INQUIRY RE MINISTRY OF HEALTH INFORMATION
CONTENTS
Tuesday 10 March 1992
Inquiry re Ministry of Health information
Honourable Shelley Martel
STANDING COMMITTEE ON THE LEGISLATIVE ASSEMBLY
Chair / Président(e): Offer, Steven (Mississauga North/-Nord L)
Vice-Chair / Vice-Président(e): Miclash, Frank (Kenora L)
Bisson, Gilles (Cochrane South/-Sud ND)
Christopherson, David (Hamilton Centre ND)
Conway, Sean G. (Renfrew North/-Nord L)
Eves, Ernie L. (Parry Sound PC)
Harnick, Charles (Willowdale PC)
Hope, Randy R. (Chatham-Kent ND)
Mills, Gordon (Durham East/-Est ND)
Murdock, Sharon (Sudbury ND)
Owens, Stephen (Scarborough Centre ND)
Scott, Ian G. (St George-St David L)
Substitution(s) / Membre(s) rempliçant(s):
Tilson, David (Dufferin-Peel PC) for Mr Eves
Elston, Murray (Bruce L) for Mr Scott
Kormos, Peter (Welland-Thorold ND) for Ms S. Murdock
Wood, Len (Cochrane North/-Nord ND) for Mr Bisson
Also taking part / Autres participants et participantes:
Edwardh, Marlys, counsel, Ruby and Edwardh
Clerk / Greffier: Arnott, Douglas
Staff / Personnel: Jackson, Patricia, Committee Counsel
The committee met at 1005 in room 151.
INQUIRY RE MINISTRY OF HEALTH INFORMATION
The Chair: Good morning. I will call the morning session of the Legislative Assembly committee to order.
Members will be aware that on the agenda this morning our first witness is Mr Harfield. I have been advised that Mr Harfield has taken ill. He is in the emergency ward of a hospital and, as such, our first witness today will be the minister. In keeping with giving some fair notice, we will be recessing this committee meeting until 11 o'clock, at which time the minister will be the first witness called. We will recess for one hour.
The committee recessed at 1006.
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The Chair: I call the standing committee on the Legislative Assembly to order. As a preliminary matter, I would like those in the media to first recognize that any flash photography, as indicated on the side notice, throws off the lighting for those who are watching through the cable television. Also, we ask those with cameras to move behind committee members so that it will be less distracting to members of the committee and to our witness and counsel.
HONOURABLE SHELLEY MARTEL
The Chair: I would like to welcome the Minister of Northern Development and Mines, with counsel, this morning. Madam Minister, it has been the practice of this committee that before any questioning by our counsel and rotation, an oath is administered. I would like to invite the clerk of the committee to administer that oath at this time.
Shelley Martel, sworn.
The Chair: Thank you very much. Minister, if you could, for Hansard's purposes, introduce counsel.
Hon Miss Martel: My counsel is Marlys Edwardh.
Ms Edwardh: Good morning, Mr Chairman.
The Chair: Good morning, Ms Edwardh. Prior to inviting our counsel, Patricia Jackson, to commence questioning, I would like to inform you, and it has been done to all witnesses before this committee, that in the event you are asked a question you cannot properly answer without divulging confidential information, could you or your counsel please advise this committee. If there is not a way to disclose this information without divulging confidential information, then the matter may be addressed in an in camera session.
Having said that, I invite our counsel, Patricia Jackson, to commence questioning.
Ms Jackson: Ms Martel, I understand that you have been the Minister of Northern Development since October 1, 1990.
Hon Miss Martel: That is correct.
Ms Jackson: And that in July 1991 you had added to your portfolio the Ministry of Mines.
Hon Miss Martel: That is correct as well.
Ms Jackson: And that from October 1, 1990, until you had that additional portfolio added to your responsibilities, you were also the government House leader.
Hon Miss Martel: I was.
Ms Jackson: You were first elected, I think, to the Legislature in 1987.
Hon Miss Martel: That is correct.
Ms Jackson: And before election you worked briefly with the Workers' Compensation Board in Sudbury.
Hon Miss Martel: Yes.
Ms Jackson: And before that you were involved, first of all, from 1983 to 1985, in obtaining your BA in international politics at the University of Toronto.
Hon Miss Martel: Yes.
Ms Jackson: And following that spent a year at the Université de Paris-Sorbonne doing a course in French language for foreign students.
Hon Miss Martel: Yes. That is probably the briefest chronology you have had of anyone.
Ms Jackson: Madam Minister, you began first to know of the threshold agreement that has been the subject of so much discussion in these proceedings between the Ontario Medical Association and the Ontario government in what context?
Hon Miss Martel: I was a member of, and continue to be a member of, the policy and priorities board of cabinet, and the agreement came into that particular group many times during the course of the negotiations between the OMA and between the government. So I was part and parcel to the decisions which were being made with respect to the government position on this matter.
Ms Jackson: And as a result of that, acquired a rather general working knowledge of the nature of the agreement, did you?
Hon Miss Martel: Yes, I would think so.
Ms Jackson: Did you become familiar with its specifics and in particular how the threshold was to operate?
Hon Miss Martel: Yes, I did, although I should say to the committee as well that it was not until I was first approached by one of the physicians who would be affected by it that I looked in greater detail and reviewed the information and the agreement that we had signed with the OMA. So I want to make it clear to people that I had a general working knowledge of it but it was not until I was approached by people in Sudbury that I took a look at it again and got much more in depth with it.
Ms Jackson: All right. And the approach that you had from a doctor was from whom?
Hon Miss Martel: Dr Abdulla. He is the head of the cardiology unit at Memorial Hospital in Sudbury.
Ms Jackson: Do you recall when that approach first took place?
Hon Miss Martel: Yes. Dr Abdulla, for many weeks after the agreement was signed, went through it on his own and reviewed the information and he came to the conclusion that not only himself but the other four cardiologists at Memorial Hospital, plus the cardiac surgeons at the hospital, would probably all be over the threshold by the end of the fiscal year. And so on behalf of the four other cardiologists and himself, he prepared a brief which he forwarded to the Ministry of Health at the end of June, and that brief was fairly comprehensive. It detailed what they did and why in fact they would probably be over the threshold, and requested the Minister of Health to make an exemption to those five cardiologists and the cardiac surgeons at the hospital.
Dr Abdulla, while he does not live in my riding, has had several occasions to deal with me in my capacity as member for Sudbury East. He forwarded a package of this information to me and asked for my support with his request for exemption to the Ministry of Health.
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Ms Jackson: You have been good enough to provide us and will distribute to the committee a copy of that request for exemption, which I think came to you by letter dated June 12.
Hon Miss Martel: Sorry, I cannot remember the actual date on which I received it.
Ms Jackson: We will have it in front of you in a minute.
Hon Miss Martel: Thank you.
The Chair: The document being distributed is going to be marked as exhibit 97.
Ms Jackson: As I understand it, Ms Martel, there was a response to that letter on June 27, which I will ask also be put in front of you.
The Chair: The next document being distributed is to be marked as exhibit 98.
Ms Jackson: Ms Martel, can you identify the letter of June 12 and the attached supporting information as the material your office received, it would appear, around June 17, 1991?
Hon Miss Martel: Yes, it is.
Ms Jackson: And the letter we have marked as exhibit 98 is your response to that letter?
Hon Miss Martel: Yes. May I make a comment about the response?
Ms Jackson: Yes.
Hon Miss Martel: Thank you. I was a bit negligent in outlining specifically to my staff what request they should make of the OMA. We wanted to not only write to the Ministry of Health and explain our support to the Ministry of Health, we also thought it would be a good idea to express to the OMA my support for the cardiologists in question.
However, when we did write, there was a suggestion that we were writing to have cardiology services declared underserviced, and that was not correct. That was my fault in giving not very good information to my staff on how to phrase the letter. What we had wanted to do was contact the OMA, determine if there was a way we could provide our support for the doctors, because we knew the OMA was also jointly negotiating with the province with respect to the exemption. So the letter is a little bit bizarre but that was my own fault in not giving quite adequate instructions to the staff about what requests they should make to the OMA.
Ms Jackson: What was your understanding at this point in time as to the implications of a specialty being on the underserviced area program in relation to the threshold agreement?
Hon Miss Martel: At that point, only the fact that a specialist who was on the underserviced area program at the time the agreement went into place was in fact exempt from the threshold for the whole period in which he or she was in the program.
Ms Jackson: With respect to cardiology, I take what you are saying to be an indication that you were looking for some other solution for the problem of cardiology than just the exemption that would be available under the underserviced area program.
Hon Miss Martel: No. I should be more explicit. It sounds like what the letter says, but at this point in time, what I wanted was to write to the Ministry of Health and to the OMA and express my support as the MPP for Sudbury for an exemption as per the request from Dr Abdulla. The changes in terms of allowing those people who were in designated underserviced areas came much later on as a response to the situation in Sudbury. But at the time when I wrote, that was not in my mind.
Ms Jackson: That is as I understood it. In fact what you were doing, as I understand from what you are saying, was trying to get or supporting an exemption under the second branch of exemptions that we have heard was available under this agreement, namely, the opportunity for the minister to grant exemptions by specialty and by region.
Hon Miss Martel: That is correct. Under section 10 where --
Ms Jackson: What you are saying is, that is what you were trying to do, and the third paragraph of this letter may be misstating the case to some extent.
Hon Miss Martel: Yes it does, and that is what I wanted to make clear to the committee.
Ms Jackson: And then subsequently, I believe on September 10, you forwarded a letter to the Ministry of Health in support of this request for an exemption. Could I ask that that be placed in front of you and members of the committee, and as well I guess the companion letter to Dr Abdulla of the same date. We seem to have located the copy of the letter to Ms Lankin which you wrote on September 10, and let me start by asking you to identify that as a letter of support.
The Chair: For members of the committee, that is going to be marked as exhibit 99.
Ms Jackson: On the same day as you signed this letter, Ms Martel, I understand that you wrote a letter to Dr Abdulla confirming that you had written to the minister supporting his request for an exemption.
Hon Miss Martel: Yes, I did.
Ms Jackson: We do have a copy of that letter and we do not seem to have enough copies to distribute, and we will take care of that at lunchtime. Maybe we could reserve, Mr Chairman, exhibit 100 for that letter, which will be distributed when we resume at 2 pm.
The Chair: That will be done.
Ms Jackson: Now, after that sort of exchange of correspondence in relation to the cardiologists, could you tell the committee, Ms Martel, when your next awareness of the threshold agreement being an issue in Sudbury or for Sudbury doctors came about?
Hon Miss Martel: In about mid-October of 1991, the constituency office received a call from Dr de Blacam. Dr de Blacam, as I am sure the committee has heard, is the president of the Sudbury and district medical association. At that time, Dr de Blacam indicated that there would be a problem with a dermatologist -- he did not name the dermatologist -- and would I be prepared to meet with him to discuss this matter. I was away at the time, so my constituency assistant, Miss Morris, took the information down and told him she would discuss it with me and then would call him back with a time for an appointment. When I got back, we went through a whole list of appointments. This was one, and I agreed to have a meeting with him. At that point, Miss Morris called him back and suggested that we would be prepared to meet, gave him a time, and left it up to him to determine if he would like to come in to see me. He did not follow up on that, and I do not know the reason for that.
Ms Jackson: You made reference to your constituency assistant. That is Kim Morris?
Hon Miss Martel: Yes.
Ms Jackson: And is her title constituency assistant?
Hon Miss Martel: Yes, it is.
Ms Jackson: All right. So that meeting, for whatever reason, never took place. What was your next awareness of this issue being an issue in Sudbury?
Hon Miss Martel: My next awareness would have come in the week of November 11 to November 15. That was our constituency week, so I was in the constituency. I was doing clinics in the east end of my riding. That is to say, I go down and I go to the communities that are on the outskirts and spend some time and people can come to meet with me there in the community hall. I was also in Toronto that week to defend my estimates before treasury board, and back into the riding for other meetings. So I went back and forth between Toronto and home.
During that week, the office began to receive a number of calls from people who were calling in support of Dr Donahue. These were people who lived both in my own riding of Sudbury East and in Sharon's and Floyd's ridings, and they called specifically to indicate their concern that the threshold agreement the government had signed was forcing Dr Donahue to shut down his practice. A number of them also said very clearly to my staff that they were under the impression that he was going to leave town and they were very concerned that a specialist was going to be leaving town. That is certainly quite correct, because it is something we have always had to fight hard against.
Miss Morris, to the best of my recollection, made me aware of the number of calls somewhere around the 14th, which was the Thursday of that week. I was defending my ministry estimates. I flew back to Sudbury, and she picked me up at the airport. That day, we had two meetings in the east end of my riding and she was coming with me to drive, because I had a long week and I was tired. In the car she went through a number of --
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Ms Jackson: We are on what day now, November 15?
Hon Miss Martel: To the best of my recollection, I have pinpointed it around November 14, which is a Thursday. I had not been into the constituency office all that week, so I cannot think of any other time that I would have talked to her. However --
Ms Jackson: All right. Can I just stop you there?
Hon Miss Martel: Sure.
Ms Jackson: You have leaped ahead a little further than I expected, and before we get to November 14 I want to ask you to identify some things that I guess, in terms of the answer you have just given, were not issues in your mind, but they seem to have been events. You have provided us with some correspondence that came from Dr Donahue and your response in relation to his particular situation. Maybe just so we can keep the chronology straight we will look at that, and I would ask that we distribute a letter of October 28, which has attached to it that correspondence. I think we have it.
The Chair: That letter of October 28 is going to be marked as exhibit 101.
Ms Jackson: And so we have a record of that, Mr Chairman. That is your letter, Ms Martel, to the minister, and it attaches a letter apparently to you from Dr Donahue of October 22, 1991, with an attachment, and some correspondence from Dr de Blacam. That correspondence I take it came into your office -- I am speaking of the correspondence from Dr Donahue and Dr de Blacam -- in the latter part of October.
Hon Miss Martel: Yes, it came into our ministry office in Toronto.
Ms Jackson: And you wrote again to the minister in relation to the concerns expressed by Dr Donahue and asked her to give the matter her full consideration. When you requested that she give the matter her full consideration, what were you in effect requesting her to do?
Hon Miss Martel: I was requesting her to use her discretion, as I hoped she would in the case of the cardiologist, to provide an exemption to Dr Donahue. It was my understanding, and I had not gone through the letter terribly carefully, but it was my understanding as I read the first page, which said "Urgent," that he was in fact the only dermatologist in northeastern Ontario who was providing full-time service to that population and, as I went through both his letters and Dr de Blacam's, recognized that he had stated very clearly, as had Dr de Blacam, that he was going to have a financial problem with respect to the threshold.
Certainly my feeling at the time was that if he was in fact the only dermatologist full-time providing service to that population, if he left, we were going to have a very serious problem with respect to the provision of service, not only in my community but in a number of other communities. Sudbury acts as a regional centre for a number of specialties. Dermatology in this case is yet another. So the impact would be very much on my community, which is my thought first and foremost, but on a much broader level of population as well, in an area that I consider to be part of my constituency as minister.
Ms Jackson: And that was the reason you requested the exemption?
Hon Miss Martel: Yes.
Ms Jackson: Or in effect. I mean, you do not use that language, but you have explained that is what you meant.
Hon Miss Martel: Yes.
Ms Jackson: All right. And at that point, at the point at which you have signed this letter and sent it off or had it sent off to Minister Lankin, had the telephone calls you made reference to a moment ago started, to your knowledge?
Hon Miss Martel : No.
Ms Jackson: Now, just while we are on this issue, you have provided to us some correspondence that appears to be related from Ms Wark-Martyn, and that is a letter dated November 6, in which she essentially forwards to you the same kind of correspondence that she had received in her office. Perhaps, so we have a complete record, we could mark that as the next exhibit, after you have had a chance to identify it.
The Chair: That letter of November 6 will be marked, after identification, as exhibit 102.
Ms Jackson: It would appear from this, Ms Martel, that Ms Wark-Martyn had received similar correspondence and sent it to your office. Were you aware of that?
Hon Miss Martel: No, I was not aware of this correspondence until counsel showed it to me on Sunday afternoon. I should make something clear to people so that they understand what I saw and did not. A number of letters started coming in to the constituency office at about that time with a request to me as MPP to do something about the fact that Dr Donahue was intending to leave and had stated that publicly. I did not read all of the letters by any stretch -- I want to make that clear to everyone -- and what we did was to keep an ongoing file on this matter so that when indeed we could get a resolution to the matter I could write back to people with respect to the resolution that we had accomplished. So I did not see this letter that Shelley sent to me until you showed it to me on Sunday.
Ms Jackson: All right. Although, in fairness, you may not have seen it, but you understand that it was produced from your office.
Hon Miss Martel: Yes.
Ms Jackson: In terms of the way things usually work, do you have an understanding as to why Ms Wark-Martyn was forwarding this on to you rather than dealing with it in some way herself?
Hon Miss Martel: No, I do not. The only thing I can think is that it was because it was someone who was in my -- not exactly in my riding, but certainly in the area that I represented, and the services --
Ms Jackson: Closer to your riding than to her riding?
Hon Miss Martel: Well, I am not sure actually where his house is, but it is quite closer to mine than hers -- that she sent it on for me to deal with. I cannot speak for what else was in her mind at that time.
Ms Jackson: Now, we have had some evidence from Ms Murdock that when an issue of, for example, this kind or any other local issue arises in the Sudbury area, you and Mr Laughren and she had a method developed for dealing, as among the three of you, with such an issue. I wonder if you could describe to the committee your understanding of that arrangement.
Hon Miss Martel: Very early on, we had to devise a system for meeting with people so that we all did not go crazy. What happened very early on was that a number of groups in Sudbury who wanted to meet with us wanted all of us there together at the same time, and we tried for the first three or four months that we had been elected to do that, but it became far too difficult with our own schedules. We all do TV shows as well, we all want to get in to our constituency office, so it became increasingly difficult.
About the new year of 1991, the three of us sat down together and made a decision that we would no longer go all three of us to meetings together, that in fact whoever got the first call on an issue would be the one who would take the lead on that particular issue. That person who took the lead would also be responsible for sending any information back to the other two, requesting that they be at meetings, if that was what was necessary, or requesting that they do letters etc. But one of us on a given issue would do that and the others would be kept advised and notified of what was needed to be done.
Ms Jackson: And in the case of the threshold issue that was developing in Sudbury, who was the lead?
Hon Miss Martel: That was me.
Ms Jackson: And did that extend as well to the issues that came to arise with respect to Dr Donahue?
Hon Miss Martel: Pardon me?
Ms Jackson: The issue that you were taking the lead on, did that include Dr Donahue?
Hon Miss Martel: It included everything with respect to what we finally termed "the doctor situation" in Sudbury.
Ms Jackson: Including Dr Donahue?
Hon Miss Martel: Yes.
Ms Jackson: All right. Now, you indicated that your office started to receive telephone calls with respect to Dr Donahue's office, and do I understand that your first awareness of that was in the week that ended November 14?
Hon Miss Martel: Yes.
Ms Jackson: At some point during this period -- and I am not sure what the exact timing is; I will ask you to give it to us -- were you contacted by the regional chair of Sudbury, Mr Davies --
Hon Miss Martel: Yes.
Ms Jackson: -- about this issue?
Hon Miss Martel: Yes, I was. Between the end of October and the beginning of November, Mr Davies's executive assistant, Ms Guenette, contacted Elizabeth Diehl in my office. Elizabeth is a special assistant administrative in my Toronto office, and she was contacted and asked if our office could facilitate a meeting between the regional chair and Frances Lankin. We made some efforts --
Ms Jackson: On what issue?
Hon Miss Martel: He only said the doctors issue in Sudbury. He did not name one doctor or another. He did not give any names; specifically with a request to doctors in Sudbury.
My office attempted to try and arrange a meeting with Frances, but at the time Frances was terribly busy and she was also ill, and could not arrange for a meeting. Her executive assistant, Ms Colley, agreed to meet with Mr Davies, but Mr Davies did not want to meet with any of the political staff. So as it turned out, he finally agreed that because he could not get Frances he could deal with Floyd and myself, and that meeting was arranged for November 15 in Sudbury at the regional -- not at the chair's office, but in the regional building.
Ms Jackson: And I take it from what you are saying that meeting was arranged something like two weeks in advance, was it?
Hon Miss Martel: I do not know the specific date. The calls from the regional chair's office came between about October 31 and November 4 and the dates were confirmed between Floyd and I and the regional chair some time in those four or five days.
Ms Jackson: Still dealing with the week of November 4, we have marked as an exhibit in these proceedings a transcript of an interview apparently given by Dr Donahue, which you will find at exhibit 10 of the black volumes in front of you. This is the interview Dr Donahue apparently gave -- well, he has confirmed he gave -- to MCTV, channel 4, on the epilation issue. Were you aware of that interview around the time it occurred?
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Hon Miss Martel: I did not hear that interview the morning that it went on. We are not sure if we have the right book.
The Chair: Just for your counsel's assistance, the binders with the white covers are the exhibit binders.
Ms Jackson: The yellow covers are transcripts.
The Chair: And the yellow covers are transcripts.
Ms Jackson: You did not hear the interview at the time?
Hon Miss Martel: That morning, no.
Ms Jackson: When did you become aware of it?
Hon Miss Martel: During that week. Our communications branch in Sudbury in the ministry sends down to us on a daily basis all the articles that appear in the Sudbury newspapers, as well as the transcripts from the CBC and from the local radio stations, both English and French, and those are forwarded to my office on a daily basis, my Toronto office. So it would have been somewhere in the week of November 11 when I was back in Toronto that I would have become aware of that particular transcript. I would not have heard it that morning.
Ms Jackson: In any event, when you became aware of it during that week, do you recall whether you learned anything about Dr Donahue and his practice or his situation that you did not know before? In that interview, you will recall, he talks about epilation and the need for him to disaggregate his epilation practice.
Hon Miss Martel: What I understood was that he was going to be opening an electrolysis clinic, that he and his staff had made a decision that this was an important service they should be providing and they would take it upon themselves to open a clinic called the Doctor's Studio. I contrasted that with the fact that we were receiving calls in our office from people who were indicating that, via a letter they were receiving from the doctor and a petition he had in his office, he in fact was closing his medical practice and for all intents and purposes was leaving town. About the 14th, when I realized the letters were coming in and this is what constituents were saying to us, I found a real contradiction there in terms of his being on TV only a week before telling people this practice was going to go into effect and now telling his own patients and the community at large via the patients that he was going to be leaving.
Ms Jackson: Did it cause you any concern or did it raise any concerns in your mind at that time?
Hon Miss Martel: Yes, it did, because I could not understand the contradiction. Very clearly, patients of his were calling my office, as I am sure they were to Floyd and Sharon, because they were certainly instructed to do so in the letter he was handing out in his office. The people who were calling us were saying very clearly that they did not want this specialist to leave, and as the local MPP, I should do everything I could to ensure that he was not going to leave. Yet on the other hand, he had made it very clear in an interview only a week before that he was in fact going to be establishing a new practice in the city. That contradiction I found to be quite bizarre.
Ms Jackson: You have made reference to a letter you understood his patients received, in effect directing them to call you. Could you take a look at the notice of office closure that is contained in exhibit 48 and indicate whether that is the letter or whether you have seen it?
Hon Miss Martel: Yes, that is the letter. We did not receive a copy of it until, I do believe, the 15th. Some of the people who were calling in mentioned a letter, so my constituency assistant asked one of the people who called to be so kind as to send us a copy and that is how we got one in our office.
Ms Jackson: You have indicated that during this week, in addition to receiving telephone calls, you started receiving letters and a petition. I am going to ask, first of all, that the petition you have provided to us be distributed and ask if you can identify that as the petition that came into your office during that week.
The Chair: This petition will be marked as exhibit 103.
Ms Jackson: Is that the petition, Ms Martel?
Hon Miss Martel: Yes, it is the petition that came into our office but, Miss Jackson, I would not say for certain that it came in in that week. We knew that patients were signing a petition at Dr Donahue's office. When it actually came into our possession, I cannot tell you for certain.
Ms Jackson: You understood this was prepared in Dr Donahue's office, did you?
Hon Miss Martel: Yes. The clients who were calling us were saying they were signing a petition in his office.
Ms Jackson: All right. In any event, when it arrived in your office, this is the thing that arrived, exhibit 103?
Hon Miss Martel: Yes, that is correct.
Ms Jackson: As well, I think it might be efficient to mark right now the bundle of letters that came into your office, and I would ask that those be distributed.
Just so you understand what I have done, Ms Martel, with those letters -- we did the same thing with Ms Murdock's -- we have taken off the names of the people who sent the letters.
Hon Miss Martel: Thank you.
Ms Jackson: You can confirm perhaps even from your own recollection that these letters start to arrive in early November. There are indeed some that come in later in November, and I think in one or two cases even in early December. Perhaps you want to take a look at those.
Ms Edwardh: Excuse me, Ms Jackson, did you give an exhibit number to the petition?
The Chair: Exhibit 103.
Ms Edwardh: Thank you very much, Mr Chair.
Ms Jackson: I did, but I may have been the only person who did. I am sorry.
The Chair: The letters are marked as exhibit 104.
Ms Jackson: I am advised that these are a compilation of the letters that you provided to us, Ms Martel, that have been put together chronologically. Page numbers have been put in the upper right-hand corner should anybody have occasion to refer to them. Can you confirm that these letters arrived in your office at least to the extent that they were contained in the file that your office kept on Dr Donahue?
Hon Miss Martel: Yes, that is correct.
Ms Jackson: In addition, I think you indicated that you heard on the 14th that you had started to receive a number of telephone calls about Dr Donahue's situation?
Hon Miss Martel: Yes. Would you like me to explain that further?
Ms Jackson: Yes, I would. Can I just ask you, you first heard about that on November 14, as far as you can recall?
Hon Miss Martel: That is to the best of my recollection.
Ms Jackson: I take it you would not have had occasion up until then to discuss with anybody in your constituency office how they should handle those calls?
Hon Miss Martel: No, I did not. I was not in the constituency office that week at all.
Ms Jackson: When you did learn about the calls, you learned about them from whom?
Hon Miss Martel: From Kim Morris, my constituency assistant.
Ms Jackson: Did she have any responsibility for handling those calls?
Hon Miss Martel: Yes, she did. When she picked me up from the airport on Thursday, we were driving down to the community of Wanup and we went through a number of the cases that had come in that week. She was asking for instruction on how to deal with some of them.
She then mentioned that we were receiving (a) a number of letters but (b) far more telephone calls with respect to Dr Donahue and the fact that people were concerned he was closing his practice. She asked me what response she should give to people. I told her at the time that I wanted her to say three things to people: (a) that we were very concerned about the matter, as they were; (b) that I was going to be meeting with doctors on this matter, because I was meeting the next day with a number of physicians, I was meeting with those doctors, and I was going to be meeting with the Ministry of Health and indeed had talked -- no, I do not think I had at that point, but would be talking to the Ministry of Health based on the outcome of the meeting on Friday; and (c) to tell everyone that we were doing whatever we could to find a positive resolution to the matter.
So those were the three things that I told her. She knew at that point that any of the broader questions in terms of policy would not be done in the constituency office -- they usually are not -- but would be handled out of Toronto. I advised her if people called and they were very unhappy not to get frustrated, not to get flustered, just to say those three things: that I was very concerned, that the office was concerned, we were meeting both with the doctors and would be meeting with the Ministry of Health and we hoped to have a positive resolution.
Ms Jackson: At that point in time you had not met with anyone from the Ministry of Health on this issue?
Hon Miss Martel: No, I had not.
Ms Jackson: You indicated that already by that time you had concerns about the apparent discrepancy between two very different messages that Dr Donahue was delivering.
Hon Miss Martel: That is correct.
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Ms Jackson: Did you express those concerns to Ms Morris?
Hon Miss Martel: No. My recollection of expressing any further concerns to Miss Morris came after the meeting of November 15. She accompanied me the evening of the 15th to two other clinics that I was having in the east end of my riding, and in fact in between one meeting from 4 to 6 and the other from 7 to 9 we went to her parents' home for dinner. There were clips on the TV, and that is where I think I expressed more at that point.
Ms Jackson: All right, we will come to that after you have described the meeting, but do I take it your recollection would be, then, that you had no discussion with Ms Morris about concerns you had about Dr Donahue at least until the evening of the 15th?
Hon Miss Martel: No. To the best of my recollection, my concerns came from information I learned at the meeting on the 15th.
Ms Jackson: In fairness, you have already indicated you had some concerns. Correct?
Hon Miss Martel: Yes, but my concerns with respect to information that he gave us with regard to his financial situation did not come until the 15th.
Ms Jackson: All right. As of the end of the 14th, then, you had not had any contact with the Ministry of Health. Do you know what contacts your staff had had?
Hon Miss Martel: Mm-hmm. I had advised them to talk to the Ministry of Health and this came about in the following way. On the 14th when I was at treasury board I finished my estimates and I came out and was getting on to the elevator, and at the same time two people from Floyd's staff arrived at the elevator. They were Mr Wood, who is Floyd's constituency assistant in the riding of Nickel Belt, and Ms Nuala Doherty, who is his constituency assistant but who works in Toronto. We got on to the elevator, and I asked Ian why he was in Toronto, because normally he does the work in the constituency office and is located there. Ian said that he was in because he was getting some information for Floyd with respect to the doctor situation in Sudbury. He said that in fact they were on their way at that point to have a meeting with staff from the Ministry of Health to get some information. I said to him that I would have someone from my office call either him or Nuala later in the afternoon to find out what information they had received so it could be passed on to me as well.
Ms Jackson: In the brief exchanges at the elevator was there any discussion about the fact that, as we have heard at least, there had been some pressing attempts from Mr Laughren's office to get some information on Dr Donahue, which as of the 14th had not been successful?
Hon Miss Martel: No. The only discussion was that they were going to the Ministry of Health, they were having a meeting with respect to the doctor situation in Sudbury and they agreed that if someone from my office were to call over after, they would exchange whatever information they had obtained at their meeting.
Ms Jackson: Do you know who they were meeting with?
Hon Miss Martel: No. They did not give me a name.
Ms Jackson: All right. Who in your office did you advise, or did you advise someone in your office to follow up on that?
Hon Miss Martel: Yes, I did. I came back to the ministry just before I went up to the airport, and I told my executive assistant, MaryLou Murray, to have someone call over to Nuala and Ian that afternoon and find out what information they had received from the meeting at the Ministry of Health.
Ms Jackson: As a result of that contact, did you receive some information?
Hon Miss Martel: I received some information on the morning of the 15th. It was faxed into the ministry office in Sudbury.
Ms Jackson: All right. Can you look, first of all, at exhibit 54 and advise us whether you received that information. Sorry, I will have to get you the right number; that is not the right number. Exhibit 53.
Hon Miss Martel: Yes, I did receive this information.
Ms Jackson: Was there anything in there that was new to you in terms of understanding Dr Donahue's situation?
Hon Miss Martel: The first thing was that the Ministry of Health would be happy to sit down with Dr Donahue. I had had no indication to that point as to whether or not the Ministry of Health was aware of the situation regarding Dr Donahue and what position they were taking. So Mr Corea's memo said clearly to me that the Ministry of Health was prepared to sit down and talk to Dr Donahue about the details of his practice which would support his request for an exemption, and I felt from that that I as well would be free to make that offer to Dr Donahue if the occasion were to arise.
Second, there was the point with respect to electrolysis and whether or not this was a significant portion of his billing. At that point in time I knew that electrolysis was being delisted because Sharon had received a number of people in her office to complain about this.
Ms Jackson: That is Sharon Murdock?
Hon Miss Martel: Yes, sorry. Sharon had received a number of people in her office to complain about this delisting, so I knew that some time in November this was going to happen, but this was the first time that I made a connection, having had it pointed out to me by the Ministry of Health, that this may impact upon Dr Donahue's billings as well.
Ms Jackson: On his which?
Hon Miss Martel: On his billings as well.
Ms Jackson: Did you have any understanding as to whether electrolysis billings were or were not included in threshold calculations?
Hon Miss Martel: At that point I did not know that they were not included.
Ms Jackson: Do you recall when you did learn that they were not?
Hon Miss Martel: It was a long time after that that I realized they were not part and parcel of the exemptions.
Ms Jackson: All right.
Hon Miss Martel: I would say at least two months afterwards, so it had no relation to --
Ms Jackson: At least two months after this.
Hon Miss Martel: Right.
Ms Jackson: So some time in January?
Hon Miss Martel: Yes.
Ms Jackson: All right. This memorandum is directed to David Sword in your office.
Hon Miss Martel: Mm-hmm.
Ms Jackson: Who is David Sword?
Hon Miss Martel: David Sword is my policy assistant.
Ms Jackson: Was he assisting you on this matter?
Hon Miss Martel: David had only come out of the ministry bureaucracy to work in my office about three weeks before, so he was very new to the political staff in my office, new in the sense that he had been working with us and had a place in terms of physical location quite near to my political staff but was not working directly under our supervision. David, as I understand it, was asked by MaryLou to make the contact with Nuala and Ian with respect to obtaining information, and as soon as he was requested to do that, he then became the policy person who was in charge of dealing with this matter with me.
Ms Jackson: So it is a little bit like the arrangement you have with Mr Laughren and Ms Murdock -- whoever gets it first stays in charge? Is that sort of the way it works?
Hon Miss Martel: Yes, in most cases, although some of the staff obviously, because of the roles they play in my office, would not be asked at any point to deal with policy matters. They are there merely for an administrative function. But there are a couple of people who could have been asked, and David was the one who ended up dealing with it from thereon in on the policy side.
Ms Jackson: This memorandum comes from Larry Corea. At this time had you met Mr Corea?
Hon Miss Martel: No, I had not.
Ms Jackson: Did you have any understanding as to who he was, apart from what appears in the memorandum?
Hon Miss Martel: I only knew that Larry's title, and I did not know if it was public or not, was a customer rep for the Ministry of Health, because it was my understanding that he was the front-line staffer in Frances's office who would deal with complaints or requests for help from MPPs.
Ms Jackson: Have you ever met Mr Corea?
Hon Miss Martel: I met Mr Corea for the first time last week. He was into my office for a meeting with a group from Thunder Bay on the one hospital.
Ms Jackson: All right. Then, in addition to this memorandum, I understand you received another memorandum of information from Ms Doherty. Is that correct?
Hon Miss Martel: Yes, I did.
Ms Jackson: Could we distribute that? That is the memorandum of November 15.
The Chair: That memo of November 15 is being distributed and will be marked as exhibit 105.
Ms Jackson: That is the memorandum that you received faxed up to your office on the morning of November 15?
Hon Miss Martel: Yes, it is.
Ms Jackson: Just so we deal with the question, on the second page there is one part that has been yellow-marked over and in the Xeroxing has been somewhat lost. I understand that part says "Understand you're opening up an electrolysis practice." Are you or your counsel able to confirm that your clearer copy, the one you originally provided to us, makes that clear?
Hon Miss Martel: No, but I will take your word for it, counsel. I can only read "opening up an" on my copy.
Ms Jackson: When you reviewed this memorandum, did you learn anything more about Dr Donahue than you had known before?
Hon Miss Martel: Yes, I did, and that was with respect to the fact that other dermatological services were being provided by other dermatologists to the population.
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Ms Jackson: That is the part in paragraph 2b.
Hon Miss Martel: Yes, and I was not aware of that myself. I had only, when reading Dr Donahue's letter, taken a brief look at the part marked "Urgent," a bit of the first page and the last, and so did not see that somewhere in the middle of his letter, which I did not read very carefully, it did point out that there were other people. So my understanding when I wrote to Frances was that in fact he was the only full-time person providing service. So this was the first time that I learned that there were others and who they were, in the sense that Dr Hradsky is listed, and I do not know who the dermatologist is who flies in to Timmins.
Ms Jackson: And would that information, had you had it earlier, have affected the fact that you supported his request for an exemption?
Hon Miss Martel: No, I do not think it would have changed anything.
Ms Jackson: Was there anything else in here about Dr Donahue that was new to you when you read the memo?
Hon Miss Martel: The only other thing would have been more general information with respect to how many dermatologists would be required to service a population. I did not have a recollection of those figures before, but I do not think, Miss Jackson, that there is much else in here that would have been new to me at the time.
Ms Jackson: All right. Under paragraph 5 there is something called "Our Opinion." Did you understand that to be the opinion of Nuala and Ian, that would be Ms Doherty and Mr Wood?
Hon Miss Martel: Yes, I did.
Ms Jackson: Did you have any reaction to that opinion when you read it?
Hon Miss Martel: Well, I do not know Nuala, so I cannot make a comment on how she normally writes memos. I felt she had taken a bit of a licence, but then again, I do not know how she normally writes. I do not know if that is part and parcel or was editorial licence on her part. So I did not give it much thought.
Ms Jackson: Did you have any occasion to determine or to inquire as to what that opinion was based on? Did you ever inquire what was the basis of the opinion that is expressed there?
Hon Miss Martel: No, I never did. I did not have much of a chance to receive the information before I actually left for another meeting, so I picked up the two off the fax machine within the office not much more than a half-hour after that and left. At that point I did not think it was terribly important to call Nuala and find out why she had said it. It did not seem to be terribly important to me at the time, one way or the other.
Ms Jackson: Did it affect your thinking about Dr Donahue at all?
Hon Miss Martel: No, I do not think it did. I mean, that was the opinion of her and Ian. Why they had come to that opinion I did not know, but I do not think it changed in my mind anything with respect to the request that he had made to me or changed in my mind the concern I had with the contradiction between his opening up a hair removal clinic and at the same time telling people that he had to close his medical services. I do not think I took it at face value, as other people would.
Ms Jackson: Did you consider whether any of this information, or all of it, could be passed on by you to anyone else?
Hon Miss Martel: Well, I would certainly share this, my own, with David Sword if he had not received a copy of it, and I did not know at that time whether he did. I would see nothing wrong with sharing it with him because he was certainly the point person on the policy side for it. I do not think there is anything in here that reveals anything that could not be found in public. For example, the details with respect to the joint management committee were well outlined in the OMA agreement. Certainly it would be very embarrassing for Floyd and Nuala to have paragraph 5 out, so I would not be giving it out to just anyone, but in terms of the information which was not their opinion but was factual, I did not find much in there that could not be discussed with or given to my own political staff or others who would have been involved in trying to find a resolution to this.
Ms Jackson: I take it that would include Kim Morris as well. Hon Miss Martel: Kim Morris never received a copy of this.
Ms Jackson: I understood Kim Morris -- oh, this came into your ministerial office in Sudbury, did it?
Hon Miss Martel: Yes, that is correct.
Ms Jackson: And you never provided a copy to Kim Morris?
Hon Miss Martel: No, I did not.
Ms Jackson: Do you know if anybody else did?
Hon Miss Martel: I have no idea if anyone else did or not.
Ms Jackson: Do you recall ever discussing with her the opinion that taxpayers are being asked to support Dr Donahue's entrepreneurial greed?
Hon Miss Martel: No. I did not discuss this memo with Kim. The information that I received, and I can get into it later on, with respect to the underserviced area program etc was all kept in my Toronto office. There was no documentation of any sort in the riding office, other than the information that was coming in from constituents themselves in the form of letters and telephone calls.
Ms Jackson: By the morning of the 15th, then, in terms of the information you had about Dr Donahue, you had the information and impressions you have given us from the contacts that were made to your constituency office, your information from the November 8 broadcast and the information that you gleaned from the two memos we have just looked at. Is that correct?
Hon Miss Martel: Yes, that is. I think there is one other thing I should add. You are asking me what global picture I had at this point in time?
Ms Jackson: I was going to, yes.
Hon Miss Martel: There is one other thing I should add. We -- I should not say Floyd. I had been approached by Dr Donahue via letter seeking help for him to get an exemption, and that had been done on the 22nd of October. We wrote a letter to the Ministry of Health in effect requesting Frances to look at that very matter. I thought, frankly, if he was closing his office on November 15, as I understood he was, that he had been a little unfair in not giving me what I thought would be adequate time to try to look for a resolution. In essence, we had a period of three weeks, by the time I was even aware that there was a problem, up until the 15th, when he was announcing that he was closing. I felt that in terms of making a serious request for our help, he had not given us, on the other hand, enough time to do a serious job about trying to respond.
Ms Jackson: And the fact that he was closing on the 15th is certainly the implication of the office announcement we looked at earlier, where he says he is closing his office, the business, effective November 18, which is a Monday.
Hon Miss Martel: That, and the conversations that were being relayed by people who were calling in. The case forms as they were relayed to me, or the comments on the case forms that were relayed to me by Kim, were that very clearly people were leaving his office with the impression that he was (a) shutting down, (b) leaving town. Their calls to us were, "What are you going to do to make sure that Dr Donahue stays?"
Ms Jackson: All right. And just so we have the complete picture, on November 13 we know there was an interview with Dr Donahue. You will see that and you have had a chance to look at it before. It is at tab 11. It is an interview that apparently occurred on CBC Morning North in Sudbury on November 13 in which Dr Donahue discusses the fact that he is closing his office. I understand that you became aware of that, but not until some time in the following week.
Hon Miss Martel: Right. There were actually two articles, one that was written a day before in the Sudbury Star and this particular article. But I did not see either of those until I was back in Toronto in the following week.
Ms Jackson: All right.
Hon Miss Martel: So any information that I got from those was after the week of -- or the new week starting the 18th, 19th of November.
Ms Jackson: I want to then take you to the November 15 meeting, and I am advised that I should probably do that after lunch. So this, I think, would be an appropriate point to -- oh, before that, yes --
The Chair: Just one moment.
Ms Jackson: The Chairman has reminded me that we now have a copy of your September 10 letter to Dr Abdulla, which we have already marked as exhibit 100. Perhaps we could just, before we rise, circulate that to people in the room.
The Chair: That is being distributed as exhibit 100. We will now recess until 2 pm.
The committee recessed at 1159
AFTERNOON SITTING
The committee resumed at 1406.
The Chair: Good afternoon. We call the afternoon session of the Legislative Assembly committee to order. At the end of the morning session our counsel was in the midst of questioning the minister, and we will continue on with that questioning.
Mr Christopherson: On a point of order, Mr Chairman: Just regarding Mr Harfield and some of the difficulties that have transpired so far and the importance that he plays in all of this, could I ask if there is any kind of update on his status?
The Chair: As a result of subcommittee meetings, I think we are all well aware of how we very much require Mr Harfield to attend before the committee. The first time I heard of the illness of Mr Harfield was at approximately a quarter to 10 this morning, and to this point in time, although we are endeavouring to find out, we have not yet heard a further report on his condition. We will continue to do so and when there is further information, certainly that will be shared with the committee.
Mr Christopherson: So he is still tentatively scheduled for tomorrow afternoon, after the questioning of Ms Martel.
The Chair: There is no question that, subject to his condition, it is still the intent of the subcommittee and the committee as a whole to have Mr Harfield called as a witness, of course.
Mr Kormos: Further to that, we all know that Mr Harfield evaded service of the invitation to attend here for a significant period of time, made himself hard to find, played hard to get, obviously was reluctant to be here and indeed was here yesterday morning and then got nervous and departed. Are you telling us that a Speaker's warrant will be used to compel his attendance here? His illness today is interesting, to say the least.
The Chair: Mr Kormos, all I can do is inform this committee of the information I have that a witness to this committee has indicated he has taken ill and that he is in the hospital. We are endeavouring to find out his condition and when there is further information we will certainly share that with the committee.
Having said that, I would then invite Ms Jackson to continue with her questioning.
Ms Jackson: Ms Martel, I think chronologically we were on the morning of November 15 when we broke for lunch. May I ask you, as of that morning had you received any information from Sharon Murdock or anyone in her office about calculations this committee now understands they had been doing of Dr Donahue's billings?
Hon Miss Martel: No, I have not, and our office never received those calculations.
Ms Jackson: Had you received any information concerning Dr Donahue's billings as of the morning of the 15th of November?
Hon Miss Martel: No, I had not. There was information that was in the paper, but I read it after this weekend.
Ms Jackson: Yes, all right. You were in Sudbury for a number of reasons, but it was certainly planned that one of the events on your schedule that day was a meeting with some doctors in Sudbury.
Hon Miss Martel: That is correct.
Ms Jackson: Did you have a conversation with the regional chairman of Sudbury about that meeting before it occurred?
Hon Miss Martel: Yes, I did. When I received the memos from both Nuala and from Larry Corea's office I noted clearly in the memo from the Ministry of Health that there was an invitation to have Dr Donahue come and have a meeting to explain the details underlying why he thought he needed an exemption. I took from that memo that either Floyd or I would be quite free to ask Dr Donahue the same if we were to see him at this particular meeting. We had no indication at that time who was to attend, and my understanding was that the regional chair, Tom Davies, was going to be chairing because he had called the meeting in the first place.
So after I received the memos, which would have been 11:30, 12, I called Mr Davies at his office and said that the position that I would be taking at the meeting would be that I would be inviting Dr Donahue to have a meeting with the Ministry of Health. I would ask him if he wanted someone from my office there, either myself or a staffer, in order to go through the details of his practice and explain to the ministry why he felt he needed an exemption and what the details were of his costs on the one hand and his revenues on the other, and why he was going to be over the threshold.
Ms Jackson: Did Mr Davies indicate that he had received any information about Dr Donahue's situation?
Hon Miss Martel: Yes. Mr Davies indicated that he had been speaking to Dr Donahue's accountants -- I do not know their names and the names were not provided to me at this time -- but that he had felt in conversation with them that indeed he was going in the hole, that he was in financial difficulty. When I told him that I would be making the request to Dr Donahue, if he was there, for a meeting, he agreed that that was fine.
Ms Jackson: Was there any expression of a view by Mr Davies as to whether this was a significant political issue in Sudbury?
Hon Miss Martel: Well, there certainly was, and Tom was very quick to talk to me. He also explained that he had called Mr Laughren earlier that morning and told him, and was telling me in this conversation very clearly that this was the most significant political issue that the region had ever seen.
Mr Davies has been the regional chair for some time now. I am sorry I do not have the exact number of years, but he certainly has been around as long as I have and before that when my father was the MPP for Sudbury East. He made it very clear to me that in all his time as regional chair this was the most significant issue. They were receiving calls from a number of people in the region asking what the region was going to do, asking what could be done on a more global nature. So in his mind it was very significant for us and one that we had to pay some serious attention to.
Ms Jackson: Now, when he said this was the most significant issue that the region had ever faced, did you understand that he was speaking of the situation with respect to Dr Donahue?
Hon Miss Martel: No. My understanding was that it was the situation with respect to the potential of doctors leaving. He was aware, it is my understanding, of Dr Abdulla's request for an exemption on behalf of a number of other cardiologists as well. He would have known about Dr Donahue at that time because he had spoken to Dr Donahue's accountant, so he had told me. Who else he knew about in terms of having a potential problem of going over the threshold, I am not clear. But my understanding is, it was a general concern about specialists and the fact that they may be leaving our region.
Ms Jackson: In terms of the reaction that your office was getting, did it seem that the biggest political controversy at that time was centring around Dr Donahue rather than others?
Hon Miss Martel: Oh, yes, that is correct, because he was the only one who had given any indication to his patients that they should call my office and the other two MPP offices. He was the only one that we had any indication was also in the midst of having a petition in his office and having that signed in order to forward on to us. Certainly he, although I did not see those articles, had been in the paper, so the general public would have seen articles in the paper from certainly the 12th or so of November, saying that he was going to be leaving. So there was a broad knowledge that there was a problem, but it was certainly focused around him at that point.
Ms Jackson: All right. What time was the meeting with the doctors scheduled for?
Hon Miss Martel: It was about 2:15 in the afternoon. I could only stay a half an hour because I had another meeting at four and I had some drive to get to it, so --
Ms Jackson: All right. Prior to attending the meeting with the doctors, did you attend some other proceeding or meeting at which Dr Donahue's situation was discussed?
Hon Miss Martel: Yes. Floyd and I had had a meeting arranged for some time to meet with the executive of the Steelworkers. This was to get in touch with them with respect to some of the legislation we were proceeding with. There had been some hard feelings around the fact that some of the Steelworkers did not go to Floyd's dinner, so we wanted to iron that out, and we had gone and agreed some time ago that we would meet at the steel hall in order to have this out and see where we were going in future.
So we went to the meeting and Floyd began by saying that we did not have a long time to be there because both he and I were off to the regional council to have a meeting with the doctors on the doctors' situation. At that point the president of the local, whose name is Dave Campbell, said that he had been contacted earlier in the day with respect to providing support for this particular issue. I cannot remember his exact words, but he did say he had been requested to provide his support for an end to the threshold or an exemption from the threshold or some removal of the threshold so that doctors would not be in the position of having to leave.
We asked what his response had been, obviously, and he said to us that he had not given blanket support for that, or support without reservation; that he had some concerns himself and felt he could relate those concerns on behalf of his membership and that he was not convinced that just removing the threshold and allowing people to bill whatever they wanted was the solution to the problem. He expressed, as well, some concerns about health care and how we were going to maintain it.
There was another member who was sitting further down -- I am sorry, I cannot recall who it was -- who also expressed a concern that there were 14 people working in this dermatologist's office, and what were these 14 people doing? That was the first time I had any knowledge of how many staff people Dr Donahue indeed had at his office.
Ms Jackson: All right. After that meeting, then, did you attend the meeting with Mr Davies and the doctors?
Hon Miss Martel: Yes, we did.
Ms Jackson: That was in Civic Square, was it?
Hon Miss Martel: Yes.
Ms Jackson: You arrived at about the time the meeting was to start?
Hon Miss Martel: Yes, we arrived at the front door. My special assistant who works in the ministry office in Sudbury met us and told us --
Ms Jackson: And who is that?
Hon Miss Martel: Her name is Andrea Valentini. My apologies. Andrea met us at the door as we were coming into Civic Square to say that there were a number of the media who were there and to be a bit cautious when we came and went because Dr de Blacam, who is the head of the medical society, had been there and told the media that they should stick around, there would be a good show going on that afternoon. That was the start to our going into the meeting and there were indeed a great number of the media there, but we did not really talk to any of them as we went in.
Ms Jackson: Who had you understood in advance was going to be attending this meeting?
Hon Miss Martel: I only knew that Tom Davies would be there, because he had asked for the meeting. Normally when Tom is at a meeting, his executive assistant, Gloria Guenette, is also there. We were not given a list beforehand or any indication of who would be there representing whom.
Ms Jackson: In fact, who was at the meeting?
Hon Miss Martel: There were a number of people, both representing the region and representing the medical society as well, and a number of political people. To the best of my recollection, there were a number of staff people who worked for Dr Donahue at the back of the room. The table is in a U form, like this, in that particular meeting room.
The people from the region included Tom Davies, the regional chairman; Gloria Guenette, his executive assistant; Jim Rule, who was there representing the region as well, and Mark Mieto, the chair of the social services committee for the regional municipality of Sudbury.
Now, if you came one way, there were political people: Andrea Valentini and myself. The Treasurer was sitting beside me and he had a staff person there by the name of Sue Wyers, who is also a constituency assistant of his who works in his riding office in Nickel Belt.
Around the other side of the table were a number of representatives from the medical community: Dr de Blacam, who ended up chairing the meeting; Dr Abdulla, a chief cardiologist at Memorial; Dr Malloy, an obstetrician; Dr Farrell, who is also an obstetrician, and Dr Bergh, a paediatrician at Laurentian Hospital. At the back of the room as well was Dr Donahue, and he also had some financial people there with him whose names I do not know.
Ms Jackson: Was the general format of the meeting what you had expected?
Hon Miss Martel: No. It was far from what I had expected. We had been approached to ask for help in this particular circumstance by Dr Abdulla and I certainly had been approached by Dr de Blacam and Dr Donahue with respect to those individual circumstances. I cannot speak to who contacted Floyd with respect to help, because I do not know.
In any event, I had responded, I thought, positively to the request by Dr Donahue for an exemption and, second, we had rearranged our schedules on very short notice in order to be able to attend this particular meeting because we thought it was very important. The region has spent many years and millions of dollars trying to establish health care facilities in the city, and health care and physicians and doctors and nurses etc are very important. So we took it seriously. But when the meeting started it was pretty clear that it was going to be confrontational and adversarial from the first.
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Ms Jackson: Why was that?
Hon Miss Martel: Well, the first presentation was by Dr Donahue. Dr Donahue came from the back and he had a slide show that was going on on the side of the wall and he showed about 10 to 20 slides of his patients -- faces, necks, backs, legs, feet, hands. He did not indicate at any time that he had ever gotten a waiver or a release for these people to be on the screen and I was hoping that I was not going to see a number of my constituents up there.
When he finished that particular slide presentation he came around to the Treasurer and he pulled out of his pocket an envelope and he said to the Treasurer, "Here are the final paycheques for my employees and I think you can give it to them," and he threw the envelope on the table in front of Floyd and then he went back and stood at the back of the room with his accountant. And my reaction was that for someone who had requested our help and we in good faith had given it, it certainly was a bizarre way to go around requesting further help and, if anything, it was going to tend to turn people off rather than being really willing to go to the wall.
Ms Jackson: It turned you off?
Hon Miss Martel: Well, it did not impress me a lot at all. It frustrated me a great deal because in the back of my mind was also the context that he really had not given us enough time to try to deal with the matter. He had written to us, I had responded, and within about three or four weeks he had announced the closure of his practice before he had received any response either from myself or from Frances, and that really bothered me. I just did not think it was the way to go about trying to solicit help from your local MPPs.
He stood at the back of the room at that point and indicated that he had some people there who were aware of his financial matters and that his financial people would be prepared to answer some questions, but only three questions; one of those questions was with respect to what his operating line of credit was, and I cannot remember the nature of the other two. So at that point in time he gave us a great deal of financial information with respect to his individual circumstances; I have some of this written down but I think I can remember most of it.
He told us, for example, that his expenses on a monthly basis were anywhere between $60,000 to $100,000; second, that at that point in time 30% of the work he was doing was skin lesions with respect to cancer, but that that would grow to 70% in the next little while -- he did not give a time frame; third, that he had already used up to $138,000 of his operating line of credit and in the near future he would reach $150,000.
Finally he said -- and this is what caught the attention of the Treasurer and I the most. He indicated to us that he had reached his cap, and he used the word "cap," three months ago. And the Treasurer had a sudden intake of breath and I leaned back in my chair to him and said, "That's incredible," because what that meant to me was that he had reached the threshold or had billed $400,000 between the period of April 1, when the agreement kicked into place, and some time around mid-August of 1991. He was telling us very clearly at this meeting that he was well over the threshold, he indicated three months, so we just backed up and figured somewhere in mid-August. To me, that meant he had billed about $400,000 or over in a period of four to four and a half months, and taking that on an annual basis, which I did from there, I figured his billings were in the order of about $1.2 million, and I thought at that time that that was a lot of money.
Ms Jackson: Was there any indication in his description of his circumstances that he was on the underserviced area program?
Hon Miss Martel: There was none.
Ms Jackson: Did you know whether he was on the underserviced area program?
Hon Miss Martel: No. I was not made aware of that piece of information until later on.
Ms Jackson: What conclusions did you draw from, first of all, the level of his billings, if any, as you would calculate it?
Hon Miss Martel: I thought that was a fairly high amount of billings, $1.2 million. If I were to take $400,000 in four months and annualize that, I thought that was a lot of money to be billing. Secondly, I wondered, but I did not ask him at the time, what the 14 staff were doing and how the 14 staff would relate to those kinds of billings. I had some questions in my mind -- that had come from the earlier morning -- but some questions then again about what that meant. I was not clear whether or not expenses in the order of $60,000 to $100,000, was what you would find in any other dermatology practice, whether that was high, whether that was low, whether that was about normal, and I did not have anything to relate that back to. So that struck me as well, as a question you would want to know something more about; just an overall level of concern that I thought that was a fair amount of money and I was not sure at this point how he should quite be into an operating line of credit, because my understanding was that the adjustments to the agreement were not coming until December, so my understanding at that point was that he was still being paid dollar for dollar everything that he was billing.
Ms Jackson: By that last remark, you mean the threshold, that is, the reduction in income, would not take place until the end of December when it would take place retroactively?
Hon Miss Martel: Exactly.
Ms Jackson: So you did not think the threshold would have affected his income stream at that period?
Hon Miss Martel: Not at that point in time; not to the point that he would be telling people that he was shutting his office.
Ms Jackson: You say you were wondering about the 14 staff and what they were doing. What do you mean by that?
Hon Miss Martel: If I go into my own doctor's office, there is a receptionist and there is a part-time nurse and my doctor, and my doctor sees me every time I come. I had also been seen by a dermatologist some years ago and in that case there was a dermatologist, there was a receptionist and a nurse, and that was the extent of the practice. So I wondered at that point in time what the practice entailed in terms of what services were being provided and frankly who was doing what in terms of actual provision of service, supervision, monitoring, those kinds of questions, all related to the delivery of health care and how that delivery was being carried out.
Ms Jackson: So he was delivering health care in a way that you were not personally familiar with?
Hon Miss Martel: That is correct.
Ms Jackson: Did you have any other reason or experience on which to question its propriety?
Hon Miss Martel: No, only that the matter had already been raised by someone else earlier in the day.
Ms Jackson: Who, as far as you knew, would have no particular experience in judging its propriety?
Hon Miss Martel: No. The gentleman who indicated that to me did not say that he would have any knowledge one way or the other about it. He only indicated that he wondered what the situation was.
Ms Jackson: If he had 14 staff -- and you saw that day that he did -- that would be some indication that his expenses on an annual basis would be quite high. Is that not fair?
Hon Miss Martel: Yes, that would be a fair comment.
Ms Jackson: In so far as the number he gave you was concerned, you had no basis to judge against whether it was a high or a low number or proper or improper?
Hon Miss Martel: That is correct. I had nothing else to judge it, only my experience in another dermatology office at another time, which was significantly smaller.
Ms Jackson: So at the end of his presentation, there are a number of questions in your mind. That seems to be one thing we can draw.
Hon Miss Martel: That is correct.
Ms Jackson: For which there are no clear answers to a lot of them. Is that fair?
Hon Miss Martel: That is right.
Ms Jackson: You were not particularly impressed with his political savvy in terms of how he had chosen to approach you and Floyd, is another thing I am taking from what you said.
Hon Miss Martel: That is about the best way to describe it. That is true.
Ms Jackson: Did you draw any other conclusions from that meeting or from -- well, from Dr Donahue's presentation?
Hon Miss Martel: I asked him, because he had asked me for help, whether or not in light of the fact that he was going to be closing, he would be prepared to have a meeting with the Ministry of Health, and I would send a representative or come myself, in order that we could put all this on the table. I thought that was a legitimate request for me to make, given that he had certainly appealed to me to help him gain an exemption and given that from the side of the Ministry of Health, it appeared to me that they would be prepared to participate in that.
Ms Jackson: Was this a question you put to him in the course of his presentation?
Hon Miss Martel: Yes, it was.
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Ms Jackson: And what did he say?
Hon Miss Martel: I reminded him that he had sent me a letter, but the letter gave no indication with respect to what his practice was all about in terms of what salaries he was paying, what his rent was, did he have machinery, what the price of that in terms of an ongoing lease might be; on the other side, what would be his revenues coming in and where did he feel in all of this --
Ms Jackson: These are all things you told him you wanted to know?
Hon Miss Martel: Yes. I asked him if he would be prepared to have a meeting. I do not remember that he gave me an answer, because at that point in time the chair stopped and said, "Well, Miss Martel, I understand that you have to leave early and there are other doctors here who would like to make presentations to you before you go."
Having said that, before I left I did stop at his chair, which is at the back of the room. I knelt down beside him and I asked him again if indeed he would be prepared to have a meeting with officials from the Ministry of Health and a representative from my office and his accountants and whoever he needed with respect to financial people to come and talk about his case. He said he would be prepared to do that.
I asked him where I could find him in the next couple of weeks, because he had indicated that he was closing his practice. He said that if we needed to get hold of him, he would still be at his practice for the next two weeks because he and his staff were going to spend that time shutting down their operation and sending their files out to the referring physicians.
Ms Jackson: You may be aware of this: Dr Donahue gave evidence yesterday and he indicated that in response to that inquiry he was not quite as committal as you recall. He recalled saying, in effect, that he would be in touch or call back or something to that effect. Is it possible that he may have said that and that you are now recalling it a little more positively?
Hon Miss Martel: No. He made it very clear to me that he wanted a meeting. In fact, he said to me that he had been trying to have some discussion with the Ministry of Health for eight months and had not been able to have any communication with it. He made it very clear to me that he was prepared to have a meeting. In fact, he was prepared to have either myself or one of my staff people there at that particular meeting when he was to meet with the Ministry of Health. There was no hesitation on his part to agree to that.
Ms Jackson: Now, in between that conversation and the presentation by Dr Donahue, I take it there were some presentations by other doctors. Were there?
Hon Miss Martel: Yes.
Ms Jackson: I am not going to ask you to describe all those. Was there anything else that happened at that meeting that affected your knowledge of or view of Dr Donahue?
Hon Miss Martel: There was a point made with respect to technical fees. Dr Abdulla made it clear in his presentation that a number of the cardiologists would soon be over the threshold and that he was very concerned about the impact that would have on the delivery of cardiology care in Sudbury and the northeast.
At that time he stated that he had made a request for exemption. He also talked about being clear that we understood the differences in what was happening in their practice. He mentioned technical fees at that point in time.
Then I recalled that technical fees were in fact exempt from the agreement. I wondered how that might also impact on Dr Donahue, because it was my understanding that he had machines in his office. I did not know what kind they were. I wondered if in fact some of the operation of that would also be excluded; therefore what he might be billing would be even higher.
Ms Jackson: So that is another question you have in your mind?
Hon Miss Martel: Yes, that is right.
Ms Jackson: And again no clear answer one way or another?
Hon Miss Martel: No.
Ms Jackson: Just something else you would like to find out about?
Hon Miss Martel: That is right.
Ms Jackson: As a result of this meeting, I take it one thing you concluded was that you wanted to find out a little bit more about what Dr Donahue's actual financial situation really was.
Hon Miss Martel: I certainly said to him clearly that either my staff or myself would make ourselves available for a meeting.
Ms Jackson: That was a fairly important piece of information, from your point of view. Was that fair?
Hon Miss Martel: Well, I thought it was, because I was making clear to him that I recognized he had a problem but that I had no sense of what the magnitude of that problem was. His letter to me referenced only the dermatological rate that one can bill for, which is somewhere in the order of $49.60 for any procedure, but it gave no indication as to what any of his expenses were, staff, the whole thing that I have already gone through. So I could not make a clear judgement of the magnitude of the problem, whether or not he might be okay to continue to operate his practice while we tried to find a solution, which I thought might be the case given that the adjustments were not to take place in December. At that point I was still trying to figure out how we could help him even though I did have the concerns in my mind; that is quite correct.
Ms Jackson: What you wanted to know in terms of whether you should help him, just to summarize it, was what his real revenue was, what the underlying costs for that revenue were and whether, in view of the number of staff he has, he is delivering his services appropriately.
Hon Miss Martel: That is correct. I felt it was not untoward of me at the time to make that request to him that one of my staff or myself be there, because he has certainly come and asked us for help.
Ms Jackson: Fair enough. Did you come to any conclusion in that meeting about whether or not Dr Donahue was behaving candidly?
Hon Miss Martel: I still had a concern about why he would be making it quite clear to the public that he was being forced out of business and therefore was in essence going to leave the community when he had also made it clear publicly that he was opening a clinic somewhere else to provide electrolysis service.
Ms Jackson: That was the only question in your mind about candour at that point?
Hon Miss Martel: I think so.
Ms Jackson: Did you ask him?
Hon Miss Martel: No, I did not.
Ms Jackson: Why not?
Hon Miss Martel: Well, I was still in the process of asking him whether or not he would like to have a meeting, and was stopped from that, so my line of questioning did not go very far before I was interrupted by the chair of the medical society to say that clearly other people were there to make presentations, and in view of the fact that I could only stay for half an hour, they would like to get their presentations on the record with me too.
Ms Jackson: When you had your conversation with Dr Donahue on the way out, did you ask him then?
Hon Miss Martel: No, I did not.
Ms Jackson: Why not?
Hon Miss Martel: I do not know. I am sorry, I cannot answer any more than that. I was in a hurry to leave. What I was trying to get at that point was whether or not we could arrange a meeting. That seemed to be the most important point to me at that stage.
Ms Jackson: You indicated that by this point your office had been having a number of telephone calls in support of Dr Donahue. Was there any question in your mind, as a result of this meeting, as to whether that support might be misplaced?
Hon Miss Martel: Well, I did not get the impression from the people who were calling in that they knew he was going to be operating another clinic somewhere in town. Clearly what people were telling us was that (a) we were forcing him out of business and (b) he was going to be leaving the community as a result. The nature of their calls to us was to say: "What can you do to ensure that he stays in the community? We don't want him to leave."
Ms Jackson: Was there any concern in your mind at that point, as a result of what you had learned, that anything Dr Donahue was doing was illegal?
Hon Miss Martel: No. I wondered what the relationship of his staff to him was and to the nature of the work, but I had nothing to compare it to. "Illegal" would be a bit harsh. The question that would come later to me was whether it was proper or not in terms of the delivery of health care, but I do not think that concern was well out in my mind yet.
Ms Jackson: Well, you did indicate you had a concern about whether he had too many staff or what he was doing. Was that a question of the propriety of the delivery of health care?
Hon Miss Martel: Well, "illegal" is --
Ms Jackson: No, I am not --
Hon Miss Martel: I do not think the word "illegal" came to my mind.
Ms Jackson: No, no, but you say you later developed a concern about the propriety of the way he was delivering health services.
Hon Miss Martel: Mm-hmm.
Ms Jackson: I took from your earlier evidence that the beginning of that concern was this day.
Hon Miss Martel: Yes, it was, but there were other conversations that people had with me with respect to the practice that seemed to form it more clearly in my mind that I felt that there was something wrong about what was going on. But I did not have as much information then as I did later on because we continued to be contacted by people who then were also describing to us when they visited and when they did not and who they saw when they went. So I would have to say that it was later on that I felt more firm about that question.
Ms Jackson: You mentioned that you had seen Kim Morris the night before when you arrived. Was Kim Morris with you on November 15 when you went to the two meetings you have just described?
Hon Miss Martel: Yes, she was at the meeting ahead of me when I arrived, and that was in Warren. I arrived late; she had been there --
Ms Jackson: No, I am sorry, I mean the two meetings. You mentioned a meeting with the Steelworkers and then a meeting at Civic Square. Was she at either of those meetings?
Hon Miss Martel: I am sorry, we had two meetings that night. I thought that was what you were referring to. No, she was not. Andrea Valentini was with me only at the meeting at the region. She was not at the earlier meeting with the Steelworkers.
Ms Jackson: When did you next see Kim Morris, then?
Hon Miss Martel: That afternoon at about 4:30. We had had a clinic prepared already for the community and she was at the municipal office when I arrived because there had been some constituents there waiting for me. That clinic was from 4 till 6 and there was no discussion really about how the meeting went, because there were people there who were waiting to see me already.
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Ms Jackson: I think you did already indicate this morning that you recall having some conversation with Ms Morris that evening about 6 to 7 o'clock concerning Dr Donahue.
Hon Miss Martel: Right.
Ms Jackson: What do you recall of that conversation?
Hon Miss Martel: We were at her parents' home and we were having dinner there before a meeting at 7. There was a clip on TV from MCTV with respect to the meetings that afternoon. Dr Donahue came on first and he said at that point that he felt he was the thin edge of the wedge. I remember saying aloud, "But you're not leaving the community." That is the one thing I remember saying: "You're not leaving the community. You're opening up another clinic. Why are you giving the impression to the public that you're going anywhere?"
Ms Jackson: Is it fair to say that the clear impact of what you were saying was that what he was saying on television was misleading?
Hon Miss Martel: That is correct.
Ms Jackson: Do you recall saying anything else about him?
Hon Miss Martel: That is the clearest thing in my mind. I remember saying that because I remember saying it out loud as I was watching TV, and her parents were also sitting in the room with us. I cannot recall whether I relayed to her any of the information I had learned earlier on, although I may well have. I cannot recall one way or the other if I did or did not.
Ms Jackson: Is it possible that you would have raised the concerns that were starting to develop about the propriety of the way he was delivering services?
Hon Miss Martel: Given the intensity of the meeting that afternoon, I would agree with you that it is possible I did do that. If you are asking me for the exact words, I cannot give them to you. I do not know.
Ms Jackson: Is it possible that you expressed some disapproval of the way he had conducted himself at that meeting?
Hon Miss Martel: That is possible, yes.
Ms Jackson: Is it indeed likely?
Hon Miss Martel: I would have to err on the side of yes. I was late getting there and so obviously it had been a much longer meeting than we had thought. I think in the normal course of events she would have asked me how it had gone and I --
Ms Jackson: Were you reasonably angry as a result of that meeting?
Hon Miss Martel: I would say that I was pretty frustrated by the whole thing. I think at that point I felt we were not being treated fairly in terms of what we were being asked to do as MPPs with respect to Dr Donahue's case in particular.
Ms Jackson: Because of the time frame?
Hon Miss Martel: That is part of it, and because as well, letters were coming into all our offices saying he was going to close and yet I knew -- I cannot speak for Floyd or Sharon -- that in all likelihood he was not leaving the community. That was certainly the impression he was leaving with the broader public, hence a whole bunch of calls into our office about what we were going to do to keep him. I thought, in those two cases for sure, what he was saying to the public and what I knew at least were two different things.
Ms Jackson: I want to ask you specifically about the procedure for handling telephone calls on this issue during that week in your office. We talked a little about that this morning. I want particularly to ask you to focus on the day of the 15th around lunchtime. Can you describe the routine, as you understand it, for calls that came in that week and in particular on the 15th dealing with Dr Donahue?
Hon Miss Martel: Staff had set up, and have had in place for some time, a system whereby the receptionist/typist answers the phone calls that are coming in and takes the information from the constituent with respect to whatever the case happens to be. The receptionist/typist does not do the case work, therefore I would not expect her, nor would I want her, to be making any comments on any case that people are calling in about. The procedure we have had in place and the procedure that I understand was followed in this matter as well, was that if people called with comments about Dr Donahue, strictly saying, "This is how I feel; I want you to let Miss Martel know," that would be written down.
If, however, people called and wanted to know more information or wanted to know specifically what I was trying to do about it, then the receptionist/typist would pass the information on to Kim Morris, my constituency assistant, and Kim would contact the people and ask them what their concerns were. She had been given, by me on the 14th, indication of what I wanted her to say, which was, as I have already mentioned here, three items that I do not think I need to go through again. That was all she had been instructed to say and was to reassure people that we were doing the best we could to try to find a positive resolution.
Ms Jackson: If Ms Morris were out of the office and somebody called in with the kind of request for information or request for an opportunity to speak that would normally be directed to Ms Morris, what would happen?
Hon Miss Martel: The message would be left on her desk and it would be there until she got back to respond to it. No one else would respond to it.
Ms Jackson: So as you understand it, the only person who would deal with these inquiries, beyond simply taking down a name and a message, is Ms Morris.
Hon Miss Martel: That is correct.
Ms Jackson: In terms of the record of the calls, that is made by whom?
Hon Miss Martel: The incoming calls are written down by the receptionist/typist. At that point in time, the receptionist/typist who was in the office was a woman by the name of Monique Lavigne. She is off on pregnancy leave right now, but she was the one that would have been answering the majority if not all of the calls with respect to the incoming calls. We were also at that point training a Futures student who had been working in my office, but she was answering very few of the calls on the phone at that point. She was learning how to use the computer, learning our filing system etc, so we did not have her on the phones at that point.
Ms Jackson: In any case, when somebody called in with a comment or a view on, say, the Dr Donahue issue, a note of that person's name and address would be taken.
Hon Miss Martel: That is correct.
Ms Jackson: Is that done by subject? That is, people who would call on Dr Donahue go on one list and people who would call on another issue go on another list?
Hon Miss Martel: We have case forms -- I am sure all of us do -- which list information with respect to who is calling, the name and address, telephone number etc, and at the bottom of the case form there are comments.
In this particular instance, because we started to get a large number of calls, they began to input that into the computer and to have a running total every day of who was calling in and what their comments were. Some people called in and refused to leave their name and address, but by and large the majority called in were prepared to leave all that information.
So they had two sets of information. One was a running total day after day, and on lined sheets, not case forms. Because we were getting so much on a particular issue, they put it on to lined sheets as well and kept a running total that way on a daily basis.
Ms Jackson: All right. You have been good enough to provide us with copies of the running handwritten lists starting on November 12. May I ask that those be distributed and a copy put in front of you and ask you to identify those as the handwritten records of the calls concerning Dr Donahue by people who were prepared to identify themselves. This would be for the period November 12 to November 26.
The Chair: Those will be marked as exhibit number 106.
Ms Jackson: If we turn to November 15th, in the middle of the package there is a series of different pages there. On what appears to be the second page for that day, we see the name "Susan Majkot."
Hon Miss Martel: Mm-hmm.
Ms Jackson: That would mean she called the office on November 15th.
Hon Miss Martel: Correct.
Ms Jackson: From what you have said and as you know, Susan Majkot has testified that she did call your office on that day, that she indicated she wanted to talk to you about Dr Donahue, that she was told you were not there and was asked if she would like to speak to someone whom she understands to be designated as administrative assistant.
First, let me ask you if you have anybody who is called an administrative assistant.
Hon Miss Martel: No, we do not.
Ms Jackson: From what you say about the procedure in your office, whom do you understand she would have been referred to?
Hon Miss Martel: Kim Morris, because Kim Morris was the only person who had been told what to say on the phone and would have responded.
Ms Jackson: I know you were not there for this telephone call, so I am not going to be asking you for any personal knowledge; you do not have any. But I think in fairness I have to give you an opportunity to deal with Ms Majkot's evidence to the extent you may be able to.
She has said she was told by the person to whom she spoke, who, if we understand the procedure correctly, should be Kim Morris, that Dr Donahue has been practising illegal billing procedures: "I said, `pardon?' and she said, `Dr Donahue is billing illegally and we have the documentation to prove it.'" She further says that she was told, "When the public becomes aware of what he is doing they won't be so supportive towards him."
Do you have any comment on that evidence?
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Hon Miss Martel: I find it hard to believe. We do not have an administrative assistant in my office. The titles that we use are "constituency assistants." I do not have an administrative assistant anywhere in any of the offices that I have. Second, Ms Morris was given clear instructions from me on how to respond to phone calls that were coming in, and I have already indicated to you what she was told to say to people. Third, there was absolutely no documentation in our riding office or any other office at that point in time. What was in the constituency office were calls coming in from constituents. There was no other information there at all and there never was during the whole course of this matter. The dealing of this matter was all done in the Toronto office between myself and David Sword.
Ms Jackson: Well, the committee will have an opportunity to hear from Kim Morris directly, and I think we had better leave that incident at that.
Let me pick up, then, from the point at which you spoke to Dr Donahue and he indicated, in your recollection, that he was prepared to meet with someone from the ministry and with someone from your office.
I am sorry. I meant to do something with respect to that meeting which I have neglected to do. You have provided me with some notes that you made of the meeting of November 15 and indeed other notes that you made during this period, and before we progress I think it would be appropriate to mark those notes. Mr Chairman, perhaps we could mark those notes as the next exhibit.
The Chair: Those notes, as distributed, will be marked as exhibit 107.
Ms Jackson: Ms Martel, what we have here are your handwritten notes. In every case the page in front is a typed transcription of those handwritten notes. What I understand these to be are the notes that you made in relation to Dr Donahue, the threshold issue in Sudbury, and I guess what we might call the Thunder Bay incident between November 15 and December 19, is that correct?
Hon Miss Martel: Yes. These are all of the notes that I had taken throughout the whole period.
Ms Jackson: Now, the first page relates to the notes you made of the meeting of November 15 that we have discussed, is that correct?
Hon Miss Martel: That is correct.
Ms Jackson: Now, there is no indication on those notes about the reference to Dr Donahue having reached his cap three months ago, but you have also provided us with some notes made by I think both Ms Valentini and Ms Wyers, and perhaps we could mark those two as the next exhibit and we will deal with what they say on that point.
The Chair: The notes as distributed will be exhibit 108.
Ms Jackson: Those are the notes that have a page reference on them, page 153, which I understand to be the notes of -- do you know whether these are Ms Wyers's or Ms Valentini's notes?
Hon Miss Martel: Just let us take a look at them.
Ms Jackson: I think these are Ms Wyers's notes. Those will be exhibit 108, and the notes of Ms Valentini, which run to two pages, will be exhibit 109, and both Ms Valentini's and Ms Wyers's notes reflect Dr Donahue's statement that he had reached his billing cap three months ago, correct?
Hon Miss Martel: That is correct.
Ms Jackson: Then just staying with your notes, because they may be of assistance, what then did you do in relation to the proposed meeting between Dr Donahue, your office and the Ministry of Health?
Hon Miss Martel: Before I left the room I explained to Dr Donahue that I would have someone from my staff contact him to make arrangements for the meeting. In that regard, when I got back to Toronto I made a note up for my assistant, MaryLou Murray, and asked her if she could contact Michael Decter as soon as possible in order to have this meeting arranged. As I understand it, that request was given to David Sword, my policy assistant, and he went about making those arrangements.
Ms Jackson: All right. Now, the note that you left for MaryLou, or a typed transcription of it, is contained five and seven pages into exhibit 107. Is that right? The page that starts, first of all, "MaryLou -- Nov 18/91 -- urgent," and the second page of those notes that says, "I think we absolutely have to have a meeting," and carries on; those two together are the note you wrote MaryLou.
Hon Miss Martel: I see how you have done it. Yes, they are.
Ms Jackson: And that is a note that you wrote on the Sunday evening following -- pardon me. I guess this would be the Monday following the meeting.
Hon Miss Martel: Right.
Ms Jackson: And you start by saying, "Needless to say, the Friday meeting with Sudbury OMA people and Dr Donahue left a lot to be desired." Why did you say, "Needless to say"? That sounds as though you expected it to be less than desired. Is that what you meant?
Hon Miss Martel: Pardon me?
Ms Jackson: Is that what you meant?
Hon Miss Martel: I am not sure, Mrs Jackson. I cannot tell you one way or the other why I used that phraseology.
Ms Jackson: Okay. And then you report the remarks you have already told the committee you made.
Hon Miss Martel: Mm-hmm.
Ms Jackson: And his response, and then on the next page you indicate who should attend at the meeting, and I think I must give you some opportunity to clarify the comment, "not just with rinky-dink lower MOH staff."
Hon Miss Martel: My apologies to the staff at the Ministry of Health, because at the time I thought it was a serious matter and I was not interested in having it shuffled off somewhere and not dealt with. It was not the most appropriate thing to write down and I should give my apologies to the ministry staff over there because they did not deserve that.
Ms Jackson: Well, all you mean, I take it, by that is that it is important that somebody at a senior enough level deal with this matter.
Hon Miss Martel: That is correct, but it could have been said in a better way and it was not.
Ms Jackson: Very few people probably assume their notes are going to end up being examined in these kinds of circumstances. Now, when you say in the second point there, "MOH needs to bring his billing list with them," what did you mean by that?
Hon Miss Martel: That whatever information they had with respect to what his revenues were should come to this meeting as well so that could be matched against whatever his costs were.
Ms Jackson: And then you say in the next point, "There is more to this than meets the eye and the ministry needs to get at it all." What did you mean by that?
Hon Miss Martel: That at that point in time I had also read the newspaper articles from over the weekend, on the Monday morning, and I had some real concerns with respect to him being over the threshold already at that point, and if you took that on an annualized basis, that was a pretty significant income coming into that particular office; second, that I did not understand why he would be into an operating line of credit at that point if in fact there had been no adjustments made, and my understanding was that no adjustments would be made until December. So I had trouble understanding why he was into an operating line of credit at all, because my understanding at that point was he was getting back, dollar for dollar, what he was billing.
I had questions that came over the weekend, which we have not talked about yet, with respect to the nature of the practice, because certainly at a function that I had been at on the Saturday night, there were a number of people who talked to me about the practice and about whether or not people who went were in fact seeing Dr Donahue himself, seeing others, if there was supervision or monitoring etc. So I had some concerns about how the delivery of health care was going on and what the supervision was or if there was any supervision, and as a consequence of that, if there was no supervision, what kind of fees were being billed to OHIP as a consequence, whether a full dermatological rate would be applied or whether or not there was a lesser rate that would be applied if in fact a staff person was carrying out the work and not the doctor himself.
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Ms Jackson: All right. The first two things you mentioned were the level of fees you had calculated he must be receiving -- that, is the $1.2 million you calculated on Friday -- and the next thing that you could not understand was why he would be having a cash-flow difficulty at this point in the year, since the adjustment had not been made, and you had that issue in your mind on Friday. You have said as well that there was a further question raised by a function you attended on the weekend. Can you explain how that came about? What was the concern that was raised and how did it come to be raised?
Hon Miss Martel: Okay. On that evening, the Steelworkers held what is an annual health and safety dinner to which we are always invited. I went, my father went with me, and John Rodriguez, the MP for Nickel Belt, was there. Both Floyd Laughren and his wife were there. John and I and my father sat at the same table; Floyd and Jeannette were at another.
Very early on in the conversation, people who were at the table mentioned that they had seen the newspaper articles which were in the paper that night. There had been newspaper articles as a result of the meeting that went on and that appeared on the 16th in the Sudbury Star. There had been another article on the 15th and one on the 12th. Most people at the table had seen all of them at that point. So there was a general discussion that was going on about what did this all mean, whether or not the threshold was fair or unfair. So that was what happened.
There were a couple of people who approached me particularly to express their concerns either for Dr Donahue and having him remain in Sudbury, or frankly in favour of the government policy of the threshold and urging us not to change it. I will try to go through those as best as I can recollect them.
There was a woman who was sitting across from me who talked about the practice in the terms that her understanding was that there were 14 staff, and she presumed that most of them were women. Her concern was whether or not in fact those women were being exploited. I found that a strange term to use; no one else had expressed that to me. She went on to state that she wondered whether or not a number of the staff were in fact doing work that should have been done by Dr Donahue, whether or not there was any supervision or monitoring of this work, but further and more specifically to the term "exploitation," whether or not he would be billing for work that they did at a full rate and yet paying them far below whatever that rate would be.
She was the only person either then or as this whole thing unfolded who had that perspective to the matter, and during the conversation she used in fact a figure of $12 to $13 and related that to a higher dermatological fee, which she did not give, she did not know. Her question was quite around wondering if they are getting paid anywhere near the amount of money that he might be allowed to bill OHIP for that practice or procedure.
Ms Jackson: She asked the question. Did she indicate she had any information about what they were being paid?
Hon Miss Martel: No, she did not, and she did not give any indication, to my recollection, that she knew personally of this circumstance.
Ms Jackson: So she is simply raising a question?
Hon Miss Martel: That is correct.
Ms Jackson: At that point, so far as you knew, she had no answer to it, and certainly you had no answer to it?
Hon Miss Martel: That is correct.
There were several other people, at least three, who stopped me. The second would have been -- this was after the dinner was over but before the dance started -- a couple who stopped me to say that their daughter was seeing Dr Donahue and she was being treated for an acne problem and they were very pleased with the success of that and would hope that I could do anything within my power to ensure that Dr Donahue could stay in the community.
There was another gentleman, who was by himself, who stopped me and said that we should stick to our guns and we should not open up the threshold at all, because he did not think that people should be allowed to bill dollar for dollar after $400,000. He thought that was quite a bit of money, and if you got paid two thirds and a third after, that was sufficient.
The other couple that I remember was actually a couple from Toronto who were up for the dinner, and they mentioned to me that they had read about it in the paper that day and wondered as well what the 14 staff were doing. To the best of my recollection, those were the comments that I received on the Saturday night at the dinner.
Ms Jackson: So in terms of any actual information about Dr Donahue's practice, the only information you gained on that occasion was that one pair of people who were in support of Dr Donahue had a child who is being treated for acne, and the rest were comments on Dr Donahue's practice that had no apparent factual foundation, is that fair?
Hon Miss Martel: Correct.
Ms Jackson: When we take that in combination with his income level as you had calculated it and in combination with the question in your mind about cash flow, that is why you say in this note, "There is more to this than meets the eye"?
Hon Miss Martel: No, because there was one other piece of information or two. There was another call that I received on Sunday at home. It was not with respect to financial matters but a constituent who indicated they wanted to start a petition to have Dr Donahue leave. The note on the answering machine only said that their neighbours next door were in fact taking their daughter to be treated for blackheads, and he did not think his OHIP dollars should be paying for that. That was on my answering machine on Sunday.
But what I did read on Monday morning was a transcript from an interview that Dr MacMillan had had with CBC Sudbury on the Friday. In that article, I remember Dr MacMillan saying very clearly that Dr Donahue could have parts of his practice which could have been done in a hospital or in a physician's office and not at his office. Given who Dr MacMillan is, I guess I assumed from that that there was something about the practice that he knew which suggested that indeed was the case or should be the case. So I had a question in my mind as to what that reference was to: Was in fact everything that was going on in that office -- was there not a possibility it could have been done somewhere else, if in a physician's office, for example, probably cheaper? Because the rate that a physician would bill for a procedure would be less than a dermatologist.
Ms Jackson: That interview you are referring to is the one you would find at exhibit 15 in those volumes, is it? It is an interview of November 15 on CBC radio, Morning North, an interview with Dr MacMillan. That is the interview, is that correct?
Hon Miss Martel: Yes.
Ms Jackson: And the comment I take it you are referring to is the one on page 4, about three quarters of the way down, where he says, "And indeed much of what Dr Donahue is doing could probably be done by local hospitals and other physicians," is that right?
Hon Miss Martel: That is correct.
Ms Jackson: What I take Dr MacMillan to be saying there is that if Dr Donahue leaves, some of these services will probably be picked up by others, correct?
Hon Miss Martel: Well, if I can go back to my interpretation --
Ms Jackson: Sure.
Hon Miss Martel: My interpretation in reading that was that he had some knowledge that there were things that could be done elsewhere and not in that dermatology office. I did not put it in the context that if he leaves, someone else will pick it up.
Ms Jackson: He is not specifically addressing here which is the better mode of delivering the service, correct, which is the cheaper way of delivering the service?
Hon Miss Martel: No.
Ms Jackson: Do I understand you to be concluding that it would be cheaper to deliver the service this way than through Dr Donahue's office?
Hon Miss Martel: It would be my understanding that if you were doing a procedure in a physician's office, the cost of that in terms of the procedure that would be billed to OHIP would be less than in a dermatology office, because it would be a specialist's versus a physician's rate. There would be a distinction between the two rates.
Ms Jackson: And you assume that the physician's rate would be lower?
Hon Miss Martel: That is correct.
Ms Jackson: Do you know that?
Hon Miss Martel: In terms of the agreement itself, I do recall a conversation that was had before any of this started, and I do believe it came in the context of the negotiations, that there had to be a change in the differential as well between physicians and specialists, and that would be something the OMA and the government would have to look at in the future. So I have continued to have an impression that there is a differential and that the specialist would be making more. If you are asking whether I confirmed it as a result of this interview, no, I did not.
Ms Jackson: In terms of whether it would be cheaper to deliver it in a hospital, do you know if it would or would not?
Hon Miss Martel: No. My only thought at that point would have been that if it was done on an outpatient basis, the global budget of a hospital would have already picked that up. There would not be an additional charge to OHIP for that.
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Ms Jackson: All right. With respect to this call in the afternoon about the person who was going to circulate a petition, did he give any other reason for circulating a petition against Dr Donahue apart from the fact that his neighbour's child was being treated for blackheads?
Hon Miss Martel: No, he did not.
Ms Jackson: Is it fair that that did not figure very heavily in anything you thought about Dr Donahue?
Hon Miss Martel: No, that is correct, except that again you would wonder whether or not acne treatment could not be done in a physician's office.
Ms Jackson: You would wonder, but you would not really know until you knew how serious the acne was, I guess. Is that fair?
Hon Miss Martel: That is correct.
Ms Jackson: This is not a big item in terms of how you came to think about Dr Donahue, I assume.
Hon Miss Martel: No. I think the impression I had been left with with respect to his income was probably a little more important than this. That is correct.
Ms Jackson: Have we now covered everything that deals with why you in this note say, "There is more to this than meets the eye"?
Hon Miss Martel: I think so. I read the newspaper articles that had come from the week before on the 12th and Dr Donahue's own interview on the 13th on that morning, but I do not think there was any new information that had been given. The newspaper articles reaffirmed what he had told us at the meeting, which was that he had reached his threshold about three months ago.
Ms Jackson: Let me finish off this note and what you did about the meeting, and then I will give you some press reports to take a look at while we take a quick break, and then maybe we can have you just confirm that they did not make any difference to your view.
Hon Miss Martel: Okay, sure.
Ms Jackson: So this matter is left that MaryLou is to take steps to try to arrange a meeting with Dr Donahue. What happened with respect to the setting up of the meeting?
Hon Miss Martel: It was actually David Sword, my policy assistant, who took charge of that, and he spent a great deal of time trying to arrange this meeting. My understanding is that he called Larry Corea first to advise that I had made this offer to Dr Donahue and to get some advice from Larry as to whom he should talk to in order to try to arrange the meeting and who should be there. Larry Corea instructed him to call Dr MacMillan and suggested to him that Dr MacMillan would be the point person for the ministry on this particular issue. So Larry called Dr MacMillan, introduced himself, explained who he was and the nature of the call, which was I had made a commitment, or an undertaking, to try and have a meeting. Dr MacMillan indicated to David that that was fine, that he could go ahead, talk to Dr Donahue, get confirmation from him that he was indeed prepared to attend a meeting and then to call him back and they would make arrangements for when that could occur.
David undertook to make some calls and did speak to Dr Donahue on several occasions, and he would come back to me and tell me what the results of those conversations were. To the best of my recollection, at the end of the week, around the 22nd, which was the Friday, or on the Monday, David had spoken to Dr Donahue at that point. He identified himself, said he was calling with respect to the conversation that Dr Donahue and I had had on November 15. He also told him he had talked to Dr MacMillan and Dr MacMillan was prepared to attend a meeting, and he asked if Dr Donahue was in fact prepared to have a meeting. Dr Donahue indicated clearly to David that yes, he was prepared to do that. David then asked him if it would be okay again if either myself or he attended, and Dr Donahue said that was fine.
David left that conversation, telling him that he would make the arrangements and call him back when that was in place. So my recollection was at the beginning there was no hesitation at all and he was quite prepared to have a meeting and that he also understood that Dr MacMillan would be there.
In the week of November 23 to about November 28, there was a significant change in Dr Donahue's attitude with respect to attending a meeting. David called him back to tell him that we were still working on trying to have a meeting, that at that point the Ministry of Health would be sending both Dr MacMillan and, we thought, Dr LeBlanc to Sudbury on December 5 for a meeting with the general medical society and to ask if Dr Donahue would be prepared to meet before that particular meeting so they could sit down and have a quiet conversation with him about the details of his practice and the premise upon which he needed an exemption.
It was in the second call that he felt he started to see Dr Donahue waver and that he was not as committed at all to wanting to have a meeting. However, David asked him if he would be prepared again to meet before the 5th. He said that he thought he would but he just was not quite sure, and in fact he noted much less support for that request than he had had on the first call.
On the morning of the 28th, David received a call from Dr MacMillan, and Dr MacMillan advised that he had just received a call from Dr Donahue, and Dr Donahue in fact did not want to have a meeting at all, did not give any indication. At that point, Dr MacMillan was also making arrangements with me for the meeting of the 30th, but that is another snippet that is probably not important right now.
David called Dr Donahue and did not tell him that he had already known that he had called Dr MacMillan. He called and said: "I am calling to reconfirm that you are going to attend. We are going to try and have the meeting on the 5th. Is that all right?" Dr Donahue told him at that point no, he did not want to meet, he did not think that he was the focus of the issue any more, he did not want to be the focus, that the real question and the real issue was service; that he wanted to maintain a low profile and he did not want any more media attention, and that he did not at that point want to have any other meeting.
David pressed him on it because, frankly, he had asked for a meeting and we were going to go the full route to get it. I thought that was part of the responsibility that I had as an MPP, and I also wanted to be able to say to my constituents: "Look, I went the whole mile on this. I did the best I could to try and facilitate this." So David said again: "Are you sure? We can make arrangements." He said to us at that point that he would let us know; he would let our office know.
On the weekend, there was a huge spread in both the Sudbury Star and Northern Life about Dr Donahue closing his office on the Friday, and he did not tell David when he talked to him that indeed his office was going to be closing down, that he was going to be in fact having a press conference the next day to announce that. He said in the paper that he would have made more money running a Mac's milk store, and also said very clearly in the article that he felt no one in the south understood his concerns. David took offence to that because he thought he was trying to do everything he could to try and facilitate a meeting. He called him on the Monday morning, which would have been December 1 or 2.
Ms Jackson: December 2.
Hon Miss Martel: December 2, and said to him: "Look, I saw the article in the paper. I thought you wanted to maintain a low profile, and if you had wanted to maintain a low profile, this is a strange way of doing it." Dr Donahue said again he did not think he was the focus etc etc. He again reconfirmed that maybe he would be prepared to meet, maybe on the 6th, but in no way, shape or form was he prepared to have the meeting on the 5th. We were trying to arrange a meeting on the 5th because we knew Dr MacMillan could not be there on the 6th, and we also knew that they did not want to come up and down and up and down to Sudbury, that they would be there on the 5th already for a meeting with the broader medical society.
But as we left it, after that Monday, Dr Donahue absolutely did not want a meeting before the 5th, and perhaps he would entertain a meeting on the 6th, but he would let us know. We did not hear back from him after that point.
Ms Jackson: Did anyone ever pursue the possibility of meeting with him on the 6th?
Hon Miss Martel: No, because we had left it at that point in his hands. David had called him at least three if not four times at that point. Frankly, he was pretty frustrated, and I was pretty angry that all the work we had put into trying to accommodate Dr Donahue's request for a meeting had been turned down flat by him at the end of the day.
I guess if I was to make a comment about how I felt on November 28, when David called me to say, "Dr Donahue doesn't want a meeting any more; what should I do?" frankly, I was quite angry because at that point I felt like I was being used. He had written to me. He had asked me specifically for help. He had said, even in his letter to me, that he would be prepared to discuss that at any time in a phone call, meeting or however I wanted to discuss this matter with him.
I had made a commitment to him at the November 5 meeting. He seemed quite intent on having a meeting because he had told me that he had not talked to anyone from the Ministry of Health for eight months; no one wanted to talk to him; no one wanted to deal with this matter. I think we went full tilt trying to make those arrangements, and at the end of the day, for whatever reason; I guess my feeling at that point, given I was learning more information, I really wondered why he did not want to come and what it was that he was so worried about that would make him not want to come to a meeting with one of my staff, the Ministry of Health, himself and his accountant. I guess it is very safe to say and fair to say here that I had some pretty serious suspicions about what was wrong that he would not want to come and do this.
Ms Jackson: All right. Mr Chairman, this might be the time to take a break.
The Chair: Yes. We will take a 15-minute recess.
The committee recessed at 1520.
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The Chair: We will call the Legislative Assembly committee to order and I will invite Ms Jackson to continue questioning.
Ms Jackson: Ms Martel, you have made reference to the fact that over the weekend of November 16 and 17 and shortly thereafter there was further press coverage of Dr Donahue that you became aware of, and I would like to review that with you. You may have your own marked copy. For the committee purposes I am looking at exhibit 94, which is the package of media reports we marked yesterday.
First of all, there is a report in the Sudbury Star of November 12, 1991, which is page 10 in exhibit 94. I understand that is one of the stories that came to your attention, Ms Martel?
Hon Miss Martel: That is correct.
Ms Jackson: And what did that contribute to the growing impression that you had of Dr Donahue?
Hon Miss Martel: I would have to say that there was not any new information in that particular article that struck me. I knew already, because he had told us at the meeting on the 15th, that he had been operating for the last three months above the threshold.
Second, he had already intimated very clearly that he was going to leave the community. So the statement with respect to he has got to leave Ontario, "I'm going to the United States," confirmed what had been coming out of his office from his patients, and certainly confirmed the impression that was in the community that he was, in fact, leaving.
Ms Jackson: And then over the course of that period you read, as I understand it, the transcript of his interview of November 13, which has been marked as exhibit 11 in these proceedings?
Hon Miss Martel: Correct.
Ms Jackson: And what did that contribute to your knowledge or impression of Dr Donahue?
Hon Miss Martel: He made a reference with respect to his operating costs and the reference there was quite different than the one he had provided to us at the meeting of November 15.
Ms Jackson: On the second page of that transcript he says, "My operating expenses are at the upper limit of the cap." Is that the reference you are referring to?
Hon Miss Martel: That is right. He had told us at the meeting -- and I had it written down in my notes, as had others -- that his operating costs on a monthly basis were anywhere between $60,000 to $100,000. Here, what I am reading from that is his operating expenses on an annual basis are at the threshold, which would have been $400,000. If you take those calculations -- and I did -- and work them out to try to figure out how much his operating expenses are in relation to what is in the back of my mind as the amount of money he is taking in, there is quite a discrepancy. It goes from him making zero dollars anywhere up to $800,000 after the expenses are paid. That is quite a significant difference, in my mind, or some significant changes in information based on what he had given us in a meeting and what appeared here in this particular article.
Ms Jackson: When you say there was $800,000 afterwards, I take it you are taking the $1.2-million revenue number that you had inferred from the information he gave you on the 15th?
Hon Miss Martel: That is correct. That is the basis I used to compare for each of the figures, the $60,000 and the $100,000.
Ms Jackson: And you are assuming that this statement on page 2 is an indication that his annual operating costs are about $400,000?
Hon Miss Martel: Yes, I am.
Ms Jackson: So you are assuming a net of about $800,000?
Hon Miss Martel: That is correct.
Ms Jackson: And you are saying that the $400,000 is inconsistent with saying his operating expenses are $60,000 to $100,000 a month?
Hon Miss Martel: That is right. It does not work out if you do the arithmetic on it. Even at $60,000, if that was the limit, he would be in a position of making a profit, but significantly less. If in fact his expenses on a monthly basis were $100,000, basically he would not be earning a cent, because everything that was going out would be eaten up and he would be operating his office for a zero-dollar profit.
Ms Jackson: In fairness to him, if he is giving you an estimate of $60,000 to $100,000 of his operating costs, it is fairly clear he is giving a fairly wide and ballparkish type estimate at the meeting.
Hon Miss Martel: Yes, but if you match that against the reference to the fact that his operating expenses are at the level of cap, which I took to be $400,000, because that was the cap, even the information of the $60,000 to $100,000 matched against operating expenses of $400,000 leaves you with a lot of variation between the figures.
Ms Jackson: Although looking at that now, would you agree that one other possible interpretation of what he is saying is that his operating expenses since the beginning of the fiscal year have reached the level of the cap? In other words, he does not say here that his operating expenses are being calculated on an annual basis.
Hon Miss Martel: No, he does not.
Ms Jackson: And if that is true, we would be talking about operating expenses over a six- or seven-month period by November from the 1st of April?
Hon Miss Martel: Right, that is correct, if he is going back from April 1.
Ms Jackson: So if that is what he means, that would not be inconsistent with what he told you on the 15th. Operating expenses of $400,000 over a six- to seven-month period is not inconsistent with the operating expense number he gave you on November 15.
Hon Miss Martel: Sorry, would you mind doing that again?
Ms Jackson: I have just done that calculation now and I may be doing it incorrectly. If this statement is meant to refer to his operating expenses from the beginning of the fiscal year, that is, his operating expenses over April, May, June, July, August, September, October and perhaps part of November -- so seven months or so.
Hon Miss Martel: Right, okay. Sorry. I see what you are saying.
Ms Jackson: And that would indicate annual operating expenses of over $700,000, perhaps in the $800,000 range, which was consistent with what he told you on November 15.
Hon Miss Martel: If everything was in the lower range. He did not give us an indication other than anywhere between $60,000 to $100,000 at that particular meeting, monthly. If it was in the $100,000 range anywhere, consistently month after month, he would not be making anything and then I would wonder why he was operating. The best I can tell you is I took from this article that that meant an annual figure. That was my interpretation. I did not think he meant, when I read it, that he was referring only to the time that he had been in operation, from the start of the agreement, which would have been April 1, until the time we were meeting with him, November 15.
Ms Jackson: I understand that; that is clear. As you look at it now, do you agree it is susceptible of the other interpretations? I understand that was not the interpretation you had.
Hon Miss Martel: It is a possibility. Mm-hmm.
Ms Jackson: All right. Then you as well, as I understand it, became aware of an article in the Sudbury Star on November 15, which would be found in exhibit 94 at page 13. This is the article that is entitled, "Sudbury MDs Protest Billing Cap."
Hon Miss Martel: Mm-hmm.
Ms Jackson: What did that contribute to your growing body of information or impression about Dr Donahue?
Hon Miss Martel: I do not think there was any change, because the figures were off at the bottom. I mean, he told us $138,000. He said $129,000 in the paper that day, but he had used the figure $150,000, and that was consistent with both this article and the meeting we had had on the same day. So I do not think I can say that there was anything new in this article.
Ms Jackson: Then as well there was a broadcast on the CBC on November 15, which is found at page 41 of exhibit 94. It does not actually contain an interview with Dr Donahue, but comments are made about him, and in particular the statement, "He reached his $400,000 limit three months ago." Were you aware of this interview -- or broadcast, pardon me?
Hon Miss Martel: It did not make any changes, because he confirmed what he already told us, you know, the $400,000, that he had reached the cap three months ago.
Ms Jackson: Then on November 16 there was an article in the Sudbury Star, which appears at page 48 of exhibit 94, entitled, "Sudbury Doctors Blast Cap on Billings." Is that another article that you became familiar with, at least by the morning of November 18?
Hon Miss Martel: Yes, it is. I would have had it over the weekend.
Ms Jackson: And did that contribute anything to your growing impression about Dr Donahue?
Hon Miss Martel: The use of the word "cap" was one that I had a great deal of trouble with, because the impression that was being left in the community was that once a physician reached $400,000 they earned no more money, that in fact they were cut off, there was not a cent that came to them after that. And certainly in interviews that Dr Donahue himself was doing, he was doing nothing to correct that impression and in fact used "cap" in almost every interview that I can remember him using. So there was clearly, as a result of this meeting and the media coverage from the meeting on the 15th, an impression in the community, left as a result of what he had said, that after $400,000 he would not be paid any more, and that was not correct, and that terminology was used quite frequently.
Ms Jackson: The description of the threshold as a cap was not new in this article. Is that correct?
Hon Miss Martel: No, what I am saying is it would be the use because -- Dr Donahue also was talking to his patients, I assumed, but he was also meeting with a number of groups from the city at that time to try to lobby for support, and I knew he was doing that as well. And my understanding was that if he would use the word "cap" with the media and leave the impression that after $400,000 he was not being paid any more, in all likelihood the same kind of thing was happening when he went out and talked to other groups. I thought it was a bit unfair to use that in that way when in fact it would be far better to outline exactly what the agreement said, which was that after $400,000 you have two thirds and after $450,000 you have a third.
Ms Jackson: But the use of the word "cap" does not surface for the first time in this article I guess was my first reaction.
Hon Miss Martel: No, but you are asking me what articles I had had before I sat down and wrote my own note to MaryLou, and I am trying to give you a description of what I would have had over the course of that weekend in my head when I sat down to write that.
Ms Jackson: All right. And in fact the use of the word "cap," as I understand it, was fairly common among at least members of the medical profession.
Hon Miss Martel: That is quite correct.
Ms Jackson: And indeed, we have heard, at some points within the ministry. Have you heard it used that way within the Ministry of Health?
Hon Miss Martel: No, in the Ministry of Health, when they discussed it with me, they were pretty clear to use "threshold" and were pretty clear to tell us to make sure to use "threshold" too.
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Ms Jackson: At some point, we understand -- and I now cannot recall whether it was through Dr LeBlanc or Dr MacMillan -- it became clear that it would be better to describe this as a threshold billing adjustment rather than a cap. Is that the message that was communicated to you?
Hon Miss Martel: Any message we had was to use the word "threshold" because "cap" would leave the impression that there was no more money to be had after that. We tried as best we could in our discussions to use that so there would be no mistake that in fact people were not going to be paid after $400,000.
Ms Jackson: All right. I guess my point is simply that you find the word "cap" somewhat misleading or unclear in its usage.
Hon Miss Martel: Mm-hmm.
Ms Jackson: But it was by no means confined to Dr Donahue.
Hon Miss Martel: No. Other members of the medical community used it too.
Ms Jackson: There was a bit of a war of language on this particular point. Is that fair?
Hon Miss Martel: That is part of it, but depending on what you used, it led the public to have a very different impression of what the situation really was.
Ms Jackson: Okay. Then during that week when you were back in Toronto -- we are now in the week of November 18 -- you became aware of an article in the Globe and Mail on November 19, which would be found at page 14 of exhibit 94, entitled "Doctors Say Fee Limit Will Threaten Services." I guess you would have the same objection to "fee limit," would you?
Hon Miss Martel: That is a part of it. I think what struck me more about this one was the change in the threshold. It went from $400,000 to $450,000.
Ms Jackson: I am sorry. What struck you was the reference to $450,000. Where?
Hon Miss Martel: If you go into the second column, there are comments from Dr Donahue with respect to his practice and that he cannot afford to pay his 14-member staff any more. What is reported in the article is that he himself had passed the $450,000 limit several months ago.
Ms Jackson: That is consistent with what he had already said to you, is it not?
Hon Miss Martel: No. He told us $400,000.
Ms Jackson: He told you he had passed the $400,000 limit three months ago.
Hon Miss Martel: Right.
Ms Jackson: In your view, is it inconsistent to say he has also passed a $450,000 limit three months ago?
Hon Miss Martel: I would argue it would be, because his use of the term "cap" was $400,000. He used it because it left in people's minds the impression that after $400,000 you did not get any more money. There was never any discussion that I can recall of him publicly saying: "Well, no. Actually, the whole structure works like this. Up to $400,000, I get paid back dollar for dollar," etc.
Ms Jackson: I understand that point and I think you just made that a moment ago, but I am trying to understand the $450,000 point.
Hon Miss Martel: My assumption at the time would have been what he referred to in his discussions with us, which was $400,000. That would have been my assumption at the time.
Ms Jackson: All right. You assume that when he says that, he means $400,000; you now read that he may be meaning $450,000. That is what you are saying.
Hon Miss Martel: Mm-hmm.
Ms Jackson: Therefore I take it that if it was based on $450,000 rather than $400,000, it would push your calculation of his gross annual income up slightly.
Hon Miss Martel: Upward.
Ms Jackson: Is that right?
Hon Miss Martel: That is right.
Ms Jackson: And that is what you took from this article.
Hon Miss Martel: Yes. I found it strange again that -- I mean, we are all at a meeting together. If he wants some help, I would appreciate it if the help and the information he provides is all the same.
Ms Jackson: That was the point made earlier and I was not quite sure I understood that one. I guess what you are saying is that in your view it is inconsistent to say you passed $400,000 three months ago and you passed $450,000 three months ago.
Hon Miss Martel: Three months ago.
Ms Jackson: You could, in fact, have passed both. If you have passed $450,000, you would by definition have passed $400,000. Right?
Hon Miss Martel: Yes. I guess my point is, I would have preferred to have all the same, correct information on the table so I could understand what I was dealing with and what the community was dealing with.
Ms Jackson: It may not be inconsistent, I take your point to be, but it is not exactly very precise. Would that be a better way of putting it?
Hon Miss Martel: That is fair.
Ms Jackson: Okay. But is it also not fair that Dr Donahue's description of his revenues and his costs was not of a precise nature, it was more general? I have in mind the estimate that his costs are $60,000 to $100,000. He was not being very precise, was he?
Hon Miss Martel: No, he was not, but from article to article that changed as well. The comments that he would make in one meeting were not quite the same in the next, so even on similar weekends there would be two different sets of figures used in the media with respect to the financial situation he was portraying to the public.
Ms Jackson: So when we get to the end of this period of articles and press coverage, may I take it that some of the questions you have raised contributed to the reaction you said you finally had when you learned Dr Donahue would not commit to a meeting, that you were becoming increasingly suspicious?
Hon Miss Martel: That is right.
Ms Jackson: At the same time that this process of your growing information and impression of Dr Donahue was developing, I understand that at the same time you did continue to have dealings with Dr Abdulla. Is that correct?
Hon Miss Martel: Dr Abdulla's call to me did not occur until the night of November 22. It was a Friday night. I had just gotten home. Dr Abdulla called because he was very concerned about the letter that he had received from Frances Lankin stating that there would be no more exemptions granted. I told the committee earlier that he had applied and I had supported that particular request.
Ms Jackson: And you should know the committee has evidence before it, and indeed copies of a letter that went out on November 13 to all physicians in the province, indicating there would be no exemptions of the by-region, by-specialty category.
Hon Miss Martel: Okay, fine. He contacted me at home and asked if it would be possible at all for him to meet with me over the course of the weekend and said it was terribly important that he be able to sit with me and be able to tell me very clearly and carefully what the impact of this decision would be on cardiology services at the hospital and in fact to all of northeastern Ontario.
Ms Jackson: Did that meeting occur?
Hon Miss Martel: Pardon?
Ms Jackson: Did such a meeting occur?
Hon Miss Martel: Oh yes, it did. I agreed to meet with him on the Saturday night and we met on Saturday at my ministry office in Sudbury for about two hours.
Ms Jackson: All right. Now, I am not going to ask you to tell the committee in detail what you and Dr Abdulla discussed, but could you generally describe the kind of thing that you and he discussed in terms of the kind of information he gave you and what resulted from the meeting.
Hon Miss Martel: Okay. Dr Abdulla talked to me at great length and in very descriptive form about the nature of the work of the cardiologists and the cardiovascular surgeons at Memorial Hospital. He went through every aspect of what they would be asked to do, required to do or be responsible for in that regard, and that included all of the work which they were doing in the hospital with respect to on-call emergency care, cardiac surgery, transplant, pacemaker removals -- putting them in, excuse me -- and all of the work that they would do in their offices with respect to all the diagnostic testing that was required of patients before they went into surgery or in fact in follow-up. He went through very carefully and precisely for me all of these. That conversation took almost two hours.
He told me that he was there only for himself; he was speaking for his group of people. I said that I appreciated that and that I would make the case for him but I would not make the case for a blanket exemption of all northern specialists and northern physicians. That was not what I was prepared to do; indeed the Treasurer, when I was on my way out the door the November 15 meeting, was in the process of also saying to the group that was there, "We're not interested in just saying to everyone who practised in the north, `All right, there'll be no cap.'" There had to be a better way to try and deal with it. So I reiterated that to Dr Abdulla. He said that was fine and --
Ms Jackson: When you made that statement, was Dr Donahue in your mind at all?
Hon Miss Martel: Yes, because I had some very specific concerns about his practice and about his billing, yes.
Ms Jackson: So you were in your mind not prepared to advocate a blanket exemption at that point that would include Dr Donahue.
Hon Miss Martel: That is correct.
Ms Jackson: All right.
Hon Miss Martel: Even though I had already done that in terms of the letter that I had sent. I was feeling at this point that I probably should have had a bit more information before I had gone out and written to Frances.
Ms Jackson: And the change in attitude on that point had come about as a result of the concerns and suspicions that you have described.
Hon Miss Martel: That is correct. Dr Abdulla in fact went a bit further in terms of telling me all about his practice and gave me three possible solutions that I could give to the Ministry of Health to get around this particular situation, because when he started the conversation he said to me very clearly: "I am not only here to complain. I think I have some solutions for you."
It was his case and his solutions that I carried back to the ministry and asked the ministry to very carefully consider, and I should probably say that at the end of the day it was one of the solutions that he put forward that indeed was the basis for the framework agreement that we have now worked out with the OMA and the use of the underserviced area program.
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So it was a very, very constructive meeting. At that point he offered to me any information that I would need at all from him or the other cardiologists or cardiac surgeons. He offered to meet at any time with Michael Decter or whoever would be available to try to come to some sort of resolution. Indeed, I gave him my undertaking at that meeting that I would in fact go back to Toronto on Monday and make every effort that I could to have a meeting arranged so the cardiologists and cardiac surgeons could make their case to the Ministry of Health staff as they had made it to me -- as he had made it to me on their behalf, excuse me.
Ms Jackson: Indeed, you did have a meeting with Mr Decter on that, did you?
Hon Miss Martel: Oh yes, I did, on Monday morning. Monday I called him. There were a couple of things. I called him on Monday. I told him that it was imperative really, that we had to meet. I was very concerned about the implications of what Dr Donahue had told me. Clearly --
Ms Jackson: Dr Donahue?
Hon Miss Martel: Dr Abdulla, sorry, had told me. Clearly all of the cardiologists were going to be over the threshold before the fiscal year ended. Clearly, Dr Abdulla said, they were worried about that. They were all working 100 hours a week at that point and he gave me whatever he could in terms of his practice to illustrate that very matter. I called Michael Decter in the morning and I asked for a meeting with him that day.
Ms Jackson: Did you meet that day?
Hon Miss Martel: Yes, I did, with him about 3:30, 4 o'clock. It was after question period and I went back to the Hepburn Block to meet with him in his office.
Ms Jackson: Was that meeting exclusively with respect to cardiology?
Hon Miss Martel: Yes.
Ms Jackson: Was there any discussion in that meeting of Dr Donahue and his situation?
Hon Miss Martel: No, there was none. Indeed, I brought my papers with him. I started to explain to him my concerns about the cardiologists and he cut me off and said that really he would like Dr MacMillan or someone else to deal with it because these were the point people who were involved in trying to look for solutions.
Ms Jackson: When you say you brought your papers, do you mean your notes?
Hon Miss Martel: Yes.
Ms Jackson: Of the meeting that you had had with Dr Abdulla?
Hon Miss Martel: That is correct.
Ms Jackson: And those notes are contained in exhibit 107? Starting on the third page in are notes of a meeting with Dr Abdulla; sorry, not the third page in, but if you go about eight or nine pages in, "Meeting w Dr Abdulla Saturday night, Nov. 23/91."
Hon Miss Martel: Correct, those are my notes.
Ms Jackson: Now, a point that may be small or large in the overall perspective: Mr Decter has testified to this meeting and has indicated that you did come with a large number of notes of your meeting with Dr Donahue, or Dr Abdulla, and he has indicated that he recalls elaborate notes on green paper. Can you tell the committee, since what they have before them are Xeroxed, whether you ever made any notes on green paper?
Hon Miss Martel: No, I have no green paper to make notes on. They were on white paper.
Ms Jackson: All right. In any event, how long was that meeting with Mr Decter?
Hon Miss Martel: About 20 minutes or so. I had to get back to a policy and priorities meeting as well, and Mr Decter really did not want to deal with all the ins and outs of the problem I was trying to bring to him. He felt more comfortable that he would, on my behalf, talk to Dr MacMillan about coming to Sudbury and having a meeting. He felt that was the better way to respond, rather than my giving him the whole story and trying to --
Ms Jackson: And in the result, was such a meeting arranged?
Hon Miss Martel: Yes, it was.
Ms Jackson: For what day?
Hon Miss Martel: For November 30, a Saturday, in Sudbury.
Ms Jackson: Is that the only meeting you ever had with Mr Decter on the threshold issue?
Hon Miss Martel: No, I met with Mr Decter after the Sudbury meeting, on the Monday, the --
Ms Jackson: December 9.
Hon Miss Martel: The 9th.
Ms Jackson: All right. So there were no other meetings with Mr Decter prior to December 5?
Hon Miss Martel: No.
Ms Jackson: Now, during the weekend that you were in your constituency, when you met with Dr Abdulla, did you learn anything more about Dr Donahue's practice or hear anything more about him that contributed to the growing impression you had of him and his practice?
Hon Miss Martel: Yes, two things happened: (a) I had some more clinics that weekend. I was just finishing them up finally and I was down in both Alban and Noëlville on that weekend, on the Saturday afternoon, and a number of constituents who came to see me had been reading about this in the paper and expressed their concerns, again, either in favour of the government policy or against the government policy, and said the same kinds of things, "Wasn't $400,000 enough?" etc, and questions about the staff again.
Ms Jackson: Those are comments from people who were in support of the government policy, and do I take it you also had a number of comments from people who were in support of changing the policy to accommodate Dr Donahue?
Hon Miss Martel: That is right; there were both. That is correct.
Ms Jackson: And were there any specific comments that caused you to change or develop further your specific impression of Dr Donahue?
Hon Miss Martel: There were not any comments there, because none of the people who I met with had been treated by Dr Donahue, nor did they explain to me that any family members had. However, over the course of the weekend I was talking to my father about something else, and he expressed to me that several people had talked to him about this matter, several people from my own community.
A couple of things that came in that regard: One, a woman who was going to Dr Donahue's office for treatment of psoriasis, who was going to see him three times a week at that point and had been for some time, but had only ever seen him on two or three occasions. There was a second gentleman who was receiving treatment for cancer of his left ear. In that case, he had been to the doctor's office five times but again had only ever seen Dr Donahue himself twice.
There was another case of, again, another gentleman who had gone to have some excess skin removed from the back of his neck. He had this in different places. The correct terminology is "skin tags," and he had gone to have these removed. He had gone in initially and had talked to the doctor about this and an appointment had been made. When he went back the second time, though, to have these removed, he said that in fact it was an assistant who had done all this. She had marked them, she had cut them with a scissor-like apparatus, and she had in fact cauterized them as well, and the doctor had come in at the end to look at it but had not been involved in any of the procedure at all.
I think after hearing all of those I really wondered whether or not it was proper for procedures to be going on, especially with respect to cutting and cauterizing, where in fact there seemed to be little or no supervision and certainly the doctor himself not doing that, and I wondered how much of his practice was like that, ie, people operating very much on their own and doing a number of different procedures which, to my way of thinking -- and this is only my personal view that I express here -- should be done by a physician. I guess if I go into a doctor's office I expect that I will see my own family physician and that he will deal with me. And some of those cases and faces and names -- which I have not given to the committee here but if you would want them in camera I can certainly give -- I think that it made me really wonder if that was wrong or right, and if I say to the committee in answering what I did think, I thought it was wrong.
Ms Jackson: Did you know at that time what the level of training of the members of Dr Donahue's staff was?
Hon Miss Martel: No. I did not.
Ms Jackson: Did you make any assumption about the level of training when you came to the conclusion that this was wrong?
Hon Miss Martel: Well, I would have hoped that you would have RNs doing that. Whether they were or not I did not know because I did not know the full extent of his practice and what procedures were being undertaken there.
Ms Jackson: Do I take it from what you say that you hoped they were RNs, and even if they were RNs you would have concluded it was wrong?
Hon Miss Martel: I do not want to be seen to be saying that somehow there is something wrong with RNs. I do not want to leave that impression. I think what bothered me was that there were procedures that were going on which to my mind there was no supervision of, and I would have hoped that even if the doctor was not actually doing the procedure, he would not be far away in terms of watching what was going on.
Ms Jackson: In terms of the woman who was being treated for psoriasis, were you told what the nature of the treatments was?
Hon Miss Martel: No, I was not, only that she was going three times a week.
Ms Jackson: And in terms of the person who was being treated for cancer of the left ear, were you told what the treatment was?
Hon Miss Martel: No, I was not.
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Ms Jackson: So the only actual treatment that was involved that you knew of was this cutting and cauterization, at which Dr Donahue attended at the end.
Hon Miss Martel: Correct.
Ms Jackson: Of course, you would not know to what extent Dr Donahue had given specific instructions to the people who conducted these various treatments before and after they did so?
Hon Miss Martel: No. That is correct.
Ms Jackson: When you speak of supervision, you really mean being in the room.
Hon Miss Martel: That is what I am trying to tell you, that I am giving you my personal opinion.
Ms Jackson: Yes.
Hon Miss Martel: That is my personal opinion about what I feel about the delivery of health care. I am trying to make that very clear. It was no one else's opinion, only my own, with respect to what I was hearing about people going in and not physically seeing Dr Donahue.
Ms Jackson: So when you talk about the doctor supervising, just so the committee understands, what I take you to mean is that the doctor should be physically present, as opposed to instructing in advance. Is that right?
Hon Miss Martel: Yes.
Ms Jackson: Did you ever have occasion to discuss with anybody in the Ministry of Health whether this was viewed as appropriate delegation or not?
Hon Miss Martel: No. I did not talk to the Ministry of Health officials at all until they were up in Sudbury on the 30th, and then the focus was on cardiology services.
Ms Jackson: So in terms of these questions that were raised in your mind, you did not follow them up with questions to the ministry as to whether indeed your personal impression that this was wrong was shared by the ministry.
Hon Miss Martel: No, I did not, because I never went back to the ministry at any point with respect to Dr Donahue. I went back to the ministry with my concerns about cardiology because that was, front and centre in my mind, a big priority for the community and frankly a big priority for me personally. On the level of care that they are providing, if I had to do it on a priority basis in my head, I would say that they would come up on top. So my focus very much at that point in time was how to deal with their issue and how to find a resolution to it.
Ms Jackson: I am going to take you to the meeting that dealt with cardiology on November 30, but the day before that meeting took place, as I understand it, there was a further publication in the Sudbury Star which you were aware of. I am referring to the one that is contained in exhibit 94, in fact the two pages; page 15 is part of the article and page 18 is the other part. We have something called "Patient Fears Loss of Doctor" and a second article, "Specialist Knew Trouble Was Coming."
Ms Edwardh: You say it is page 15 and what other page?
Ms Jackson: Page 18. Both of those articles appeared on November 29?
Hon Miss Martel: The day he closed his office, yes.
Ms Jackson: And were read by you, were they?
Hon Miss Martel: It would have been the next day. I do not think I read them that night because I was at my office until very late.
Ms Jackson: So the morning of the 30th, Saturday morning, you read the two articles.
Hon Miss Martel: Correct.
Ms Jackson: Did they contribute to your growing knowledge or impression of Dr Donahue?
Hon Miss Martel: There were a couple of pieces of information that Dr Donahue gave to the public again which would have given the general public and me and anyone else who cared to read them some other indications about what his billing practice would be: specifically, the reference to what he thought he would need in order to maintain a viable practice, what the level of his billing allowance had to be. There he went from two or two and a half times the $400,000, or to about $800,000, to $1 million, which was starting to get into the range that I had in the back of my mind as a result of his meeting with us on November 15.
I think the other information that was new and that I had some real difficulty dealing with was his reference to the fact that he had between 10,000 and 15,000 new patients a year, not counting his referrals. I found that really hard to believe, that you could see that many people, not only new people but also patients who were coming in several times, as I already knew, for repeat visits. We tried to work that out in terms of figuring out what that would be even on a six-day work week, and it worked out to a new patient every six minutes. I could not fathom how that could work and how there could possibly be that many patients coming in and, if there were, how that whole operation was working.
Ms Jackson: The calculation you mentioned that produces a new patient every six minutes, is that a calculation you did at that time or more recently?
Hon Miss Martel: No. It is one I did more recently, but at the time when I looked at it, I found that even that was hard because he would have -- what was in the back of my mind was that was a lot of new patients. But I also knew there were, at least in the people who had contacted us -- two of the three; one had gone five times, the other was going quite regularly. So there would have to be, if that was a general or normal operation of his practice, a fairly significant number of people who were there for repeat visits too.
Ms Jackson: And what did you conclude from that?
Hon Miss Martel: He was seeing a lot of people. And obviously he could not see that many all by himself, so that in my mind there was a great deal of work that was being done not by him but others on his staff.
Ms Jackson: The concern that you had was not so much about the accuracy of the statement but what it indicated as to the level of work that was being done by other people. Is that right?
Hon Miss Martel: The latter. There is no way that many people could be seen by him -- obviously, they are not -- so then a large part of his staff would had to have been doing quite a number of procedures in order to accommodate that many people.
Ms Jackson: After reading the article, you went on then to -- we have heard there was a breakfast meeting on November 30 before the meeting with the cardiologists. You went on to that breakfast meeting?
Hon Miss Martel: Correct.
Ms Jackson: And it lasted about how long?
Hon Miss Martel: About 45 minutes. We arrived late and the meeting at the hospital was to be at 9:30 and we had to drive there -- so under an hour.
Ms Jackson: And it took place, I think we have heard, in the Sheraton coffee shop?
Hon Miss Martel: Yes.
Ms Jackson: I am going to ask you to recollect for the committee your recollection of the seating of people at that meeting because I understand it differs slightly from Ms Murdock's recollection. Perhaps we can do it this way: May I summarize what you have already told me about your recollection, rather than ask you to redo the table yet again?
Hon Miss Martel: Okay, if you want.
Ms Jackson: As I understand it, if we were to start at the left end of the lower side of the table, we have Mr Wood. Sitting beside him Ms Murdock; sitting beside her, you, and sitting beside you, Dr MacMillan. Is that correct?
Hon Miss Martel: Correct.
Ms Jackson: And across from Mr Wood, Mr Belyea from the ministry?
Hon Miss Martel: It went the other way.
Ms Jackson: And across from Ms Murdock, Mr Laughren; and across from yourself, Mr Rodriguez, and across from Dr MacMillan, Dr LeBlanc. Is that right?
Hon Miss Martel: That is right.
Ms Jackson: And I understand that your recollection of that is reasonably clear?
Hon Miss Martel: Yes.
Ms Jackson: Now, at that breakfast meeting you were of course wanting to prepare for the cardiology meeting that was to follow, but was there in addition to cardiology a discussion concerning Dr Donahue?
Hon Miss Martel: Yes, there was.
Ms Jackson: Do you recall what prompted that?
Hon Miss Martel: John Rodriguez had a copy of the paper --
Ms Jackson: The one we have just been looking at.
Hon Miss Martel: -- with him, and he had been reading it as he was waiting for the rest to arrive. He had the copy with him. And so that started the conversation, to say that he had seen this in the paper. He had also been at a meeting the night before, a meeting of small business people. He had been there talking about, actually, a payroll tax for the federal wage protection fund and the possibility of that.
However, before the meeting ended, Dr Donahue showed up to the meeting and explained to all the people again that the NDP was forcing him out of business and out of Ontario etc. So John had been at that particular meeting and then had read the article and was quite astounded and quite frustrated by the information that was coming out.
His frustration was around the fact that indeed Dr Donahue was in a position to release figures very publicly and have a public debate around numbers that he was giving. But from our side, we had no clue whether or not the numbers he was using and bantering about in public were correct, and whether if in fact we did have a clearer sense of what his practice was, we would not be able to minimize some of the anxiety and some of the concern that was very real and very evident in the community. People were really afraid that we were going to lose not only Dr Donahue but that there would be a whole flood of doctors out of the province as well.
Ms Jackson: After he raised that concern, was there any discussion by anyone else about it?
Hon Miss Martel: Oh, yes. Dr MacMillan said that any information with respect to Dr Donahue's billings was confidential and he proceeded to name three pieces of legislation that I can recollect as to how that would be confidential and be kept confidential. He also made the comment that part of one of those pieces of legislation in particular was one that the NDP had supported when it was here during the accord. There then came from that statement a more philosophical discussion about whether or not billings information of physicians should be confidential, and certainly he and John got into a bit of a discussion about that and what it was like in other provinces as compared to ours.
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Ms Jackson: Was there any discussion about whether the numbers that had been published in terms of Dr Donahue's income levels, and in particular the estimate that he would need $800,000 to $1 million, were a high level of billing?
Hon Miss Martel: I believe that Mr Rodriguez made that comment. That was, if I understand it, his first real -- not understanding of the problem, but having to face the problem. Because he is the federal MP, he normally deals with federal issues and does not very much get involved in what we do. He was at the cardiology meeting on my request because he had been treated by Dr Abdulla and I knew he could bring a personal accounting of the importance of Dr Abdulla and his group to the Ministry of Health. It was my intention at the breakfast meeting to make sure the Ministry of Health understood how important these people were to the community. So for John it was the first time that he had seriously had to think about what was going on in the community, so he, of all of us, was expressing the most concerns about the level of billing that was indicated in the paper. Sharon was --
Ms Jackson: But was that concern shared? When you speak of the frustration on this issue that people could not get behind the numbers and test their accuracy, was the concern he expressed generally shared by others around the table?
Hon Miss Martel: Well, I already understood that it was protected and understood how it was protected in terms of at least two pieces of legislation.
Ms Jackson: I am sorry, that was not a very clear question. Was the concern about the high level of the billing that he expressed shared around the table?
Hon Miss Martel: Well, I would have to think that it was. I mean, he was talking about the article and he had it in front of him. Sharon did not seem to make -- I do not remember Sharon making a comment about the billing that appeared in the paper as much as she was trying to explain to Floyd about epilation, because Floyd came late to the meeting and she was in the process of telling him some of the calculations that she had worked out in her office. She was much more convinced, and always has been, that the real problem in his office was epilation and not threshold, so she was quite engaged in this conversation that was going on to this side of me.
Ms Jackson: And the conversation at your end was more of the conversation with Mr Rodriguez expressing concern about the level of billing and how do you deal with this, and Dr MacMillan describing that it is confidential.
Hon Miss Martel: That is right. The greater part of those two pieces was the discussion about what legislation there was in place to protect that, to protect the release of that information, and a more philosophical discussion about what was happening in other provinces: Was it working there? Is that something we should look into in Ontario?
Ms Jackson: Given the concern expressed about the level of his billings, do you recall any discussion about whether billings could be reviewed within the ministry?
Hon Miss Martel: No, I do not have any recollection of that kind of discussion at all.
Ms Jackson: Now, on your recollection you have Ms Murdock sitting on one side of you and Dr MacMillan sitting on the other side. Ms Murdock has given the committee a clear statement of a discussion that morning between herself and Dr MacMillan in which she learned for the first time about the review process in the ministry and before the medical review committee. Do you have any recollection of that discussion at all?
Hon Miss Martel: No, I do not, and in spite of the times that you have asked me about this and commented on the seating, I do not have any recollection of that conversation going on. If I did, it would probably be very helpful to me in terms of later on what I say. But I can tell you and I can tell the committee members, I do not remember that. I do not. I have to say that there were a number of conversations that were going on. There were eight of us at the table. People arrived late, Floyd in particular with Ian, so that there were conversations that were going on, some of which I picked up and some of which I did not, and the extent of those conversations and what was said I cannot elaborate on any more and I cannot give you any idea. I wish I could, but I cannot.
Ms Jackson: Do you recall if you knew at that point in time about the existence of a procedure within the ministry and at the medical review committee for the review of doctors' billings?
Hon Miss Martel: No, I do not have any recollection.
Ms Jackson: So you might have known or you might not have known. You just do not know, or you know you did not know?
Hon Miss Martel: My first recollection of having a clear idea that there was a process in place in the ministry to deal with billings that may be suspect etc did not come until I read the Kevin Donovan article in January. That is my clearest and only recollection of when I had heard that, or when I had any indication that there was such a process.
Ms Jackson: Do you recall any other discussion that morning at the breakfast meeting relating to Dr Donahue?
Hon Miss Martel: It came about in this way. Part of the conversation with John was to try to bring him up to speed on what had happened with respect to the agreement, why it had been signed, what it meant, what some of the exemptions were. Dr MacMillan was in the process of explaining to John that there were exemptions for technical fees and, as well, that people who were already on the underserviced area program, for the duration of time they were on the program, were exempt.
Dr MacMillan turned to me and he said, "By the way, do you know that Dr Donahue was on the underserviced area program?" I was floored and I said, "No, I didn't," and "When was he on it?" He said, "He was on it until August 31st of 1990." That struck me and it struck me hard, because in my mind two things: (a) He had not told us the truth when he had met with us on the 15th. He had told us very clearly at that meeting that he had reached his threshold three months ago, which would have been August 15th. Now I was receiving information to say that clearly up until August 31, 1990, he was in fact exempt and would receive everything back that he had billed dollar for dollar.
The second thing that did, because I took him at value that in fact he had reached a threshold -- certainly he had accountants there who were prepared to tell me that -- then he must have reached the threshold from the period when he got off the underserviced area program until November 15th. That would have been in my mind about September 1st until mid-November, about a 10-week period of time, and I took that to mean he had billed $400,000 in 10 weeks. If I annualized that out, his billings were in the order of about $2 million.
Ms Jackson: When Dr MacMillan told you that, did he tell you that as a result of a conversation he had had with Dr Donahue he realized that Dr Donahue had himself been confused about this issue?
Hon Miss Martel: Dr MacMillan did not tell me that he had any discussion with Dr Donahue. The only piece of information I had from a conversation of Dr MacMillan and Dr Donahue was that on November 28th, when Dr Donahue indicated he did not want to meet with us.
Ms Jackson: Did you make any assumption about the state of Dr Donahue's awareness of his underserviced area exemption?
Hon Miss Martel: There was no doubt in my mind that he would have known. Two bits: (1) Dr Donahue is the secretary of the Sudbury medical association. The doctors in Sudbury were the only group of doctors in the entire province that voted against the OMA-government agreement, and it seemed to me that they would spend some time looking at the agreement and then making a recommendation to the broader membership to vote against it. I do not know how else they would carry out that process except to examine it and then make a recommendation to their membership before they went to vote.
Clearly in the terms of the agreement it talks about the underserviced area program and clearly to my mind after having read it, both at the time that the agreement was signed and later when this process started, anyone who was on the underserviced area program was exempt from the threshold.
I guess the second thing was that in applying for an exemption himself, I felt Dr Donahue would have gone back to look at what were the terms and conditions of making a request for an exemption. In that particular section of the agreement there were two ways he could have done it: (a) It said very clearly that people who were on the underserviced area program were exempt, and (b) the minister also had some discretionary power in which she could make exemptions herself, but it was in the same place in the agreement.
So my understanding is that in order to think about even applying for an exemption, he would have gone back and taken a look at what those conditions were and would have seen that very clearly.
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Ms Jackson: Now Dr Donahue has explained to the committee that even after the confusion that he says he had on this issue was sorted out, it was not material to him in terms of the position he was taking because it would not affect his future financial planning. In other words, the exemption had run out. Did you ever consider this in the context of the future financial planning for a physician?
Hon Miss Martel: No, I would have considered what he was doing in the community at that time. If he was exempt, indeed his financial position was much different than I think he was leading people to believe. Again, that would have made me even less clear as to why he would be closing his office in November, stating that he had no money to keep it operating, when in fact the adjustment was not going to be coming till December. But the adjustment, in my mind, was going to be quite a bit different than the initial case that he portrayed to me, which was that he had reached his cap three months ago, about some time in August. In my mind, his whole financial picture changed right then for me, because he would have a whole period of billings where in fact he would get back dollar for dollar. I could not understand how it was that he was closing his clinic then and saying he was going into bankruptcy when, to my mind, that was just not the state of affairs.
Ms Jackson: So your conclusion was clearly, first of all, that he knew this, and, second, that he was being untruthful?
Hon Miss Martel: That is correct.
Ms Jackson: Now, when you learned that he was on the underserviced area program, were you given any other information about the underserviced area program and who was on it?
Hon Miss Martel: I asked Dr MacMillan who else was on the program, because I thought if there was one person on the program there might be more who were also out saying they were leaving. So I asked him if they had a copy of this, if it was public information etc, and he said to me that yes, it was, and he produced a copy for me at that meeting. It had a list of all of those people who were on the underserviced area program. For my purposes, I was interested in finding out who else from Sudbury might have been involved. It was in reading that over the course of the weekend that I discovered that Dr Hollingsworth was also on, and Dr Kosar.
Ms Jackson: In exhibit 8 in these proceedings there is a list of "Specialists on Program" dated October 31, 1991. Could you look at that and indicate whether that is the document that Dr MacMillan provided you with on the 30th?
Ms Edwardh: At what page of exhibit 8?
Ms Jackson: I am afraid there is not a page number on the copy that I am working with. It is a rather long document. About in the beginning of the second half. The document itself runs to about 11 pages and on every page at the top it says, "Specialists on Program."
Hon Miss Martel: That is correct; this is what he gave me.
Ms Jackson: Did you make any comment as to whether or not this should be publicized, or did you come to any conclusion?
Hon Miss Martel: Well, I certainly thought that would change the tone of the debate, if in fact it was made public that the first four months of Dr Donahue's billings were exempt. I guess at the time, if I look back -- we were at a meeting to talk about cardiologists. I had asked my colleagues, particularly John, to come and make the case for the cardiologists at that meeting. I knew John, better than anyone else, could do that because he had been treated by Dr Abdulla. So while this was a very important piece of information to me and one that certainly changed, in my mind, my consideration of Dr Donahue's practice and his request to me for help, at that point what I was much more worried about and focused on was trying to deal with the cardiologists, and so I did not do anything further with it.
Ms Jackson: During the course of this discussion about Dr Donahue, were you told that the ministry had any concerns about Dr Donahue?
Hon Miss Martel: No. My recollection of where Dr Donahue came up in the conversation is as I have described it to you already: Mr Rodriguez's comments and the reply from Dr MacMillan about confidentiality and the comment to me from Dr MacMillan of whether or not I knew Dr Donahue was in the underserviced area program and my response to him, which was, "He's making even more than I thought, then."
Ms Jackson: What is your best estimate of the length of time that these various comments and discussions about Dr Donahue took?
Hon Miss Martel: I think they were at the start of the conversation, because John had the newspaper there with him, but in terms of the overall conversation, it took up very little of the time of the conversation because, as I explained to you earlier, we were trying to get John to have a good working knowledge of what the agreement was and what the exemptions were. There were also questions raised with the Ministry of Health staff at the time as to what their view could be about possible solutions. So the focus of the discussion and indeed the major part of that discussion was on the meeting we were going to next.
Ms Jackson: So the discussion about Dr Donahue would be what, 10 minutes, five, or can you say?
Hon Miss Martel: I would say it was no more than five because once Dr MacMillan made it clear that in fact billings information was protected under those three pieces of legislation, the shift was then to a more philosophical debate about billings and that name was left.
Ms Jackson: After the discussion about the underserviced area program?
Hon Miss Martel: No, that was before.
Ms Jackson: I am sorry. All right. As far as you can recall, did you receive any confidential information about Dr Donahue in that discussion at all?
Hon Miss Martel: No, I did not.
Ms Jackson: Was there any discussion in that meeting about the number of physicians in the Sudbury area who would be affected by the threshold?
Hon Miss Martel: Yes, there was, because I asked the ministry for that information at that meeting. My concern, as a resident of the community and because of what I was hearing, was that the impression going on in the community was that in fact there would be a flood or an exodus of doctors out of the community. People were becoming very frightened about that because trying to attract or retain specialists has been a great deal of the work of the MPPs and the regional council.
I wanted to know what the magnitude of the problem was, because if I picked up the paper and read it, I would think that every specialist was leaving town. I asked the Ministry of Health staff, Dr MacMillan, if he could tell me how many people in Sudbury were in fact going to be affected by the threshold; that is to say, how many would be over the threshold and then in a position of making a decision on whether or not they wanted to leave. He told me at that time that there were 13 specialists who could be in that position, and there were four general practitioners who could be in that position. I did not ask for any names, and no names were given, strictly the numbers.
Ms Jackson: Did you know from your own knowledge of the community who the general practitioners were?
Hon Miss Martel: No, I did not know who the practitioners were. I knew who about nine of the specialists were, or 10, because when Dr Abdulla had come to see me he had spoken on behalf of nine, himself included. I knew that there would be at least two obstetricians who would be, and that information had come from the meeting on the 15th when Dr Malloy and Dr Farrell had been there and said very clearly that two of, I think, the five of them would be over the cap in January or February.
Ms Jackson: All right. After this meeting, did you go on to a meeting with the cardiologists?
Hon Miss Martel: We did.
Ms Jackson: Was there any discussion at that meeting of Dr Donahue?
Hon Miss Martel: No, the discussion was on the cardiologists. There were a large number of people there. I was chairing the meeting. We had two people representing the cardiologists, two representing the Sudbury medical community and one representative of the district health council. The regional chair was there along with the regional director of social services. There was John, Floyd, Sharon and myself. Ian Wood accompanied us as well, and there were representatives from the hospital, both the CEO from the hospital and Ms Kaminski, who is the director of nursing, and the people who had come from the Ministry of Health as well.
Ms Jackson: I do not propose to ask you to review what took place at that meeting, but in your recollection there was no discussion of Dr Donahue?
Hon Miss Martel: No, it was three hours on Dr Abdulla and Dr Juma, going through much of the information they provided me.
Ms Jackson: I understand. After that, we understand, the committee has heard evidence, that there was as brief luncheon meeting or a brief lunch which you attended with at least Dr MacMillan and Dr LeBlanc?
Hon Miss Martel: And David Belyea from the Ministry of Health.
Ms Jackson: And David Belyea. Do you recall any discussion during that lunch of Dr Donahue or his situation?
Hon Miss Martel: No. My recollection of that was entirely on the focus of what solutions we were going to propose to the Ministry of Health. Dr LeBlanc indicated to me that Michael Decter --
Ms Jackson: For my purposes all I need to know is whether you had any discussion of Dr Donahue.
Hon Miss Martel: No.
Ms Jackson: All right.
Hon Miss Martel: It was all focused on what solutions there could be, because they wanted to relay that to Michael Decter that evening.
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Ms Jackson: On that day you of course had conversations, which you have described in part, in which Dr LeBlanc was a participant. Had you ever met Dr LeBlanc before that day?
Hon Miss Martel: No. That was the first day I met both Dr LeBlanc and Dr MacMillan.
Ms Jackson: I asked the question because, as I pointed out to you a little bit earlier today, Dr LeBlanc's evidence is that his recollection is that he had discussed with you before this meeting some of the elements of the threshold.
Hon Miss Martel: His recollection is different than mine. The meeting that was set up on the 30th was done by a David Sword in my office with Dr MacMillan and Dr LeBlanc. I never had any opportunity to speak to them before that meeting. I had several conversations with Dr LeBlanc after that because he was the point person in trying to find the solution, but I have no recollection of talking to either him or Dr MacMillan before.
Ms Jackson: All right. I will be asking you about some of the specifics of those conversations as we go through the balance of the chronology, but may I just ask you generally, do you recall after the meeting of November 30 whether you ever discussed Dr Donahue with Dr LeBlanc again?
Hon Miss Martel: No. My discussions with Dr LeBlanc were on what the proposed solutions were that he was presenting to Michael Decter and what I could do to lobby both Michael Decter and Frances on trying to implement some of those solutions.
Ms Jackson: After that meeting with the cardiologists on the Sunday, were you still in Sudbury?
Hon Miss Martel: Yes.
Ms Jackson: On that Sunday, December 1, an article appeared in Northern Life, which you will find at page 20 of exhibit 94, entitled "Ministry Challenges Doctors to Open Books to Public." This is the article in which Dr Donahue is reported as saying he would be better off owning a Mac's milk store. Did you read that article?
Hon Miss Martel: Yes I did. I heard part of it on the radio as well. The byline on the radio was that he thought he would be better off owning the Mac's milk.
Ms Jackson: Having read it, did it add at all to your growing impression of Dr Donahue?
Hon Miss Martel: It did in a couple of ways. He talked again about the number of patients he was seeing. The number of patients listed in this article was significantly different than what had been listed the day before in the Sudbury Star.
Ms Jackson: Here he says he sees 12,000 patients a year.
Hon Miss Martel: Second, he gave a lot more information with respect to his personal practice, the $8,000 worth of disposables, including rubber gloves. I guess the thing that struck me was the $1.5 million worth of prescriptions, because I could not figure out in my mind how he would ever know that in fact the prescriptions he had written out would add up to $1.5 million annually. I found it very bizarre that he would be able to speak about the total value of all the prescriptions he had issued out of his office in a given fiscal year.
Ms Jackson: Because you did not see how he would know?
Hon Miss Martel: I am assuming that his giving prescriptions to patients is the same as when I go to my family physician; the price is not marked on the prescription, only what the physician wants you to go and pick up at the drug store. So how would Dr Donahue ever know --
Ms Jackson: That was what was bizarre to you. You wondered how he would know?
Hon Miss Martel: That is right.
Ms Jackson: Did you therefore make any conclusion about whether this was accurate or not, or were you just left wondering how he would know?
Hon Miss Martel: I wondered how he would know that particular bit of information.
Ms Jackson: Did this in any way cause you to think more negatively of Dr Donahue, or did it just raise a question?
Hon Miss Martel: No, I think it is fair to say to everyone that seeing this article really made me angry. We had done whatever we could to try to accommodate Dr Donahue, and I felt even more then than I did at the beginning that he had been completely unfair to us in terms of asking for our representation.
I felt really that he did not want our representation and probably had not right from the word go, because he had never left us with any room to move to try to adequately respond on his behalf. That really bothered me, because health care is really important in our community. It is critical in our community, and frankly, as an MPP in opposition and as a minister, I think I fought really hard to try to maintain services in the city and also bring people. I really thought the whole manner in which he had carried out his public crusade was really offensive. That was my feeling. To say he would have made more money had he had a Mac's milk store, when in my mind I am reaching billings at about $2 million, I found to be quite astounding, and I did not believe it, as a matter of fact.
I was also angry by the suggestion in the article that no one in the south understood, no one cared, when in fact I had had a policy person who had spent all kinds of time on the phone trying to arrange a meeting for him so that he could come and have some meeting, have some say and present his case in a way that he explained to us he had not been able to do for the last eight months because no one at Health wanted to listen to him. There is no doubt about it; I was very angry. I just thought I was being taken for a ride and I resented that.
Ms Jackson: Have you seen the letter that Mr Decter wrote to Dr Donahue inviting him to have a public discussion of these matters on November 19?
Hon Miss Martel: I do not remember ever receiving a copy of the letter, and my recollection is seeing quotes of it in the newspaper.
Ms Jackson: I should, having asked you that question, show it to you. It is exhibit 73. Now that you have seen it here, do you recall if you had ever seen the letter in its entirety before?
Hon Miss Martel: No. I have not. I am sorry.
Ms Jackson: Dr Donahue has expressed the view before the committee that some of these invitations, and in particular this letter, suggesting as it does in the third paragraph an investigation and public discussion of his practice pattern, was something that he found threatening. I think, to summarize his concern, it was that he was concerned that as a result of his having raised the issues he had, the government was indicating it was about to start a campaign of publicizing information about him. Did you ever have any reason to think that Dr Donahue might have felt threatened by these invitations to discuss his practice with the ministry?
Hon Miss Martel: Ms Jackson, I would say that Dr Donahue had made his practice more than public, that he had given statements to the press on many occasions and had given out information to the public that I would consider part and parcel of his personal situation. I do not think it could have been more public than it was in that community.
Ms Jackson: In making the efforts that you did -- well, first of all, let me ask you: In terms of the meetings that you were trying to set up between your office and the ministry and Dr Donahue, did you consider whether the information exchanged in those meetings was going to be exchanged publicly or privately?
Hon Miss Martel: No, I considered that those meetings would be between someone from my office, myself or David; Ministry of Health, Dr MacMillan in particular; Dr Donahue and any of his financial people whom he wanted to bring with him. My understanding all along and our offer to him was just that, that that would be the group and it would be done among that group and there would not be media there to have that process go on. But that was similar to my understanding of anyone who was going to be applying for an exemption.
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My understanding was that individual cases of people who were coming forward because they were requesting information would have to, at some point or another, sit down with the Ministry of Health and go through issues of their own practice in order to sort out with the ministry whether or not an exemption was in fact necessary -- whether or not, for example, practices could be done in a hospital that would not be counted against the physician in particular, as was the case that we started to look at in the case of the cardiologist etc. So my impression has always been that those people who would want a minister to use her discretionary power to grant an exemption would also then come forward and make their case.
Ms Jackson: So in your view this was to be, while a disclosure of information, a disclosure of information to the ministry, not to the public.
Hon Miss Martel: That is correct.
Ms Jackson: If you look at exhibit 73, though, and in particular paragraph 3, do you not agree that what Mr Decter appears to be contemplating is a public discussion of Dr Donahue's practice?
Hon Miss Martel: Well, I would be hard pressed not to, but I cannot think of what was in his mind. In looking at that, if you are asking me to respond, I would say that is probably what he has in mind. That is correct.
Ms Jackson: And would you agree that a doctor might feel more threatened by a meeting if the information is to be publicly disclosed than if it is to be dealt with privately?
Hon Miss Martel: You see, I would disagree with you there because I am of the view that Dr Donahue had made the aspects of his practice quite public. No one else in the community, no other specialist who was requiring an exemption or writing in, had ever released any financial information with respect to their own particular practice. No one else talked publicly about how many staff they had, how many patients they saw, how many prescriptions they wrote out a year, what they bought in the community, when they were over the cap, what their operating costs were, what they owed to the bank. No one else did that. Dr Donahue was the only one.
To my way of thinking, he had made his practice very public. I am not sure what more there was to disclose at that point because he had certainly put out all kinds of information with respect to his practice. Most of it was in many cases contradictory, but there was all kinds of stuff out there, and he had done that on his own.
Ms Jackson: Although clearly a lot of other information was not out there because it was some of that other information that you were hoping to get in a meeting with him. Is that right?
Hon Miss Martel: With respect to salaries, rent etc, yes, that is correct.
Ms Jackson: Then we move to --
Hon Miss Martel: I am trying to respond to your question as to whether or not he would be fearful. I cannot speak for Dr Donahue. I do not know what he was feeling like at the time. I only think there was a lot of information already out there that he himself had made public.
Ms Jackson: Okay. Now, on December 2 -- we move to a Monday -- you are back in Toronto. Is that right?
Hon Miss Martel: That is correct.
Ms Jackson: And you had mentioned before that Dr LeBlanc stayed in charge of trying to take this cardiology issue further. Did you hear from Dr LeBlanc that morning concerning his efforts in that regard?
Hon Miss Martel: Yes, I did. I called him to find out how his discussions with Michael Decter had gone over the weekend, and whether or not the proposals that we had put forward at the Saturday meeting were going to be acceptable to the minister and to the deputy.
Ms Jackson: Was there any discussion in your conversation with Dr LeBlanc about any doctors from Sudbury who were expected in Toronto?
Hon Miss Martel: Yes. I asked Dr LeBlanc if I should talk to Frances in the afternoon to lobby her further about this matter. He said to me that Frances would not be in the House that afternoon because she was being briefed on the OMA Dues Act, which was due to go into committee that afternoon. He said to me, "There are two doctors down from Sudbury, a Dr Hollingsworth and a Dr Kosar." At that point I had received a phone call from a Dr Hollingsworth and I had the slip in front of me, so I said, "Well, that's why he is contacting me."
He said to me that his understanding was that the two of them had been up at the OMA earlier that morning and Dr Hollingsworth had finally realized that he was under the underserviced area program. Therefore he would not be leaving the community and therefore some of what he had said in the media, which was that he was going to be leaving soon, was in fact not correct.
He told me that they were both there, and my recollection is he also told me where they had been and that they had discovered the knowledge about the UAP that morning.
Ms Jackson: And did you in fact meet with the two doctors?
Hon Miss Martel: I called the phone number back and it was Ernie Eves's office, but I spoke to Jane, and Jane said they were not in at that point in time. I told her I would try to find Ernie -- Mr Eves, excuse me -- in the Legislature so that he could introduce me to Dr Hollingsworth, because I did not know what he looked like.
Ms Jackson: You had never met Dr Hollingsworth before.
Hon Miss Martel: No.
Ms Jackson: Had you ever, so far as you know, corresponded with him?
Hon Miss Martel: Not as far as I know, although I know what is coming next.
Ms Jackson: All right. You have in your office file two letters from Dr Hollingsworth, which I am going to ask be put in front of you and members of the committee. Members of the committee will recognize these letters as rather similar to letters that were also sent to Ms Murdock. Mr Chairman, could we have the two letters together as the next exhibit?
The Chair: Yes. Those two letters are going to be marked as exhibit 110.
Ms Jackson: I understand, Ms Martel, that while these letters were received in your office, you had not seen them until very recently.
Hon Miss Martel: That is right. I did not see them until you showed them to me on Sunday.
Ms Jackson: All right. Indeed you had not seen them when you met with Dr Hollingsworth and Dr Kosar on December 2.
Hon Miss Martel: Maybe I can clarify this point for the committee members. We received a large amount of correspondence at this point in time, both in the riding office and at the ministry office, about half and half. Because we did not have a resolution to the matter at this point in time, I told my staff to hang on to the letters in separate files and once we had a resolution, I would respond to all of them. In fact, I did not respond to all of those until early in January, after an agreement in principle had been signed between the OMA and the government to use the underserviced area program to solve our problem.
Ms Jackson: Having made the attempt to reach Dr Hollingsworth and Dr Kosar through Mr Eves's office, what happened next as you moved towards the meeting we know took place?
Hon Miss Martel: I went into the House and Jane was sitting behind the Speaker's dais and I asked her --
Ms Jackson: This is Mr Eves's assistant?
Hon Miss Martel: Yes, my apologies. I asked her again if she would let Ernie know that I was there and also have him come and see me so he could point out the two doctors to me so I would know who they were. I went to sit in my seat and then received a note to step outside because Dr Hollingsworth and Dr Kosar wanted to speak to me. I got up from my seat and went around, and they were sitting in the public gallery, and the guard pointed them out to me. Then we went outside and sat in our members' lounge and had our discussion there.
Ms Jackson: You mentioned that Dr LeBlanc had indicated to you that Dr Hollingsworth was on the underserviced area program. Had he told you what the date of that period of enrolment was?
Hon Miss Martel: No, he did not tell me, but I had read through my copy of the underserviced area program which I had received from Dr MacMillan. I wanted to see who else on the list in Sudbury was on the underserviced area program so I could determine whether or not there were other doctors who, like Dr Donahue, were in fact on and therefore their financial situation might be a little bit different than they were telling the public. Indeed, over the course of the weekend when I read through that, I saw Dr Hollingworth's name on it. Dr Hollingsworth had been on a TV interview with Dr Abdulla some time before that, telling people that he was going to reach his threshold soon and that he was going to be forced to leave the community. So it struck me, when I saw it, that there was a second person who had been out as well and that the information that had been released to the public was not quite correct. So I had read their names already on my package of UAP.
Ms Jackson: Did you consider that Dr Hollingsworth was also misleading the public?
Hon Miss Martel: I guess what was in the back of my mind was that if people voted against the agreement, then I hoped they had read it and understood what they were voting on, and I would have said at that point it would have been pretty clear within the terms of agreement that in fact there was an exemption for people who are on the underserviced area program. I think what I felt, though, was a sense of frustration more than anything else, because it was just making things worse. I mean, there was a lot of incorrect information floating about in the city that was leading to a real sense -- I think the best way I can describe it is of hysteria that there was going to be a mass exodus of people out. I was frustrated by that because of the kind of reaction it was creating in the community, a community that has always fought hard for medical services.
He was not in the same position as Dr Donahue in that my understanding was that he does not hold any executive position on the Sudbury medical society, therefore perhaps the likelihood of him going through the agreement was less than the likelihood of Dr Donahue not going through the agreement.
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Ms Jackson: So you gave him a bit more of the benefit of the doubt as to whether he knew whether or not this underserviced area program had an effect on his situation?
Hon Miss Martel: That is correct to say.
Ms Jackson: When you read through this list on the weekend and determined that Dr Hollingsworth was on the underserviced area program, did you make a note of the date when he completed his service?
Hon Miss Martel: I did and it was June 1992; because I knew already that he had said something publicly about being in the position that he would have to leave, so when I saw his name on the list, I recognized that he was another person that in fact was not in any danger of reaching his threshold nor of leaving the community. Others who were on the list were in totally different situations. No one else on the list other than he himself, he and Dr Donahue, had been out publicly telling people they were going to reach their threshold. So he was the one other person on that list who had gone public and whose position was different.
Ms Jackson: Was there anything noteworthy in your mind on the weekend about Dr Kosar?
Hon Miss Martel: No, I do not think so.
Ms Jackson: Do you recall noting whether or not he was on the underserviced area program?
Hon Miss Martel: Well, I went through the list and there were about 20 people from Sudbury, so I had a fair sense of names. I cannot remember whether or not I reviewed the list before I started the meeting, although I do believe I was carrying around stuff with me on the agreement, but I could not recall right now whether I took a look at it Monday morning when I got back to Toronto or not.
Ms Jackson: So you went to the members' lobby and you met with Dr Kosar and Dr Hollingsworth?
Hon Miss Martel: Mm-hmm.
Ms Jackson: I take it this was a reasonably non-confrontational meeting?
Hon Miss Martel: No, it was fine.
Ms Jackson: You were not particularly angry or pressed by anything at that point in time?
Hon Miss Martel: I made it quite clear to them that, as Floyd had indicated at the meeting on November 15, we were not interested in just giving a blanket exemption to every physician who was operating in northern Ontario. When the discussion began, they expressed to me their concerns about the situation in Sudbury, which I agreed with, and told them as well that I was concerned and was trying to have some meetings and deal with the Ministry of Health to try and find a resolution.
Ms Jackson: Could I just stop you there?
Hon Miss Martel: Sure.
Ms Jackson: I am going to ask you some of what you said in the conversation, but just as the conversation between you started or as it developed, was there any point in this when you felt either angry or pressed by the conversation?
Hon Miss Martel: No.
Ms Jackson: It was an ordinary, natural exchange of information. Now, the conversation in total went on for about how long? What is your best recollection?
Hon Miss Martel: An hour. It was almost the entire question period, so I was out of the House for the whole thing, which I did not particularly mind either.
Ms Jackson: I am not going to ask you to repeat everything that you and Dr Hollingsworth and Dr Kosar discussed, but I would like you to recall as best you can what you said to them about their own personal situations; what they said to you and what you responded.
Hon Miss Martel: Okay. Their personal situations came near the end of the conversation, in fact quite near the end of the conversation. We had been talking about how heated this had become in Sudbury.
Ms Jackson: How which? I am sorry.
Hon Miss Martel: How heated this whole matter had become in Sudbury, and the public concern about it. I said to Dr Hollingsworth, "Well, frankly, you didn't help the matter." He said, "What do you mean?" and I said: "Well, you were on TV with Dr Abdulla and you were telling people that you were going to reach your threshold and you were going to leave the community, and that is not true. I've seen your file and you're on the underserviced area program and you're not finished on the program until June 1992. By then, I can assure you, we will have had a resolution to this matter." And he said to me, "I thought I was on till January." And I said: "No, I've checked. You're on until June, 1992." And he said to me at that point, "You seem to know more about me than I know about myself." And I said: "Well, doctor, this is public information, and on the public information it is quite clear when you start, and if you know the program ends in four years then you know when you end, and the public information also says whether you're receiving a grant or not and what your specialty is." And that is how I knew.
Ms Jackson: When you said, "I've seen your file," what were you referring to?
Hon Miss Martel: I was referring to the information I had on UAP. When I talk about "file," I talk about it in the context in having a bunch of information, or pieces of information, or letters or correspondence or memos, or in this case newspaper articles. In this particular case, it was the list I had already taken a look at with respect to all of those people who are on the underserviced area program. For me, it is a term of reference. It is an expression that I use when I have collected stuff together and have it on a particular issue.
Now, I certainly was referring to the information that I had about his underserviced area, beginning and end, because that is what I had taken a look at over the weekend, that is where I had seen his name, and certainly that is when I had seen very clearly that he was in no way threatened to leave the community. He was in no way threatened by the imposition of the threshold, because in fact he was going to be on and exempt until at least June of 1992.
Ms Jackson: Do you recall any similar discussion with respect to Dr Kosar?
Hon Miss Martel: I do believe that I told Dr Kosar that I knew he was on the UAP as well now, because I said to him, "Well, neither of you is in any position of being threatened to leave the community." Whether I used the word "file" with him or not, I cannot remember. I definitely used it in the context of Dr Hollingsworth.
Ms Jackson: All right. Now, Dr Hollingsworth has testified as well that by your general attitude you seemed to indicate that you knew they were good guys, and he has in fact said you stated, "I know you're good guys." Do you recall whether you made any such statement?
Hon Miss Martel: I only met those two gentlemen that day. I knew nothing about them, except for Dr Hollingsworth where he had been on TV to say he was leaving. I had not met them before. I knew what their practices were because I had read it on the UAP list, but after that I did not know anything about them and I have no recollection of telling them either they were good or bad guys.
Ms Jackson: And Dr Hollingsworth has testified as well that in the conversation there was reference made to the four GPs who I guess you had learned on Saturday were billing over the threshold. Do you recall a discussion about those four GPs?
Hon Miss Martel: That is correct. At the start of the conversation, they put to me that their solution to this possible problem would be to have the blanket exemption from the Ministry of Health for anyone who was practising in northern Ontario. And I repeated very clearly at that time that I would not support that kind of an approach and I think I told them as well that Floyd had made that very clear at the meeting on November 15. I said to them very clearly that what I would be looking at was certainly specialists, and while I knew there were four GPs who were going over threshold, I would not support their particular cause because in fact there was no shortage of GPs in Sudbury. Sudbury was not underserviced for GPs, and I was not going to get on that bandwagon as well. I was only concerned about the specialties, where there was a definite designation of underservice, where the Ministry of Health from their own statistics knew that there was a chronic shortage of people. There was no shortage, to my knowledge, at all of GPs in the city.
Ms Jackson: Do you have any recollection of saying that it was "unacceptable," or "totally unacceptable," for GPs to be earning over the threshold?
Hon Miss Martel: No, I do not remember using those words. Let me think back. My recollection in terms of the GPs was that there were more than enough of them in Sudbury, so there was no need to have an exemption for them in order to bill more.
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Ms Jackson: Then, Dr Hollingsworth has testified that there were remarks made by you, that: "Dr Donahue's practices are totally unacceptable. What he is doing is totally unacceptable." Do you recall making those remarks?
Hon Miss Martel: Let me describe this to the committee as best I can. I do not remember now making any remarks at the time. I do not have any recollection. However, on December 11, when Dr Hollingsworth was on the radio in Sudbury, stating that I had seen his file and he thought that meant his confidential billing file, when I got back to my office that day, my executive assistant sat down with me and said: "What was your conversation about? What did you say?" I had had no staff there and I have no notes from that particular meeting. I said to her then, "I think I said something about Dr Donahue, but I can't remember what it was." So that is my only recollection with respect to what went on, as relayed to me by her. I cannot remember now, I could not then, but she assures me, and I am assuring this committee, that I did say that I had said something; I did not know what it was.
Ms Jackson: Just so we have it clearly, but for the prompting of your executive assistant, who recalled that earlier conversation, you yourself have no recollection of even mentioning Dr Donahue in this December 2 conversation?
Hon Miss Martel: No, I do not, but I thought it was important that the committee know that.
Ms Jackson: I understand that, but I think it is also important that the committee understand what you remember and what you do not. You do not today remember at all mentioning Dr Donahue, correct? You have no recollection? You have no independent recollection --
Hon Miss Martel: No, I do not. I am going on her recollection of a conversation we had on December 11 and what, to the best of her recollection, I said in trying to sort out what went on at that meeting.
Ms Jackson: All right. So based on what you said at the time, then much more close in time to December 2, it would appear that you said something about Dr Donahue, but you have no recollection of what it was.
Hon Miss Martel: That is correct.
Ms Jackson: Therefore, is it fair that you would have no reason to dispute Dr Hollingsworth's recollection of what you said about Dr Donahue?
Hon Miss Martel: I have no recollection. I mean, if you want me to say yes, I can do that, but I am not -- I mean, all I know, in trying to respond to the question as best I can, is that my staff tell me that yes, as of December 11 I thought I had said something about him. I could not remember at that time, nor can I now, what it was. Ms Jackson: In terms of the view you then held of Dr Donahue, this kind of statement, I take it, would be consistent with the view that you then held. Is that fair?
Hon Miss Martel: Well, given that the day before the Mac's milk article had been in the paper, that would be fair. I would say that would be fair. That would certainly be the context that I would have in the back of mind about what was going on in the community and how his whole situation was being portrayed by him. That is correct.
Ms Jackson: Is it fair that if you made these kinds of statements to people you did not know in an unpressed, unangry situation, you might have made these kinds of statements to other people?
Hon Miss Martel: Those were the only meetings that I had during that course of time with respect to anyone around the Sudbury situation. You see, there was work going on in the Ministry of Health. I was tapped into that, because I would talk to Dr LeBlanc on a fairly regular basis to figure out how we were moving along in terms of finding a solution and what I could do to try and push that along. Should I talk to Frances, should I talk to Mr Decter etc? But there were not other meetings that I was having with respect to the Sudbury situation. The meetings that I had in reference to doctors or the matter were the ones that I have tried to outline with you today. So I have no recollection of other times where I would be meeting with people on this matter and saying things.
Ms Jackson: Putting yourself, if you can, in the shoes of a listener hearing those comments, and hearing them coming from a person such as yourself -- a minister of the crown -- in calm circumstances, can you understand that a listener might assume those comments were based on inside knowledge?
Hon Miss Martel: I guess I would disagree with you because you are asking me to speculate (a) on what I said, which I have no recollection of, and (b) you are asking me to assume that what Dr Hollingsworth told you was in fact correct. I think that in the testimony that I have given you and what Dr Hollingsworth has said I said in other parts of that conversation, there have been discrepancies. So you are asking me to respond to a question that I guess, if I can tell you, I find a little bit unfair, because I cannot say 100% that, yes, that is what Dr Hollingsworth said. I would not say that, especially in regard to the conversations, because there were other things where his version and my version of the conversation are quite different.
Ms Jackson: Well, I do not mean it to be unfair; in fact, quite the reverse. I am sorry if it seems that way to you. I want to give you an opportunity to respond to the assertion by somebody who swears that this statement was made to him and who concludes from it that you were speaking from a position of inside knowledge. You may have no comment on it, in which case that is fine, but I wanted to give you the --
Hon Miss Martel: So you are referring back to the doctors. I thought you were referring to the general public hearing this.
Ms Jackson: No, no. I am sorry. I wanted to give you an opportunity to comment on the fact that a listener hearing that kind of statement from a minister of the crown would conclude that it was made on the basis of inside knowledge. If you have no comment, that is fine. I just wanted to give you the opportunity.
Hon Miss Martel: If he assumed that "practices" meant billing or medical, as a physician that may well be what he would take away in terms of his interpretation of "practice."
Ms Jackson: Then you could understand how that conclusion might be arrived at.
Hon Miss Martel: All right, okay. Sorry. My interpretation was that you were asking the broad public -- that is the impression they would take away. No, sitting at that conversation as a physician, I would expect that he would think "practice" and think "medical practice." I do not know whether he would think "billing," but one or the other. He may at that point walk away and think I had more access to something.
Ms Jackson: Just to close off this area, Dr Hollingsworth recalled in his evidence a telephone conversation with you the following day. Do you recall that conversation?
Hon Miss Martel: I do. He called to talk to me about the OMA Dues Act. He had been in the day before and had put a position forward to the committee that Sudbury be excluded from that part of the agreement. He called me and urged me to talk to the committee members and urged me to tell them to support this particular piece of legislation.
I told him that I did not quite think that was a direction that the committee was going in. He mentioned that he was quite convinced himself that Mr Owens, who had sat on the committee, and Mr Hope had in fact understood a lot about unions and were in fact supporting him.
I said that I found that a little bit difficult to believe, but in any event I would take his word for it and I would talk to them. Indeed, I did speak to Mr Owens about whether or not Dr Hollingsworth had called him on this matter and found that he had. But the whole conversation, to the best of my recollection, was strictly about the dues act, because it was either in committee that afternoon and going to be passed or going to be passed shortly, and he wanted to know what kind of pressure I could apply to see that the amendments that had been put forward to help them would in fact pass.
Ms Jackson: Sorry, I forgot one last element of the meeting on December 2. There has been evidence that Dr Hollingsworth and Dr Kosar indicated to you that they were not billing over the threshold and that you said approximately words like, "I know." Do you have any comment on that evidence or do you have any recollection about such a discussion?
Hon Miss Martel: I remember when they said they were high billers. It was the end of the conversation and it had gone on quite a bit longer.
Ms Jackson: They said they were high billers?
Hon Miss Martel: No, they said that they were -- hmm. Yes, they said that they were high billers. It came in this context. It was near the end of the conversation. We had gone through everything else and what I was trying to do in the community. At one point Dr Hollingsworth, who had spoken a great deal during the conversation, said, "And we're not high billers, you know." My response was to nod my head, because at this point in time we had been at it almost an hour and to my way of thinking it did not matter anyway, because they were on the underserviced area program, therefore they were not specialists that I was going to have to worry about in terms of finding a solution for. So my only recollection is nodding my head to have him keep going and get to the end of it.
Ms Jackson: Okay.
The Chair: I think that this might be an appropriate time to take a 10-minute recess.
The committee recessed at 1720.
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The Chair: We will call the session back to order. I would like to indicate that we will be recessing for the rest of the day as a result of discussion with members of the subcommittee. We will be reconvening tomorrow at 9:30.
Mr Kormos: My information is that Robert Keith Harfield was admitted to the Toronto General Hospital emergency at 4:30 this morning for abdominal pain. My grandmother used to call it a stomach-ache. No wonder health care costs are what they are. I am advised as well that he was discharged today. I am hoping then, in view of the fact that he merely had a stomach-ache and that he is not in the hospital any more, that he will be made available to us. It would seem only fair.
The Chair: Mr Kormos, after discussion, and through further discussion with counsel, it will hopefully be our intention that Mr Harfield may in fact be called tomorrow, but that will be subject to discussion with counsel to the committee and counsel to witnesses. Having said that, we will adjourn this meeting until tomorrow at 9:20 am.
The committee adjourned at 1739.