because what you're asking for is the legislative authority to not do that. You're asking for the legislative authority for the minister simply to make the unilateral decision.

Mrs McLeod: What happens to the ones that aren't the most?

Mr Phillips: Frankly, I'm suspicious. My apologies, Mr Chair, for taking the time on this, but we thought you wanted the one blank cheque. Now you want two blank cheques. You want the blank cheque for the minister wherever he wants to send it to the commission and then wherever he wants to just do it himself anyway. It frankly is a bit frightening and your explanation has not been overly helpful. You gave me an explanation why you wanted this, which was: "We're setting the commission up. It's going to go to the commission." This has nothing to do with the commission. This gives you the authority to bypass the commission.

I'm actually wondering what in the world you are doing. You give a big explanation of the need for the commission in this process and then you essentially set up a completely parallel process that is contrary to what you said in the commission. Whoever drafted this -- I suppose it's a bureaucrat's heaven, because if we don't like one route, we take another route, and there's no appeal. We are going in circles primarily because you have no logic. You give us a logical explanation for one route, and then you set up a completely different route going the other way and you give us a completely logical explanation for that.

Mrs Johns: I feel that's happening too. One moment you're saying to me the minister shouldn't have the power and the next minute you're saying the commission shouldn't have the power. So you don't want anybody to have the power to restructure.

Mr Phillips: No, no, Ms Johns, you've not listened to me. I'm asking you why you want these two different processes. I'm not making a judgement on it. I'm asking you why you want the two different processes. You might have heard somebody else say that but you didn't hear me say that. Why do you want two what seem to be contradictory processes built into the bill?

Mrs Johns: We don't think they're contradictory processes. We believe that the commission may implement the results of a district health council study and may assist in the restructuring in a community or we believe that the minister may approve and allow the community to go forward and to work to create its own localized situation. We believe there has to be an approval level and an ability to implement on two levels.

The Chair: Mr Phillips, do you think we can get somebody else into this?

Mr Phillips: I certainly will, just because we know we will lose, they will win, and the logic of the argument means nothing here. They've got the gun, we're unarmed.

The Chair: Mr Silipo, can you contribute to this?

Mr Silipo: I'm going to try, Mr Chair, because, I tell you, I found following this exchange and a couple of previous ones quite frustrating. As a member of the opposition, I don't agree but I can certainly accept the position that Ms Johns has been taking, which is that the government feels they need to do this restructuring largely and almost unanimously through the restructuring commission -- I think that's what Ms Johns has been saying -- and that you don't see that the use of section 6 really will come into play except maybe in a couple of instances.

All this amendment is doing is -- it's not saying change one process for the other -- is saying that, in those instances where the minister chooses to exercise that power, he should take into consideration the recommendations of the commission, the same commission that will have done the bulk of the work, so that the government will still have the two choices available to it, the two routes.

They can choose to have the commission do all of the work, make all of the decisions, as Ms Johns has said, in which case, section 6, amended or unamended, would never come into being, would never come into use, because the commission will have used the power that the ministers will have given to it through regulation to simply do all of that. All we're saying through this amendment, and this is where it's completely consistent with that, is that where, instead, the minister decides to get involved directly, he should at least take into consideration the recommendations of the commission because the commission will have done some work in that area.

That is really the nub of it. That's why I find it really frustrating to understand what Ms Johns and the government are having trouble with as far as this recommendation is concerned. I don't know if Ms Johns wants to reply, but I guess I'd just put that again, because there isn't an inconsistency.

It doesn't say that the minister has to be involved in every instance; it simply says where he chooses to be involved, and you're giving him that power under your own drafting -- you're saying the minister can get involved directly -- he should at least take into consideration before he exercises his judgement the recommendations and the work done by the commission up until that point. What's the problem with that?

Mrs Johns: As we see it, the minister approves the plan in the first place, so why does it go to the commission and come back to the minister again? This is the quandary we're caught in, and I think it's a difference in the vision of how this restructuring committee is going to work that is the problem. I've tried to express it very clearly.

Mr Silipo: Are you saying, Ms Johns, that there are instances where the minister will choose not to have the commission involved at all?

Mrs Johns: Yes. If the local planning process is going through by itself and they can handle it by themselves, the commission may well not get involved. That's correct.

Mr Silipo: So you want a situation where, on the one hand, you have the commission involved to do all the work that you said, to make all the decisions around closing hospitals etc, and in some instances the minister will just make that decision on his own without even that work taking place.

Mrs Johns: The minister may say when Windsor comes to the table -- well, Windsor is a bad example because it has already happened -- but when Huron county comes to the table and says: "Here is my report. We have consensus. We would like to cease to operate one hospital," or, "We would like to bring services together," and says, "We can handle this," it will go forward, it will be a local-initiative-driven process.

1710

Mr Phillips: Put that in then.

Mr Silipo: Yes, I can see that in those instances your objection would be that the recommendation of the commission would mean that the commission would have to deal with it when it may be your intent not to have the commission deal with it.

The importance I think we're placing on this is that we feel before the minister exercises his discretion, he ought to take into consideration and there ought to be something in the legislation that says the minister just won't wake up one day and decide he's going to exercise his discretion without taking into account the work that's happened locally.

If that work has happened locally through a district health council, surely we can find a way to write that into legislation in a way that still leaves the discretion in the minister's hands, which you want to see, and in a way that assures us that at least the minister in exercising that discretion has considered the work that has been done by the community. We managed to do that earlier on in one of the amendments.

Mrs Johns: And we have done that by saying that the process will happen in the public interest, so we believe we have done that.

Mr Silipo: But you would not be prepared to amend this to even include a provision as harmless as the one we negotiated into the other section, which said, "having regard," I think were the words, "to the reports from the district health councils."

Mrs Johns: As I suggested before, if you have an amendment you're thinking of, we could talk about that. I can't come right off the top of my head. If you want to put something in writing, I'm prepared to look at it.

Mr Silipo: I just wonder, Mr Chair, whether it would be then acceptable that we stand this down and try to see if some acceptable wording could be arrived at.

Mrs Johns: This amendment I can tell you is not acceptable, so there's no sense in standing it down.

Mr Silipo: I'm looking for a way to hold the place, Mr Chair, because if we simply vote on this, we're not able to come back to it, I gather, under the rules.

The Chair: With unanimous consent we can come back to it.

Mr Silipo: That's fine. I'll defer to Ms Lankin on this, but certainly that would be my suggestion at this point.

The Chair: Mr Silipo has suggested that we deal with this motion but then have consent to come back --

Ms Lankin: Am I still on the speakers' list?

The Chair: Yes, you are.

Mr Clement: Where are we, though, Mr Chairman? I'm not quite sure where we are.

The Chair: I'm not quite sure either. Mr Silipo has suggested that we continue to deal with this motion but stand down any decision so that we can revisit it.

Mrs McLeod: The parliamentary assistant made it clear that they're not prepared to consider the amendment, so what do we gain by standing it down?

The Chair: We can't stand it down. The parliamentary assistant has suggested she's not in favour of standing down the amendment, she will not agree to that, so we have to continue to deal with the amendment, then we can make your decision after.

Ms Lankin: Ms Johns, you have on a number of occasions said in response to questions I've put or in response to questions Mrs Caplan has put that the minister probably wouldn't act independently on local district health council reports as they come forward from a local community, even where there's consensus, without the commission looking at it, because there are broader provincial interests and issues to be considered.

On a number of occasions when we said, "Gee, you don't really need this commission in all circumstances. There are communities that are proceeding and are going ahead," you said, "Yes, but we want that provincial body, that commission, to look at these reports and to make sure that there's some consistency in terms of how things are being approached from community to community, not to have a cookie-cutter approach, realize there are regional differences but some consistency, that we take a look at the savings that are going to be made because there's a process of provincial allocation, not just local allocation."

You argue both sides of every issue, which is really difficult, because when we said you don't need the commission in all circumstances, you said, "Yes, we do, because we have to have a provincial overview of this when we're proceeding to implement it." You also said: "The local district health councils can't implement. They're not an implementation body; they're a planning body. So we need the commission to be able to implement." But now you're saying, "Gosh, no, because you've recommended, Ms Lankin, that we have the commission make a recommendation to the minister." Now you're saying: "No, no, no, we can cut the commission out of it completely and the minister can do it simply on the basis of the local committee and they'll go ahead and they'll implement it." You keep arguing both sides.

You say I'm not being consistent in terms of my position around the powers of the minister. Let me come back to this. I've said on a number of occasions that I don't oppose the concept of a hospital restructuring commission. I don't think it's as necessary as you do, but I've said I wouldn't oppose it. But I said, "Let's get a process here." The minister should be making the decisions and the minister is the one who should be accountable. I don't think he should delegate his authority to make the decisions and to implement. I think he should be listening to the advice of district health councils and, if you're going to have a commission, the advice of the commission. But he's the one who should make the decision in the end. You've said no to that in some circumstances. You've said, "No, we want to be able to give the power to the commission and the commission can make the decisions and the commission can implement."

I had to fight to find the most weaselly words you would accept to get you to even agree that the commission would look at reports of district health councils. We've got that little, tenuous link now in the legislation.

But you're the ones who said: "No, it's not the minister who's going to be the final arbiter here. We want to give that power to the commission." I disagreed with that, but I also argued that when the minister made the decision, it should be an informed decision; it should be informed by local planning processes and, if you want this other step of the provincial perspective, the commission, that should be it.

My amendment is entirely consistent with that. It doesn't undermine the decisions you've taken. You still have delegated the power to the commission where you choose to do that. That's fine. I don't like that, but you've done it. But it says where you're going to have the minister act -- back to my argument -- it should be informed. It should be informed by somebody. The previous amendment from Mrs Caplan was informed by the district health councils. You said, "Oh no, no, it can't be by the district health councils because the commission's out there." So I've said, "Then informed by the commission, which has to have regard to local district health council reports," and you say: "No, no, no. The commission may not be involved because the minister may listen to the district health council."

Can you understand why this is so frustrating and why it's so totally unacceptable for you to say to us, "Well, go away and write another amendment and come back"? Are we going to play pin the tail on the donkey here? There's a simple request here to have the minister listen to the recommendation of the commission you're establishing, of the commission you have put all your faith in. When Mr Phillips asked why you need the minister to be able to do this, you said: "Because we want to move forward" -- I've almost got your words memorized, I've heard them so often -- "We have to be able to restructure hospitals. We have to be able to do it quickly. We have to be able to do this." It's the exact same answer you gave me when I asked you why you needed the commission.

What is it you want? Absolutely no process set out in legislation? That's what I come down to -- no process set out in legislation. Why don't you just have one line in this act that says, "We want to be able to do anything we want, whenever we want it"? Then we wouldn't have to quibble for so long about all these other sections. You've not put in any due process.

I want people to understand that all this amendment does is add the words "upon the recommendation of the commission," if the minister's going to exercise these powers to close or merge hospitals. That's all it does. And if we ever get to two sections down from this in this particular section, we've added what the recommendation of the commission shall look at. It will "be based on consultations between the commission and a district health council and on the advice and recommendations the commission received from the council as a result of that consultations." It doesn't bind them, but they have to consult, they have to talk, they have to listen. You've said all along that's what you expect will happen, that that's the process.

It would have to "include a labour adjustment plan for all health care workers, including physicians, who are affected by the proposed hospital closure or amalgamation or the proposed reduction in services." You will remember all of what we heard in terms of concerns, that where you're going to close or merge a hospital, what about the labour adjustment plans and particularly what about the revocation of privileges for physicians? You said: "No, no, no. If it's legit, the work's going on over there, there should be a physician human resource plan where the physician follows it."

And it includes a report prepared by the commission which sets out the commission's reasons.

1720

I think the real reason you are refusing to support my amendment is because you don't want to have any kind of process at all. This is a process that would say there's some public scrutiny and would say there's 30 days before the minister actually implements an order under this section. You're prepared to give 30 days' notice to the hospital. I'm saying, give 30 days' notice to the public and let the report and recommendation of the commission see the public light. Let the public see the recommendation for 30 days.

You don't like that. I think that's the real reason you won't support this. All your arguments that, "We need to move quickly; we need to restructure hospitals; we need to do this" -- you need some restrictions on unbridled, unfettered powers that you're taking on to yourself in the Ministry of Health. You need some restrictions on that. You need some due process that at least ensures that you hear what people say locally and that you tell them in advance what it is that you're going to do about what they've said.

This is the minimalist approach to getting due process. There are many other concerns I raised during the weeks we were on public hearings. This is an attempt to deal with the bill that we know you're going to ram through and pass, to minimize some of the damage and set some minimal standards of public scrutiny. That's all this does.

Mrs McLeod: I get a sense that we're not likely to make much progress on this issue. I don't know why it has to be so confusing, particularly for anybody who has been on the health subcommittee, because there were two concerns that were expressed almost universally. One is that the Minister of Health should not have the power to delegate to a non-elected body or individual decision-making capability, that ultimately that decision-making ability must rest with the elected member of the government responsible for the ministry. We proposed amendments to respond to that concern; we lost; that's not what we're debating now.

Then we move to the second concern, which was that in those areas where the Minister of Health keeps his ability to make the decisions unilaterally -- because he doesn't have to delegate, and you've made that clear; it's still an option for the Minister of Health to act unilaterally -- he should not be able to do that without reference to either the DHC or the commission or at least his own cabinet.

You've made it clear that you want the minister to have the power both to dump his decision-making responsibility on to someone else or to act unilaterally without reference to anybody else. As long as those are your bottom lines, any amendments we propose to respond to those two concerns are going to be lost, and we might as well move on.

Mrs Ecker: I appreciate and sympathize with the opposition as they attempt to understand what is very important legislation. I'd also like to say that I understand the opposition agree, that restructuring is necessary, that there may well need to be, across the province, amalgamations, mergers or closures, yet you've objected to the powers the minister has in the legislation to make that happen; you don't agree he should have that. Yet when there is an opportunity for the minister to delegate this to the commission, you don't agree it should be delegated to the commission. I guess I'm having a little difficulty understanding exactly how we should be making these decisions.

Mrs Caplan: That's provoked me. I wasn't going to speak to this --

Mrs Ecker: I have the floor, Mrs Caplan, thank you very much. We all agree the restructuring needs to happen. The minister in this legislation is clearly ultimately accountable for the management of the process. He is the Minister of Health. The legislation clearly says those powers are his.

Mrs McLeod: To delegate as he sees fit.

Mrs Ecker: I have the floor, Mrs McLeod. It is interesting to note that many of the people who did come before us -- I remember this very clearly -- said they actually trusted this particular Minister of Health. I say that for the record, because I found it a very interesting point. He is clearly accountable for the management of the system. He has these powers. In this legislation, he chooses to delegate these powers to the commission to do a task which is very important, to do a task which one person as a minister could not logistically, feasibly do as one individual.

The time that will be taken to meet with the local communities, to go over the reports and the data -- I'm certainly familiar with the restructuring exercise. It's happened in my own region, and with the number of individuals who have to be involved in that process, the time that has to be taken to make sure it's done right, I really think we don't want the Minister of Health to spend the rest of his or her time for the next four or five years sitting down going through all the nitty-gritty of 60 restructuring plans that are coming in.

The commission will be a very helpful process to assist him in doing that by being able to go and make those decisions. But ultimately, he is accountable: He is accountable for the commission; he is accountable for the powers he has delegated to the commission; he's accountable for the people who will be appointed to the commission, a group of individuals who will have the time and expertise to do the job.

He's also choosing the commission route, I believe, because one of the concerns that has been heard is about the politicization that can happen when you get into a local area and try and make decisions about who shuts what hospital or how things change. That's an extremely difficult thing for any community to accept and to go through. He is choosing to not have that politicization happen, again by using the route of the commission, because I believe that is an effective way to do it.

The other thing I would like to point out is that we do have process. There's process for closure and notice to hospitals when this has to happen, opportunities for hospitals to make representation. That is there, and I think this will be an effective tool for us to get on with the restructuring of the system, which we all agree needs to be done.

Mrs Caplan: I was provoked by Ms Ecker because she clearly, and I think deliberately, although I don't want to impute motive, misrepresented exactly what she knows is not what we have been saying. She has deliberately tried to distort what we have said.

I want to be clear and I want to be on the record. I, as a former Minister of Health, do not believe that any one person, whether it is Jim Wilson or any minister of the future or any minister in the past, including myself, should have all the powers contained in this bill. Not only do I believe that no minister should have those powers, but I don't think all those powers are necessary to restructure the health system and create a health system in the province.

Clearly, there are some changes that need to be made and we have put forward proposals for changes and actually supported updated wording on funding powers and so forth. What is needed is some process for how that's going to happen, and ultimately, it is the accountability of the minister. He cannot distance himself so that there's no political storm about this. If you don't think communities are going to be concerned and want political accountability for decisions made, they will. And if you think setting up an unaccountable, unelected commission -- we've heard they want it to be arm's length -- is going to diminish the political accountability of your minister, you're nuts. The government is going to be accountable for every decision that commission makes because it appoints them, gives them all the powers. And let me tell you something. You're making a big mistake if you think the communities don't know that this is a deliberate attempt to protect your minister from having to make those decisions.

We have said consistently that the minister must make the decision, the minister must be accountable. There must be due process. You have eliminated most of the due process protections. If you want to depoliticize and get support in the community, for God's sake, build in, in the legislation, the role of the district health council and the local planning body.

You've given the minister in this bill -- and we've heard from your parliamentary assistant the confirmation that he doesn't have to wait for a report from the district health councils. He does not have to have any recommendations. He can act unilaterally without any authority. He can direct by regulation and give a mandate to a restructuring commission to do his will, without any due process in the community, without anybody at all advising him. That's what this bill says. He can do it. That is unprecedented in the history of this province.

1730

I want to be very clear. We all understand the need for restructuring. The only person in this province who said he didn't believe there was a need to close hospitals was Mike Harris, who said, "I have no plan to close hospitals." Everybody understands and accepts the need to restructure.

We do not believe the minister should have absolute and unfettered powers, to have the ability to influence and micromanage every aspect of the delivery of health services in the province in the name of restructuring. We are certainly willing to discuss and consider appropriate mechanisms for arriving at those important restructuring decisions. We believe the district health councils should be advisory but that the minister should ultimately make the decision to accept or reject or amend their decision. We believe there can be a restructuring commission, but the minister should not be able to delegate his powers but give them their authority by virtue of accepting their recommendation.

Am I clear? Do you understand what we are saying? Do not distort what we are saying. This is too serious to play stupid, partisan political games. Do you understand? That's what you are doing. You are being deceitful when you tell people what our position is when that is not so. I want to be very, very clear. I feel very strongly about this. I was not going to speak to this amendment, but you deliberately distorted our position.

The minister must be accountable, there must be due process and there must be the ability for community participation. This bill does not do any of that. If you want my support for any of it, you'd better God-damned well fix it.

Ms Lankin: Mrs Ecker spent a considerable amount of time explaining why the government wanted to be able to delegate powers to the commission. We dealt with that hours ago. I still am disagreeing with that aspect of it, but that's done and dealt with.

But, Mrs Ecker, you made some very interesting arguments. If I can replay them to you quickly, you talked about the fact that there's going to be extensive work involved in the restructuring process and meeting with communities and consultations and the minister couldn't be tied up doing all of that. You also said it should be depoliticized, that there should be a group that can make recommendations based on the best interests of that community. We've been saying that in terms of the DHCs, but you're saying that in terms of the commission. Okay.

Now tell me, with all the arguments you made, which were the most articulate and eloquent arguments made yet in defence of my motion for amendment which says that the minister, if he's going to do this, should do it upon the recommendation of the commission, could you tell me, could someone tell me -- I should come back to you, Mrs Johns -- what is wrong with my suggestion that, where the minister is going to exercise these powers on his own, he at least has a recommendation from the commission, which is the body that's going to be having all the expertise, building all the expertise in this?

What's wrong with that? It doesn't change anything else you've got in there. You agreed to the minimalist fact that the commission, where it's going to act, has to have regard to local district health council reports. It took a lot of effort to find the mildest words you could agree to there. Now I'm asking you to look at what's pretty mild, that where the minister is going to act, that at least he listen to a recommendation from his commission, which is the body you've established, that you've vested all the powers in, that you say is necessary to move things forward, that you say is going to have all the implementation expertise; that's where it's going to be. Why is it a problem? Why is this language a problem? What problem would this cause in your system of moving ahead and getting things done quickly?

Mrs Johns: I'll try this again. What I think is being recommended here is that district health councils do reports. They find out what the people in the local community want. Now you're suggesting that the commission takes that same role and redoes what the district health council has done?

Ms Lankin: Mrs Johns, with all due respect, that doesn't say that at all. I mean, you keep --

Mrs Johns: We've already ascertained that we will at least consider what the district health council reports. We approved that amendment.

Ms Lankin: The commission will, not the minister.

Mrs Johns: We've already suggested that we will look at those district health council reports. I have told you that we believe the minister will look at those district health council reports and consider them also.

Ms Lankin: But you refuse to put that in the legislation. I don't know how many times here in response on this one amendment you've said the process is that the local district health council will do its report, it will go to the minister, the minister will approve it, then the minister will give it to the commission and the commission will implement it. You've said that over and over again. Guess what? That's not in the legislation. Would you like to put that in the legislation, because that's what you keep telling us is going to happen?

If you would agree to put that in the legislation, I'll withdraw this amendment and the other amendments that I have on process, because mine are much less satisfactory to the public and the communities of Ontario that are doing work on it than what you say is going to happen. If you'd agree to put that in the legislation, I think we could move on fairly quickly and take a whole lot of these other amendments off the table.

Mrs Johns: I'm just telling you what we're planning to do.

Ms Lankin: Would you put what you're planning to do in the legislation?

Mrs Johns: We believe we have done that.

Ms Lankin: Would you tell me where in the legislation it indicates that the minister will review a local district health council report and approve it? Where does it say that?

Mrs Johns: Since we have district health council reports and they're being prepared in 60 communities, it would seem to me that someone will review them to be able to make decisions on that. That process was always there, is still always there. We have not touched that process.

Ms Lankin: No, but what you've done is you've set up other layers of processes. You've set up a commission, you've set up a process for someone to be appointed to review the commission, so you've got all these levels that you've set up. What's interesting is that you've refused to build the direct linkage to those district health council reports. But I digress. That's already done. You already refused that. We've already passed that section. You've already passed the section to delegate the powers.

Now we're here at the section where the minister is going to act and you've made it very clear that someone other than the minister is going to review all of those local district health council reports and that someone is the commission which has the implementation expertise. Please tell me what's wrong with the minister, if he's going to actually go in and close a hospital on his own, at least talking to the commission. Maybe it's because you have to use that other section where you appoint two people to look at what the commission's doing and then to report to the minister because you don't envision the minister can actually talk to the commission. I'm sorry, I am getting facetious at this point in time.

Interjection.

Ms Lankin: Well, I'm sorry. What is wrong --

The Chair: Ms Lankin.

Ms Lankin: Please answer the question. What is wrong --

The Chair: With all due respect, I think we've plowed this field quite enough. We're not making any progress at all here. The same question is being asked.

Ms Lankin: That may be your opinion, Mr Chair, that we've plowed this field enough. I don't know where you get off having a right to interject in this process with respect --

Mrs Ecker: He's the Chair.

The Chair: The same question has gone back and forth several times.

Ms Lankin: -- to whether or not my questions have been answered. We have had a parliamentary assistant who has given different answers every time the question is put, who has not been acceptable in terms of the performance of providing us with information, has not in fact answered the questions that we have tabled with respect to our amendments and has sat here and said in two different breaths, two different answers with respect to this amendment and refuses to tell me what is wrong with this amendment.

For God's sake, Mr Chair, we are trying to have some kind of due process put in this legislation so that communities know that the work they're doing is going to be listened to so that the experts you're putting in place and the expertise you're putting on to these commissions are going to have some relevance to decisions being made by the minister.

I come back to the point I made. You may as well have a damn act that says, "I'm going to do anything I want, when I want," end of clause, because that's all you do in every section.

Mr Clement: On a point or order, Mr Chair: I believe it is part of your responsibilities, if I'm not mistaken, and I stand to be corrected, to ensure that full and fair debate has occurred, and make a determination that if it has occurred we should move on. I encourage you to make that determination in this particular case.

The Chair: Basically, I'm in the position of suggesting things. Ms Lankin obviously didn't agree with my suggestion.

1740

Mr Silipo: Mr Chair, we've had a discussion on this, as I think you've noted. I just want to make the point as clearly as I can and I'm going to move an amendment to Ms Lankin's motion, which makes it fairly clear. What we'll see on the basis of that amendment is what the government's position really is.

I move that in the two parts where the words "upon the recommendation of the commission" appear, in 6(1) and 6(2), we insert right after the word "commission" "or having regard to district health council reports." So the subsections would now read, "upon the recommendation of the commission or having regard to district health council reports, the minister may direct" etc. That makes it clear that the minister would look either at the recommendations of the commission or, where there are no recommendations because there is no commission, would at least have to have regard to the district health council reports.

I chose those words specifically, Mr Chair, because they are the same words that we did get agreement on from the government in the earlier amendment. So that's what I'm putting, and I think we will see very clearly from the government side -- if they're true to what they're saying they should have no problem whatsoever with this amendment to the amendment.

The Chair: A quick point of clarification, Mr Silipo. The terminology "upon the recommendation of the commission" appears in all three sections. Are you suggesting a change to all three sections?

Mr Silipo: I'm sorry, wherever it appears. Yes, in the three. I said two; you're quite right.

The Chair: Mr Silipo has moved an amendment to Ms Lankin's motion.

Ms Lankin: Actually, Mr Chair, I'm pleased to accept that as a friendly amendment. I don't think you need to vote on it as a subamendment.

The Chair: Thank you, Ms Lankin.

Ms Lankin: May I indicate that the answer we heard from the parliamentary assistant was that she couldn't support my amendment because it said "upon the recommendation of the commission," and that there are times when the minister was going to act, without going to the commission, directly on the recommendations of the local district health councils. So if that was the real reason, then we've solved her problem.

Mr Silipo: The wording would be to add, right after "upon the recommendation of the commission" in the three places that appears, "or having regard to the district health council reports."

Mrs Ecker: With all due respect, Mr Chair, we have been through this. We have provided the answer. I have said, for example, that the minister is ultimately accountable for this, remains ultimately accountable for this. Quite frankly, I don't think that the amendment is at all helpful to this motion, because the legislation clearly states the role of the district health council, clearly states they are there to advise, to make recommendations, to plan, to the minister. That is still there.

So the minister has within his power now, as he does under the old legislation and will have under 26, the ability to listen to and respond to the district health council recommendations according to how he may decide he needs to respond to them. I don't think we need to bring in another amendment to make something possible that is already there. I'm sure at this stage of the game if we couldn't have an amendment that said the sun was going to come up in the morning tomorrow, you wouldn't think it was going to happen. So I don't think I can support that amendment to that motion.

Ms Lankin: I actually would like to hear from Ms Johns in terms of this amendment because she has said there was only one reason why she couldn't support "upon the recommendation of the commission," and that's because the minister may sometimes act without the commission having to be involved directly on the advice of the local district health council. We've now covered that off. Unless she's saying that the minister is going to act unilaterally, and every time we asked her if that was the intent of this section she said no, that was not the intent of this section -- unless in fact that was your intent, you will see that we have met your concern about the ability of the minister to act where there is a consensus in the local community and, "The report's been provided to me to approve and you don't need to involve the commission." So please tell me whether or not you will now support this amendment, and if you won't, why you won't. That was a specific question to the parliamentary assistant.

Mrs Johns: We'd like to stand it down and have a look at it, please.

The Chair: Do we have all-party unanimous consent to stand the amendment down? Agreed? Okay.

The next amendment we will consider is a government amendment.

Mrs Johns: I move that section 6 of the Public Hospitals Act, as set out in section 6 of schedule F to the bill, be amended by adding the following subsection:

"Notice of intention

"(4.1) At least 30 days before issuing a direction under subsection (1) or (3), the minister shall serve notice of intention to issue a direction on the board of the hospital to which the direction will be issued."

Subsection (1) is where a hospital ceases to operate and subsection (3) is a direction for amalgamation. We're suggesting that with either of those two issues we will serve notice that we are giving 30 days before we proceed with either of those two issues.

Ms Lankin: I'll start with a question about procedure. I suspect the next motion for amendment that will come forward, which is one I'll be moving, will have to be stood down as well because it relates back to the question of "on the recommendation of the commission," which you just stood down. It contains within it a limitation, "that at least 30 days before making a direction under this section." That's all of section 6, not just the two sections that the parliamentary assistant referred to with respect to 30 days' notice to the hospital involved.

I just want to be clear that that motion wouldn't be ruled out of order, contrary to the motion that Mrs Johns has just moved. I don't think it is, but I just want to be clear on that before we proceed, otherwise I would think all three sections together should be stood down to be looked at.

The Chair: While that determination is being made, in actual fact, the next motion after this one would be the Liberal motion 33a, just a technical change. There are two out of order here.

Ms Lankin: My question still stands with respect to 33. We need that clarification before we can proceed.

The Chair: It seems to be a question that is going to take a recess to get an answer to, Ms Lankin, so we're going to take a 5-minute recess.

Mrs McLeod: I just wanted to make two requests, if you consider them to be in order. The first is that the clerk's office would provide us with a list of the amendments that have been stood down so that we can know which amendments are outstanding and how they'll relate to future amendment consideration. I'm concerned that we're going to lose track.

The second is that we obtain a list of all questions that have been tabled in both subcommittees, with some indication of which of those questions have received an answer and which go unanswered at this point.

Mr Phillips: Are we having a break?

The Chair: Yes, we are now.

The committee recessed from 1750 to 1753.

The Chair: The answer to your question, Ms Lankin, is that passing the amendment we're talking about now would not rule your amendment out of order.

Ms Lankin: Okay.

Mrs Caplan: I'd like to place on the record a copy of a letter written by one of the presenters.

The Chair: Is this in connection with the amendment that we're looking at?

Mrs Caplan: It's just placing questions on the record to be answered in writing.

The Chair: We are dealing with an amendment.

Mrs Caplan: When would be an appropriate time for me to do this?

The Chair: Between amendments.

Mrs Caplan: That's fine.

The Chair: Mrs Johns has moved an amendment. Ms Lankin, you were asking whether or not I would rule your amendment out of order. Do you have any additional comment on Mrs Johns's amendment?

Ms Lankin: No, thank you. I have no problem with Mrs Johns's amendment.

Mrs McLeod: We will support this amendment only because it is minimally better than nothing at all, but I can tell you, I don't think this amendment is going to provide any reassurance at all to people in communities when the Minister of Health comes in and exercises all of these powers which continue to exist under the act, because virtually every other amendment we've proposed to put a check on the powers has been defeated. So as the minister takes unto himself the power to come in and say, "I'm closing your hospital, but I'm going to give you 30 days' notice," I don't think there's going to be a lot of reassurance in that.

The Chair: Any further discussion on the amendment? Shall the amendment carry? The amendment carries.

Mrs Caplan: I received a copy of a letter written by one of the presenters, Ms Elizabeth Margles. I'd like to table it. It was written to the minister and has 12 questions. The minister is preparing answers to this, but I'd like them presented to the committee and tabled for our information as well. Thank you very much.

The Chair: The next amendment is a Liberal amendment, page 33A.

Mrs Caplan: I'll read this into the record, on schedule F, section 6.

I move that subsections 6(5) and (6) of the Public Hospitals Act, as set out in section 6 of schedule F to the bill, be struck out and the following substituted:

"Amend, revoke direction

"(5) Upon the recommendation of a district health council and subject to subsection (6), the minister may amend or revoke a direction made under this section to a hospital in the jurisdiction of the council where the minister considers it in the public interest to do so.

"Limitation

"(6) The minister shall not make a direction under this section or amend or revoke such a direction unless, "(a) the Health Services Restructuring Commission established in section 8 of the Ministry of Health Act has completed a human resources study on the effects of the proposed hospital closure, amalgamation or of the proposed reduction in services on nurses and other hospital staff and has proposed a transitional labour adjustment plan for nurses and other affected hospital staff;

"(b) the recommendation of the district health council upon which the direction, amendment or revocation is based is published in the Ontario Gazette and a notice of the recommendation given to the board of an affected hospital and to every physician with hospital privileges at the hospital;

"(c) the publication in the Ontario Gazette and the notice referred to in clause (a) states that public hearings shall be held with respect to the recommendation and states the time and place of the hearing; and

"(d) the minister has held public hearings with respect to the recommendations.

"Recommendation

"(6.1) A recommendation of a district health council referred to in subsection (1), (2), (3) or (5) shall include,

"(a) assessments of community needs with respect to health services and of the impact on the community of any proposed hospital closures or amalgamation or reduction of services, as the case may be;

"(b) analysis of hospital human resource plans with respect to physicians;

"(c) economic analysis of ways of delivering health services in the jurisdiction of the district health council, including studies as to the impact of the proposed hospital closure or amalgamation or of the proposed reduction of services, as the case may be;

"(d) assessment of the effect the proposed hospital closure or amalgamation or the proposed reduction of services, as the case may be, will have on physicians providing services in the hospital and proposals as to how to remedy such effects; and

"(e) discussion of alternatives to the proposed hospital closure or amalgamation or to the proposed reduction of services, as the case may be."

The Chair: In view of the hour, we are adjourned until tomorrow morning at 10 o'clock.

The committee adjourned at 1759.