Legislative Assembly of Ontario

The House resumed at 8 o’clock, p.m.

HEALTH DISCIPLINES ACT

Hon. Mr. Miller moves second reading of Bill 22, the Health Disciplines Act, 1974.

Mr. Speaker: The hon. member for Ottawa East.

Mr. A. J. Roy (Ottawa East): Thank you, Mr. Speaker. The first comment I would like to make on the bill is that we wish the minister well in the health field. It is hoped that he will not continue the perpetration of the mistakes made by his predecessors. I go back to the hon. member for Carleton East (Mr. Lawrence), the present Minister of Education (Mr. Wells) when he was Minister of Health, and this minister’s predecessor, now the Minister of Correctional Services (Mr. Potter).

This minister seems to have been making statements lately which indicate that he intends to sort of fly on his own -- that he intends to depart from some of the approaches taken by his predecessors. But I’m afraid that maybe the approach he is taking in relation to this bill is certainly not evidence that he intends to deal effectively and thoroughly and logically with the problem of health delivery in this province.

The reason I say this is that some two weeks ago we had presented in the House the Mustard report. In his statements on the Mustard report he said at the time, as I recall, and he can correct me if I’m wrong, that he wanted to study the recommendations of the Mustard report for a period of four or five months before bringing in legislation or legislative changes. Yet he wants to press ahead with the Health Disciplines Act. That is not evidence of any consistency or any willingness on his part to bring on major changes in the health field.

Looking at some of the recommendations in the Mustard report, I can’t see how he can proceed with the Health Disciplines Act. In fact, what may well happen is that if he passes certain matters in this Act, it could well prohibit the adoption of certain recommendations in the Mustard report.

I look at some of the recommendations of the report -- for instance, the section where they divide between the primary contact with the public and the primary and secondary aspects of health; or the recommendation for sharing of tasks and delegation of responsibility among all health personnel in the group in order to achieve optimum efficiency in the provisions of health service of high quality; the establishment and operation of an evaluation procedure based on an audit of health services in the review of the performance of health personnel by their peers; the recommendation for the proposed health district services; the provision of an effective consulting advisory service.

In other words, the Mustard report looks at the question of the health delivery system, the various professions, as a package, as a relationship or distribution of responsibilities in this field between professions, allied health professionals, and so on. Had there not been any Mustard report I can’t see how the minister could bring in a total package when he only dealt with five disciplines -- when he didn’t want to deal with all the disciplines together and show the co-relationship of all the disciplines in the total health package.

First of all why did he decide to come along with only five disciplines? In fact the five disciplines have not changed all that much in their aspect of responsibility. What he has done basically in this bill is to take various Acts and put them all under one Act called the Health Disciplines Act.

I congratulate the minister for setting up what is called the Health Disciplines Board and this type of thing, and I intend to make comments about this later on. But I was concerned first of all that the minister was dealing with only five disciplines, and secondly and more importantly the evidence given to us by the Mustard report in the recommendations make it exceedingly difficult -- in other words he is doing things piecemeal, the problem that his predecessors ran into.

I look at the present Minister of Correctional Services. His problem was that in light of the fact that they were spending so much money, that they had so many people involved, he kept dealing with peripheral things. I would suggest to the minister he is not really attacking the problem as set out in the Mustard report.

Let me read to him some of the things that in fact the Mustard report had to say about the health problem.

Mr. Speaker: I should point out to the hon. member that in debate on second reading we deal with the principle of the bill as enumerated in the bill. I have not restricted some straying from the principle but I think the hon. member --

Mr. E. Sargent (Grey-Bruce): He is right on target.

Mr. Speaker: -- should not stray too far by reading at any great length from any other report.

Mr. Roy: No, I don’t intend to read at any great length. But Mr. Speaker, we are dealing with the principle of a bill that deals with five major disciplines. The Mustard report gets right into that and it is the same principle basically. I don’t want in any way to crowd your ruling.

Mr. Speaker: Well, the hon. member for Grey-Bruce says it is all right, so proceed.

Mr. Roy: Mr. Speaker, that’s why I brought him in here. I said, “If the Speaker gives me a bad time, Eddie, you take care of him.”

In any event, Mr. Speaker, if I might just read some of the aspects of the Mustard report which deal basically with the problem of health delivery, the question of professionals. I read from page 3 of the report where it states:

“The provision of universal health insurance has not automatically improved the level of health for the population of Ontario.”

Right there is quite an indictment to the system as --

Hon. F. S. Miller (Minister of Health): The Liberal government.

Mr. Roy: The Liberal Government? This government was the one that brought it in. It wasn’t forced to come into that. It brought it in. It can’t blame the Liberals for all its mistakes -- certainly not in health.

Hon. G. A. Kerr (Solicitor General): Come off it, it was blackmail.

Mr. Roy: The minister doesn’t know what I am talking about so he shouldn’t make any noise.

In any event, Mr. Speaker -- he is minister of -- what now? Solicitor to something? The pinball man.

Mr. Sargent: The Solicitor General should be downstairs, in the Attorney General’s deal.

Mr. Speaker: Order. Let’s get back to the bill.

Mr. Roy: He is being provocative, Mr. Speaker. The report goes on to say, Mr. Speaker:

“While it is true that under OHIP many people have been able to obtain medical services that they could not afford in the past, in certain areas of the province certain residents still do not have access to the services they need, and more significantly, where the need for service is greatest new measures have been undertaken to influence the social and environmental causes of ill health and none in co-ordination with the provisions of remedial service.”

Hon. Mr. Kerr: Still not talking on the bill.

Mr. R. Haggerty (Welland South): Right on.

Mr. Roy: This is supposed to be an objective group saying this, it is not the opposition. That is what we have been saying all along, that we are being supported by this task force that was appointed in Health. It goes on to say:

“In short, no plan has been developed for the delivery of health services in relation to the overall needs of the population.”

Again, it is a telling indictment of the approach to health taken by this government, Mr. Speaker. It goes on:

“Some problems inherent in the current arrangements are the concentration of the specialty services within hospitals, the random dispersal of general physicians throughout the province.”

That’s what we are dealing with now -- physicians.

Hon. Mr. Kerr: He’s still not talking to the bill.

Mr. Roy: The minister doesn’t understand “ -- the lack of co-ordination” -- read this -- “the lack of co-ordination among specialty services -- .” What is the Health Disciplines Act all about? It is supposed to be right on this, the co-ordination of --

Hon. Mr. Kerr: More Liberal midwives.

Mr. Roy: Quoting:

“-- the lack of co-ordination among specialty services, family practitioners, public health services, and other personal health services, the inaccessibility to service in certain areas of the province.”

Anyway, Mr. Speaker, the report points out the deficiencies in the system, and if I might just deal with another problem which has been pointed out by the Mustard report, it says:

“It was only to be expected that health costs would rise in Ontario, in view of the fact that under OHIP more people were using health services than had previously been the case. The cause for concern, however, has been the proportion of costs incurred in providing health services as related to the benefits resulting from their provision. It appears that the two are not in balance.”

Mr. Speaker, just one line of page 5 says:

“Any changes that are made in the organization of delivery of health services will require related adjustments in the training and education of health professionals.”

Again the report points out the deficiencies in relation to the individuals within the system. Another aspect of the report, Mr. Speaker --

Mr. Speaker: Order, please. I think really the hon. member should not completely review the Mustard report. He should not be speaking of things that are not in the bill. He should speak to the principle of this bill before us.

Mr. Roy: Mr. Speaker, this bill has 176 sections which deal with five professions -- dentistry, nursing, medicine, optometry and pharmacy -- and these individuals are all dealt with extensively in the Mustard report and that is what I’m reading. This is right on.

Mr. Speaker: It seems to me the hon. member is just --

Mr. Roy: I know it’s embarrassing to the government, Mr. Speaker, but I feel I must say these things. They’re in the report and I feel it’s pertinent to this.

An hon. member: The federal government is embarrassed.

Mr. Roy: We’re talking about the improvement of health delivery. We’re talking about the co-ordination of professions.

Mr. Speaker: With respect, will the hon. member please keep to the principle of this bill?

Mr. Roy: Yes. Right on. It states here, Mr. Speaker, just two lines: “There must be a shift away from the traditional focus of health services in a hospital setting to community settings accessible to the public.” In any event, Mr. Speaker, I think it’s important that we ask the minister how he can possibly proceed with this bill now, in light of the recommendations in the Mustard report and in light of the fact that they talk about co-ordination among professions, which he doesn’t deal with here.

He sets up a sort of rigidity in the professions which in fact inhibits transferability of functions, for instance, in relation to what the nurse practitioners can do. We feel, Mr. Speaker, in the light of this aspect that the bill should not proceed now.

In fact, it’s ironic that when the government asked for the Mustard report, when it set up this commission, some of the terms of reference are very interesting. I think, Mr. Speaker, I should read just briefly the terms of reference, which only have 10 lines, and point out to the minister why he is delaying, for instance, the Mustard report or why he is going ahead with this bill. Why doesn’t he proceed with the two jointly?

Apart from the fact that the committee was “asked to develop proposals for a comprehensive plan to meet the health needs of the people of Ontario,” at the end of the terms of reference it went on to say: “To the maximum extent possible, the committee is requested to employ interim reports so that the most pressing problems can be addressed without delay.”

What is the minister doing if he’s putting this over for four or five months and yet he is proceeding with this bill? He had asked for interim reports. He felt that there were some pressing problems that had to be dealt with immediately. The minister is not dealing with them.

Now, Mr. Speaker, another aspect of the bill which gives us great concern is the fact that apparently what has been done is the taking of various Acts dealing with these various disciplines -- dentistry, medicine and so on -- and lumping of them under this particular bill. Unfortunately a lot of powers seem to have been left to the executive arm -- in other words, order-in-council regulations, which we will never see in this House. That is a great concern to us. Regulations are passed. My God, one only has to look at the great stack of regulations -- and, of course, I may be straying away from the principle of the bill; and I just do it with permission, Mr. Speaker --

Mr. Speaker: What permission is that?

Mr. Roy: Pardon me? The regulation committee is a useless function.

Interjections by hon. members.

Mr. Roy: No, but what I -- I’m very honest about it; I tell you when I’m off the principle of the bill.

Mr. Speaker: Well I recognize it -- I recognize it.

Mr. Roy: Yes. In any event, we are greatly concerned about the fact that a lot of matters, a lot of aspects of the practice of these various professions, these various disciplines, are going to be set up by way of regulations which we will never see.

I think by the minister’s own admission he hasn’t started to draft the regulations. In fact, in answer to a question in the House dealing with the question of optometrists and the difficulties of the optometrists and the opposition they have -- the minister has the regulations here. Will we get to see them when the bill is being discussed?

I take it, Mr. Speaker, if the minister would answer this question, this bill is going to standing committee, is it not? He shakes his head yes. We should put that on the record. It’s going to standing committee.

In any event, we feel that too many aspects of the bill are going to be dealt with by regulation. I would be very much surprised to see that he had all the regulations in the bill for all the various professions. He doesn’t? He admits that. Put that on the record. Yes, we’ve got to get that on the record.

An hon. member: The member is a very trusting soul.

Mr. Roy: In any event --

Mr. J. A. Renwick (Riverdale): It all goes on the record.

Mr. Roy: The nodding as well?

Interjections by hon. members.

Mr. Roy: It’s a matter of approach, you see.

Mr. Speaker: The shaking of the head is not recorded in Hansard.

An hon. member: Yes, it is.

Mr. Roy: In any event, Mr. Speaker, we are greatly concerned about the fact that too many aspects of the disciplines will have to be dealt with by regulation. And surely there must be some way the minister can let us know about it in certain areas.

For instance, we thought an important area is the opposition by the medical profession to the use of drugs by the optometrists. Why isn’t that regulation prepared so we know exactly what drugs the optometrists are going to be using? Is it prepared? I guess not -- he’s shaking his head. That means no. In any event, Mr. Speaker, we feel to properly support, or not support the government on this issue, it would be wise for us to see the regulation.

Another aspect of the bill which makes it evident that the minister doesn’t intend to change his ways, in spite of his statement, is the fact that he is dealing with the profession of dentistry, and yet he has not solved the problem of denturists.

We are extremely disappointed and surprised by this approach because it appeared to us that following his nomination as the Minister of Health, he made certain rumblings that he was reconsidering --

Mr. D. C. MacDonald (York South): Not nomination.

Mr. Roy: -- in fact, reconsidering this whole problem.

An hon. member: Rumination.

Mr. F. Laughren (Nickel Belt): What is his position on denturists?

Mr. Roy: And in fact, if I might read -- and this is right on the principle of the bill, Mr. Speaker -- correspondence that the minister had with the denturists; if I might read a reply to the denturists by way of a letter dated March 12, 1974.

Hon. Mr. Miller: Is this one of mine?

Mr. Roy: It is signed, “Frank S. Miller, Minister of Health.” It is directed to the attention of Mr. Groves, the president of the Licensed Denture Therapists of Ontario.

It says:

“Thank you for your thoughtful letter concerning the denturists’ problem. I am keenly aware of it. I can assure you that the problem is not going unattended at the present time. It may be a bit [A bit, he says!] premature to make any comment -- ”

Although at that time the minister had already made some comments; just let the cat out of the bag -- that sort of thing. He had indicated he was reconsidering the situation and was not struck by the former Health Minister’s approach on the problem. He says:

“It may be a bit premature to make any comments upon possible changes in the working conditions or licensing requirements. However, I can assure you that a solution to the problem remains one of the highest priorities.”

Now, what happened to that? The minister has made certain comments in the House. We’ve been sitting --

Mr. M. Shulman (High Park): It still remains a high priority.

Mr. Roy: Pardon?

Mr. Shulman: It still remains a high priority.

Mr. Roy: Yes, it still remains a high priority. Well, that’s a good --

Mr. Shulman: He should resign.

Mr. Roy: Well, I wouldn’t ask for his resignation. I’m not as combative as the member for High Park. He only gave the minister 20 days. I gave him an extra 20 days. He is slowly running out of time if he keeps taking this approach --

Mr. Shulman: He’s slowly sinking below the waves.

Mr. Roy: How can the minister deal effectively with the dentistry situation, without settling once and for all this question of the denturists? The bill brought in by the minister’s predecessor obviously was only a half-hearted measure. But he has gone ahead and attempted to lay charges against certain people. We don’t know whether the minister is going to proceed with the prosecutions. I’d like to have an answer on that.

Does the minister intend to close all the others who are practising illegally? If he doesn’t, what consistency do we have there? What permits the minister to close up certain shops and to leave other shops open?

Mr. Shulman: It’s a lottery.

Mr. Roy: And in the light of the minister’s statement, giving them a certain amount of credence, that he was prepared to reconsider or that he was looking at the situation, doesn’t the minister think it’s high time that he made a policy decision on this? And why did he miss the opportunity to include it in this bill? In fact, sections 27 and 29 of the bill deal with the question of denturists up to a point. Why didn’t the minister settle it once and for all? And if he doesn’t intend to deal with it --

Mr. Shulman: Does the minister suffer from indecisions?

Hon. Mr. Miller: Is that a disease?

Mr. Shulman: Yes, it is for politicians -- even young ones.

Mr. Roy: I suspect that possibly as a person the minister is a very affable fellow -- he is not as abrasive as his predecessor.

Hon. Mr. Miller: I even like the hon. member for Ottawa East.

Mr. Shulman: We will give him a local anaesthetic.

Mr. Roy: It might take us longer to get to the minister, but if he keeps going at this rate and starts dealing offhandedly with problems such as this, he is going to be in big trouble soon, because he is going to be setting the same pattern as two or three of his predecessors.

For instance, why doesn’t the minister admit to the House that in his opinion the denturists should be able to practise without the supervision of dentists? And that it is a fact that the minister took it to caucus, that it was his caucus that spoke against it, and that’s why he ran into trouble. The caucus is against him. Why doesn’t he wipe the slate clean and tell us about it, and not leave us --

Mr. Shulman: And remember that no Minister of Health has ever been promoted; they have all gone downhill.

Mr. Roy: Right.

Hon. Mr. Miller: How could one be promoted?

An hon. member: It’s a very unhealthy portfolio.

Mr. Roy: The minister is a very ambitious young man. Surely he wants to go places. We are giving him advice as to how to enhance his position.

Mr. Speaker: Order, please. These personal observations are not in the bill.

Mr. Roy: I think they really are, Mr. Speaker --

Hon. Mr. Kerr: They are on the principle --

Mr. Roy: They are on the principle of the bill, aren’t they?

Hon. Mr. Kerr: They are on the principle of the bill.

Mr. Roy: Are you going to bring me to order when I am being complimentary toward the Minister of Health, Mr. Speaker?

Mr. Speaker: I might. I might.

Mr. Roy: You might? Anyway, I am pretty well finished on that point. I can’t be complimentary for too long. But it seems to us that if the minister really wanted to settle this problem once and for all, he had the ideal opportunity to do it in this bill. And we’d like to know why he didn’t do it.

Mr. Shulman: They’ll settle it after the next election.

Mr. Roy: In fact, he went on a frolic of his own on the question of the squabble between the medical profession and the optometrists. Since the minister has taken that approach toward the optometrists, surely he must have some sympathy for the denturists if he is going to have any consistency in his approach.

Mr. Shulman: If he’s going to take on the doctors, he might as well knock off the dentists at the same time.

Mr. Roy: Why not? He’s got the doctors mad. And the way it is now he’s got everybody mad.

An hon. member: I am not mad.

Hon. J. W. Snow (Minister of Government Services): Even the opposition.

Mr. Roy: He’s got the dentists mad at him because they think he is going to change his mind. And he has got the denturists still hoping that he will change his mind but mad at him because he can’t make up his mind.

Mr. Shulman: But the psychiatrists like him.

Mr. Roy: So he is losing votes quickly for his party.

Mr. W. J. Nuttall (Frontenac-Addington): We can lose a lot and still win.

Mr. Roy: In any event, Mr. Speaker, we felt that the minister should have dealt with this problem once and for all in this bill. Having said that, if I might, I would like to proceed with certain other comments.

Mr. Speaker, I would like to deal briefly with certain sections of the bill. We don’t intend to deal with individual disciplines, but we certainly support the government on the matter of setting up a Health Disciplines Board. We feel that this is an important aspect of the bill, and we will certainly support the government. The fact that there will be lay representation on these discipline committees and on the board is certainly a step forward.

The members on this side of the House take great pride in supporting this, because the minister will recall, when he was a parliamentary assistant, that we raised the question some time ago of conflict of interest on the board of ophthalmic dispensers because five members of a particular company were on the board, and we suggested that the minister should name one or two lay members to that board. In fact, we have made some suggestions as to who the lay member should be.

The minister accepted our suggestion and at least he has had the good sense to follow our suggestion by setting up these particular boards. I intend to come back to the question of the board. The member for Downsview (Mr. Singer) intends to deal in depth with the question of the board and the powers it should have but doesn’t have, such as the powers of representation and the fact one can examine and cross-examine witnesses and so on.

Mr. Speaker, if I might just make certain comments in relation to the setting up of the board.

For instance, in section 4 of the bill where changes can be made and submissions made to the minister, we feel that these submissions should be made to a committee; they should be made to the Legislature as well.

If the minister intends to have lay representation, if he intends really to have some public input, he should try as often as possible to involve the Legislature in decisions and let the Legislature know what some of these recommendations are.

We feel that in setting up the board, first of all, the terms -- the regional appointment on the board -- should be for a period of one, two or three years. Mr. Speaker, we feel there should be a time limit to when people can be appointed to a board. With boards we have often seen rigidity in approaches to problems whether it is in health or anywhere else. We have seen difficulty in boards adapting to relevant community situations, to the changing times. We are in changing times and matters change from one year to the next. If we have a board appointed with no term -- in other words, they can be reappointed indefinitely -- we suggest, Mr. Speaker, that tends to cause certain rigidity in the board.

We feel as well that the minister should spell out whether this is a full-time or part-time occupation for the members of the board. We would like to have the minister’s comments on whether these people are going to be on this full-time. We feel that an important board such as this with a regulating, in fact, a watchdog approach over so many professions possibly should be on a full-time basis.

We would like to know from the minister, as well, what kind of money the minister has in mind when he is going to be paying these people certain remuneration. We would like to know what amounts he has in mind.

We feel that when the board, pursuant to section 7, will be submitting reports, these reports should not only be made to the minister -- the reports should be made to the Legislature. It may well be that the minister may decide to make the reports public to the Legislature but we feel it should be in the legislation.

We are concerned as well -- and I would like to get the minister’s comment on this -- that the board will be composed strictly of lay representation. For instance, section 7(2) states that the board can seek legal advice independent from the parties. In other words, to assist them in their deliberations or in making certain decisions. I wonder, when we have a board with lay representation like this, whether the minister should not have in the legislation as well that the board can seek expert advice. I mean, if they are dealing with technical problems in a field, be it dentistry or pharmacy or medicine, what sort of guidance can a board have?

We feel, Mr. Speaker, that it should not only get legal advice, it should be able to get expert advice as well. Of course, expert advice can be obtained, but not necessarily, from people who are within the certain professions involved in the decision. We feel there should be something in the legislation that would allow this board to seek a certain amount of guidance. It appears to me to be logical that lay representatives don’t have sufficient knowledge of some of these very technical fields. Why wouldn’t you have it in your legislation when you say in section 7 (2), for instance, that they can seek legal advice, that they could seek expert advice as well?

Mr. Speaker, we feel that certain matters in the board could certainly use improvements and my colleague, the member for Downsview, intends to go into this. If the minister would have read his bill that he presented in the House he would have seen what sort of a setup he gives to the board that he had in mind. We feel that the legislation does not provide for any representation before the board, the calling of evidence, the cross-examining of witnesses. We feel that the legislation does not provide, when decisions are made, for any reasons given for the decision. Surely the best way to challenge a decision is to find out what the reasons are. How can one go on to appeal? There are provisions in your bill for appeal, but it gets extremely difficult for one to say whether your decision was good or bad without having any reasons.

We feel, for instance, that the board does not have any time limit for making a decision. Certain setups in the board -- for instance the complaints from the registrar and that -- have time limits to make certain decisions. You have certain time limits for instance, in section 9 and section 8. Why wouldn’t you have time limits for the board to be making its decision?

Mr. Speaker, we feel that these aspects would certainly improve the board. I notice that the minister inserts in section 11(5) that the Statutory Powers Procedure Act, section 15 and 16, will be applicable. Why would he not insert that, for instance, in section 17 which deals with the question of reasons given for decision? Why would he not include that section if he is going to talk about the Statutory Powers Procedure Act? In other words, if he is going to set up a board surely he should do a complete and whole package of this -- set out the time limits that the board has to make a decision.

Secondly, what are the rights of individuals before this board? Can they call any evidence? Can they cross-examine witnesses? Can they have reasons for their decisions? Is there a time limit when the board has to make a decision?

We feel, Mr. Speaker, that these are all matters that would certainly improve this board. If these amendments are not made, I can’t see how one who feels he has been wronged will feel that he is getting a full and fair hearing before this board if there are no procedures by which he can get this full and complete hearing.

What about the right to counsel before the board? I don’t see anything in the legislation here allowing individuals to have counsel.

Mr. Speaker, we also feel that certain aspects of the legislation go too far. For instance, we feel that when it comes to the immunity of the board, the immunity of the members of a college or council and the committee, which are dealt with in section 16, the legislation goes too far. I could see protection given to individuals for instance, for any act done in good faith. But it seems to me that section 16 goes a bit far when it says that no action shall be taken even for neglect or default in performance. I would just like to get the minister’s comments as to why he’s prepared to go that far.

There’s one aspect of this bill which was a surprise and was not fully publicized. This was that in section 17 of the Act, the limitation period is extended for taking actions against the professions which are governed by this Act.

As you know, Mr. Speaker, most professions had a time limit of one year. The limitation period now -- and I would like to get the minister’s comments on this -- the way I read the section is that the limitation period is extended for some two years. That is what I consider to be a precedent-setting piece of legislation. The court may extend the time for commencing an action either before or after the time limit.

I am surprised that we have not heard too many complaints from the various professions on this. The time limit for the starting of actions has been extended -- in fact, doubled -- and jurisdiction given to the courts to extend the limitation period. In my limited experience in the law, I’ve never seen legislation whereby courts had power to extend limitation periods, not only before the limitation has expired, but, according to this legislation here, after the time has been limited. I would like to get the minister’s comments on this.

It’s a cardinal rule in law, Mr. Speaker, that once your time limit has expired for any particular action, generally speaking the court has no jurisdiction whatsoever to extend the time. For instance, in motor vehicle accidents the time limit is one year, and after one year the court has no jurisdiction, whether you have a valid action or an action in good faith or not, to extend the period.

That’s the way I read this section here. Possibly the minister can clarify the situation. Possibly my colleague for Downsview might have some comments that, in fact, the limitation period is too short -- two years. In my opinion, this is something that we would support, especially when you’re dealing with actions that are difficult and complex, be it medical malpractice or otherwise. Very often it will take a period of two years for the individual to realize the seriousness of whatever injury or whatever damages he might have incurred because of the negligence or the malpractice of any individual. Very often he is limited. He is statute-barred because his action has not been started within a period of a year.

So, it should be very interesting, Mr. Speaker, to see how the courts interpret that particular section. The section goes on to say that the court can extend it on such terms as it considers proper where it is satisfied that there are prima facie grounds for relief, and that no substantial prejudice or hardship will result to any person affected by reason of delay. I think, Mr. Speaker, that this type of legislation will certainly receive comment in standing committee.

The other aspect of the legislation that I would like to make a comment on, Mr. Speaker, is section 18 of the bill where certain fines can be imposed on individuals, for instance, for falsification of certification or offences involving false representation. I would think that it might be wise for the minister to include in these sections provisions whereby in the court or whatever body it is that imposes these fines or penalties the cost of the investigation would be part of the penalty imposed.

Some of these investigations can be very long, very complex and very expensive. I would think that the court should be given this discretion where they are going to investigate certain situations and where they incur certain expenses. That’s the approach we’re taking to law. That’s better than throwing someone in jail or where the type of retribution is to make someone pay for the cost of the investigation. I think the Law Society of Upper Canada in fact has instilled this. Very often when they’re imposing certain penalties, they make individuals pay the cost of the investigation.

Mr. Speaker, I do not intend to deal with the various disciplines at length, except to make certain comments about matters that have been raised recently. We feel that there may well be conflicts of interest in certain sections of this bill. For instance, in the section dealing with nursing, section 75, there may well be a conflict there in the sense that the discipline body carries the malpractice insurance for the nurses, and at the same time is responsible for disciplining them. It just appears to us a strange situation.

We feel, Mr. Speaker, that section 117 of the Act might well be looked at as well. This falls under the part relating to pharmacy. At the present time, hospitals are exempted from the Pharmacy Act, and very often the nurse is expected to dispense medication if the hospital pharmacist is not there. Nurses are concerned about this section in the Act and perhaps there should be some protection for the nurse who has to dispense medication in a hospital. We consider this to be certainly a valid point and something that might be looked at by the minister.

It seems to us, Mr. Speaker, that since the minister will be distributing the proposed changes in legislation to all health disciplines, that the nurses feel that perhaps when an individual college makes changes these should also be distributed to the colleges of other disciplines, which I think would be a good idea. And again, that is consistent with the package approach if the minister is going to deal with it as a group.

Again I come back to the Mustard report, Mr. Speaker, which is right on the principle of the bill. When you deal with a sort of package approach to health -- I mean, one doesn’t have to read the Mustard report very long to see different jurisdictions and different sharing of responsibilities. That is what the minister should work toward.

I think he has really missed the opportunity to do so by bringing in this bill at this time when he has decided to put the Mustard report over four months.

Now, Mr. Speaker, recently we have had some pressure exerted. Certain submissions have been made to various members of the assembly here from either the optometry association or the Ontario Medical Association dealing with the question of the use of drugs by optometrists. It would seem to us, Mr. Speaker, that we would like to hear comments from the minister as to why he has decided to allow the optometrists to use drugs.

We are not saying that we are opposed to this. We would like to know, first of all, what was the basis for the decision. Was there an in-depth survey done, for instance, to first of all indicate it was to be to the benefit of the patients that the optometrist was using drugs? Secondly, has he any evidence that there has been difficulty by optometrists using drugs? I understand that in England optometrists are allowed to use drugs. Has the minister made any in-depth survey to show whether there have been any difficulties there to support the decision? It seems to us that if the minister expects the opposition to take what we consider to be a responsible position in relation to an issue like this, we would be entitled, Mr. Speaker, to know what was the basis for the ministry arriving at that decision.

Mr. Speaker, we are concerned that the medical profession, a responsible profession, is very concerned about this decision. I sometimes question the approach by the medical profession in trying to push their weight around a bit. I think it has been seen in the past. We have seen this. And if the minister should crumble under the pressure of that profession, he wouldn’t be the first minister to do so. It seems to us that the minister’s predecessor most often was looking at the ceiling, or looking up to the medical profession, crumbling under them. He never talked tough to the profession, in other words. I recall as far back as the member for Carleton East, when he was Health Minister. He used to go around and tell the medical profession that it had better shape up or something was going to happen; but we never saw anything happen under him.

We have seen the minister’s predecessors talking tough to the medical profession and nothing has happened. We don’t feel that the minister should be talking tough and not doing anything. If he feels that changes should be made, he should make them and not submit to any pressure. But the recent pressure by the medical profession has come to the attention of many of us in this House -- and we are concerned about this. In fact, I read some of the reports submitted by the profession, Mr. Speaker, and undoubtedly you will be interested to know what might happen if mistakes are made in using a particular drug. I will try to enlighten you, Mr. Speaker, on some of the submissions that have been made to us by the medical association.

An eye physician’s report describes what is called topical ocular anaesthetics -- and I am sure you have understood that, Mr. Speaker. It goes on to say:

“Ocular complications of topical anaesthetic in the normal eye are certainly not uncommon in the ophthalmologist’s practice. We are concerned about the number of local systematic reactions to topical anaesthesia.

“Ocular side effects are surprisingly common: damage to the cornea because of anaesthetic effect with subsequent rubbing of the lid by the patient, cornea ulceration, ciritis, conjunctival haemorrhage have been well described. Also, allergic contact dermatitis has been described in the literature.”

I take it the minister got all that.

Mr. Speaker: Well, as long as the hon. member can assure me that those words are parliamentary, I will accept them.

Mr. Roy: Yes, they are parliamentary.

Hon. Mr. Kerr: Is the hon. member going to survive the night?

Mr. Roy: Just listen to this; the hon. minister will be sick by the time I am finished.

Interjection by an hon. member.

Mr. Roy: Going on.

In fact, every topical anaesthetic instilled in the eye has been shown to cause allergies -- dermato-conjunctivitis -- on occasion --

Interjection by an hon. member.

Mr. Roy: Don’t interrupt me. I am having a hard time.

Mr. Shulman: I’m just trying to help the hon. member with his pronunciation.

Hon. Mr. Kerr: Did the hon. member finish pre-med?

Mr. Roy: Why do they use such difficult words in medicine?

Mr. Shulman: It makes it a nice closed shop.

An hon. member: It’s a closed shop.

An hon. member: It justifies their fees.

Mr. Roy: Even lawyers don’t use words that are that big. Anyway, to continue:

“Keratitis is not uncommon following topical anaesthetics such as tetracaine and proparacaine” --

Mr. I. Deans (Wentworth): The member should have read it over before he brought it into the House.

Mr. Roy: I did read it. The member for Wentworth couldn’t do much better.

Interjections by hon. members.

Mr. Roy: It goes on to say:

“As well, reference has been made in the British Journal of Ophthalmology, 1969 to intra-ocular complications such as mydriasis, cycloplegia and amblyopia.”

In any event, apparently these are some of the things that disturb the doctors and somehow I can’t be persuaded that it is all that serious. For instance, I am told that in most ophthalmologists’ offices it is the nurses that end up putting the drops in the eye anyway. I have not been convinced that optometrists who use these drugs will be a danger to the public. In fact, Mr. Speaker, don’t they have something like a four- or five-year course? How complex is a five-year course?

Interjection by an hon. member.

Mr. Roy: The minister says a five-year course. I can’t be convinced, Mr. Speaker, that after five years these optometrists are not in a position to deal with this problem. I think the minister should advise us as well, before a decision is made on this, if he has any evidence of any abuse or any problems. Does the minister have any documented cases --

Mr. Shulman: Well, I have. The member can ask me.

Mr. Roy: Well, I suppose there are documented cases in many professions, but --

Mr. Shulman: I have had three cases within recent weeks involving local anaesthetic in the eye.

Mr. Roy: In any event, Mr. Speaker, I think it is important for the minister to advise us if he has any other documented cases, besides those of the hon. member for High Park -- not that I don’t accept your cases, “Morty,” but just because we want to be convinced.

Mr. Speaker: The hon. member should not refer to the hon. member for High Park as “Morty.”

Mr. Roy: Did I say that? I am sorry.

Mr. Shulman: I gave him permission.

Mr. J. R. Breithaupt (Kitchener): It’s unparliamentary language -- but he has been called worse than that by his own colleagues.

Mr. Roy: In any event, Mr. Speaker, I apologize --

Interjections by hon. members.

Mr. Roy: Mr. Speaker, we would like to be convinced by the minister that it is going to be necessary for the practice of optometry --

Interjection by an hon. member.

Mr. Roy: No, we want to take a reasonable approach. If the minister wants us to support him, let him convince us and tell us why he has arrived at this decision as well as why this is necessary for the optometrists who use it. Is it in the best interests of the patient?

We are concerned as well, Mr. Speaker, by the fact that if it is necessary for that practice, that they will not be allowed to use it. We are told that some 60 per cent of the communities in this province don’t have ophthalmologists, so if they can’t consult their optometrists and get a full eye test because these drugs are necessary, there is a certain amount of discrimination here against smaller communities.

Our feeling about this situation at the present time, Mr. Speaker, is that we would have a natural inclination to think that the minister is right and we will support the bill --

An hon. member: Just stop right there.

Mr. Roy: -- but we think it is important that he show us the regulations for the types of drugs they use.

Mr. Shulman: There the Liberals go again.

Mr. Roy: No, I say we are flexible --

Mr. Deans: We have principles.

Mr. Roy: Yes, flexible. The member doesn’t know flexibility. He is hung up on principle that he questions which days he is going to get his hair cut.

Mr. Deans: You can never get hung up on principles.

Mr. Roy: No, we don’t get hung up. We bring in policies which are relevant to the situation at hand. We are not hung up on principles.

An hon. member: For obvious reasons.

Mr. Roy: Another aspect of this bill concerns us -- section 113 of the Act which deals with the optometrists. If I might just refer to section 113 of the bill --

An hon. member: The section on the sale of optics.

Mr. Roy: What’s that? Yes, Mr. Speaker, this section applies to the ophthalmic dispensing by ophthalmic dispensers registered under the Ophthalmic Dispensers Act. The Act says that retail merchants operating as part of this business “an optical department in the place of business where the practice of optometry is carried on” -- we are concerned about this particular section, section 113, subsection 2 (a). We are concerned that the minister is encouraging a situation again where a large monopoly like Imperial Optical can walk in and start hiring certain professionals like optometrists to work for them.

Mr. Speaker, you recall that some time ago in this House we raised a question of the dominance by one large firm in not only the market for eyeglasses but also on the question of one certain profession. It’s the opticians in this province who, to the tune of about 70 per cent, were working for one large company. We feel that this type of legislation encourages a large company like Imperial Optical to start hiring these professionals to work for them. We feel that if one is a professional there should be a certain amount of independence inherent in that profession. In fact, in the optical field, one of the professions that has held and continues to hold a certain amount of independence from Imperial Optical has been the optometrist. We feel, Mr. Speaker, that if this type of legislation is allowed to go through, this section 113, it is encouraging large firms to hire the professionals.

Do you not feel, Mr. Speaker, to the minister, that he should try always to encourage the independence of these professionals? Isn’t it in the ethics of certain of these professions that they have this independence? We are concerned about this aspect of this legislation and we would like to see an amendment. If the minister is not prepared to make an amendment, we will suggest an amendment to him to avoid encouraging these monopoly situations, and breaking down the independence of certain of these professionals.

We would ask the minister to give some consideration to our submissions, in the sense that if he intends to deal as a package, if he really intends to deal with the improvements of health care in this province -- you might have confused me, Mr. Speaker, when you made your interjections a while ago about the principle of the bill -- I forgot to read page 51 of the Mustard report, just three lines of the Mustard report.

It states that one of the major reasons for the difficulty in the health field presently is that “despite its assumed role as chief financier of health care, the provincial government has failed to develop a systematic co-ordinated plan for the organization of the health sector.” Surely when the minister’s own report tells him that he lacks systematic approaches, when he lacks co-ordination in his organization of the health sector, he should consider what he is doing. He is encouraging this by proceeding with the bill at this particular stage and putting off the recommendations of the Mustard report for four or five or six months. He says he wants to consider it in four months. If things continue at this rate, Mr. Speaker, probably we will not see these recommendations for a period of a year. We will be forced to come back to this House if some of the recommendations are adopted.

It may well be that the minister has decided to shelve the Mustard report. In fact, I understand that he spent a lot of time trying to convince us that this was a green paper and not the colour it is to show that he is not necessarily locked into it. The minister seems to want to draw some distance away from the Mustard report.

I would like to hear his comments on this. Maybe he is not prepared to go into these aspects of it? If the minister is, it seems to us that in proceeding with this bill at this stage he will be inviting some major and wholesale legislative changes at a later date. He is in fact doing what his predecessors have done. He is uncoordinated and he lacks a systematic approach.

We would like to see the minister take the opportunity as a new minister to change that approach, and to really deal comprehensively with the health delivery system of this province.

Thank you, Mr. Speaker.

Mr. Speaker: The hon. member for Parkdale.

Mr. J. Dukszta (Parkdale): Mr. Speaker, even before I can deal with the principle of this bill, I would like to point out that in light of the fact that over 50 per cent of individuals affected by this Act are women, the Act should be rewritten to reflect this fact by using the pronoun “he/her” throughout.

An hon. member: Oh, come on.

Mr. Dukszta: I suppose the Health Disciplines Act is the government’s response to the challenge of existing problems in the field of professional law and relations between various health disciplines.

The Health Disciplines Act has two major tracks to it. The first track articulates the public’s concern felt at the lack of public input and community control over the self-governing professions. The second track attempts to regulate the codes of the self-governing professions and to make them more similar in terms of organization, discipline, systems of dealing with complaints, licensing and uniformity of procedures for all professions.

The Act consists of six parts, one general part setting out the role of the Health Disciplines Board and the Minister of Health, and five parts dealing with the professions of dentistry, medicine, nursing, optometry and pharmacy. In time I assume the Act will be expanded to include the numerous other disciplines outlined in the original health proposals.

Each of the five disciplines mentioned above will be established as a college -- some of them already are -- which is responsible for regulating practice and establishing standards. Each college is administered by a council on which there is a minority of lay representation and a majority of registered professionals who are members of the college.

The responsibility for administering the Act, as a whole, falls on the minister and not on the Health Disciplines Board as envisaged in the original proposals. It is the duty of the minister (page 2) to see that the disciplines are “effectively regulated and co-ordinated in the public interest” to ensure appropriate standards and to see that the individuals have access to services.

The Health Disciplines Board consists of five to seven members appointed by the Lieutenant Governor in Council. No person who is a civil servant or who is or has been registered in the health disciplines may be a board member.

According to the Act as it now stands the board conducts hearings and follows up on decisions of the complaints and registration committees of the colleges when necessary.

I am going over in summary some of the details proposed. I intend to go into much more critical detail on each point I am bringing up right now.

The Act establishes within each college mechanisms for complaints by the public -- that is at least in part the claim of the Act.

The complaints committee investigates written complaints. Should they be sufficiently serious they are referred to the discipline committee. The latter holds hearings regarding charges of misconduct and incompetence and may take appropriate action if the complaints committee does not deem a complaint to be sufficiently grave to warrant referral to the discipline committee, it takes action itself in accordance with regulations and bylaws of the college.

I should like to examine the bill in its various aspects. It is surely accepted that the whole question of self-government of the health profession has to be looked at not from the point of view of what is good for the professional but from the safeguards it provides for the public against incompetent and unscrupulous practitioners.

The interest of a professional organization like OMA or GMA, in spite of many pious disclaimers to the contrary, is to advance the interest of the professionals who have banded together in organizations. On the other hand:

“The advancement of the economic interests, prestige and status of the practitioner is not the business of the statutory regulatory body whose duty is to the public. For such a body to take on functions that are intended to advance the interests of the practitioners would be to involve itself in a possible position of conflict of interest....

“The history of the regulatory bodies in Ontario abounds in decisions, policies and regulations of a truly or apparently restrictive-practice nature.... The practices of the professions disclose an inclination on the part of the statutory governing body to see itself as the defender of interests of the members.”

These remarks come out of a volume which is published by Elizabeth MacNab, “A Legal History of Health Professions in Ontario,” Committee on the Healing Arts, Queen’s Printer, Toronto, 1970.

Concern about the professions, the professional law and the direction of the development of the health profession has been voiced in Ontario, Quebec and virtually all of Canada.

J. C. McRuer, in his report on the royal commission inquiry into civil rights, speaking on the question of self-government in the professions stated:

“The granting of self-government is a delegation of legislative and judicial functions and can only be justified as a safeguard to the public interest. The power is not conferred to give or reinforce a professional or occupational status. The relevant question is not ‘Do the practitioners of this occupation desire the power of self-government?’ but ‘Is self-government necessary for the protection of the public?’ No right of self-government should be claimed merely because the term profession has been attached to the occupation. The power of self-government should not be extended beyond the present limitations unless it is clearly established that the public interest demands it.

“In a statement published in 1966 of the functions, procedure and disciplinary jurisdiction of the General Medical Council of England, the purpose of the power of self-government is well stated in words that should apply to every self-governing body: ‘The general duty of the council is to protect the public, in particular by supervising and improving medical education.... The council is not an association or union for protecting professional interests.’”

The major dilemma that exists is to determine the balance between the issue of self-regulation and the issue of public regulation.

The principle of professional self-regulation has been generally accepted in our society but it has been most inconsistently applied and various professional groupings have been deferentially treated, in terms of privileges and responsibilities, and in terms of overall relatedness to each other. The predominance of the dental and medical professions in the field of health care reflects their status and the present extreme degree of self-government which is virtually at the point where, like the Cabots and Lodges in Boston, the physicians need only to talk to God. It does not reflect the reality of the health care field as it is now.

Health care is presently technologically, ideologically, and organizationally very complex, with other professions impinging significantly on what was originally the dominion of the medical profession.

The present bill in principle has made an effort, according to many statements made in the bill, to change the nature of the self-government of the senior health professions by setting up a Health Discipline Board. It is on this level and the level of this pretension that this bill has to be examined in detail.

In principle the thinking underlining the Act is that the public function in the life of a professional college is not sufficiently free from the socio-economic role of a professional organization but this is not stated very clearly nor implemented very effectively in the nature of the present Health Disciplines Board as it is envisaged in the Act. The fact that the professional organizations have experienced a definite time lag with respect to contemporary sociological and professional conditions is not reflected in the Act.

The thrust of my argument that I shall develop in these remarks is that the proposed Act, though providing some new state control in the form of a ministerial control, is failing lamentably in implementing the community and the consumer input. For reasons, some obviously political, i.e., pressure from the professional bodies, the Act reflects none of the recent interest in the whole changed nature of the health care field and the definition of health, health care and the health practitioners engaged in the field up to now, and whose practice is transfigured by the changes in the nature of health care.

More simply, the Act doesn’t recognize the fact that a different type of professional practitioner may be delivering health care in addition, concurrently or in substitution to the present duly constituted and historically legitimated professionals. Thus, in the words of “The Professions and Society,” which is a report of the commission of inquiry on health and social welfare, part 5, government of Quebec, 1970:

“The major problem of professional law and organization at present is its lack of adaptation. Not only does professional law no longer express the needs of modern society but often it goes against the very ideological and technical concepts which prevail and which guide its evolution. As for professional organization, it presents the major and hardly acceptable inconvenience (since it then contradicts its raison d’être) of no longer expressing the real state of professional disciplines and their reciprocal relations, without, however, meeting the specific needs of those basically concerned, the professionals themselves.”

And a remark which is added later on, which deals with the conditions essential to the admission to practice of a profession established as a monopoly, should be mentioned here, because it has some relevance, some importance as to how the various members of the public who want to become professionals enter the profession. It says:

“Conditions essential to admission to practice of a profession established as a monopoly should be set by the legislator; in no case should orders have the right to determine the qualities required by candidates to the practice. It is the legislator, by means of state diplomas, who should determine general conditions of admission to professional practice. The only role of orders [here they mean the professions] in this respect should be to assure the presence of the qualities required. Anything resembling limitation of competition should be eliminated.”

The Province of Quebec has led the way in formulating realistic recommendations for legislation which was undoubtedly based on two things: 1. Where the public interest and the professional interest conflict, the public interest takes precedence; 2. The Province of Quebec has looked deeply into the actual workings of the disciplinary process and has taken nothing for granted.

We in Ontario take it for granted that certain necessary things -- like checking the authenticity of licences -- will somehow happen.

In the same report which I have quoted, certain recommendations are made which formulate, in some sense, the ideal system which should prevail in terms of regulatory bodies in the colleges which govern the professions.

I would like to mention them, one after another, with comments on where we have failed here in Ontario, both in the existing Medical Act and in the present Act which is to supersede it, the Health Disciplines Act.

The first major recommendation that they suggest is that “regulations prepared by professional orders be the object of public consultation and discussion before being adopted by the government.”

Now, in Ontario, I think, possibly the only way we could explain public involvement in the present Act is to say that each college will have public representation in terms of three to five lay people appointed to it.

Recommendation No. 16 is that the “power now held by certain professional corporations to regulate admissions to studies be abolished and that, thereafter, it not be granted to professional orders” -- they mean the professions again.

It has not been abolished in Ontario. I am not dealing here specifically with each discipline separately; I have combined them and I have pointed out that in some of the five, this has not been done. I am also pointing out that it does not appear in the Act itself. In that sense, if one is going to question the relevance of it, I am trying to draw an ideal system against which I can judge the present attempt to order the order in the health field.

Recommendation No. 18 is that there be “established a system of state diplomas whose requirements would be specified in a government order in council after consultation with the professional order and educational institutions involved.”

Here, it is obvious that the state does not grant diplomas, and I am not suggesting that that particular part should be adopted as our ideal.

Recommendation No. 19 Is that the “professional order be authorized to grant specialty certificates but that programmes of studies and other conditions required to obtain a specialty certificate be determined by universities, after consultation with professional orders, and be administered by them.”

Recommendation No. 20 is that the “legislator be parsimonious in the granting of powers to professional orders to establish specialities.”

Recommendation No. 21 is that “professional orders be authorized to verify the equivalence and to countersign the authenticity of non-Quebec diplomas before permitting the holder to make use of it to practice his profession.”

This is, I think, more glaringly not done in Ontario in respect to nurses. This Act, the whole section on nurses, deals in fact only with registered nurses and registered nursing assistants and not with nurses generally who practise what would be more broadly defined as nursing.

No nurse is required to be licensed or registered in Ontario to practise nursing -- registration is entirely voluntary. A registered nurse can be cancelled for incompetence. There is nothing to stop her from taking a job in a hospital as a graduate nurse and in many cases performing functions almost identical to functions of a registered nurse.

The Globe and Mail documented the case of a newspaper reporter being promised a job by a registry in a downtown hospital. She was not even asked for any credentials by the registry. While many hospitals who employ non-registered nurses are careful to check that the graduates are from some nursing school, there are other hospitals and institutions who do not validate even this.

And so it is possible for a totally untrained individual to be given major nursing care responsibility in Ontario. Licensing is the only way to be sure that all nurses’ credentials are checked by the College of Nurses. Those who can’t be licensed could continue to provide care to patients, but simply should be called maybe something else than a nurse.

Many individuals have expressed some fear that this would mean a loss of jobs to virtually thousands of nurses who now work in Ontario. I am certain that if the minister wants to accept this principle, which is essential in terms of promoting better health care, some arrangements could be made in terms of a grandfather or grandmother clause for the future.

Recommendation No. 22 is that the “professional orders be endowed with an internal appeal mechanism to review any decision denying a candidate a licence to practise or use a title.”

The new appeal mechanism is in the Health Disciplines Board; but I think there should be an appeal mechanism within each college.

Recommendation No. 23 is that the “possibility of admission to practise by private bill be abolished and that the prohibition be included in the code for the professions.”

I don’t think that applies here, nor does recommendation No. 24 that the “citizen requirement be abolished for all professions.”

“25. That [however] the members of boards of directors or of disciplinary bodies of professional orders, by virtue of the delegated powers which they exercise, be Canadian citizens.

“26. That the deontology of each profession be enunciated by the interested order.”

They each have their own code of ethics. There probably should be a general code of ethics pertaining to health professions.

“27. That the Code for the Professions contain a provision relieving as witnesses in all civil, criminal or administrative proceedings arising from provincial jurisdiction, practitioners of any profession whose discretion is required by the public interest. Moreover, that the voluntary disclosure by one of these practitioners of any secret learned during practice of his profession be severely punished.”

In Ontario we have had a precedent-setting case in terms of the court not being able to compel a physician to give confidential information, but this is not at the moment a law which applies to all the professions mentioned in the Act.

“28. That professional orders whose members render services generally defrayed by the state within the framework of an agreement not be entitled to set a fee schedule (even on an indicative basis) for their non-contracting members.

“29. That the government approve fee ceilings proposed by professional unions whose services are not defrayed by the state.

“30. That the Code for the Professions prohibit any flamboyant or commercial advertising in publications or on radio or television, or by neon signs or by any other means other than those now authorized for attorneys or physicians.

“31. That the order be empowered, by appropriate regulations, to allow the members to inform the public of their titles, availability of their services and their work schedules.

“32. That the Code for the Professions contain a prohibition against refusing professional services to any person because of race, sex, sexual orientation, language, origin, colour, religion, convictions or citizenship.

“33. That the Code for the Professions prohibit all practitioners from furnishing a certificate or document which is false or erroneous or which is not based on personal knowledge of the facts enunciated in such document when he knows, or should know, that such certificate or document may be used so that another person or some organization pose an act or refuse to pose an act.”

I do not think that this is specifically prohibited.

“34. That professional orders be authorized, in all cases where the mental or physical health of a practitioner is challenged, and when they consider it appropriate, to carry out an inquiry, to order medical examinations and to take any other appropriate measure.” [They are so authorized now.]

“35. That professional orders, for the public good, be authorized to issue any supplementary deontological standards compatible with the Code for the Professions or any other applicable statute in this connection in Quebec.

“36. That there be formed in each professional order a professional inspection committee, composed of members of the order, representatives of the public and, should the case arise, representatives of the unions involved, charged with undertaking a systematic review of records and with the study of individual complaints of the public with a view to laying a formal complaint, if it be in order, before the disciplinary tribunal of the first instance, and to resolving certain conflicts between practitioners and individuals.”

I suppose in some sense the Health Disciplines Board may meet some of those standards, but not in terms of each of the colleges.

“37. That there be formed in each professional order a disciplinary tribunal of the first instance; that it be composed of practitioners, presided over by an attorney (in good standing with the Bar and having practised 10 years) designated by the judge in chief of the provincial court, and that it hear in the first instance any complaint relative to acts derogatory to the honour and dignity of the profession.”

Well, I don’t have quite that much involvement in that particular aspect. I’m not sure I consider that essential.

“38. That there be formed in each professional order a disciplinary tribunal of the second instance; that it be composed of practitioners, presided over by a judge named by judge in chief of the provincial court, and that it hear any appeal against a decision of the disciplinary tribunal of the first instance.”

I think our first court of appeal here is the Health Disciplines Board. Again, I think I would urge that we adopt some kind of an appeal board within each college.

“39. That the courts of common law be invested with the power to deal with any appeal of a final decision of a disciplinary tribunal of the second instance.”

This course is already in practice in our courts. There are only about five more major ideological statements on that point.

An hon. member: Go on. We are enjoying it.

Mr. Dukszta: I will go on.

“40. That the disciplinary penalties which orders have at their disposal to enforce their regulations be made uniform for all professions and be included in a single enumeration inscribed in the Code for the Professions.”

I’m not sure whether it’s there but I doubt it.

“41. That the list, inserted in the code for the professions, enumerating the disciplinary penalties enforceable by professional orders include, among others penalties, probation, which may involve a supplementary internship, and an examination of competence or restrictions on the right to practise, and the obligation to reimburse. [Yes, we have that in the Act.]

“42. That professional orders, responsible for the definition of deontology and the acts which deviate from it, be empowered to attach to each infraction the penalty of their choice, provided it be inscribed in the Code for the Professions. [It is in the code too.]

“43. That a single code of disciplinary procedure for all professions be adopted and integrated into the Code for the Professions. [We don’t have that. We have it separately for each profession.]

“44. That the code of disciplinary procedure contain provisions aimed at assuring that:

“(a) the complaint be in writing and precise;

“(b) the parties and witnesses be entitled to legal counsel;

“(c) the presumption of innocence be recognized;

“(d) the right to assign, swear in, examine or cross-examine witnesses be recognized;

“(e) the evidence be recorded in writing;

“(f) the testimony be automatically protected against use in other proceedings;

“(g) the hearing be in camera, unless this be lifted by the tribunal in the public interest;

“(h) the decisions be rendered in writing, communicated to the parties, brought to the attention of those involved and published in collections of judgements;

“(i) internal appeal bodies and courts of common law proceed on the constituted record but be authorized to reopen the inquiry in certain cases.”

Many of these recommendations are already part of Ontario codes for various disciplines. I am reading and I have read most of the Quebec recommendations in order to point out how far we still have to go.

On the question of lay representation on the professional governing council, the NDP’s view is that to appoint, for example, as in the case of discipline of dentistry, not fewer than three and not more than five persons who are not members of a council under this Act or registered or licensed under this Act, or any other Act governing a health practice is tokenistic and resembles a prevalent USA practice in many industrial combines of appointing as a receptionist in a highly visible entrance area black girls, preferably with an Afro haircut. Those lay people are lost in practice in the mêlée of nine to 12 elected professionals and one professional appointed from the respective university faculty.

Only a significant number of intelligent, informed laymen, preferably approaching 50 per cent of the composition of the council, can have a chance of exerting some countervailing power to the existing professional power structure. Finally it is only when the lay representation is secure in the knowledge that they have at least equal power to be able to say to the profession that they do not agree with a particular item of business or decision and will oppose it that we shall have a more meaningful consumer participation.

To go over the principal changes that the bill is supposedly introducing, in the explanatory note there are four points mentioned: lay representation on the professional governing council; closer supervisory power in the minister; the creation of a Health Disciplines Board for the purposes of conducting hearings and reviews respecting complaints and applications for licensing; and a complete system of hearings and review for all matters of licensing and disciplining with uniformity of procedures for all professions. All those four statements, incidentally, although I suppose it is hardly incidentally, which are supposed to define what the Act is doing, are not met in actuality.

The second intent of this bill, which is to create a closer supervising power in the minister, has indeed been accomplished. It is interesting to reflect here on the major shift in emphasis that has occurred in the role and the relationship of the minister to the proposed Health Disciplines Board, between the set of proposals as articulated in the legislative proposals for the Health Disciplines Act of June, 1972, and the Health Disciplines Act of 1974.

In 1972 most of the new controlling powers were vested in the board, while in 1974 the government has decided to augment the role, the functions and the powers of the minister of the Crown over the five senior health professions and consequently and logically over the whole health field, in terms of ensuing legislation.

The section of the Health Disciplines Board, part 1 of the Act, the general part, pages 1 to 10, outlines the duties of the minister and the board. It is the responsibility of the minister to direct the councils to inquire into the state of practice of any discipline, to require councils to provide information, to review proposals by councils, to amend legislation or regulations, to advise councils regarding bylaws, to request councils to change regulations, and to review legislation concerning the provision of health services.

Wherever the minister has a request of the council of the college to make, amend or revoke a regulation and the council has not complied within 60 days, the Lieutenant Governor in Council may take the action specified in the request.

The responsibilities of the board, section 7, page 4, are vague. It is to conduct such hearings and perform such duties we are assigned to, by or under this or in the other Act, and to submit an annual report to the minister, not the Legislature. This means that the main responsibility of the board will be to deal with appeals arising from the complaints procedure and from the registration committees (section 10, subsection (1), page 5, and section 11, subsection (7), page 6).

The division of responsibilities between the minister and the board has changed significantly between the original proposals and the present Act, in that the minister, who was hardly mentioned in the proposal, now has been given wide authority implicit in the above enumeration of tasks. This introduces some “interesting” possibilities, but does not change the basic problem.

On the one hand, if the minister is truly committed to the principle of lay control and gives the board a fairly free range and if strong knowledgeable lay representatives are appointed as board members, the Act could certainly be a positive force to making the health professions more responsive to the wishes and needs of the public.

On the other hand, if the minister is unwilling to delegate authority and if the government decides to confer the honour of board membership on individuals who are tied to the notion of self-regulations and the traditional independence of the professions, the board could become little more than an innocuous patronage body. What direction the board and the Act generally will follow depends almost exclusively on the individuals appointed to the board and on the whim of the minister. A statement of intent is acquired at the beginning of the Act, which would clarify to what end the board’s activities and powers should be directed, what changes this Act is to bring about, and what ills it is to remedy. But more importantly some of the minister’s powers should be transferred back to the board.

The Health Disciplines Board is being created for purposes of conducting hearings and to review complaints and applications for licensing. The original board as envisaged by the 1972 proposal, was seen as a reasonably strong board with definite powers. This type of board should always have certain logical powers, and those powers are the following: the board should be able to confirm, to alter, to vary, to substitute and to reverse, if necessary, the decisions of councils of various colleges. Only some of these powers are now vested in the present board as it is envisaged by this Act.

Originally, the board would have had some permanent staff in the form of an executive director or officer, other officers, secretaries and a budget. Also envisaged were consultants and advisory committees. This would have fitted well with the recommendations of the report of the Committee on Healing Arts. The board would also, subject to the approval of the Lieutenant Governor in Council, be able to make regulations with respect to any matter that a council is authorized to make regulations under this Act. Where there is a conflict between a regulation made by council and a regulation made by the board, the board shall prevail. This is a good strong point originally made in the proposal which is no longer present in the Act as it is now designed.

Additionally, and very importantly, the board was envisaged to be able to make recommendations to the minister as to the health disciplines to be designated under this Act. I should add another point --

Mr. Shulman: The Conservatives have all left. We should at least have a quorum. Not one single minister. Make them bring in a quorum.

Mr. Dukszta: I am actually hoping to have all this in Hansard, and I am intending to at least finish --

Mr. Shulman: We should at least have the minister. We don’t have a single cabinet minister in the House. Ask them for a quorum.

Mr. Dukszta: I have always been able to send more cabinet ministers away from this House. I don’t regret this ability.

Mr. Shulman: Ask for a quorum. Pull them in out of their offices.

Mr. Dukszta: No, I am not going to call a quorum.

An hon. member: There are three Tories here. What more do you want?

Mr. Shulman: Surely we should have someone from the Tory side. Surely 11 members is not really sufficient.

Mr. Dukszta: I am not yielding the floor.

Mr. Shulman: Well, I ask for a quorum.

Mr. Dukszta: I am not yielding the floor.

Mr. Shulman: On a point of order, how many members have we got here -- 12? With one person on the whole other side there. Count them.

Mr. Speaker: It has been drawn to the Speaker’s attention that we may not have a quorum. Will the Clerk do a count, please?

Clerk of the House: Mr. Speaker, there are 14 members.

Mr. Speaker: It appears we do not have a quorum.

Mr. Speaker ordered that the bells be rung for four minutes.

Clerk of the House: Mr. Speaker, there is a quorum for us.

Mr. Speaker: There appears to be a quorum. Will the hon. member for Parkdale continue with his remarks?

Mr. Dukszta: I need your guidance Mr. Speaker. Should I try to summarize for the benefit of those who were away the essence of my arguments?

An hon. member: Please, will the member summarize?

Hon. Mr. Miller: I think the member should start all over again.

Mr. Speaker: There was one minor request to start over again.

Hon. Mr. Miller: I missed point 22.

Interjections by hon. members.

Mr. Dukszta: I will not summarize, but I’ll mention where I was at. We were discussing the powers of the present board, envisaged by the Act.

I was making a point that one of the major difficulties for this type of a board to function is that the board, not having a full secretarial staff or a full complement of full-time staff, will not really be able to deal with the number of complaints that would be going to it. Additionally and very importantly, the board was envisaged to be able to make recommendations to the minister as to the health disciplines to be designated under this Act, originally, not any longer.

In summary, had there been a very strong board then it would have been able to break the medical chain that stretches from the medical profession, the college, all the way to the Ministry of Health and the minister. The board, as envisaged by the Health Disciplines Act, 1974, is an eviscerated and emasculated body, largely deprived of any substantial authority. Not only will the proposed board not have a full-time chairman or a vice-chairman on the lines of the Ontario Securities Commission, but no provisions are made for a fairly extensive staff that will be necessary if the function of the board is to become more than window dressing. All five colleges now have full-time members to allow them to deal with the load of daily ordinary business complaints, licensing, and so on. Yet for what should be a supervisory board, very little money or staff is provided. Even if the powers of the board were not so severely limited as they are, the very fact of time, staff and money limitations will make sure that the board will be ineffectual and token-like.

In terms of power, the scope of the board’s functioning has been severely limited. I have outlined already the numerous powers which the board has lost to the minister. This leaves the board with few areas of authority, one of which is following up on appeals from decisions of complaints committees. But even here the board is stymied. Section 10, subsection (1) of the Act reads as follows:

“The board may, after review or investigation of a complaint under section 8 or 9, refer the complaint to the complaints committee and the board may (a) confirm the decision, if any, made by the complaints committee, (b) make such recommendations to the complaints committee as the board considers appropriate or, (c) require the complaints committee to take such action or proceedings as the committee is authorized to undertake under the applicable part of the Act.”

To be really effective in this area, the board should be able to substitute its own decisions for that of a complaints committee.

When it comes to dealing with the specific colleges, the Act is an attempt to deal with many of the problems of professional self-regulations which the government has been overlooking for so long. In combination with this Act, the Statutory Powers Procedure Act and the Judicial Review Act will tighten up some of the mechanisms for review and control of delegated legislative authority and plug a lot of the holes in the previous Acts.

There are a number of criticisms that can be made, however, and I offer my reflections on the content of the Act, recognizing of course that the real test of the Act’s effectiveness will be found in the regulations made under it and in the procedures for implementation of a dictate. My overall concern is that the Act does not address itself to the question of how a complaint gets to the college concerned upon which the whole structure rests. Nowhere do I find any machinery that ensures that all bona fide complaints would actually get to the great structure and start revolving around.

Some of the most serious deficiencies in the Act concern the complaints mechanisms which tend to be complicated and time-consuming, and which may be relatively ineffective in repairing the relationship between the consumers of health care services and the professions. At least, as far as the medical profession is concerned, the process does not significantly deter existing mechanisms but provides only an additional route of appeal.

Sections 8, 9 and 10 (pages 4 and 5) of the general part (and parallel sections in each of the parts dealing with specific disciplines) establish complaints committee and procedures. After a complaints committee of a given college has investigated a complaint respecting one of its members, it must send its written decision to both the complainant and the member, either of which if not satisfied, may within 20 days, lodge an appeal to the board for a review.

The complaints committee is not compelled to inform the complainant of the reason of its decision. This should be changed.

One area in which the Act has been improved over the proposals is that there is now a time limit of 60 days (section 9, page 5), for complaints committee deliberations, where previously the only limit was “within a reasonable time.” If a committee has not acted within 60 days, the board has the authority to require it to undertake investigations; if this is unsuccessful the board must itself take over the full investigation.

A complaint regarding a serious offence, such as incompetence or malpractice, would normally be referred by a complaints committee to the discipline committee of its college (sections 12 and 13 of the general part and parallel sections in the other parts). The latter then holds hearings to which the college and the member of the college whose conduct is being investigated are parties. These proceedings are held in camera, except when the individual being investigated requests otherwise. The committee has the authority to seek independent legal advice. Decisions of the discipline committee may be appealed directly to the Supreme Court, bypassing the Health Disciplines Board.

Provisions regarding the discipline committees favour the health professional and his or her college, as complainants are not specifically included as parties to the proceedings. It appears that the complainant may be called as a witness, but his or her right to sit through the entire hearing is not ensured. Moreover, while a professional whose conduct is being investigated is afforded the opportunity (section 12(2), page 7, general part) to examine any evidence brought before the committee, a complainant does not have this right.

The whole business of complaints, pertaining to both levels of the committees, is obviously complicated and formalized. This may be an adequate way in which to deal with charges of malpractice and so on, but there is simply no mechanism for complaints of a relatively non-serious nature -- for example, regarding the social relationship between the professional and the patient -- and it is reasonable to assume that the bulk of complaints from the public will fall into this latter category.

Perhaps some sort of a low-level ombudsman would be helpful in settling such difficulties. This could be an individual whose function would be to bring together the complaint and the professional in a face-to-face situation and to mediate informally with a minimum of delay.

Another flaw in this whole general area is that as far as assurance of quality health-care delivery is concerned, the complaints procedure is over-emphasized; that is, it is assumed that a high standard of service is ensured because incompetent or inadequate practitioners are weeded out through complaints by the public. That’s probably the biggest delusion in the Act.

This punitive action should be reinforced by greater emphasis on preventive measures. For example, reprimanded practitioners might be made to enroll in some programme of re-evaluation and re-education, or an ongoing system of random reviews of all registered professionals (not just physicians) might be implemented. This Act must couple the complaints mechanisms with some positive preventive procedures for ensuring high quality care.

Despite this, the Act should provide for advertising the complaints system so that the public is informed of redress procedures. In addition, the names of reprimanded, restricted or suspended practitioners should be publicly circulated in some manner -- and all other professionals, I should add -- if the whole complaints procedure is to assist the public at all. It is not quite sufficient that such names only be known within the profession.

This whole Act rests on the assumption that the colleges will be informed of complaints so that they can deal with them. Yet, a case can be stated for easing the access to the colleges.

It is well known that citizens with valid complaints are hesitant to approach large bureaucratic official bodies. They often need help to make this complaint in an articulate and a sophisticated manner without feeling intimidated. There should be, I quote, “a patient advocate” -- someone who will know where the complaint should go and how to present it.

The colleges do not advertise their presence nor go out of their way to make it easy for the complainant. Indeed, they often make it very difficult for the patient to be heard. In other words, under our present system a citizen must be rich, well-educated and persistent to gain satisfaction for his or her grievances.

He or she needs a patient advocate -- a person quite outside the system and independent of the colleges and the ministry -- who would make every citizen “rich, well-educated and persistent.”

It is my contention that the system of self-government which depends on written complaints from a grieved patient is doomed to fail him. As a reference here, one should look at the institute for the study of responsive law in New York.

What we need here is something along the lines of New Zealand’s ombudsman, except dealing specifically with health care matters.

I was going to mention a particular case as an example to show that a more informal approach, maybe with someone like a patient advocate, would have saved many problems. It is a fairly famous case of Mrs. Coy and was reported by Sidney Katz in an article in the Toronto Star, Saturday, Dec. 29, 1973. She was, in fact, in the wrong. She believed a particular procedure followed by a physician was a contributing cause in her husband developing cancer and dying.

As I said, she was quite wrong; but the way she had to deal with it involved a most elaborate way of approaching the College of Physicians and Surgeons of Ontario. They reacted somewhat negatively and stated the obvious truth as to what the problem was -- but did not deal with the human element of it. If there had been a face-to-face contact between this individual and someone from the college, many of the problems which ensued from it would have been solved.

I would like to spend some time -- well, not too much time -- to deal with the specific disciplines which I have mentioned in the Act.

Initially, we need to comment on the definition of practice of the various disciplines and consider whether the so-called Practice Act is a good thing or not.

The practice of pharmacy, of nursing and of medicine is not defined under separate parts. The general part does not require them to define their practice.

Had the framers of this Act recognized it, a strict legal definition of each practice might impede the expansion of paramedical practice. Expansion should be required to meet health needs as they are, or maybe are expected to develop in the Mustard report -- the health planning task force.

The question of whether the practice of health discipline should be strictly defined is another matter. To quote a line from the report of the Committee on the Healing Arts: “Maybe defining practice is sometimes like a kind of scratching; it makes the itch worse than it was before.”

I think that the purpose and the point is in clause 52, subsection (4):

“A licence shall be deemed to authorize a member or person authorized by the regulations to engage in the practice of Medicine, notwithstanding that any part of such practice is included in the practice of any other health discipline.”

The various committees set up under all the parts to deal with practitioners who are incompetent by reason of mental illness or drug dependency is a sound addition and provides a more humane way to deal with the problems than by dragging them through the discipline committee which is in sections 61 and 62.

There seems to be no provision for ensuring that mandates appearing in this Act, which require their inclusion in another Act for implementation, will so appear (section 62, subsection (2)). For example, if a college is concerned about incapacitated members, it should take positive steps to find out about these members by requiring that a regulation be placed in the Public Hospitals Act or the Mental Hospitals Act, whichever Act applies, compelling the body having control over the institutions to report such incapacitation.

If the nurses are serious about requiring notice of dismissals from registries, section 87, that requirement must also appear in the Employment Agencies Act. A clause similar to clause 4 could be inserted to ensure that these requirements were directed to the institutions and agencies concerned.

Two things come to mind about the cancellation of a licence. The pharmacy part requires that a revoked licence be delivered to the college, section 164. I would think this would be necessary for all the disciplines because, I believe, legally the licence is the owner’s property and he or she could refuse to give it up. The other matter is that licences and certificates are issued annually and therefore it would seem necessary that the word current should precede the word certificate or licence in section 45(d).

I can conceive of situations where it might be necessary to take a practitioner out of circulation pending a hearing. Sometimes a hearing may take months to call, particularly during the summer months when it is difficult to find a quorum. I would suggest something like -- the complaints committee may, by notice to the respondent and with or without a hearing, suspend the respondent’s certificate or refuse to issue an initial certificate pending a hearing by the discipline committee when, in the committee’s opinion, it is necessary to do so for the immediate protection of the interests of the respondent’s patients or clients.

It may be that this is expected under the right to take such action as is deemed appropriate but it would be wise to clarify this since it does interfere with certain civil liberties of the individuals involved. The pharmacists seem to have anticipated the problem of finding a quorum in section 125, subsection (3). They provide that someone may be pulled off the council in this event.

If, after investigation, the registrar considers that an allegation of incompetence or professional misconduct is justified, it should be possible for the discipline committee to proceed on an allegation by the registrar, even though no complaint has been made; section 60, subsection (1). This may well be the intent of section 60 but it would be well to clarify this also.

The next thing one notices about the Act is that the parts are almost identical except for the nursing part which stands out because it is different in some major respects. The question comes to mind -- is it better by being different or is it weaker than the other parts? After examination, I find it has serious faults particularly in respect to the making of an inquiry.

All the parts allow the registrar to inquire into a belief that a member has committed an act of professional misconduct or incompetence, section 64, subsection (1). The nursing part restricts an inquiry to matters arising out of a written complaint except in the case of incapacity. This prevents, or at least does not authorize, the College of Nurses to act on such things as newspaper reports. I think that knowledge of possible incompetence should suffice by itself to start an inquiry.

I think it is fundamentally wrong to have knowledge of incompetence and refuse or not be allowed to act before some person has been harmed enough to write a complaint. Further, I believe that any decision to dismiss knowledge of possible incompetence without making an inquiry by the registrar should be justified at least to the council of the college concerned. That’s section 110, subsection (7). We should keep an eye on the regulations in this regard and I hope that the minister is listening at least with a third eye or a third ear to some parts that I am saying.

An hon. member: We have lost him.

Mr. Dukszta: I think we have lost him, rather. We could be charitable and assume that this omission in the nursing part of the Act was an oversight. If it were not an oversight, the drafters of the Act should be able to explain it. Maybe we will have an explanation later on. Perhaps it has something to do with the fact that nurses are not licensed but this fact does not make the incompetent nurse any less a danger to the public than any of the other practitioners. If the College of Nurses did not ask for this or propose it, one could well ask whether the College of Nurses is entirely sincere in its desire to carry out its mandate.

Given that a complaint has been made, it would be instructive to know why the investigation of an incompetent practitioner of the nursing art does not require as much legislative assistance to get at the facts as does the investigation of an optometrist or a dentist -- no one shall obstruct or hinder an investigator from these colleges, section 40, subsection (2), (3), (4), (5). The College of Nurses investigator must get along as best he or she can.

In this connection, one also wonders why all the parts require secrecy and confidentiality, section 65 is an example, while no such restriction is placed on the College of Nurses. I should think that this requirement is a must for every investigator who is serious about conducting a thorough inquiry. My feelings about this are expressed in the following quote from a Florida statute:

“And as the board is seeking to encourage persons to bring bona fide complaints as to the conduct of any nurse to the attention of the board in order that the board may best perform the duties imposed upon it by the statute, and as this freedom of disclosure would be inhibited to some extent by revealing the correspondence leading to the charges filed with the board, all letters and reports shall not be revealed to any person.”

The last point is that all the disciplines are licensed except nursing. Numerous reasons have been given for this mainly having to do with protecting the job market and concerns re monopoly. I have examined many of these reasons and I find they do not hold water.

It seems, in any case, that considerations such as these have no place in this Act and indeed, are contrary to the stated objective of regulating the practice of health disciplines in the public interest. The lack of foresight in the nursing and medical parts of this Act may reverberate very strongly in the future when a question of shifting some responsibility which is now defined as medical from a physician to a nurse will come up for discussion and possible implementation.

The lack of teeth in the Health Disciplines Board and rigid codification of the existing powers and responsibilities of the profession means that the Health Disciplines Board will probably be very ineffectual in dealing with many of the problems mentioned.

Physicians will continue to have too much control in the health care system, specifically in regard to decision-making about treatments and patient care. The new Health Disciplines Act should have had some of this tight control loosened, making it possible for other members of the health team to participate more in patient care.

A nurse wrote me:

“The nursing profession is particularly being stifled by the present Medical Act. The expanded role of the nurse is a very real and important issue that has implications for government, for the health care system and for the public.

“The implications for the government are directly connected with economics. It is far cheaper to train a nurse practitioner, a skilled intensive-care nurse or a nurse-midwife than it is to train a general practitioner or a specialist such as an obstetrician. With rapidly rising health costs, means of providing care at a lower cost should be of great interest to the government. I am afraid that the Act, as it is designed right now, will not help open up new alternatives and new ways of dealing with the paramedical personnel.

“The extended role of the nurse does not mean infringement or duplication of medicine but means the nurse is prepared to handle the routine or uncomplicated care aspects, allowing the physician more time to deal with complications and problem areas. The nurse and the physician may now work as a team, in co-operation with other health members. This would result in cohesion and co-ordination of efforts which would benefit the total health care system.

“In regard to quality of care, I feel this is one aspect that could definitely be improved. Medical care does not mean the best care possible at all times. A nurse has a lot to offer to patient care, such as the psycho-social aspects, continuity of care, and a family and community centred outlook. I do not feel that nurses are able to function to their fullest potential.”

Not at the moment, nor will they be able to do so under proposed revisions in the Health Disciplines Act. They are limited by the present legislation and it is my concern that the new Act may even limit them more in some senses than they have been so far.

“The health situation in Canada is changing dramatically, so let us update the laws to accommodate these new trends. I would like to put in a special plea for nurse-midwifery. I feel that maternity nursing is moving in this direction and the use of nurse-midwives in Canada is inevitable. The United States has had a long struggle over nurse-midwifery, where a midwife has been classified more as a physician’s assistant.”

“[Another quote:] The role of a nurse-specialist is also just emerging.

“The introduction of clinical specialization in graduate nursing programmes in Canadian universities is relatively new. Success of the clinical nurse-specialist is determined in large measure by the employment situation. There is a need for physicians, employers and allied workers to appreciate the contribution that may be made by clinical nurse-specialists toward optimum health care if effective use is made of their special knowledge and skills. Without some degree of freedom in practice and the support of the staff within the system, the nurse-specialist is unable to assume the role for which he or she is prepared.”

Again, I don’t believe that this is possible in the context of the present Act.

In the Act, the practice of medicine is not defined, and it is not defined in the present statutes. In the areas of five disciplines there is no definition for practice of nursing, pharmacy, medicine, yet there is a relatively strict definition for the optometrists, which virtually puts them in a straitjacket, and a strong definition for practice of dentistry.

The definition of practice of dentistry is composed of two parts; one part contains the usual autological definition of practice as that performed by the practitioner of the practice, but the second part attempts to define the practice of dentistry in listing the procedures that are usually performed by the dentist. I quote:

“In its submission to the Committee on the Healing Arts, the College of Physicians and Surgeons of Ontario proposed that the Medical Act should be amended to include again a definition of the practice of medicine. The precise proposal was that the Ontario Act should contain a definition similar to that found in section 71 of the Medical Act of British Columbia.

“The definition is still disease-oriented and is certainly not forward-looking, because it fails to take into account the role of the paramedical personnel. The committee has concluded that it would not be in the best interests of the public and of workers in the health field to recommend that there should be a definition in the Medical Act of the practice of medicine.

[Yet it is recommended, under recommendation 308:]

“That the Medical Act be amended to state clearly that an act which if done with regularity would amount to the practice of medicine, surgery or midwifery should be deemed to be the practice of medicine, surgery or midwifery, notwithstanding that it was done, or was shown to have been done, on an isolated occasion only.”

There is a certain lack of logic in the way the Act is applied to this particular recommendation which has at the same time listened to the other part which is not to define the practice of medicine at all.

Paradoxically, the very lack of definition is extremely restricting in itself, for in a legal sense the practice of medicine is defined solely as what the duly constituted practitioner of medicine does, which virtually makes illegal, unless exemptions are made, anyone who by other legislation is permitted to practise their form of healing arts.

Recommendation 308 of the report of the Committee on the Healing Arts is enshrined in subsection (3) of section 52 which states:

“For the purposes of this section, proof of the performance of one act in practice of medicine on one occasion is sufficient to establish engaging in the practice of medicine.

“[Section 52, subsection (1), states:] No person shall engage in or hold himself out as engaging in the practice of medicine unless he is licensed under this part.

“[Subsection (2):] For the purposes of subsection (1), (a) rendering first aid or temporary assistance in an emergency without fee; or (b) the administration of household remedies by members of the patient household, shall be deemed not to be engaging in the practice of medicine.”

At least in the legislative proposals for the Health Disciplines Act, June, 1972, in section 26, subsection (2), the following were considered as not contravening the law:

(a) the rendering of first aid or temporary assistance in cases of emergency.

(b) constituting similar errands by the use of prayer or spiritual needs if duly ordained or authorized members of a religious institution or order that maintains and actively and readily makes use of a place of worship in Ontario.

(c) the administration of household remedies.

(d) paramedical or ancillary personnel performing services in the manner and to the extent authorized by their relations.

(e) any person registered under another part of this Act, to the extent that the actions and conduct in question of that person are within the scope of practice authorized in that part at the time the provision of such part first came into force.

(f) Medical students who were provided in section 28.

Two very key recommendations in the same report are recommendations 310 and 311. Section 310 says that the thrust of the practice is for hire, gain or hope of reward should be eliminated as a constituent element of the offence created by section 51 of the Medical Act. Section 311 says the prohibition against the practice of medicine by any person not registered under the Medical Act should be specially provided so that it does not extend to family care of the sick or family health care, persons performing acts under the authority of other statutes, and persons engaging in acts of psychotherapy.

I have mentioned the original report because it has excluded a number of procedures which legitimately fall in our, so to speak, practice of medicine, yet under the new Act would be considered illegal. The present Act, by listing only two parts instead of the ones listed in the original proposal and in the report of the Committee on the Healing Arts, has failed to take into account what the report of the Committee on the Healing Arts has suggested very strongly.

I would also like to stress that any psychotherapy which in section 311 in the report from the Committee on the Healing Arts should be excluded specifically from the definition of the practice of medicine, is now not excluded, which puts a number of practitioners under a cloud and I would say places them in direct conflict with a number of other legislative Acts that are already in existence.

The major reason for the first exception of recommendation 311, as the Committee on the Healing Arts states, is recommendation 310 -- that payment be eliminated as an element of the offence created by section 51. The reason for the second exception is a desire to minimize jurisdictional dispute and needs no elaboration. The reason for the third exception is to be found in our views that we do not regard psychotherapy as a matter within the exclusive confidence of physicians or house workers to cope with that which is necessarily defined by statutes.

The inconsistency of the definition of the practices of medicine, dentistry, pharmacy, nursing and optometry, is that there is no definition for the fields of nursing medicine or pharmacy, a straitjacket definition for optometry, and an extensive definition for the discipline of dentistry, which in part points a dagger at the head of the paradental health worker, namely denturists. This leaves the minister and the Health Disciplines Board with no intelligible definition to be used in co-ordinating the activities of various disciplines. At least the semantic framework of the definition of the practice of dentistry, however iniquitous it is to the denturists, would allow the Health Disciplines Board to co-ordinate the activities of the health professionals.

One of the last remarks I shall make is on a few points in the recent controversy between the optometrists and the ophthalmologists. We have all received telegrams from the ophthalmologists only recently. Optometrists have contacted us in a different fashion.

Mr. Shulman: How?

Mr. Dukszta: Personally.

Mr. Shulman: Campaign contribution?

Mr. Dukszta: I could ask the same question if the member would let me.

I think I could make a couple of points or, at least, try to find my own position on it. I’ll read a part of the proposals from the Ontario Association of Optometrists, which is not the college but a trade organization like the OMA. As they have suggested in their brief: “The modern optometrist requires the use of all diagnostic tools which will enable him to carry out an examination. A drug can be useful in detecting the presence of an eye disease in some cases.”

In response to this, and in response to the proposal in the Act that is now for our consideration, the Ontario Medical Association came out with a number of statements. I will not read them all since they are much too extensive, but in summary, in the section on ophthalmology, the Ontario Medical Association suggests that:

“No member shall use drugs in his practice except such topical anaesthetics for the purposes of tonometry as are designated in the regulations. Any member who in the course or his practice detects an anomaly of the eye or adnexa that may be pathological in origin, shall refer the patient to a legally qualified medical practitioner.”

This is a somewhat controversial subject but, in response to it, I would like to point out that the statement made in a very extensive letter by the Ontario Medical Association in respect of the possible dangers to the patients if their optometrists are allowed to use certain drugs which go beyond the local anaesthetics are -- I was going to say they’re somewhat tendentious, they’re rather strong statements. They may be somewhat exaggerated, especially if we take into account the practice in other jurisdictions outside Ontario.

I don’t really think we can limit ourselves to treat this very serious question only in our own experience. I have, in front of me, a submission of the College of Optometrists of Ontario to the Committee on the Healing Arts. It’s in section 98:

“Further, the college wrote to the Board of Optometrical Registration in Sydney, New South Wales, Australia. For three years their Optometry Act was amended to permit optometrists to use cycloplegics, local anaesthetics, mydriatics, miotics and such other drugs as may be prescribed for use under certain conditions (ref. Optometrists Act, 1930-1963, New South Wales) and the college was interested in obtaining their experience.”

It was learned that the requirement of the statute was that a special course would be set up to qualify those optometrists in practice who wished to use those drugs. The special course has not been abandoned but has been deferred indefinitely because, as the Vice-Chancellor of the University of New South Wales advised the Minister of Health, the university council has reached the conclusion that at the present time the views of optometry and ophthalmology cannot be reconciled and, in the circumstances, the implementation of the special course in the use of drugs in refraction or examination of the eyes must be deferred.

I would like to point out that in England they have been using not only local anaesthetics for the purposes of tonometry, but drugs like atropine and pilocarpine for the purposes of examination without obvious disaster occurring to the number of patients who have been seeing their optometrists in the many years that this particular practice has been in effect in Great Britain.

In a small summary to that point, there is probably no real need for optometrists to use all the other expensive drugs, but surely there is a need for them to use local anaesthetics to help with the tonometry. I know that there are newer ways of doing tonometry

-- electronic tonometry, which employs a very expensive instrument that is not within the financial capacity of many of the ophthalmologists to buy. It’s quite unnecessary to go to such an extent that we should compel them to do it. On that point, which is one of the few points on which I tend to agree with the minister, maybe they should be allowed local anaesthetic.

In summary -- and it’ll be a very short one -- I would like to point out that the Act fails in two key points really. One is that it does not deal at all with the form of making sure that there is a public and community input into the profession. The way the Health Disciplines Board has been set up is ineffectual, tokenistic, and will not deal in any other way except as a window dressing with what now is a growing public concern for a public input into the five senior health professions.

Secondly, the Act will rigidify the boundaries between the professions and will not allow for easy future implementation of any more forward looking or more scientifically correct ideas in health care. It will remain in fact, a monument to intellectual bankruptcy on the part of the Ministry of Health and the government. Consequently we cannot support it.

Mr. Speaker: The hon. member for Kitchener.

Mr. Breithaupt: Mr. Speaker, first of all, in entering this debate, I do congratulate the minister on bringing before us a bill which, hopefully, will attempt to deal with the various medical professions and put them in a position whereby the public will be well served by the co-ordination of the various health disciplines within Ontario.

Mr. R. F. Nixon (Leader of the Opposition): We’ll expect his full and undivided attention to it.

Hon. A. Grossman (Provincial Secretary for Resources Development): That is a good place for the member for Kitchener to finish the speech.

Mr. Breithaupt: Well, perhaps the Provincial Secretary for Resources Development --

Mr. R. F. Nixon: This is his policy field.

Mr. Breithaupt: -- would know more about the finishing of speeches in short words than I would.

Mr. R. F. Nixon: What is his policy field?

Mr. Breithaupt: In this bill, Mr. Speaker, it is important for us to realize that, since the Committee on the Healing Arts reported in 1970, there has been a long and involved public discussion and interest in the taking of a common approach to the resolving of various of the medical requirements within our society. I congratulate the minister further on making the commitment that this bill will be going to standing committee.

As you will recall, Mr. Speaker, in the discussions which we have had on certain of the revenue bills as a result of the most recent budget, those bills have not gone to standing committee. I think that that is unfortunate because the kind of public involvement that is necessary to deal with those particular matters is every bit as important as the public involvement that is necessary in this situation.

Various professional groups have been involved. It was interesting to note in the press reports when this bill was first introduced that generally the spokesmen for the professional groups seemed content and encouraged by the fact that there was to be a co-ordinated approach with respect to the various health disciplines. The minister in his opening comments, stated, and I quote; “This Act ensures that the activities of health disciplines are effectively regulated and co-ordinated in the public interest.”

I think that we will all agree, Mr. Speaker, the approach the minister has taken really divides itself into two parts. The first part is that the approach be regulated and co-ordinated, but the second and most important part is that this regulation and co-ordination be done effectively. So, as far as I am concerned, the matter of effective action on the part of the Health ministry is the important thing in this circumstance.

The member for Parkdale has reviewed the four principle changes that are set out in the explanatory notes to the Act. I certainly won’t go into the same detail as he has done with respect to his own personal knowledge of the particular medical matters which this bill represents. But as a layman in this particular area I am interested in these four principles because I think they will go a long way to the resolution of some of the concerns that many citizens have with respect to the development of health services in the province.

Last year in the provincial budget, as I recall, we committed some $2.2 billion to the operation of the Ministry of Health, and that was approximately 28 per cent of the budget of the province. This year, I presume we are approaching about $3 billion, about a third of our expenditures dealing with moneys in the health field. If that percentage is perhaps a little generous, at least it shows that the commitment of moneys and the expenses for health are becoming a vital, and indeed a most important part of the moneys which we are spending on the citizens of Ontario for the provision of health services.

As a result, I think it is important that the matter of closer supervisory powers by the minister is clearly set out for those operating in the health disciplines to realize and to understand. The minister must of course involve himself, particularly in these areas, to ensure that we are getting the best return for the very large numbers of dollars that are being spent.

The matter of lay representation has been pointed out by the member for Parkdale as being one that seems to be a two-edged sword. It has the opportunity of course, of involving citizens in the particular colleges and the governing bodies of the colleges, but it also has the unfortunate connotation that sometimes in the past, at least, these appointments have been made more as a matter of patronage than as a necessary benefit to the public interest.

Mr. R. F. Nixon: That’s the distinct impression that we get.

Mr. Breithaupt: If the minister is serious about involving the public interest, then I am certain that his appointments, each one of them, will be well received by all sides of the House because they will be based solely on merit.

Hon. Mr. Miller: They are all from Muskoka.

Mr. Breithaupt: Well, I would hate to denude Muskoka of its residents, especially in the winter, so that they must necessarily all be serving on ministry committees.

Mr. R. F. Nixon: They are all Santa’s little helpers.

Mr. Breithaupt: However, it may be that the elves in Muskoka, who are otherwise unemployed during the summer months, could well find full employment on all the boards and commissions that eventually find themselves reporting to the Minister of Health.

Mr. R. F. Nixon: The Minister of Health is trying to reward them all.

Mr. Breithaupt: In any event, Mr. Speaker, the matter of lay representation is an important one. It is also one that in our society should be co-ordinated to the point that our citizens are aware that this kind of an approach, taken to the governing boards of the colleges in these areas, is one which the government views seriously and one to which the government is in fact committed.

The matter of the Health Disciplines Board will be dealt with, I am certain, by other speakers, particularly by my colleague, the hon. member for Downsview, who has a particular interest in that area. It is of course important that those boards be independent in fact and that the public participation on them be assured so that they have the breadth and depth of involvement and knowledge, as well as the expertise available to them, that they will be able to do the kind of job that we all hope for them.

It is natural of course that there is a system of hearings in review which on occasion is going to involve the courts of Ontario. There has to be uniformity of procedures in this matter and I think that again we have taken at least a reasonable step to attempt the co-ordination of the kinds of hearings and review procedures which have been called for by the McRuer commission over the years through its various reports and by other responsible bodies.

As I understand it, Mr. Speaker, there will be other sections which will eventually find their way into this Act dealing with chiropractors and therapists, with technicians of various kinds and podiatrists. I don’t know whether there are other particular disciplines that are going to be included, but I think it will be worthwhile for the minister, if he is able to do so, to advise us in his remarks as to when we may expect to have these other areas brought forward, so that the whole package approach which is being taken to the operation of the ministry can be seen by the Legislature.

There certainly is a general agreement among the spokesmen for the various professional groups that this kind of an approach will hopefully resolve the various interdisciplinary conflicts that exist and will also set a guideline by which we can be assured that the moneys being spent in these areas are being well and properly spent. Much has been said as a result of the approach that has been taken by both the optometrists and ophthalmologists in the attempt to resolve the particular points that are raised by section 99 in the bill.

It would appear to me that the whole matter will resolve itself one way or another when the minister advises clearly in the House what sorts of drugs are going to be available and included in the regulations. Surely that is going to be the way that we are able to show whether, based upon the training and experience of optometrists, the various drugs that are allowed will either permit them to do the job for which they are trained or will not. This surely is the point that we will have to see when the regulations come in. I think that there are going to be many members concerned with this particular point. I hope that the minister will be able to resolve it so that especially those of us without a medical background will understand just what the terms of reference are supposed to be -- delineating the work of these two professions.

There is one other area that I would like to refer to and it deals with a series of letters that I’m certain many members have received from those persons who are members of the Christian Science organization. In the letters which I have had they have dealt with a particular point. If I might I will quote briefly from one letter:

“We of Christian Science very much cherish our religious rights with respect to the above-mentioned Bill 22. We request that the practice of healing by prayer without prohibition or interference be reinstated in Bill 22.”

Mr. Speaker, not being a member of that particular religious denomination I am not aware in depth as to the difficulties which apparently have been foreseen by this religious group. I am certain that the minister would not wish to offend any group of persons, and I hope that in his comments --

Mr. R. F. Nixon: Certainly not in his position.

Mr. Breithaupt: -- he will be able to advise us just whether or not the concerns that Christian Scientists have written about are in fact something that is going to take place.

The minister shakes his head, and he shakes his head “no.” Are we to presume then that these various letters of concern are without foundation and in fact this kind of problem is not going to occur?

Mr. R. F. Nixon: The minister is not going to persecute the Christian Scientists?

Mr. Breithaupt: The minister at this point shakes his head up and down which I presume means yes.

Hon. Mr. Miller: I could answer the member if he wishes.

Mr. Breithaupt: I would hope the minister will take the opportunity in his reply to set out clearly just what the situation is so that these citizens will be able to be assured that their particular religious belief will not be interfered with or compromised.

Mr. Breithaupt moves the adjournment of the debate.

Motion agreed to.

Mr. Speaker: In accordance with the provisions of standing orders 27 and 28, I now deem a motion to adjourn to have been made.

The hon. member for Port Arthur had filed proper notice with me that he is dissatisfied with the answer given to one of his questions yesterday. He now has the right to speak to this point for five minutes.

LAKE SUPERIOR OUTFLOWS

Mr. J. F. Foulds (Port Arthur): Mr. Speaker, the government of Ontario has failed to be open and frank about the regulation of the level of Lake Superior. The Premier’s (Mr. Davis’) reply to my questions yesterday was just the latest in a series of evasive answers.

On May 22 of last year, I asked the then Minister of the Environment (Mr. Auld) about IJC proposals to use Lake Superior as a reservoir for the rest of the Great Lakes system. He said:

“Now, what is transpiring at the moment with the IJC and the lake level and whatever studies are being considered, I am not totally up to date on. I will try to find out and let the hon. member know.”

But there was no further answer.

On June 18, the minister admitted that Mr. Steggles of his ministry and representatives of the Ministry of Natural Resources were present at an IJC meeting held in Duluth on that very day. He further clearly indicated that “there are provincial people on the Lake Superior Control Board Advisory Committee ... ”

More interestingly, he indicated to me quietly in the hallway that the thing that fascinated him was the information that there was massive potential to use Lake Superior as a reservoir because of the vast surface area of the lake.

Then the IJC released its special interim report on the regulation of Lake Superior outflows on June 29. This recommended an increase in the allowable water level of Lake Superior.

I wrote the Premier on July 18, asking him to make Ontario’s position on the matter clear and public as all the affected shoreline on the Canadian side is in Ontario. I suggested that as this was the case, Ontario should have a large say in the determining of the Canadian government policy on the matter.

The Premier replied by saying in a letter of Sept. 27:

“I hope I can relieve your anxiety by confirming that the province has been studying the special interim report for some time and has already made recommendations where appropriate.”

But nowhere in his letter or publicly since has he indicated what these recommendations were or to whom they were made.

I might also add here that Louis Robichaud, the Canadian chairman of the IJC, said in a letter to me:

“Before final conclusions are reached, the commission will hold public meetings at strategic locations in both countries in order to give the public full opportunity to express their views.”

But no such meetings have been held.

Therefore, Mr. Speaker, you can imagine my surprise when I learned that at an IJC meeting in Washington on April 2, the American attorney and the Canadian lawyer attached to the commission said that the two parties had reached an agreement in principle on the regulation of Lake Superior. The Canadian lawyer further stated that the Minister of External Affairs was to contact Ontario to obtain confirmation.

Subsequently, I raised the matter with the present Minister of the Environment (Mr. W. Newman), who said: “I will be glad to bring the member more detailed information tomorrow.” He said this on April 9.

Thirteen days later, with an answer not forthcoming, I raised the question with the Premier as the chief administrator of the province. The Premier said:

“I recognize the federal government at Ottawa and the American government have had discussions on the issue and on a number of other issues. I’m not sure that there is in fact an agreement, I will check that out and find out whether there is in fact an agreement.”

I simply cannot accept that answer, Mr. Speaker. There are too many contradictions, too many partial omissions of knowledge on the part of Ontario government officials for me to accept the Premier’s statement at face value.

There is an agreement. The Premier should be aware of it, as Ontario is now considering it at this very time, if it has not already agreed to it. I believe that the Premier used his talks about pollution control on the Great Lakes with Governor Milliken as a cover-up. I believe he agreed to the Michigan governor’s desire to raise Lake Superior as a sawoff to persuade Michigan to clean up some of its pollution. Ironically, the IJC admits in its own special interim report that holding back Lake Superior will not significantly ease high water levels lower down on the system.

I will continue to oppose the raising of Lake Superior until I am satisfied that northern Ontario will not economically or ecologically be damaged by the proposals. We in northern Ontario have for far too long been treated as hewers of wood and drawers of water for the industrialized sections of this continent. We are not now prepared to become mere storers of water in order to satisfy either the United States or southern Ontario to our own detriment.

Mr. Speaker: The member’s time has now expired.

Mr. Foulds: I believe the Premier is deliberately withholding information from the Legislature. I would like him to come clean about the whole matter. What is he trying to hide?

Mr. MacDonald: That’s a full record.

Hon. W. Newman (Minister of the Environment): Mr. Speaker, in reply to the ruling which was made, I would just like to say the Premier is not withholding information. As usual the member for Port Arthur, with his fragmented information in bits and pieces, certainly has not got the story correct and does not really know what the facts are.

Mr. Foulds: Give us the full information,

Mr. MacDonald: Give us the facts. The minister has the chance now.

Hon. W. Newman: He asked me a question; he pointed out in his question to me on April 9 that accord had been reached between the federal government of Canada and the federal government of the US. This is not true. There has been no accord reached at this point in time, as of tonight even.

Mr. Foulds: Has there been an agreement in principle?

Hon. W. Newman: There has not been. Will he listen to me? When the federal government originally last October rejected the IJC’s idea of regulating Lake Superior, it rejected it on the basis there wasn’t sufficient information. The federal US government asked it to reconsider the matter and as a result of the reconsideration of the matter the government of Canada asked the Province of Ontario for its comments. Our comments were duly put together in this ministry, forwarded to the Ministry of Intergovernmental Affairs, TEIGA, and from there, which is the proper channel, they went to Ottawa. The federal government has our thoughts on the matter now; our thinking on the matter. We are now waiting for Ottawa to make its decision with the US federal people.

Mr. Foulds: Comments on what?

Hon. W. Newman: Pardon me?

Mr. Foulds: Comments on what?

Hon. W. Newman: On where we stand on the matter. As a result of these developments the government of Canada is now reconsidering and has requested our views. The proposal was under study by our ministry and the Ministry of Natural Resources.

Mr. Foulds: So there is a proposal?

Hon. W. Newman: They asked for our comments --

Mr. Foulds: On their proposal.

Hon. W. Newman: -- on the IJC’s recommendations. Not on what the member is talking about, two lawyers who came to some concurrence. I don’t know anything about that.

I do know that the federal government of the US asked the federal government of Canada, which asked for our comments. We made our comments to the federal government of Canada and we have said that the two federal governments should provide compensation for power interests at Sault Ste. Marie and property owners along Lake Superior damaged by higher levels on the lake if we go along with the regulating of Lake Superior water levels.

Mr. Foulds: That’s a tacit admission that the government is going along with the raising of Lake Superior water levels.

Hon. W. Newman: We are saying, in effect, that if the two governments wish to do this there should be compensation considered for the power people and the shore property owners. We have sent our submission through the Ministry of Intergovernmental Affairs to the federal government in Ottawa.

The Premier has not been misleading the House, nor have I. The reason I couldn’t give the member this information is that in the question he asked me, he said they had reached accord. They had not reached accord and until today they still have not reached accord. I just hope when he makes his resolutions on whatever section of the regulations it is he will get his facts straight before he brings it up.

Mr. Foulds: It might help if the government was frank in bringing those facts to the public.

Hon. W. Newman: We are working with Environment Canada, with the federal ministry, through the proper channels to try to resolve this problem. We are concerned and don’t let the member forget we are just as concerned about the people on Lake Superior and all the other Great Lakes as anybody else is.

Mr. Foulds: Not this government.

Hon. W. Newman: We are very much aware of what is happening and we are very much concerned.

Mr. Foulds: The Tories have sold out the north for 30 years and they are prepared to do it again.

Hon. W. Newman: We are very much concerned about what is happening and certainly we did respond to the IJC’s recommendations to the government of Canada. We are waiting for them now to make their decision.

Mr. Foulds: That is a switch.

Hon. W. Newman: Thank you, Mr. Speaker.

Mr. Foulds: The government should make those representations public. What is it hiding?

Hon. E. A. Winkler (Chairman, Management Board of Cabinet): Mr. Speaker, on Thursday we will return to the second item, consideration of Bill 26, to be followed, as I said previously, by the estimates of the Ministry of Energy. If there is any change from that I will announce it on Thursday but at the moment that order stands.

Mr. Breithaupt: That is without, Mr. Speaker, a return to the health bill?

Hon. Mr. Winkler: That is correct.

Mr. Breithaupt: Thank you.

Mr. Speaker: I now declare the motion to adjourn to have been carried.

The House adjourned at 10:40 o’clock, p.m.