Legislative Assembly of Ontario

The House met at 2 o’clock, p.m.

Prayers.

Hon. M. Birch (Provincial Secretary for Social Development): Mr. Speaker, I would like to introduce to you, and to the members of this Legislature, 60 grade 7 and 8 students from St. Brendan’s Separate School in West Hill. Would you join with me in welcoming them to the Legislature?

Hon. J. W. Snow (Minister of Government Services): Mr. Speaker, I would like to take this opportunity to introduce to the members of the House a group of some 60 students from the Oakville-Trafalgar High School in Oakville who are visiting with us today; I believe some are in each gallery.

Mr. E. P. Morningstar (Welland): Mr. Speaker, I would like the hon. members of the Legislature to know that today we are honoured to have Mrs. Esther Arthur with 55 members of the Women’s Progressive Conservative Group of Welland in the east gallery, along with some campaign managers from the great riding of Welland. I would like you, Mr. Speaker, and all hon. members to join with me in extending to these charming ladies a very warm welcome.

Mr. Speaker: The member for Ottawa East.

Mr. A. J. Roy (Ottawa East): Mr. Speaker, I rise on a question of privilege under standing order 42(a) and (b) pertaining to certain statements made on Oct. 28 by the member for Ottawa Centre (Mr. Cassidy), statements reported extensively in the Ottawa paper, which statements are false.

Mr. Speaker, the member for Ottawa Centre stated on that date that the former member for Carleton East bought land from a man whose widow, Mrs. Nesbitt, is now destitute, for a few thousand dollars; and that this land is currently for sale for $500,000.

Mr. Speaker, these statements are false. Mr. Lawrence bought 18 acres some 15 years ago for approximately $3,000 per acre, which land was developed some 12 years ago. The land that is presently up for sale for $500,000, Mr. Speaker, was bought from a Dr. Niven, is called Niven’s Woods and has nothing to do with Mrs. Nesbitt.

The member went on to say, Mr. Speaker, that Mrs. Nesbitt lives in federally assisted rent-controlled housing. Mr. Speaker, this statement is false. She is in the family home and lives on 3 1/3 acres of land in Rothwell Heights, which is on the outskirts of Ottawa, and which, Mr. Speaker, is probably worth something like $30,000 per acre. The house and property are looked after by the estate.

The member for Ottawa Centre went on to state, Mr. Speaker, that she is practically destitute. I have talked to the widow, Mrs. Nesbitt, the executors of the estate and the lawyers involved, and am advised that she gets adequate income from the estate, and as well is getting old-age pension. She has advised me she has always been honourably treated by the former member for Carleton East.

I state, Mr. Speaker, that the member for Ottawa Centre, who is clearly shown to be wrong, should withdraw or apologize to these people, or have the courage to repeat these statements outside of the House.

Some hon. members: Resign.

Mr. Roy: Mr. Speaker, in closing may I state that we strongly condemn such statements made --

Mr. Speaker: I would say that the hon. member’s privileges have not been trespassed in here. I can’t check into the facts.

Mr. S. Lewis (Scarborough West): That’s a coup de grace for political purposes. Some point of personal privilege that was.

Mr. M. Cassidy (Ottawa Centre): On a point of privilege, Mr. Speaker --

Mr. Speaker: Order, please. There was no point of privilege. I listened the member out because --

Mr. Cassidy: Mr. Speaker --

Mr. Speaker: Order, please. The Speaker is on his feet.

Mr. Lewis: There is a point of privilege now.

Mr. Speaker: All right. Just a moment, please.

Interjections by hon. members.

Mr. Speaker: Will the hon. member take his seat when the Speaker is on has feet, please?

Mr. I. Deans (Wentworth): He has taken his seat.

Mr. Speaker: Order, please. I can see quite well from here, thank you. The member rose on a point of personal privilege, and I listened to him merely out --

Mr. Roy: That is a privilege -- the privilege of the House not to be lied to.

Mr. Speaker: Well, I fail to see where anybody’s rights and privileges were trespassed in the fact that someone may have issued -- may have issued, I say -- wrong information. I know nothing about the facts so I can’t rule on that; nor should I. Does the hon. member for Ottawa Centre wish to correct something?

Mr. Cassidy: Mr. Speaker, the member for Ottawa East has stated that I made false statements to the House.

Mr. Roy: No, it was a lie.

Mr. Cassidy: He said I lied to the House, which is not parliamentary.

Mr. Roy: I challenge him to repeat that outside the House.

Mr. Cassidy: I think that if the member for Ottawa East had cared to speak with me personally, we could have determined exactly what the facts were.

Some hon. members: Oh, oh!

An hon. member: This is the House, not a private deal.

Mr. Speaker: Order, please. This is developing into a debate which is completely out of order.

Mr. Cassidy: On a point of privilege, Mr. Speaker --

Mr. Speaker: What is your point of privilege?

Mr. Roy: Why doesn’t he repeat it outside? Why doesn’t he go outside right now?

Mr. Cassidy: I would ask the member for Ottawa East to withdraw the statement that he made, and if there is an opportunity in the House I will make a statement about the facts concerning Mrs. Nesbitt.

Mr. Roy: Mr. Speaker, I am quite prepared to step outside with the member for Ottawa Centre and --

Hon. A. Grossman (Provincial Secretary for Resources Development): I’ll be the referee.

An hon. member: How about the TV rights?

Mr. Speaker: Maybe that is where it should be settled. Order, please.

Statements by the ministry.

Oral questions.

The hon. Leader of the Opposition.

SUGAR BEET INDUSTRY

Mr. R. F. Nixon (Leader of the Opposition): Thank you, Mr. Speaker.

I’d like to ask the Minister of Agriculture and Food, in light of the announcement today of a further substantial increase in the cost of sugar, if any further negotiations are going on between his ministry and the Department of Agriculture for Canada, or the agricultural people in the southwestern part of Ontario, about re-establishing a sugar beet industry here so that we can be at least partially self-sufficient in meeting our sugar requirements in view of these increased costs.

Hon. W. A. Stewart (Minister of Agriculture and Food): Mr. Speaker, I have had discussions with the federal Minister of Agriculture within the last three weeks on this very subject. He, at that time, was exploring the possibility of having a national sugar policy established for Canada. He, at that time, was not able to give me any direct answer but told me and assured me that he is pursuing it with some vigour because most of us, and I am sure the people of Ontario, share the conviction that there should be a sugar beet industry re-established in Ontario. But there would be little sense in doing it until the federal government comes around to the point of establishing a national sugar policy for Canada, as some other nations have seen fit to do.

Mr. R. F. Nixon: A supplementary: Since the minister is prepared to put it on that footing in his answer, does he not recall that when the sugar beet industry closed down, he shared at least part of the responsibility with the then Minister of Agriculture in not giving public support to the industry, which would have tided it over the days when the prices were so low that it could not justify its continuation here, so that it would still be in operation now that it certainly would be justified. And would he not --

Hon. W. D. McKeough (Minister of Energy): Nonsense.

Mr. R. F. Nixon: What does the minister mean, “nonsense”? It was in his area that he allowed it to close. He was the member.

Hon. Mr. McKeough: There is no blame attached to us --

Mr. R. F. Nixon: The government wanted it closed down.

Interjections by hon. members.

Mr. R. F. Nixon: It was the government’s inadequate policy.

Interjection by an hon. member.

Mr. R. F. Nixon: I’m apologizing for nothing.

Mr. J. R. Breithaupt (Kitchener): Has the government no responsibility?

Mr. R. F. Nixon: I would like to ask the minister if any of those facilities remain which --

Interjection by an hon. member.

Mr. R. F. Nixon: -- have to start with a clean sheet without any of the facilities that could be established.

Hon. Mr. Stewart: Mr. Speaker, my hon. friend knows full well that at the time the industry went down the drain, as he describes it --

Mr. R. F. Nixon: That’s where it went.

Hon. Mr. Stewart: -- it was because there was no federal policy established --

Mr. Breithaupt: Nor a provincial policy!

Interjections by hon. members.

Hon. Mr. Stewart: Regardless of how upset our friends across the aisle may be --

Mr. Speaker: Order, please.

Hon. Mr. Stewart: -- they know full well that when Joe Greene was Minister of Agriculture --

Mr. R. F. Nixon: And a good minister he was.

Mr. Breithaupt: And who was the provincial minister?

Interjections by hon. members.

Hon. Mr. Stewart: -- at that time there was no possible way that we could persuade the federal government to establish a national policy for sugar. We urged them to do that. As a matter of fact, we have maintained the Sugar Beet Growers’ Marketing Board to this day. They are still there. And every one of them will suggest to you, Mr. Speaker --

Mr. Breithaupt: The minister will be sorry he ever said it.

Interjections by hon. members.

Hon. Mr. Stewart: -- that as soon as the federal government makes up its mind to say that a certain percentage of sugar used in Canada will be produced in Canada, we will have no difficulty in re-establishing the sugar industry in Ontario.

Mr. R. F. Nixon: A supplementary.

Mr. Speaker: A further question?

Mr. R. F. Nixon: I would like to ask the minister if he does not feel that in view of the current price of sugar, which is over 50 cents a pound, we could have an economic, competitive sugar-producing industry here, even though, in his view, the federal government does not meet his minimum requirements.

Hon. Mr. Stewart: Yes, Mr. Speaker.

Mr. R. F. Nixon: Well, why don’t we get on with it?

Hon. Mr. Stewart: All right, I’ll tell the member why we don’t get on with it.

Mr. Speaker: Order, please.

Hon. Mr. Stewart: We won’t get on with it because the members opposite would lead the farmers into getting into this business again and they would lead the industry into getting into the business again --

Mr. J. E. Bullbrook (Sarnia): The minister is sweet-talking us.

Mr. R. F Nixon: The way the minister led them in the beef industry.

Interjections by hon. members.

Hon. Mr. Stewart: -- then, when the world price of sugar slumps, if and when the world price of sugar slumps, those same farmers and the industry would be left with their equipment and the industry would be left with plants that it wouldn’t know what to do with.

Interjections by hon. members.

Hon. Mr. Stewart: And that’s the reason we need a national policy.

Mr. Speaker: Any further questions?

Mr. R. F. Nixon: I’d like to ask the Treasurer --

Interjections by hon. members.

Hon. Mr. Grossman: You put him up to the question.

Mr. Bullbrook: A lot of sweet talk.

Mr. Speaker: Order, please. The hon. Leader of the Opposition has the floor.

Interjections by hon. members.

COSTS OF REGIONAL GOVERNMENT

Mr. R. F. Nixon: I would like to ask the Treasurer when he is going to make a statement on the cost of regional government that was promised earlier in this session, particularly with reference to the problems that are being experienced in Haldimand-Norfolk where the startup costs that have been payable from the provincial Treasury have fallen far short of the expectations? As a matter of fact, from the point of view of the people in Haldimand-Norfolk, they have fallen short of the expectations of the fulfilment of the commitment of the provincial government to meet those costs.

Hon. J. White (Treasurer and Minister of Intergovernmental Affairs): Without accepting the editorializing, as soon as the statement is available.

Mr. R. F. Nixon: Supplementary: Since he felt that the statement was of such importance when the Legislature began two weeks ago, and since the ratepayers down there are being faced with the establishment of mill rates far in excess of what had been expected, wouldn’t the minister consider expediting that statement, certainly for the good of those people who are going to have to pay the residual bills in communities like Port Dover, the minister’s favourite town, and Waterford?

Hon. Mr. White: Yes, sir, I will do it.

Mr. Speaker: Any further questions?

DOCTORS’ PRESCRIPTIONS

Mr. R. F. Nixon: I would like to ask the Minister of Health if he has any comment on the statement made by the president of the Canadian Medical Association, Dr. Stephenson, about the practices of certain practitioners in prescribing drugs, either unnecessarily or in professional error, which have led to probably an increase of five per cent in our Medicare and hospitalization costs. I believe her statement was made just about a day ago.

Hon. F. S. Miller (Minister of Health): Mr. Speaker, at this point in time I cannot make a comment on it. I want to look at it and find out more facts about it.

Mr. R. F. Nixon: Supplementary: Is it in conjunction with any further statement on the province’s drug programme itself that the statement might have some particular significance, since there’s still substantial, let’s say, dissatisfaction with the programme that has been instituted in the last few months for the provision of prescription drugs?

Hon. Mr. Miller: There’s always the possibility that the two would be interconnected because there has been some dissatisfaction about certain drugs not in the formulary and as it relates to prescribing habits of physicians. I’m reasonably sure during the debate on estimates which will take place this afternoon this will probably be aired.

AVAILABILITY OF NATURAL GAS

Mr. R. F. Nixon: I would I like to ask the Minister of Energy if he can make some further statement that might clarify the apprehensions that have grown from press comments about the availability of natural gas through the three commercial distributing firms in this province, particularly having to do with the apparent unwillingness of the company called Pan-Alberta Gas Ltd., which has the government of Alberta as one of its shareholders, to allow our distributing companies to deal directly with the producers.

Hon. Mr. McKeough: Mr. Speaker, I am delighted to have the opportunity of saying really what we said on Sept. 4 and repeating it here again in the House. I was disturbed about the statement which appeared in Saturday’s Globe and Mail which did not emanate from any of the Ontario utilities nor did it emanate from TransCanada PipeLines. On Sept. 4 I said that failing any major breakdown in the TransCanada PipeLine system, we have been advised that there are not expected to be any shortages this winter. This is an improvement as compared with the supply forecast they made earlier this year.

TransCanada has purchased additional volumes of gas, and has made arrangements for some supplemental supplies from a major exporter. Assuming similar improvements in TransCanada’s gas supply position next year, we are hopeful that they will be able to maintain at least 1974-1975 supply levels in 1975-1976. Nothing has come to our attention which would change that opinion. Barring a breakdown of some sort or another, we do not see any gas supply problems this winter and perhaps not even in the winter of 1975-1976.

Mr. R. F. Nixon: Supplementary: Is the minister aware that at least one of the big distributors, Union Gas Ltd., has sent letters to some major users, one example being the Norfolk General Hospital, indicating that they should make plans to convert from gas-fired heating to some alternative since they would have some problems meeting their supply commitments in the next period? Is there any rational reason why the distributors ought to be writing to hospital’s in that regard and is there a policy to assist the changeover if it’s necessary?

Hon. Mr. McKeough: Mr. Speaker, I dealt with that very fully in the Sept. 4 statement. I would be glad to send the Leader of the Opposition a copy of that statement. The Norfolk General Hospital, which has been in touch with me on, I think, two occasions through the good offices of the member for Haldimand-Norfolk (Mr. Allan), the former Treasurer, is on an interruptible service. They are a large user. It is an interruptible service and that means that they can be interrupted and that they are under a contract. What Union has said is that unless their gas supply situation improves -- I don’t know for what date as far as they are concerned -- that contract will not be renewed.

Mr. Speaker: Any further questions? The hon. member for Scarborough West.

CONSUMERS’ GAS RENTAL CHARGES

Mr. Lewis: Can I ask the Minister of Energy a question, Mr. Speaker? Does Consumers’ Gas have the right to increase, dramatically, by about 30 per cent, the monthly rental charges it makes for water heaters and conversion burners, without having that approved by the Ontario Energy Board?

Hon. Mr. McKeough: I’m not altogether clear on this, but it’s my understanding, Mr. Speaker, through you to the hon. member for Scarborough West, that the Ontario Energy Board approves certain rates, and rates to allow a rate of return. Other matters, if I can call them peripheral, like water heater rentals, for example, would simply be filed with the board. I think it would be correct to say that if the board has authority -- and I really don’t think it has -- in any case the authority has not been traditionally exercised. It’s my understanding this morning that they probably don’t have the authority to get into that sort of thing.

Mr. Lewis: Well, by way of supplementary: How is that ascertained, since Consumers’ Gas is in the process of jacking its rental rates up very high, and for precisely this kind of equipment, much of which has been paid for 10 times over? Is there any way that we can apply, that citizens can apply to the Ontario Energy Board for a hearing to see whether or not these rate increases are legitimate?

Hon. Mr. McKeough: There is a hearing going on, which started yesterday, in terms of their rate of return. I have no doubt that the matter will be raised there. But, specifically, as to whether that’s in the board’s power or not, that’s a question I hope to have answered very quickly.

Mr. Speaker: Supplementary.

Mr. F. Young (Yorkview): Supplementary, Mr. Speaker, to the minister: Would the company also have to apply to the board in order to vary its former contract or understanding in connection with the purchase of a hot-water heater? The understanding was that they should pay for 10 years and then could purchase them for around $1 or $1.09; and now they’re asking $50 for that purchase. Would that variation have to go before the board, as well?

Hon. Mr. McKeough: I think this is the same question, with respect, Mr. Speaker. But, no, the board is not a third party to those contracts. That question might well be directed, I suppose, to my colleague, the Minister of Consumer and Commercial Relations (Mr. Clement), who at the moment is busy -- but presently the member might give him a new question on the subject when he is listening.

Mr. Lewis: I will leave that to my colleague, the member for High Park (Mr. Shulman), because he is appropriately rapt in conversation with the minister.

Interjections by hon. members.

Mr. Lewis: My advice to the Minister of Consumer and Commercial Relations is that he should sell.

Mr. Breithaupt: What is he going to do with all that corn, anyway?

YORK SANITATION CO.

Mr. Lewis: Mr. Speaker, a question of the Minister of the Environment, if I may: When does his ministry intend to file prosecution charges against the York Sanitation Co. for the violations of his ministerial order and the movement of tonnage much in excess of what has been allowed to the Stouffville-Bremner dump?

Hon. W. Newman (Minister of the Environment): Mr. Speaker, the only violation of the order was in the ordering of the weigh scales to weigh the tonnage going in there. Our people were watching the trucks going in, and were estimated at one point in time they were running over the tonnage which was in the control order. We subsequently notified them that we estimated they were running over. We have a copy of the waybill to show that they ordered) the scales when the order went out. The scales, I understand, are now in place and are being used. The only violation of the control order was the fact that the scales to weigh the trucks going in were not available. They were on order from the day the ministerial order went out. I understand the scales are now in and are being used.

Mr. Lewis: When the minister has evidence submitted to him by his own ministry officials of a serious violation of the control order as to the tonnage which is being transported, and the municipalities request prosecution, do they then have to write the Attorney General (Mr. Welch) to ask that the laws be upheld? Does the minister not think that he has an obligation under the Environmental Protection Act to take the company to court rather than let it violate his control order with impunity for several months?

Hon. W. Newman: Mr. Speaker, as far as the control order went on the amount of tonnage going in there, it is the word of the people involved who counted the trucks going in. We originally felt that they were taking in more, and although we originally kept a very close tab on it, we have no way of proving whether they were taking 300 or 325 or 275 tons per day in there.

Now the scales are in and operating, I understand, and we can control it. But can you see laying a charge against somebody when the scales have been ordered -- and the scales had been ordered; they have been fulfilling their obligations as far as the ministerial control order is concerned -- and were not available?

Mr. Lewis: So the minister has no proof -- that is what he is saying -- except by counting the number of trucks and estimating tonnage.

Hon. W. Newman: No, we haven’t.

Mr. Lewis: That is a very good way of running it.

HEALTH SURVEY OF ELLIOT LAKE MINERS

Mr. Lewis: May I ask a question of the Minister of Health? Is the health survey that has been taken of the Elliot Lake miners now available, and have they been informed of the results of the survey?

Hon. Mr. Miller: My understanding was the individual miner was entitled to findings based on the survey made of him-that they could be given to his physician -- and that at no time were we trying to exclude him from knowing what the findings were as they related to him.

I will double-check on the current status of the survey itself -- as to whether it has been released or not -- and will let the member know at a future question period.

BEEF PRICES

Mr. Lewis: One last question of the Minister of Agriculture and Food, Mr. Speaker: The minister will doubtless have noticed the comments of the hon. John Diefenbaker about the price differentials in supermarkets in Toronto --

Mr. R. F. Nixon: An unimpeachable source.

Mr. Lewis: Unimpeachable is right -- in Toronto and Ottawa at the supermarket level for various cuts of beef, compared to what the farmer is receiving at the farm gate.

The Premier (Mr. Davis) indicated the other day that the minister might answer a question on how we can establish what happens to the differential between the 13, 14 or 15 cents a pound that is received by the farmer, and the $1.50 or more a pound that is charged the consumer. Might the minister do that?

Hon. Mr. Stewart: Mr. Speaker, there is no comparison whatever between the 13 or 15 cents a pound that the farmer is supposed to be receiving for cattle at the farm gate or on the local market in comparison with the price of A-1 and A-2 beef that is being sold over the meat counter in our food outlets.

Mr. Lewis: I understand that.

Hon. Mr. Stewart: That is a completely different type of beef.

Mr. Lewis: Not at all.

Hon. Mr. Stewart: It certainly is, with great respect.

Hon. Mr. Grossman: The member shouldn’t argue with the Minister of Agriculture and Food.

Hon. Mr. Stewart: The type of beef from which the A-1 and A-2 beef is produced that is sold over the supermarket counter is selling higher last week and this week in the Toronto market -- that is the Ontario stockyards -- than it did this time last year.

Mr. Lewis: What is it selling at?

Hon. Mr. Stewart: It is selling at from 50 to 54 cents for steers, and 44 to 47 cents for heifers, in that range. Now that is about $1 to $1.50 a hundred higher than in this week last year.

Mr. Breithaupt: Discrimination.

Hon. Mr. Stewart: The price of the cattle to which my hon. friend refers at 15 to 30 cents a pound are the feeder calves -- that is the calves that are being produced on the grass this summer --

Mr. Lewis: No, these were not feeder calves.

Hon. Mr. Stewart: Well, what were they?

Mr. Lewis: They were cattle taken to market, they were not feeder calves.

Hon. Mr. Stewart: Oh well, all right, taken to market. They were probably yearlings off the grass that were selling around 30 cents a pound, but those are not the cows that are producing that kind of beef. That kind of cattle is producing hamburg that is selling today at about 50 per cent of what it was a year ago. I see the Toronto Star carried stories of fresh ground hamburg selling at 74 cents a pound; there were a variety of prices in there at various stores.

So that is substantially less than it was last year because of the use of this lower-grade beef that is coming in from lower-quality cattle. But that high-quality cattle that is producing the beef going over the supermarket shelves is higher than it was last year.

Mr. Lewis: Is the minister satisfied with the discrepancy between the range he has quoted -- 44 to 54 cents -- and the price that is paid by the consumer at the supermarket counter? Is the minister satisfied that that price is a legitimate markup increase, given the difference of $1 to $1.50 between farm gate and cash register?

Hon. Mr. Stewart: Mr. Speaker, as I understand it from studies that have been done by our food council on the markups on beef at the various chain stores, it is a consistent markup to that which pertained for a number of years in chain store prices. This is what we’re told, and we have no reason to believe otherwise.

Mr. Cassidy: The minister never checked.

Hon. Mr. Stewart: Yes, we have checked.

Mr. Lewis: Has the minister?

Hon. Mr. Stewart: My hon. friend doesn’t know that, but we have.

Mr. Speaker: Are there any further questions?

Mr. Lewis: By way of supplementary: Where has the minister checked? What evidence is there in Ontario of big price increases?

Hon. Mr. Stewart: Yes, we have checked. We have checked through the various supermarket outlets and we have checked the price. We know the price of beef going in. We know the breakdown of beef. We know the pounds of meat actually sold from every carcass of beef that goes forward, and the breakdown. We know that the markup on those commodities is about consistent with what it has been in years previous.

Mr. Lewis: Would the minister table the material which his ministry has apparently assembled on the price differential between the farm gate and the cash register?

Hon. Mr. Stewart: I see no reason why that shouldn’t be done, Mr. Speaker.

Mr. Lewis: Thank you very much.

Hon. Mr. Grossman: Why doesn’t the member ask if the Human Rights Commission knows why a heifer sells for less than a steer?

Mr. Speaker: The member for Ottawa East.

FULLERTON REPORT ON NATIONAL CAPITAL

Mr. Roy: Mr. Speaker, I have a question of the Treasurer. In light of the fact that the Fullerton report dealing with the national capital area was presented to the federal House yesterday, could he advise the House here on the Ontario Government’s views pertaining to some of the recommendations about super-government and the national capital being, for instance, on both sides of the Ottawa River.

Hon. Mr. White: Mr. Speaker, I read this report yesterday with very great interest. It is a readable and imaginative document. I have studied, to some extent, the three recommendations addressed to the Ontario government. I don’t fully understand the ramifications of those recommendations, although I have had discussions with my own staff, very briefly, and with Mr. Bert Lawrence at noon today, and will be meeting Mr. Ed Gallant at 3 o’clock today. When we have had an opportunity to test the recommendations and come to some understanding of their import, we will have a response to make.

Mr. Roy: Mr. Speaker, if I might ask a supplementary to the minister’s answer: Are we going to get a response, or a government position, pertaining to that report prior to obtaining the Treasurer’s own report? As he knows, he is having a report about the regional area of Ottawa-Carleton prepared by a professor at Carleton. Are we going to get his response to the Fullerton report prior to the tabling of that other report, which we can’t expect for approximately another year?

Hon. Mr. White: I don’t know the exact timetable for Prof. Mayo’s review -- but, surely, it will take a year or two. I think that we are obligated to provide a response of some description to the Fullerton report well before Prof. Mayo’s report is released. I wonder, myself, if we should review Prof. Mayo’s terms of reference so that he can consider alternatives.

Mr. Cassidy: A supplementary, Mr. Speaker.

Mr. Speaker: The member for Ottawa Centre.

Mr. Cassidy: Is the minister prepared, under any circumstances, to endorse a super-regional government in which one-half of the members of its council will be appointed by federal and provincial government, rather than elected?

Hon. Mr. White: This is the kind of thing I don’t want to comment on until I understand the report.

Mr. Speaker: The Provincial Secretary for Resources Development has an answer to a question.

HISTORIC FARMHOUSE

Hon. Mr. Grossman: Mr. Speaker, on Friday last, the hon. member for Ottawa Centre asked me a question -- in the absence of the Minister of Transportation and Communications (Mr. Rhodes) -- regarding the matter of the Jamieson property near Renfrew; and I offered to get the information. In the absence of my colleague, I would advise the hon. members regarding the current status of the Jamieson house.

This century-old stone house is situated on a right-of-way required immediately for the construction of Highway 417 around Renfrew. The house, along with about 60 acres of Jamieson property, was expropriated by the ministry over a year ago after a hearing of necessity that found the taking to be fair, sound and reasonably necessary.

Mr. Cassidy: But recommended moving the house.

Hon. Mr. Grossman: A subsequent court order gave the ministry possession of the property last Friday, Nov. 1, the date the hon. member asked the question. The contract for the construction of that section of Highway 417 was awarded on the understanding that the contractor could commence construction activity on the property Oct. 15, 1974.

Mr. Speaker, on Thursday afternoon of last week, one day before the possession date -- and I might add the day before the hon. member asked the question -- the deputy minister and other officials of the Ministry of Transportation and Communications met with a delegation from the Renfrew area interested in the preservation of the house. This delegation included representatives of the Jamieson family, the reeve of the township of Horton, the president of the Ottawa Valley Historical Society and the hon. member for Renfrew South (Mr. Yakabuski).

They expressed the view that there was a growing awareness of the historical significance of the house in the Renfrew area and a strong feeling that it should be retained. They further indicated that the Jamieson family and others interested in the retention of die house were prepared to make a significant contribution to its preservation.

As a result of the meeting it was agreed that the ministry would take possession of the property the following day for the purpose of allowing the contractor entry, but that the house and its occupants would remain undisturbed for the time being. In the interim, both the ministry and the members of the delegation would work toward finding a plan that would allow for the relocation of the house within the time available.

It was agreed that such a plan should not only deal with the immediate problem of funding the relocation of the house, currently estimated to cost around $125,000, and its restoration, but should also provide a mechanism whereby the house would be permanently available to that community as a historical resort.

Mr. Speaker: One supplementary.

Mr. Cassidy: Before this juggernaut goes any further, will the minister consider or agree that the government will consider looking at rerouting the highway rather than having to go through the very expensive and difficult problem of moving the house, which is something that was unnecessary if one considers the other acres and acres that were available for the route in eastern Ontario?

Hon. Mr. Grossman: Mr. Speaker, I am not qualified, nor is the hon. member, to decide what is the best thing to do in that particular situation, as to whether the highway should be relocated or whether it would be better to relocate the house. That’s a decision for qualified people to make. Having regard for the fact that the historical society is involved and is concerned, he may rest assured that whatever is the proper thing to do, whatever is the proper method to employ to retain this old farmhouse will be the action that will be taken.

Again, Mr. Speaker, I would suggest that the hon. member knows perfectly well that it isn’t quite as simple as he is suggesting. Just to get up in the House and say “relocate the highway” is a simple thing to do. Provided we retain the farmhouse one way or the other, and we’ll do whatever is the best thing to do, I think that’s the most important thing.

Mr. Speaker: The member for Kitchener.

SAFETY REGULATIONS FOR APARTMENT SCREENS

Mr. Breithaupt: A question, Mr. Speaker, of the Minister of Consumer and Commercial Relations. Following the recent unfortunate death of a five-year-old girl and other deaths of children falling from apartment buildings due to the failure of screens on windows and doorways, will the minister advise us as to what plans he has to influence the industry or bring forth various safety regulations that will prevent this most unfortunate occurrence, which seems to be becoming almost a monthly event in metropolitan areas in Ontario?

Hon. J. T. Clement (Minister of Consumer and Commercial Relations): Mr. Speaker, the Ontario Building Code, which has already been introduced into this House, and in particular the regulations under the code, will reflect legislation prescribing safety devices or equipment which will provide for the locking of screens, and thus hopefully preclude this type of tragedy from reoccurring. But remember that the building code will really deal with new buildings commenced after the implementation of the code.

At the present time the municipalities have the power or jurisdiction to deal with requirements insofar as standards and materials are concerned. I want to assure the House that the regulations under the code have, or will have, legislation by regulation dealing with that sort of thing so that these types of tragedies hopefully will not reoccur in buildings commenced after the code is implemented.

Mr. Breithaupt: Supplementary: Has the minister advised the various municipalities of any standard approaches that could be taken in order to have bylaws which are consistent and which will require either upgrading or improved safety features in this area?

Hon. Mr. Clement: Mr. Speaker, I’m unable to answer that. I haven’t personally advised them, and I don’t know if my officials have, because most of the municipalities in Ontario today operate under the National Building Code, plus modifications that suit their own character or the climatic needs of that particular municipality. I have not personally communicated with each community nor has my staff, to my knowledge. Whether there are requirements contained in the National Building Code or not, I am not aware. I can’t venture any opinion on that at this time.

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

CARLETON EAST BY-ELECTION

Mr. Cassidy: Thank you, Mr. Speaker, I have a question of the Treasurer and Minister of Economics and Intergovernmental Affairs. The time for this kind of question is fast ebbing, and I’m sorry that the Premier isn’t here to receive it. I would like to ask the minister whether some hints about the government’s 1975 campaign strategy are revealed in the fact that Mr. Benoit’s main leaflet for the Carleton East by-election mentions, of all the government ministers, only the Treasurer and makes no mention of either the Premier or the Progressive Conservative Party.

Mr. Speaker: Order, please. It seems that that is not an appropriate question for this time.

Hon. Mr. White: I didn’t know about this but I’m not surprised.

Interjections by hon. members.

Mr. Speaker: The hon. member for Downsview.

AID TO JEWISH SCHOOLS

Mr. V. M. Singer (Downsview): Mr. Speaker, I have a question of the Minister of Education. Could the Minister of Education advise what arrangements, if any, have been made as between the North York Board of Education, the group representing the Jewish parochial schools and the Ministry of Education insofar as alleviating, if possible, the costs of education of those youngsters who attend these parochials.

Hon. T. L. Wells (Minister of Education): Mr. Speaker, no arrangements have been made at this point in time.

Mr. Singer: By way of supplementary, since the minister is probably aware of the controversy as it was reported in the newspapers, could he tell us what role the ministry has been playing and if anything is contemplated as being possible to arrange?

Hon. Mr. Wells: Mr. Speaker, I think, as my friend knows, there were some approaches made by the Jewish day schools as to how they could qualify for some type of financial assistance. It was suggested that they sit down and talk with the North York Board of Education to see if there was any way that they could come within the ambit of the public system and, of course, they would have to come within the ambit of the public school board to qualify for public grants for their educational system.

They have made these approaches, I understand, to the North York board. The North York board has commissioned a feasibility study which is presently, I think, just about completed. When they receive that they are going to sit down and then review the matter.

All through this piece our regional director of education for the Metropolitan Toronto area has been part of certain discussions that have gone on so that he will know exactly what is happening. He has also been able to present the ministry and government point of view in this particular case. That point of view is that in order to be eligible for financial assistance they must become part of the public educational system of this province. Whether that would be possible or not, I don’t know at this point in time.

Mr. Speaker: The member for Sandwich-Riverside.

DONOR CONSENT FORMS

Mr. F. A. Burr (Sandwich-Riverside): Mr. Speaker, I have a question of the Provincial Secretary for Resources Development. In view of the recent announcement concerning the serious shortage of pituitary glands for the treatment of sick children in hospitals, will the minister or the secretary consider speeding up the introduction of the new driver’s licence forms which will contain a donor consent form instead of waiting until the supply of old forms is used up many months hence?

Hon. Mr. Grossman: Mr. Speaker, I will take that up with the Minister of Transportation and Communications.

Mr. Speaker: The Minister of Government Services has an answer to a question.

APPRAISAL OF HOMES AT BURWASH

Hon. Mr. Snow: Thank you, Mr. Speaker. I believe it was last Friday the hon. member for Wentworth asked a question on behalf of the member for Sudbury East (Mr. Martel). I would like to reply, if I may.

The question related to a property .owned by a Mr. Charles Moore. On October 17, 1974, Mr. Moore was transferred by his ministry from Burwash to Haileybury. He elected to take advantage of the government’s employee homeowner assistance plan under which he is guaranteed a fair purchase price for his property. To establish a fair and reasonable property price, two appraisals were carried out by independent, competent real estate companies in the local area. One appraisal carried out by the firm of W. Bruce Martin of Sudbury established a value of $12,000 for Mr. Moore’s property. Another appraisal by the firm of William R. Gray of Sudbury valued the property at $12,300. A committee of the firm of H. Keith Ltd. accepted the Martin appraisal as the more realistic.

I emphasize that these were only appraisals carried out by recognized competent brokers to set a fair value on Mr. Moore’s property. He is under no compulsion to accept the appraised value of his home. He can simply withdraw from the plan and proceed to list it with any other realtor. I hope he will be able to sell it for the $16,900 at which he had it independently appraised. If, however, he decides to remain in the plan he is guaranteed a purchase price based on what we consider the fair appraised value.

While I cannot positively state today that Mr. Moore agreed to the appraisals, the procedure set out in the plan states that the results of the appraisals shall be made known to an employee within 10 working days and prior to his agreement on the property price.

I should explain that the employee home-owner assistance plan is being administered for the government by the real estate company of H. Keith Ltd. This firm was the successful tenderer for the plan administration in response to a public tender call. H. Keith Ltd. does not have an office of its own in Sudbury; it follows the same procedure as many other large firms and employs local associate realtors. They have five firms in Sudbury with which they normally do business. This may be the short list the hon. member referred to in his question.

Mr. Speaker, I have copies of the two appraisals, a description of Mr. Moore’s house and particulars of the lot. which I would be pleased to show to the hon. member if he wishes to see this additional information.

Mr. Deans: May I ask one supplementary question? Is it necessary for the employee to have the appraisals undertaken by firms on the list of approved appraisers -- approved by Keith, I imagine -- or is it possible that one appraisal can be from out of that group of five and one appraisal undertaken by a truly independent appraiser of the employee’s choice?

Hon. Mr. Snow: Mr. Speaker, I would certainly hope that the five firms listed are truly independent appraisers. They have to be specialized appraisers.

Mr. Bullbrook: The minister said himself that they are not appraisers; they are brokers.

Hon. Mr. Snow: The two appraisals are paid for by the government; we pay two different firms to appraise these homes. Now if the owner wants to get a third appraisal he is perfectly at his leisure to do so.

Mr. Deans: Supplementary question: Doesn’t the minister agree that the owner of the home should be entitled to choose from among any number of appraisers he wishes, to conduct an appraisal on his behalf; and that the government under its programme might then want to have an appraisal conducted by one of their choice -- one of the five, for example, set out by Keith -- but that if the owner undertakes to have an independent appraisal done, there is no legal status to that appraisal other than that it is information available to the owner, and it doesn’t bind the government in any way to accept that?

Hon. Mr. Snow: Mr. Speaker, of course this plan doesn’t bind the owner of the home in any way, either. It is a service that was established and which is in operation for its first year in an attempt to make it easier for government employees to be transferred from one location to another, by way of guaranteeing that employee that he will be able to sell his home at supposedly -- according to certified appraisals -- the current market value for that home.

As I mentioned in this case, there are two appraisals almost identical in price.

Mr. Deans: I worry about that.

Hon. Mr. Snow: These two firms have been selected. If the owner wishes to get an independent appraisal he is perfectly at leisure to do so.

Mr. Speaker: The member for Nipissing.

Mr. R. S. Smith (Nipissing): Mr. Speaker, as a supplementary to that, why did the government enter into this exclusive contract with H. Keith Realty Ltd. which effectively excludes all other brokers in the province doing business with employees of the government who choose to go under the home disposal plan, which also effectively gives the home seller no choice of realtor other than Keith; and which also effectively gives the home seller no choice of legal counsel in so far as who is going to look after his legal affairs in the sale, as that is left to Keith as well? Why wasn’t the brokers’ association approached to provide a service under this disposal plan, which would open the plan up to all the brokers across the province on an equal basis?

Hon. Mr. Snow: Mr. Speaker, I detected about 20 questions there.

Mr. R. F. Nixon: All of them good ones.

Mr. Deans:. This proves the minister makes a good detective --

Hon. Mr. Snow: Mr. Speaker, this plan, as I tried to explain a few moments ago -- the member may not have been listening --

Mr. Singer: It’s hard to understand.

Hon. Mr. Snow: It’s a plan that was developed to assist members of the civil service who are transferred from one location to another at the request of the government, and to guarantee they will be able to dispose of their homes at a fair price.

Mr. R. F. Nixon: To assist Keith too.

Hon. Mr. Snow: In order to do this --

Mr. R. S. Smith: More to assist Keith.

Mr. J. F. Foulds (Port Arthur): When?

Hon. Mr. Snow: In order to do this, the government advertised by way of public tenders --

Mr. R. S. Smith: All real estate firms?

Hon. Mr. Snow: -- and received about 15 or so tenders -- I would say 12, anyway; I don’t have the list here --

Mr. R. S. Smith: All real estate firms?

Hon. Mr. Snow: -- some from trust companies, some from real estate firms. Now I don’t know of any realtor that has total provincial coverage. The Keith firm submitted the lowest bid of --

Mr. Bullbrook: Explain that tender call. How do you tender for a job like this?

Hon. Mr. Snow: Well if the hon. member would like to ask that question, I’ll get him the full information as to how the job was tendered.

Mr. Bullbrook: All right.

Hon. Mr. Snow: It was tendered on the cost per appraisal, the cost of carrying charges if we have to take the home over from the owner, the commission for reselling it, the amount that would be charged for legal fees for the search and that type of thing. There were several items.

When bids were received, as I say, there were several bidders. They were very carefully scrutinized by members of Management Board, by members of TEIGA and by representatives of my ministry. The recommendation was for the acceptance of the Keith firm’s tender.

As I said, no real estate firm has offices in every city or town in the province, so we would expect that any firm that had been successful would have had to use a number of local realtors. In this particular case, the Keith firm have selected five local realtors in Sudbury, whom they would have act as their agents.

Mr. Deans: But why should they do that?

Mr. R. S. Smith: The minister still hasn’t answered my question.

Mr. Bullbrook: Supplementary --

Mr. Cassidy: Mr. Speaker, by way of supplementary --

Mr. Speaker: This will be the final supplementary.

Mr. R. S. Smith: Mr. Speaker, my --

Mr. Speaker: Order, please. There have been several supplementaries. The time for the question period has about expired. The member for Nipissing, one supplementary.

Interjection by an hon. member.

Mr. Speaker: Order, please. May I determine whose original question it was?

Mr. Deans: It was in answer to a question --

Mr. Speaker: Well there have been quite a number of supplementary questions. I’ll allow one more. The member for Nipissing.

An hon. member: It would be interesting --

Mr. R. S. Smith: What I would really like to know is why Keith was given the right to choose the lawyer for the person who was selling his house, and why the brokers’ association of the province was not approached to provide a similar plan so that all the brokers in the province could take part? Those are the key questions the minister has not answered whatsoever.

Mr. Speaker: Order please.

Hon. Mr. Snow: I am not so sure whether the brokers’ association was consulted about the setting up of this first tender call --

Mr. Foulds: No, they weren’t.

Hon. Mr. Snow: -- but certainly it was a public tender call. There were definite specifications as to what the firms bidding were to supply --

Mr. Breithaupt: Who would you?

Hon. Mr. Snow: -- and one of the items that was to be supplied by the firm handling the transaction as part of the contract was the legal fees.

Mr. Speaker: I’ll allow one question to the New Democratic Party and that’ll be the end of the question period.

DUNDAS SEWAGE TREATMENT

Mr. Deans: Thank you, Mr. Speaker. I have a question of the Minister of the Environment.

Does the minister agree that to permit the further expansion of the Dundas sewage treatment plant and to allow for the disposition of the effluent into the marsh area would be detrimental to the overall environment of the area? Will the ministry undertake to provide substantial funding to allow for the further enlarging of the Hamilton sewage treatment plant and the piping of sewage from the Dundas area, to meet that area’s future needs, to the Hamilton sewage treatment plant?

Hon. W. Newman: In answer to the member’s question, I would be glad to look into it. We have close to 400 projects now under way in the province. In any expansion of treatment plants, we certainly require pretty stringent controls as far as effluent is concerned. But certainly I will look into the matter for the member.

Mr. Speaker: The oral question period has expired.

Petitions.

Presenting reports.

Mr. Nuttall from the miscellaneous estimates committee reported the following resolution:

Resolved: That supply in the following amounts and to defray the expenses of the Ministry of Revenue be granted to Her Majesty for the fiscal year ending March 31, 1975:

Ministry administration program..........$3,358,000

Administration of tax program.............15,723,000

Municipal Assessment program...........38,771,000

Guaranteed income and tax credit programme............50,500,000

Mr. Speaker: Motions.

Introduction of bills.

INCOME TAX ACT

Hon. Mr. White moves first reading of bill intituled, An Act to amend the Income Tax Act.

Motion agreed to; first reading of the bill.

Hon. Mr. White: Mr. Speaker, the purpose of this bill is to extend in 1975 the personal income tax rate of 30.5 per cent, which is the lowest rate in Canada; compared to 42.5 in our socialist sister to the west.

Mr. Lewis: Just add in die health insurance premiums we pay. Just add in the OHIP premiums and the Treasurer will find what people are paying.

Hon. Mr. White: The amendments also provide for the increases in the property tax credit and the pensioner tax credit, the maximum deductions for tax credits and the percentage of taxable income to be deducted from the aggregate amount of tax credits as set out in my budget.

The bill also prevents anyone from making a double claim for tax credits through a provision in the federal Income Tax Act. We are also allowing taxpayers four years in which to take advantage of any deductions they may have failed to claim at the time.

MOOSONEE DEVELOPMENT AREA BOARD ACT

Hon. Mr. White moves first reading of bill intituled. An Act to amend the Moosonee Development Area Board Act.

Motion agreed to; first reading of the bill.

Hon. Mr. White: Mr. Speaker, this bill will carry out the proposal, concurred in by the chairman of the Moosonee Development Area Board, to increase the membership of the board from five to seven persons in order to permit more local participation.

ONTARIO MUNICIPAL IMPROVEMENT CORP. ACT

Hon. Mr. White moves first reading of bill intituled, An Act to amend the Ontario Municipal Improvement Corp. Act.

Motion agreed to; first reading of the bill.

Hon. Mr. White: Mr. Speaker, this bill enlarges the objects of the Ontario Municipal Improvement Corp. to permit it to purchase debentures issued by any municipality in Ontario with a population of more than 100,000 for the purpose of erecting or altering a stadium.

ONTARIO PENSIONERS ASSISTANCE ACT

Hon. Mr. White moves first reading of bill intituled An Act to repeal the Ontario Pensioners Assistance Act, 1973.

Motion agreed to; first reading of the bill.

Hon. Mr. White: Mr. Speaker, with the establishment of our historic guaranteed annual income programme for the needy, elderly, blind and disabled this year, we discontinue the interim programme of assistance for the elderly.

Mr. Speaker: Orders of the day.

Clerk of the House: The 20th order, House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

On vote 2803:

Mr. Chairman: Vote 2803, item 2. I believe the hon. member for St. George was the first speaker.

Mrs. M. Campbell (St. George): Thank you, Mr. Chairman. I would like to continue with my discussions on the ambulance service. I would like an answer from the minister on if, in fact, it is to be policy that those ambulance services which have been taken over by the government from the private sector at the government’s price are to be turned over to former members of the ministry, or if he would elaborate on those which appear to have been finalized.

I also want to look at the matter of morale in the ambulance service. During the time that I was close to that service, I found that the morale was affected by two different problems. One is that these people, these drivers, are required --

Hon. F. S. Maier (Minister of Health): I’m still listening. Honest I am.

Mrs. Campbell: Are you? Well, once you missed on me and I want to be sure I’ve got your attention. These ambulance drivers are required to have special training. At the Metro level they felt that they ought to be regarded as part of the APS group, which is a group which is not within the union but not in the executive level of government. They were not given credit in their salary or rate for this special training. Naturally when this province has no good Samaritan legislation, they are open to serious problems which I think have to be taken into consideration. That was one of their basic problems.

The other problem was that they were not consulted at any time nor did anyone really get back to them after the design of the ambulance itself was determined, because the ambulance as it was designed, and it became a requirement, in their view was not satisfactory to them in the handling of the patient and they felt that the patient was not well serviced by that design. I would like the minister’s comment on that.

Also, the minister had undertaken to answer some of the critics’ opening remarks. Since he did not choose to do so on the matter of the question put as to what happened to the women in this ministry on the reorganization -- I guess he has a perfect right not to answer and a very good reason for not answering -- I will put the question here. Is there any effort to ensure that women are invited to participate in this training at the same time as the men are?

I would like to move on now. Are we going to proceed, Mr. Chairman, now in an orderly pattern? Am I to speak now on item 3 or are we first closing off item 2, and opening it to others who wash to get into this item? It has been confused in the way in which we have proceeded to this point. Those are my remarks which would include the general hospitals and related activities, but I am prepared to continue on the total item if that is the way the Chair wishes to proceed.

Mr. Chairman: I would suggest that we deal with item 2 and then go on to item 3.

Mrs. Campbell: Fine.

Mr. Chairman: The hon. member for Wentworth.

Mr. I. Deans (Wentworth): Thank you, Mr. Chairman. The other evening I started to speak to the minister about ambulance service. I want to follow up on the comments of my colleague from St. George, because what she has said about ambulance service, and what I said on Thursday last, I think expresses a feeling of a great many people in the Province of Ontario.

I had the opportunity over the weekend to read the interim report of the ambulance services task force, of 1968, and I read it at some length because it was very interesting. That task force set out pretty clearly what ought to be done by way of the establishment and maintenance of an adequate ambulance service in the Province of Ontario. It talked about all aspects of the service, including the integration of the private services, and the provision of service in areas where service was difficult to provide.

It also talked about training and status of personnel, and it is about that that I am most concerned, because an ambulance service with good equipment is of no value at all if the personnel are demoralized, inadequately paid, and if the conditions under which they work don’t reflect the important position that they hold in society. I think it is that to which the minister has to address himself.

You can’t run an ambulance service like a taxi service. It is not the provision of some vehicle to move someone from point A to point B. It is an attempt, surely, to provide people with immediate health care at a time when they are desperately in need. There is no point in the minister going on with this ridiculous programme that he is talking about of developing an ambulance service with an attendant and a driver simply to transport people to hospital. That isn’t nearly enough.

The direction in which the minister was moving between 1966 and last year was, I suspect, the direction the majority of knowledgeable concerned people felt was the proper direction, and it is only in the last short while that we have seen the deterioration of the service.

The kinds of training and the status that the task force recommended ought to be available to the ambulance service personnel were vital. They spoke about adequately trained personnel, about the setting up of facilities for training, about ensuring that they were able to cope with emergency situations, and of guaranteeing that they could operate with the benefit of direct instruction in the fields of providing immediate care, emergency care, to people at the time when they are most vulnerable and most in need. The recommendations they set out, starting with recommendation 29, and running through recommendation 33, speak very clearly to the point of training, of status, of the capacity of the people in the service to provide this kind of health care. But that’s not enough. This obviously hasn’t made any impact on the minister, or on this particular ministry as it’s set up today.

I want to refer you to another report, a letter of some six or seven pages, much of which I’m going to put on the record, because I think it’s important. It was written by Dr. Ghent, and I assume the minister may well have had the advantage of reading it. Let me just read some of the material for your interest. It’s called “Requiem?” -- with a question mark. I quote:

“The past history of ambulance services in North America has been one of private enterprise. This has produced a few good services and many poor services. Transport, rather than aid for the acutely ill and injured has been the aim. This, in part, was due to lack of standards and regulations governing ambulance services at a national level in Canada or the United States.

“The Province of Ontario presented the same picture until change came in 1965. At that time, the responsibility for ambulance service regulations was changed from the Department of Highways to the Department of Health. The first Ambulance Act for the province was written in 1966 and, for the first time, defined an ambulance, its equipment and the training required for ambulance personnel. A licensing procedure for approved services was inaugurated.

“The responsibility for the direction of this new dimension of health care was given to the emergency health services branch of the Department of Health. A physician-director was appointed and the organization of the previous chaotic situation was started.”

It goes on. I’m not going to read it all, but I want to turn two pages. I quote again:

“All of the services had to meet the same standards of equipment, vehicles and personnel. The government of Ontario then supplied fully-equipped ambulance vehicles to licensed operators. Eventually it was planned that a fully-integrated, province-wide ambulance service would be developed with all personnel employed by the Ministry of Health.”

I pause at that point to let the point be driven home.

“All services, where possible, were to be affiliated with hospital emergency departments. A communications network was instituted with assigned frequencies for ambulance calls. Central dispatch centres were created in all of the major urban areas.

“This service became an insured benefit under the Ontario hospitalization plan. A ‘user’s’ fee of $5 was applied to each ambulance call. The remainder of the fee was in form of payment from the hospital insurance plan.

“To create a group of professional paramedical ambulance attendants a 30-day basic training programme was started at Camp Borden to provide ambulance personnel with a standardized advanced first-aid course. Eleven of these courses were completed each year with civilian instructors. This course has trained about 2,200 men for the service in Ontario, and for other parts of the Dominion of Canada by year-end 1973.

“It was realized at the time that this was a bare minimum of education and that basic training would have to be increased in the future. To this end, a six-month basic training, or emergency medical technician’s course, was started at Humber Community College in Toronto in 1972. Eventually this course was to have been offered in five of the community colleges in the province. The course was designed to replace the Camp Borden module as the minimum required training for ambulance personnel. However, a true paramedic, equal to those in the armed forces, required more training, preferably in a hospital milieu.

“An advanced training programme was begun at the Hotel Dieu and Kingston General Hospital in Kingston in 1970. Originally, this 11-month course was designed to familiarize selected and experienced ambulance personnel with life-support techniques that could be applied in the sickroom or at the roadside. These men were capable, with radio supervision, of applying cardiopulmonary resuscitation techniques, including defibrillation, intratracheal intubation, intravenous injections and the administration of selected cardiac drugs.”

I have a little trouble with the words, but I understand what they mean.

“This would be in addition to their basic skills of haemorrhage control, fracture splintage and extrication techniques. Thus, treatment as well as transport was the philosophy of the ambulance service.

“During the ensuing three years, 40 men received emergency medical assistance certificates from this course. The course content was shortened to eight months and reduced to a modular form so that it could be shortened still further when the emergency medical technicians received this level of training. The plan included the provision of one emergency medical assistant in each ambulance by 1980. In smaller communities, it would be possible for personnel with this training to be of assistance in the emergency department and the operating room if required.

“Thus, Ontario presented a forward philosophy in ambulance services when the programme was detailed as a special presentation to the General Council of the Canadian Medical Association in 1970. Since 1970, the policy of the Ministry of Health of Ontario was changed and the paramedical discipline of ambulance attendant has been downgraded.

“In part, this is due to a lack of registration mechanism for the EMTs and EMAs as a part of the health care team. Medico-legal status to practise the art of life support has been promised for ambulance personnel for years in Ontario. [And recommended in 1968, I might add as an aside.] It has not appeared in spite of the support for the concept from the Ontario Medical Association and the Canadian Medical Association.

“The State of California, one of the most litigation conscious areas of North America, has passed a bill allowing trained ambulance personnel to practise life-support techniques with radio supervision. The public as usual are ahead of the medical profession and most governments, and it is a commonplace to see rescue squads defibrillating electric shock victims on television.

“A major reorganization of the Ministry of Health started in 1970, whereby all phases of the ministry’s activities were streamed in three directions: 1, finance; 2, standards; and 3, operations. Each division was headed by an Assistant Deputy Minister of Health. This reorganization replaced the physician-director of the ambulance services branch with a man from the ranks of the ministry in Toronto. The previous director was given status as a senior medical consultant to the ambulance services branch. [Again, I pause. I question seriously what that really means.] The timing of this move was unfortunate. The fledgling service came under the complete control of ‘operations,’ which of course answered to ‘finance.’ Education and training lost the emphasis that had been placed upon it previously.

“In June of 1974, the planned course for 20 emergency medical assistants at Kingston for September, 1974, was cancelled, as was the next phase of this advanced course planned for 20 men at Ottawa. The reason given by a Ministry of Health official was that funds are unavailable to support the emergency medical assistant course.

“The actual cost of training an EMA was $23,000 for the course. This includes replacement personnel for the trainee’s home service, lecture costs, pay and maintenance for the trainee. This, in perspective, must be balanced against the six months of minimum in-service training required to familiarize the new two-year nurse with patient care at a cost of $5,100 in salary and benefits.

“The role of the EMA has been assessed in the total health delivery system and we find that his or her responsibilities are equal to those of a nursing supervisor in charge of a 38-bed hospital ward.

“The direction of the service with a planned gradual transition to a complete Ministry of Health service has changed, and suddenly services bought from private owners just a few years ago were ‘franchised’ to individuals on a ‘global budget.’ It was not and is not necessary for the applicants to have special training for their supervisory role in this new service. The instructions for prospective supervisors do not include educational or training standards for their employees.

“The situation has deteriorated to such an extent that the director of the ambulance services branch of the Ministry of Health was quoted in the Globe and Mail as saying: ‘The government owns all the company’s equipment and it should be looked on as a sort of McDonald’s hamburger franchise.’

“This is in keeping with the Minister of Health’s philosophy as well, if an interview quoted in the Hamilton Spectator is accurate. It stated: ‘Rather than staffing ambulances with highly trained attendants, Mr. Miller believes they need only people competent to deal with the bulk of the problems they meet.’ [Whatever that’s supposed to mean.]

“Thus the morale of the professional ambulance attendant has been undermined and is reflected by an ambulance attendant with a service in Ontario stating in the Globe and Mail: ‘At one time we used to save lives, now we are taxis and move bodies.’

“The total budget for the ambulance services branch for the year 1972, including the educational component, was $24 million. The population of Ontario at eight million renders this emergency care service too expensive at $3 per capita per year. [That figure isn’t even really accurate; it is less than that.]

“Thus has ended the leadership supplied by the government of Ontario for the rest of Canada in the field of emergency care. However, the exercise has not been in vain entirely. British Columbia is in the process of developing a provincial ambulance service based on the Ontario experience, using in part the paramedical educational expertise from Ontario to facilitate their efforts. Alberta and Manitoba are considering provincial ambulance services based on the original concept and philosophy developed in Ontario. Members of the medical profession that have been associated with the ambulance service in Ontario hope that the present attitude of our elected representatives is merely a temporary plateau, not a headlong dive downwards into the abyss of indifference from whence we climbed so recently.” It’s signed: W. R. Ghent, MD, CM, FRCS(C), Oct. 2, 1974.

What was said in this letter, Mr. Minister, is very much in keeping with what I tried to say to you on Thursday last. What you are doing in the Province of Ontario is destroying what was the beginning of a very valuable service to the people of this province.

We don’t simply require people who are strong enough and able enough to pick up stretchers and put them in the backs of ambulances. We don’t only need people who are capable of driving safely in hazardous conditions. We need to have a trained ambulance service in the Province of Ontario capable of meeting the problems which as you say, they encounter, and they encounter many problems. If they were adequately trained they could deal with them better than they have been able to deal with them in the past and certainly would be able to deal with them better than the kind of personnel that you are talking about will be able to deal with them in the future.

I don’t quite understand what this re-privatization of the ambulance service is all about, or then again maybe I do. I hate to tell you this but if you are in the business of providing an ambulance service and you recognize that it is an essential part of the health-care delivery system, then you are going to have to ensure that the people who work on it are (a) adequately trained; (b) suitably recompensed; and (c) that they have the same kinds of standards that prevail right across the province. If you are not going to do that, then you are turning it into a McDonald’s hamburger operation. And that’s not suitable, adequate or acceptable to the people in the Province of Ontario.

The cost of $3 per capita, even if that were the true cost, can be borne by the people of Ontario. Just talk to anyone who needs an ambulance and ask them whether they would rather have someone who had adequate training and was capable under supervision, whether it be radio-controlled or otherwise, to deal with their immediate problem or whether they would rather lie in the ambulance and die because they had your type of people on it. I suspect that you would immediately find they would prefer to have adequately trained people.

I tell you that the system across the Province of Ontario is deteriorating. The morale of the people in the system in gradually being eroded, in fact, rapidly being eroded. What you are doing makes no sense. Maybe you can explain to us what this reprivatisation is all about and why you feel this urgent need to hand over franchises all across the province to people who have absolutely no training in ambulance handling, who have neither the background nor the knowledge to be able to adequately supervise their personnel or train them and who are simply being given a global budget and who are able to rake off from that budget whatever they are able to keep -- or keep whatever they are able to rake off, I suppose is the right way to put it.

I don’t understand how your private enterprise ambulance system works when we, the people of Ontario, provide all of the facilities, when we provide the communication network, when we provide the ambulance itself, the vehicle, when we provide all of the essential component parts of the vehicle and when we audit the budget and provide the money. I don’t understand how you can justify paying something called a user fee, so much per call, to the person who is operating the ambulance service, because that doesn’t provide a better service. Why don’t you take the people in the ambulance service, establish one overall service in the Province of Ontario, train them adequately, pay them a decent wage and create some kind of an environment whereby they may feel that the service which they render to the people is recognized as being valuable?

One closing comment, you can’t be an ambulance attendant without having a certain amount of dedication. It takes a lot of dedication to work in that field because it is not the most pleasant job in the world. It is not suited to a great many people. I strongly urge you to abandon this ridiculous programme that you currently have under way and revert to what was a reasonable, sensibly planned approach to a provision of a very sensible and necessary ambulance service wide. province-wide.

Mr. J. Riddell (Huron): Mr. Chairman.

Mr. Chairman: The member for Huron.

Mr. Riddell: Thank you, Mr. Chairman. It seems a lot of attention is being focused on Ontario’s ambulance system, and rightfully so, for I firmly believe that it has been a neglected section of our overall health-care programme. It was all very interesting to hear the hon. member for Wentworth expound on the reasons why he thinks that ambulances should all be dispatched out of hospitals, but there are always two sides to the coin, and I wish to present the other side.

Mr. Chairman, there are several problem areas within Ontario’s ambulance system which must be rectified. I wish to list them, and then make some remarks on each one. The problem areas requiring immediate attention are:

1. The placing of more government and hospital-operated ambulance services under the management of private enterprise;

2. The introduction of an advanced training programme;

3. The registration and licensing of casualty-care attendants;

4. The provision of new vehicles and equipment;

5. The hiring of qualified regional coordinators;

6. Input by medical consultants and responsibility for disaster planning.

Now, under the first item mentioned -- government and hospital-operated services -- it is questionable whether the government and hospital-operated ambulance services are being operated in an efficient and economical manner. The persons responsible for the management of these services do not have the vested interest that the owner-operator has in his service. They do not normally put forth the effort the private operator puts forth in an endeavour to improve his service, maintain a high standard of training, promote economy and foster good public relations. The interests of efficiency and economy would be better served if some of the government and hospital-operated ambulance services were placed under the management of responsible owner-operators. The services best suited to this type of arrangement are those whose employees’ prime duty is ambulance work as opposed to hospital work.

Mr. J. E. Stokes (Thunder Bay): Who owns ambulances?

Mr. Riddell: There are many advantages to placing some of these services under the management of responsible owner-operators. Examples are strategic placing of ambulances, central control in dispatching, proper staffing patterns, standard training programme, standard vehicle-maintenance programme, cost savings by bulk purchasing of supplies and equipment, and centralization of administrative functions.

Mr. Stokes: Is this Liberal policy?

Mr. Riddell: With the above in mind, it is suggested that in some areas of the province a private owner-operator would manage services based within close proximity to one another, while in other areas a private owner-operator would manage services based over a much larger area of the province.

The idea of placing some of the government and hospital-operated ambulance services under the management of private owner-operators is in keeping with the views expressed by the Minister of Health. In an article published in the Hamilton Spectator on July 16, 1974, the Minister of Health was quoted as saying he would like private enterprise to play a bigger part in running ambulances in Ontario. It is recommended, therefore, that consideration be given to placing more of the government and hospital-operated ambulance services under the management of responsible owner-operators.

Under training: Ontario’s insured ambulance system came into effect on July 1, 1968. At that time a programme was introduced by emergency health services to train ambulance personnel in the techniques of casualty care and patient handling. This programme proved to be very successful, but in the past year it became apparent that the curriculum required considerable updating. There is no indication, however, that it will be updated.

Since 1972, three emergency medical assistant courses have been conducted at the Hotel Dieu Hospital and at Kingston General Hospital in Kingston, Ont. The students attending these courses were drawn from various ambulance services throughout the province. Unfortunately, however, it was recently announced that this course would no longer receive financial support from the Ministry of Health. As a result, there is now no training programme open to the casualty-care attendant whereby he can progress in his knowledge and skills, unless he attends full-time at a regional college without benefit of pay.

The lack of an advanced training programme for casualty-care attendants is not only detrimental to the welfare of the people of Ontario, but is also detrimental to the morale of the casualty-care attendants. Our casualty-care attendants have the ability to absorb more advanced training in life-support procedures and they should be afforded the opportunity to receive such training. It is recommended, therefore, that an advanced training programme be introduced as soon as possible and that the curriculum include intubation, cardiac monitoring, analysis of arrhythmia, drug therapy, diagnosing multi-system injuries, myocardial infarction, and care of coronary and trauma patients.

The type of training programme we require is feasible because it is being carried out very successfully in the United States in such places as Seattle, Columbus and Indianapolis. Such a training programme would provide Ontario with a better trained and more stable ambulance force.

Training with in-hospital affiliation should be an ongoing programme. In this case highly trained ambulance personnel would work in the hospital under the direction of a physician. These personnel would also respond to emergency ambulance calls as a third man when specialized techniques or special equipment must be used. These personnel, however, should be administered by their own ambulance service as this method has proved to be the most satisfactory.

Unfortunately, due to a cutback in ambulance staff, the private operator is not able to place his best-trained personnel in this type of in-hospital training. This situation will remain until such time as more funds are made available to hire staff.

I have a few comments, Mr. Chairman, on registration and licensing. As members of the health-care delivery system, it is imperative that the qualifications and level of competency of the casualty care attendants be recognized by the members of the other health disciplines. This recognition, however, can only become a reality through registration and licensing, with the government setting the standards and qualifications required.

The regulations under the Health Disciplines Act should be expedited immediately. Under this Act it is the responsibility of the College of Physicians to state what procedures and practices nurses, ambulance personnel and other allied health workers may perform. The College of Physicians presumably would also state what degree of supervision will be required. The college should also determine the type of training and qualifications required for registration and licensing.

It is recommended, therefore, that the government introduce the necessary legislation to permit the registration and licensing of the casualty care attendant. Such legislation should include permission for the casualty care attendant to perform more sophisticated procedures.

A few remarks on vehicles and equipment: Ontario has an acute shortage of late-model ambulances, and consequently many services are operating with vehicles that have passed their lifetime expectancy. This is resulting in mechanical breakdowns on the road and prolonged downtime awaiting repairs.

It is recommended, therefore, that the ministry, firstly, provide more funds to purchase new vehicles; secondly, institute a periodic evaluation of vehicles to determine their mechanical and structural condition; and, thirdly, accept recommendations from the field inspectors for their replacement.

There is a definite need for new and more sophisticated ambulance equipment. In particular, consideration should be given to providing cardiac monitoring and telemetry equipment. It is recommended therefore that the ministry, firstly, provide more funds for the purchase of new equipment and, secondly, accept recommendations from the field inspectors for the replacement of equipment.

Under communications equipment, which was one of the items I mentioned previously, the provision of portable radios is essential to ambulance service operations. There are many instances where the ambulance crew are a considerable distance from their vehicle and have no way of contacting their base. This lack of communications could be detrimental to the patient’s condition. It is recommended, therefore, that portable radios be provided.

A few remarks on regional co-coordinators: Private ambulance service operators with the expertise and proven management ability should be hired as regional co-ordinators. This matter was discussed with Ministry of Health officials who indicated that there could be a conflict of interest. The Ontario Ambulance Operators Association, however, is not in agreement with this reasoning.

Recently co-ordinators were hired by the ministry whose past performance was a source of great concern to the Ontario Ambulance Operators Association. Although there were private operators far more qualified for the job, they were ignored because of the conflict-of-interest reasoning.

I would like to mention a little bit about the input by medical consultants and disaster planning. The ambulance programme should have more input from medical consultants. Although the Ministry of Health does have a medical consultant. Dr. N. H. McNally, it would appear that he is not being consulted. The lack of input by medical consultants is damaging to the whole system. Since the ambulance programme was severed from the department of emergency health services, no one has assumed the responsibility for disaster planning and other programmes. This is not a good situation as disaster planning is of paramount importance. The responsibility for this function, therefore, should be delegated immediately, as it should be for other programmes.

In conclusion, Mr. Chairman, I would like to say that most of Ontario’s private ambulance service operators are mainly interested in the improvement of the ambulance system. The areas discussed in the remarks that I am making are detrimental to the system and as a result are a source of much concern to the majority of private operators. It is hoped, therefore, that favourable consideration will be given to implementing the recommendations which I have just referred to. Thank you.

Mr. Chairman: The hon. member for Peel South.

Mr. R. D. Kennedy (Peel South): Mr. Chairman, with respect to the ambulance service, we have a local problem which involves the relocating of some ambulances due to some transaction between a funeral home and the current operators, which I believe were combined and are now to be split off. It seems that a new location needs to be found for these ambulances. There’s a problem of finding space at a rate that will be supported or acknowledged or paid by government.

The question I would really like to know the answer to is, what are the rental rates? Are there rigid schedules? Are these flexible, depending on the location and the rates you have to pay and what the market is? I hope this problem can be resolved. It’s pretty difficult because it isn’t every vacant garage or even vacant open space that’s suitable for storing or maintaining ambulances. I think they have been stored outdoors but naturally with the weather as it is, it’s more desirable to have them under cover. I would like to have your comments on that.

Mr. Chairman: The hon. member for Sandwich-Riverside.

Mr. F. A. Burr (Sandwich-Riverside): Mr. Chairman, I have written the minister on a couple of occasions at least concerning the sub-minimum wages that are paid to the ambulance drivers. The work of the ambulance driver is closer to that of the fireman than any other occupation I can think of. They have long periods of inactivity, interspersed with short bursts of intense activity. In fact, the firemen are supposed to be more susceptible to heart attacks because of this kind of life they lead and the ambulance men are much in the same boat.

If you totalled up the number of lives saved by one ambulance man and the number saved by one fireman you would probably find the ambulance men were saving more lives. Yet the Minister of Labour in his announcement of the minimum wage every time has made a special discrimination against ambulance drivers. Why? I can’t understand that unless he has been in consultation with the Ministry of Health. The drivers of ambulances that the government runs are paid fairly respectable wages but the private operators who must make a profit are finding that this is where they can make it.

If you want to get a job as an ambulance driver, you have to volunteer to donate dozens of hours overtime every week because, according to the minimum wage, you get $108, which is $2.25 an hour for a 48-hour week. And, of course, an ambulance driver has to be on call far more than 48 hours a week. I’m wondering just why this is tolerated for a service that is so important when it’s needed.

A related question: I was puzzled the other evening about this incentive motive that was mentioned; the incentive motive for the operators. The only example I can think of is in the removal of corpses. I’ve had it drawn to my attention that there is a removal service which is supposed to remove dead bodies, and that the ambulance operators are not supposed to move dead bodies. Now, an enterprising operator would snatch a dead body, and that would give him an extra trip, an extra income. Is that the kind of incentive that an operator is supposed to exercise? Those are two questions.

There is a third question under general hospital policy. What policy is the minister developing, or has he developed --

Mr. J. F. Foulds (Port Arthur): If any.

Mr. Burr: -- about non-smoking in hospital rooms and in hospital waiting rooms? As the minister is aware, smoke is the most intense form of air pollution. To go to a hospital to recover from an ailment, particularly a bronchial ailment, and to be in a room with two or three other people, some of whom are smoking, is just no way to cure a bronchial ailment. What policies are being developed for this problem?

Mr. Chairman: The hon. member for York Centre.

Mr. J. E. Bullbrook (Sarnia): Is this the second reading of the bill?

Mr. Chairman: I believe the hon. minister was going to answer the question when we finish with the inquiries.

Interjections by hon. members.

Mr. A. J. Roy (Ottawa East): Come on. The minister shouldn’t be bashful.

Mr. Bullbrook: These are the estimates. Give it to him. Come on, give it to him.

Mr. Roy: Don’t be a cop out.

Mr. Chairman: Does the hon. minister wish to answer some of the questions at this point?

Mr. Bullbrook: This is parliament. Get up and debate once in a while, it’s fun. You’ll enjoy it.

Hon. Mr. Miller: I’m quite pleased to, and in your absence we’ve been doing it.

Mr. Bullbrook: Try it, you’ll like it.

Mr. Roy: Don’t be a cop out.

Hon. Mr. Miller: I’m glad you’re back again; there’s someone to talk to.

Mr. Bullbrook: That’s what I tell you, you’ll enjoy it.

Interjections by hon. members.

Hon. Mr. Miller: Are you ready?

Mr. Bullbrook: Answer the question.

Mr. Chairman: Order, please. The hon. minister is about to speak.

Mr. Roy: We said stand up. Oh, sorry!

Hon. Mr. Miller: The member for Ottawa East is only two inches taller, physically.

Well, Mr. Chairman, there have been a lot of good questions and there’s been some philosophy expounded on ambulance services. I think I’ll start in a generalized way first.

I apologize if the hon. member for St. George thinks I have ignored answering the questions in the opening statements. I think you have to realize that we agreed that I would have you ask detailed questions throughout, and I would try to answer when I’d finished any that didn’t come up in the individual votes. So, I’m not purposely ignoring any questions posed by the lead speakers for either party.

I have to say that if I sat listening to the comments made by one or two speakers on the ambulance issue, I, frankly, would be afraid to go out and place a call for an ambulance. And really, I won’t say that I resent that implication, I just think it is not a statement of fact as the ambulance service exists in the Province of Ontario today.

Contrary to some of the criticism, I do not believe that the morale is the problem that has been stated. In fact, we have a well-trained, well-run ambulance service that is just now entering its final stages of organization.

We have to realize that we’ve gone through the years from 1968, when Dr. McNally, as head of the emergency health services division, was given the challenge to get a province-wide service functioning in rapid order, and at that point in time had to make do with a great mixture of types of ownership and types of service across the province. From that we have gradually tried to evolve a more standardized type of service.

I think the member for St. George was referring to morale and training in the city of Toronto department of emergency services. As you know, the training for the DES system has been done by them, at their wish, in the city of Toronto. I have attended the school to which the people go; I have been impressed with the training programme they give; I have been impressed at the amount of time given to the staff, not only for initial training but for on-the-job training on a periodic review basis. I think they use a facility on the comer of Davenport Rd. just where it turns into Bay St. -- a former police station in that area.

It has been their wish to keep that service and training separate from the provincial one. It is, I think, the only municipally operated service in the province -- there are three, I am sorry, but certainly it is the major one in the Province of Ontario. As you know, across the summer we had discussions with the committee in charge of the emergency services in Toronto, and agreed upon a gradual transition to unified control of all the ambulances within Metropolitan Toronto to this group, and a study is under way at this point in time to bring on control on those services, because the shortfalls and response times in fact were felt to be to some degree a function of two services operating in the same area.

Mrs. Campbell: No, it wasn’t. It was the empirebuilding of one to bypass the former independent --

Hon. Mr. Miller: Well, I am trying to say it is because of a competition between two groups.

Mrs. Campbell: All right, you are turning it over to one.

Hon. Mr. Miller: Yes, we are turning it over to one, and I believe the Metropolitan government has changed management and in fact is working out the details. It is opening up new locations within the city of Toronto and in the boroughs for ambulance stations and in fact there has been quite a bit of study. I have the detail here; I am sure you are aware of it. We have put another $350,000 in cash into the operation for this year to assist them.

The question of the Oakville-Burlington-Port Credit issue was not quite the way it appeared, I think. That is owned by us and franchised to people who previously were on our staff. They are trained people; they are competent people. The implication that we turned it over to people that know nothing about the ambulance service --

Mr. Deans: About training people.

Hon. Mr. Miller: -- I am sure would be resented by the very people you are talking about.

Mr. Deans: Well, I don’t much care if they resent it or not.

Hon. Mr. Miller: I didn’t talk when you talked -- now you be quiet.

Mr. Deans: I think your system of handing these things over to people is ridiculous.

Mr. Chairman: Order, please. The hon. minister is trying to answer some questions.

Hon. Mr. Miller: There is a fundamental philosophical difference. If you hadn’t left your seat so quickly after you finished talking and listened to some of the other positive comments made by other people, you would have learned some of the other points of view.

Mr. Deans: On a point of order, I happen to have a voice box in my office. I had to go and make a phone call and I listened to the positive comments of the other people, for the minister’s information.

Mr. Bullbrook: This is really something. I don’t have a voice box in my office.

Mrs. Campbell: Neither do I.

Mr. Chairman: Would the hon. minister continue?

Mr. P. D. Lawlor (Lakeshore): Stop being so provocative. Stay in a healthy state of mind.

Hon. Mr. Miller: Thank you. By the way, you asked me one question that didn’t really relate to the vote that I was talking about at the time, and that dealt with the women in the Ministry of Health.

Mr. Roy: I raised that question.

Mrs. Campbell: It was your question I referred to.

Hon. Mr. Miller: In the Ministry of Health at the present time, if I can return the question, there are 160 women earning in excess of $15,000 a year versus 681 men earning more than $15,000 per year.

Mr. Roy: Terrible.

Mrs. Campbell: That is a big ratio.

Hon. Mr. Miller: A women’s adviser position is being established; the Civil Service Commission has been asked to classify the jobs. The ministry’s supervisory and management courses are given by the development section of the human resources branch, and they are attended by about as many women as men. The actual figures can be made available.

Mrs. Campbell: What about the women in the ambulance programme? Where did they disappear to?

Hon. Mr. Miller: I am only giving the current status of things. I am saying that we are giving as many women --

Mr. Roy: How about over $30,000 or something? Let’s get up in those brackets.

Hon. Mr. Miller: Well, there is me and the deputy.

Mr. Deans: One of you is overpaid.

Hon. Mr. Miller: Stan, you will have to go.

Mr. R. S. Smith (Nipissing): There is more than that over $30,000.

Mr. Foulds: The member for Wentworth is being kind.

Hon. Mr. Miller: Thank you.

Mr. Chairman: Order, please. The hon. minister will continue.

Hon. Mr. Miller: I am sorry, Mr. Chairman, but they are being provocative.

Mr. R. S. Smith: There have to be more than that over $30,000. I can see them from over here.

Mr. Roy: Those over $30,000 please stand.

Hon. Mr. Miller: I go on to some of the comments made by the member for Wentworth. We have had a long discussion on the salary issue and the philosophy of ownership. I said previously, and I have to say again, that I subscribe more to the views just read by the member for Huron than I do with yours. I recognize your views are yours and you believe them. That doesn’t mean that they are either right nor wrong.

I happen to subscribe, though, to the fact that a person who is running a business where he is personally accountable for it on a private enterprise basis of some type or some incentive type of basis or by some means by which he is in control directly, with all the structures and strictures placed upon him by the normal governmental procedures and policies, does a better job of running the business. I can’t help but echo the fact that, while there are places where the province must step in and provide services because no one is available, where the private operators --

Mr. Deans: No, because it is not profitable.

Hon. Mr. Miller: The word “profit” is not quite fair because it isn’t a profit on the basis you’ve implied.

Mr. Deans: Well, what is it?

Hon. Mr. Miller: For example, the bonus system you’ve alluded to is not a part of the new district service in the Oakville-Burlington area. There is no payment per call basis and as we’re renegotiating contracts this is being dropped off. In the beginning there was one and it exists in a number of contracts yet. I can read it to you. I’m sure you know what it is.

For the first 200 calls per year, they received $5 bonus; for between 200 and 1,800 they got $2 bonus; for between 1,800 and 4,000 they got $1.50; and for over 4,000 they got $1.

As time goes on, we are phasing that out of agreements and it will not be a part of new agreements.

Mr. Deans: Tell us about the new agreements.

Hon. Mr. Miller: I would be glad to get you more details on them. I can’t give you the details off the top of my head. I just know that at this point in time we’re basing it upon the staffing requirements of the area, the number of vehicles we expect to be in service for so many hours of daylight and so many hours at night. We supply the vehicles and the equipment, as you know. They are our property. We supply the funds to pay the men based on their estimated budgets.

Mr. Stokes: What is the gobbledegook about owner-operators?

Hon. Mr. Miller: They don’t own the vehicles except in the odd instance where they’ve had vehicles carried over from the previous times.

Mr. Deans: But as they are replaced they will be replaced by government-owned vehicles?

Hon. Mr. Miller: They are replaced with government-owned vehicles, yes. They are standardized vehicles. There are more than two types of vehicles in the province but Metro Toronto has stuck to its own vehicles because they sincerely believe that for the short hauls they are faced with in the city the replaceable van body is a more economical way of doing it. I think the total unit costs about $11,000 and that the chassis costs around $4,000 to $4,200, or somewhere around that range. I’m told that they can get about three chassis per body. They have estimated that in the city this was to their advantage.

Mr. Stokes: Is that why we’re getting old ambulances in northern Ontario?

Hon. Mr. Miller: They certainly aren’t Metro Toronto ones. You know that because they are easily identified by their truck bodies, by the chassis they have. They have a removable body on the back end; a van type of body.

Mr. Stokes: We have been offered some with 70,000 and 80,000 miles on them and our operators didn’t think they could make the trip out there.

Hon. Mr. Miller: We discussed that once in the question period as to how many miles a vehicle can go. I’ve had a fair amount of experience in that. I suggest to you that there is no arbitrary limit at which one can say one should dispose of a truck. Many trucks do hundreds of thousands of miles. I’m sure you’re aware of that. It’s a function of maintenance.

Mr. R. S. Smith: Would you buy a used truck from this man?

Hon. Mr. Miller: I’m proud to say many people have.

Mr. Chairman: Order, please. I’m wondering if we can get back to the estimates.

Hon. Mr. Miller: Thank you, Mr. Chairman.

Mr. Deans: May I ask you a question because I don’t understand this. Can you take the time to explain to us where the incentive is going to be built in for this free enterprise operation? If you provide all the requirements, you provide the total global budget, where is this person in a private business? Surely to heavens all the person is doing is managing, on behalf of the government, with government funds and government equipment. If you are going to pay him a salary then why are we going through this facade of some sort of private enterprise operation when there is no investment by the individual whatsoever and the only losses that can be incurred are losses the government must make good on?

Hon. Mr. Miller: Sometimes there are certain capital parts of the business that are his. For example, the physical plant that the vehicles are kept in is often the property of the operator.

Mr. Deans: That is like a real estate investment paid for by the government indirectly.

Hon. Mr. Miller: Sure it is, but the fact remains it is an incentive to own that and he owns it and operates it often at a cost less than we would be able to own and operate a similar piece of property.

Mr. Deans: But he owns it, and you are paying for it.

Hon. Mr. Miller: Sure he owns it and we are paying rent for it. That’s all I’m saying. I understand in the Oakville-Burlington area there is a global contract and if the budget is met there is an incentive for the operator for living within the very tight budget we have applied to him.

Mr. Deans: Can you tell us about that incentive?

Hon. Mr. Miller: I will be glad to get more details. I don’t have them right now. As soon as they are available, I’ll try to get them back to you.

Mr. Deans: Didn’t you think we would be talking about this today?

Hon. Mr. Miller: Let me get back to some of the other issues you talked about. I think training is a very vital thing. The implication that we are making taxi operators out of the ambulance personnel is just so far from the truth it deserves some explanation. Dr. Ghent and Dr. MacKenie are very fine men who are specialists in their field and I have a great respect for them. I still have the right to disagree whenever a person who is totally committed to one narrow field in health feels that certain trainee requirements are the bare minimum for the people in the section he works with.

In fact, in the debates on the health disciplines bill I’m sure you heard this kind of argument come up a number of times. Every discipline feels it should upgrade its training to the maximum. On that basis, frankly, we couldn’t afford the personnel for almost any field of health care. Our object is to tailor the training to the job. Those are the words that, in effect, were contained in the letter to me, which you quoted. I think you asked, “What does that mean?” One still can assess the kinds of functions and the kinds of experience a person needs to have on the job for the great bulk of the experiences he is going to face and then train him to do just that.

You know we’ve had the course at Base Borden as an interim measure. It has been going on for several years. I hear it’s got two more years to run. It’s a four-week course. It is basically, I believe, a first-aid course with amplification to a degree.

We did experiment in Kingston, basically at the request of one of the physicians whom you named, to try a more intensive course. It was our opinion that the course was both very expensive and didn’t really turn out the people trained to do the job we needed. I think the cost per student, just for the on-site training I’m told, was over $10,000. I’m told it was inefficient in time, it was not accessible throughout the province, it did not help to build a solid base of general knowledge but tended to concentrate on subjects such as operating room technology for at least one third of the course.

Then we had trouble getting people to use some of these skills that they had reason to believe they would use, and that’s where I run into trouble with the health disciplines every time. You let a man learn something and prevent him from using it and you’ve got a very unhappy man. It just happened that you couldn’t have people hanging around to work in the operating room who suddenly may be called out for a trip. This is one of the problems we ran into.

Instead of arguing its merits we tried it, and based on the course and on the experience we had with the people who graduated, their abilities to get jobs to meet their expectations, it was rejected.

Mr. Deans: May I ask, in order to get to the answer -- I don’t mean the truth, but to get to the bottom of it: Wasn’t a substantial part of the problem the whole legal matter of whether or not the persons would be legally covered in the event that they were to undertake the things for which they were trained and they weren’t to work? Weren’t they open to suit right across the province?

Mrs. Campbell: First-aid coverage.

Hon. Mr. Miller: You are accurate on that to a degree, yes, in that the Medical Act defines certain duties that may be performed.

We aren’t downgrading the paramedical concept of the driver or the attendant. Just the opposite is true. The fact is that the incoming people to the ambulance services in the future will come through the community college system. We set up basically a one-year course for that system, and I’m told it’s a very fine course. It has been given for some time now. I’m told it has better scope and depth in the biosciences and in clinical skills than either Camp Borden or Kingston, and that it provides a greater consistency in the paramedical groups within health. I’m told that, and I assume it’s true.

We are saying that with the creation of the regulations, which we badly need -- and I apologize for their absence; it was not easy to accomplish. I’m not sure the first set of regulations will meet all our needs, but we are trying to make them meet them. We will have those regulations in January, I am told. We will then have a basis for a number of the factors which up to date could not be insisted upon because we didn’t have a regulation to state that the person driving a given vehicle didn’t have to have the certain training or experience. We will now have it.

As I recall, there are four or five categories of people, including dispatchers, described within those regulations. We name their experience as well as their educational requirements. For instance, a dispatcher, as I recall the regulations -- I haven’t read them for three or four months, and they may have changed -- was a person who had to have the normal training and experience as an attendant or a driver before he became a dispatcher. A dispatcher, as somebody said a few minutes ago, is often called upon in an emergency situation to give some direction and to assess things either from the person making the telephone call or from the crew on the site. Therefore, it was felt that these people needed to have this kind of thing. So we will have regulations that in fact set standards we will be able to enforce.

I feel that with those steps in mind, we are getting over some of the fears that have been expressed to the public lately. And I regret that fear is expressed or there is talk of poor morale, because it can create just that in a system that didn’t have it. If someone keeps on telling you long enough that you are sick, then you are sick. And I feel this has happened here to some degree.

Regarding the question of salaries in the city of Toronto, as you know, they were negotiated through CUPE Local 1000, I believe, when the strikes were on a year ago or so. I understand that they were trend-setters in the ambulance field across Ontario.

Mr. R. Haggerty (Welland South): The Minister of Labour hasn’t followed that practice.

Hon. Mr. Miller: I am just commenting on the Toronto settlement, to which the member for St. George referred.

Mrs. Campbell: They still aren’t treated as paramedics. They are treated as more of the heavy equipment operator type of person within the city, and yet they take risks without any good Samaritan legislation to back them up.

Hon. Mr. Miller: Regarding a couple of comments from the member for Huron, I was pleased by the support he expressed for both the system and the concepts, and I would agree with some of the shortcomings he talked about. I never pretend to think that we have perfection yet, or necessarily ever. We are working towards it.

We are working seriously, as you know, with the Ontario Ambulance Operators Association. About four months ago, I requested of that association the beginning of regular meetings with my parliamentary assistant on a monthly or semi-monthly basis, as they found it necessary --

Mr. Foulds: Who is your parliamentary assistant?

Hon. Mr. Miller: The hon. member for London North (Mr. Walker).

Mr. Foulds: Where is he?

Hon. Mr. Miller: He is away with my permission, for your information. He checked with me before the estimates. I had to admit the same fact last year. There is no use having a parliamentary assistant if in fact he isn’t assisting you, which in fact means he should be doing something when I am here and vice versa. I should be doing something when he is here.

Mr. Chairman: I am wondering if the hon. minister could deal with item 2.

Mr. Foulds: Are you saying you are not doing anything while you are here? Are you denying the legislative function?

Mr. Chairman: Item 2, please. The hon. minister.

Mrs. Campbell: Don’t get off on that one.

Mr. Chairman: Item 2 please.

Hon. Mr. Miller: You talked, I think, about the number of units per year and the state of the vehicles in the ambulance force. I think we have about 500 vehicles in the ambulance system at the present time. We had 80 new units this year. There was a shortage; we had trouble getting new units, I understand, during the course of the year.

Mr. Haggerty: I don’t wonder, you can’t.

Mrs. Campbell: I don’t wonder.

Hon. Mr. Miller: As a matter of fact, for your information, at the current time the specifications only cover one brand -- the Chrysler Corp.

Mr. Riddell: How long would those units be in operation?

Hon. Mr. Miller: I think one can take the average life expectancy. We had 450 units, and we were running them about five years, by the looks of things.

Now, we are getting 100 new units in the coming year.

Mrs. Campbell: What design? I have asked you that question and you have not dealt with it.

Hon. Mr. Miller: At the present time I believe we were studying some of the stability problems involved with our present vehicle -- is that correct? Is the study finished?

You will recall back in the spring there was an accident in the north end of Toronto, where a child or a person was burned to death in an ambulance accident. Immediately following that accident we asked for a study of the vehicle’s handling characteristics, etc., to make sure we were handling a safe vehicle. I have been told the study was completed and the vehicle was approved by that study.

Mrs. Campbell: That is not what they are talking about. They are talking about the ways in which it functions as an ambulance. Have you talked to the ambulance drivers?

Hon. Mr. Miller: Now, you are talking about Toronto’s ambulances.

Mrs. Campbell: All right, my information was that that was what you were going to do. You designed those ambulances.

Hon. Mr. Miller: No, no, we did not, with great respect. In fact, there was a long fight --

Mrs. Campbell: I know that.

Hon. Mr. Miller: -- I think it’s a safe statement to make -- between the Ministry of Health and the department of emergency services over what constituted the proper design of an ambulance.

Mrs. Campbell: That’s right.

Hon. Mr. Miller: The fact is that they could both be right. But I am told we are replacing theirs with ours, starting next week.

Portable radios have been mentioned. It’s a good idea, but a question of dollars and cents and whether we can, in fact, afford them, it’s one which I am quite willing to look at.

Mr. Riddell: They feel they could save many lives if they could contact the base when they are out there. And I think it bears some consideration.

Hon. Mr. Miller: I question whether they would be able to contact base with some of the radios of a portable nature, but I am quite willing to look at that issue and discuss it more with staff.

The member for Peel South talked to me about rental of property for the ambulances in his area. And he mentioned that they are discussing it with a fireball within a community, and the community isn’t too convinced that it should let them use it. I think we are also not convinced in terms of traffic flow in the area. There may be some problems in that particular area.

Generally speaking, though, when any land is being acquired under a private contract where the operator is leasing it and we, in fact, are paying the rent -- if we are in doubt about the value of the rent, we will have it appraised by MGS to see whether the rent is a fair rent and come up with a figure.

Mr. Kennedy: There are no rigid rates though?

Hon. Mr. Miller: There are no rigid rates, no. It, of course, depends upon the apraised value of the property. The municipalities usually give us some kind of a break in these instances, because they are often interested in the provision of a service.

Now, I would look at the comments of the member for Sandwich-Riverside; he got into body removal services, and body snatching. A few months ago I --

Mr. Foulds: That’s the only initiative that is left -- the way you set it up.

Hon. Mr. Miller: Well, I am sure you would respond to almost any initiative of that nature.

Mr. Burr: You mean you condone it?

Hon. Mr. Miller: No, I don’t. As a matter of fact, I understand the Ambulance Act prohibits an ambulance from picking up a person who is known to be dead. You are aware of that, are you?

Mr. Burr: Would you repeat that again, please?

Hon. Mr. Miller: The Ambulance Act, I believe, prevents an ambulance from picking up a person who is known to be dead.

Mr. Burr: Right.

Hon. Mr. Miller: This has, at times, been a very serious issue -- because there have been arguments occur when a person was deemed by one person to be dead, and by another person not to be dead.

It’s very difficult to set policy in that kind of area, except to say if there is any reasonable doubt, then one should assume that the reasonable doubt prevails and the person be taken.

Mrs. Campbell: I hope so.

Hon. Mr. Miller: I say that in all seriousness because that can be one of the kinds of arguments that go on between the dispatcher and an attendant out in the field where they radio back and try to describe the symptoms. You may recall a case back some time in the late winter where there was some kind of discussion among a dispatcher, an ambulance crew and a policeman, all of whom were trying to use medical terms. I can even recall post-mortem staining was used. Terms of this nature were used over the radio trying to impress the world of their knowledge and to determine whether the person was dead or not, it may be assumed.

As far as the carrying of dead bodies is concerned, to the best of my knowledge there is no current licensing procedure for that operation in the Province of Ontario. It is true, if I am not wrong, that some ambulance operators run a business apart from their own business but they are not using vehicles of the provincial ambulance service. If they were caught doing it, they would be subject to either loss of their --

Mr. Deans: They’d lose their franchise.

Mr. Stokes: They’d be disenfranchised.

Hon. Mr. Miller: Yes. The member also mentioned one thing with which I sympathize completely, and I don’t know, the answer. We can both carry on our non-smoking campaign. I wish you all the luck in the world because I sympathize with the restrictions. Many, many hospitals are putting up signs, “No smoking in patients’ rooms.” I can only say that they are often not observed and the very first offenders are very often the patients themselves.

Mr. Burr: Are you encouraging this?

Hon. Mr. Miller: I am encouraging this, yes.

Mr. D. M. Deacon (York Centre): Do they have a policy?

Hon. Mr. Miller: I don’t think we have got to the point yet where I can tell people they must not smoke in this world. I have not got to the point where I can tell them they must not drink and the other thing I keep harping about is their lifestyles. But I thoroughly encourage the ban of smoking in a hospital atmosphere. I have seen the bill of rights of non-smokers. I was happy to endorse it not long ago and I would continue to endorse it.

Mr. Chairman: The member for Durham.

Mr. Burr: Mr. Chairman, please.

Mr. Chairman: On this vote?

Mr. Burr: No, Mr. Chairman, on this question I raised with the minister. I wrote to the minister on March 20, June 26, and July 31. I asked a question in the House of the Minister of Labour on June 21 and I wrote him a letter on July 24. I still don’t know why you are permitting this sub-minimum wage for ambulance workers at $2.25 an hour with a limit of 48 hours a week when they must volunteer many, many hours of overtime in order to hold their jobs. They have to work in the neighbourhood of 80, 90 and 100 hours a week for $108. Why is that so?

Hon. Mr. Miller: I would like to look into the details with the member and I would be pleased to do so. I am assured that employees working in excess of the number of hours for which they contract, and it’s not always 48 hours, are paid not at an overtime rate but at whatever hourly rate they are entitled to receive.

Mr. Burr: No, Mr. Chairman, the Act says that they are paid $2.25 an hour for a 40-hour week. That is by the hour. But for a week of 48 hours, that’s $108. They get neither overtime nor even simple time for overtime.

Hon. Mr. Miller: Again, Mr. Chairman, the minimum wage law sets the minimum that any person on any job may be paid; it is by no means necessarily the amount they are paid. I am told by my staff that this is equally true of many of the ambulance services. I am told the average hourly rate is in excess of $4 an hour in the Province of Ontario for ambulance operators. I assume this is a correct figure.

Mr. Burr: Are they for private operators or for --

Hon. Mr. Miller: This is the average of the system.

Mr. Burr: The whole system?

Hon. Mr. Miller: Yes.

Mr. Chairman: The member for Durham please.

Mr. A. Carruthers (Durham): I have two or three questions I would like to ask, Mr. Chairman. When an ambulance service is transferred from a private operator to another private operator, that is, under management for the ministry, what policy is followed? I understand there is a great variety of ambulance services and there has been in the past throughout the province. When an ambulance is transferred from, one party to another, what policy is followed?

Mr. Haggerty: Conservative policy.

Hon. Mr. Miller: No, I think we’d be fairly liberal in our policies.

Hon. S. B. Handleman (Minister without Portfolio): That’s the best policy.

Hon. Mr. Miller: It’s the normal transaction between any businessmen for the purchase of one man’s business by another -- whatever assets he may have of his own to sell, including whatever he may consider the value of the business per se without the goodwill of the business itself. Now, one of the considerations, I understand, and I will look down to the desk for confirmation, is that the people buying the service must be acceptable to us as managers and operators of the next business.

Mr. Carruthers: Mr. Chairman, another question: How does the ministry determine the area that will be served by local ambulances? Does this vary throughout the province, or do you set up a radius within which an ambulance service will operate?

Hon. Mr. Miller: I suppose if there is any part of my ministry that has a lot of data, it’s the ambulance service. We have an information centre called Oasis that details almost every facet of an ambulance call.

I recall being in a town near your area not long ago where they wanted to know how many calls were done on one side of the river versus the other side. We could not only tell them that, but we could) tell them what streets, what houses and what types of call.

So when we go to define an area to be serviced by an ambulance, whenever we are amalgamating services through the voluntary or sometimes not voluntary transactions, we look very hard at the historic requirements of the area and plan the service area on the traffic flow studies that already exist.

Mr. Carruthers: Thank you, Mr. Minister. In a number of instances, I understand, volunteers are used in the ambulance services. How does the ministry regard this type of policy? Do you favour the use of volunteers?

Hon. Mr. Miller: I would say volunteers in the main have been in remote areas rather than the major centres. I am thinking of southern Ontario, of the Windsor area. I have met a group of people there a few times from the area. I wouldn’t say we go out and solicit them, but we are by no means opposed to volunteer services. There will be some assumption that volunteer services of necessity would be much cheaper than non-volunteer services. That is not necessarily so, I am told.

Mr. Carruthers: Following up that question on the training of the ambulance operators, is this in the future to be conducted in our community colleges? At the present time it is being done at the local level, generally through one of the local hospitals. Will the future of this be confined to community colleges? I am wondering how these volunteers would undergo training and if they are apt to find other employment.

Hon. Mr. Miller: First of all, the community colleges have packages of either upgrading courses or parts of the total course that are available almost on a correspondence basis, to some degree. I think the training you have been getting in hospitals would be an upgrading type of service training rather than a basic training, although it need not necessarily be so, because up to this point in time there has been no mandatory regulation imposed upon ambulance attendants’ training. There will be, starting in January.

Mr. Carruthers: That’s very interesting, and certainly it’s a very worthwhile undertaking.

One other question, Mr. Chairman: Is the policy to have ambulances stationed at hospitals? Is this a preferred system or are you planning to set up central dispatching stations where the ambulances can be housed and operated on a 24-hour basis with a permanent staff?

Hon. Mr. Miller: I am sure the hon. member knows that at one time it was stated policy -- well, not necessarily stated but implied -- that ambulances should be attached to the hospitals of the Province of Ontario. This wasn’t particularly well received by many of the hospitals, let alone many of the ambulance operators. It is not policy at the present time to require it. We are working with those hospitals that still have it. Some like it. Some have indicated their wish to get out of the business of keeping ambulances on the property. It has sometimes resulted in staff conflicts, because there may be different rates of pay between ambulance attendants and, say orderlies in the hospitals. Orderlies resent the fact that ambulance attendants appear to do nothing a great bulk of the day and aren’t available as they were theoretically going to be available to assist them, because they say: “My job is waiting for a call.”

So we’ve had some friction in some places when ambulances were attached to hospitals. In other cases, they have been very successful, so I only say it is not policy at the present time to move in that direction.

Mr. Chairman: The hon. member for York Centre.

Mr. Deacon: Yes, Mr. Chairman. I was wondering why it is that apparently a policy has been brought in where ambulance drivers have to have perfect eyesight; virtually the same eyesight levels as a person going into the police force. Does the minister have any idea why this is necessary?

The reason I say this is because one chap in my area has tried valiantly to join the ambulance staff. He certainly has every qualification except that.

I’m one who all my life has been able to get by with one eye. I managed to get myself in the forces and do some work overseas with very little difficulty. I think that, somehow or other, one is compensated by other means, in judging distance and things like that, without the second eye. In view of the fact that the most important thing is to have a person who is interested and keen to do a good job, if one’s physical abilities do permit one to do the job well, which I think would be the case with an ambulance driver, why do we set such an impossible standard and prevent somebody like that going into the service?

Hon. Mr. Miller: I hope to give you some encouragement, because your next job could be as an ambulance operator. You would pass the tests.

Mr. Deacon: In other words, it can change and one could get in under those conditions?

Hon. Mr. Miller: You have to have two operative eyes.

Mrs. Campbell: His next job isn’t going to be an ambulance driver.

Mr. Deacon: You have to have two or one?

Hon. Mr. Miller: Two operative eyes.

Mr. Deacon: Why is it necessary to have two? This is what I’m saying. A lot of us who operate with one eye seem to get along quite well. Why do we put in such a high standard?

Hon. Mr. Miller: This is for driving.

Mr. Deacon: I can pass the test for driving anytime with my one eye, and so can a lot of others who are driving and who are very good drivers. There’s no problem with one eye.

Hon. Mr. Miller: I understand the requirement for two eyes is one of the requirements for drivers of school buses and commercial vehicles, as well as for ambulances.

Mr. Deacon: Not all commercial vehicles. Maybe it is for school buses.

Hon. Mr. Miller: I will check that.

Mr. Deacon: I’m surprised it is required even for school buses, because certainly there are a lot of drivers who are absolutely qualified and able to do this. There’s absolutely no problem as far as judging distance. There are ways you can judge distance other than the method most people are able to use when they have both eyes.

The other thing I was going to ask the minister is, if they’re moving over to the system of allowing and encouraging private operators, would it not be wise to think about setting up the designation of areas in the same way we have fire areas? For example, don’t have them in large areas such as Metro where we have a real serious problem, as you know, because of the single area, of someone operating it in a very dictatorial fashion.

Mrs. Campbell: If he doesn’t recognize it he won’t answer questions about it.

Mr. Deacon: He will, I’m sure. Why not set up areas and provide in the tender call for a fixed overhead, variable running mile basis and mutual help arrangements going back and forth across into other areas? Those of us who have been active in municipal government worked that out with mutual fire protection arrangements and things like that. It certainly would provide opportunities for others to get into the business.

If you set up too large an operation then there’s no way you can have competition. It’s just too big and it’s too big an investment, but if you have it broken down into small areas you can be sure of competition to provide good service.

I think it is important that we have that pressure of competition and performance, in addition to the economic considerations and advantages the minister has described, which are possible when you have free enterprise involved in this business. Has the minister given some thought to that?

Hon. Mr. Miller: Yes, I have. In fact, I would echo your comments and say they are worth following. We are following them at the present time and are trying to work up a system that will have a number of these features involved in it.

You were talking about pooling services or something of that nature, and it is interesting to see this already in certain areas of the province. The private operator in the town I live in is just half way between Toronto and North Bay. I happened to drop in and visit his ambulance service on the weekend, and he told me that he and the North Bay operator have voluntarily worked out a system whereby patients who are going from North Bay to Toronto are changed at Bracebridge. They change vehicles because at this point in time vehicles are assigned to a specific station, and they save a great deal of overtime time, overnight trips and things of that nature by having two five-hour runs rather than one 15-hour run or whatever it may be.

There is room for a great deal of this, and I think you will see a great deal more of it occurring, particularly if you get better district dispatching and controls of that nature.

Mr. Chairman: The member for Algoma.

Mr. B. Gilbertson (Algoma): Mr. Chairman, I would like to make some remarks in regard to ambulances. My riding stretches from about seven miles east of Blind River right through to White River and Hornepayne in the west.

I must commend the government and the Ministry of Health for the improvements there have been in ambulance service throughout the various parts of northern Ontario. I must say that it has been upgraded considerably in the last few years --

Mr. Foulds: When you start from zero, that is not hard.

Hon. Mr. Miller: At least we started.

Mr. Gilbertson: -- which I am very happy about.

Mr. Foulds: You have been in government for 32 years.

Mr. Carruthers: Why don’t you say something positive for a change?

Mr. Foulds: It’s very difficult.

Mr. Gilbertson: If the member for Port Arthur would allow me the floor without too many interjections, I would like to continue.

Mr. Foulds: Yes, I will allow you to make your sycophantic speech.

Mr. Gilbertson: There is one stretch of highway from Sault Ste. Marie to Wawa which is about 145 miles.

Mr. Stokes: It’s 143 miles, to be exact.

Mr. Gilbertson: The member for Thunder Bay says 143.

Mr. Foulds: He services it for you.

Mr. Gilbertson: It has been brought to my attention that it is one of the most treacherous stretches of highway, especially with the varied weather conditions that exist there, since it follows the shoreline of Lake Superior. I know from experience that you can leave Sault Ste. Marie and the sun can be shining; part way up you can run into a snowstorm; and before you get to Wawa you might run into fog. This can all happen in the same day, within a few hours. As I say, it has been drawn to my attention that on account of the weather conditions, this is a very treacherous stretch of highway.

There isn’t any ambulance service between Wawa and Sault Ste. Marie. We know that there is quite a populated area north of Sault Ste. Marie in the region of Batchawana, Goulais Bay and so on. I know there have been requests to have an ambulance service established somewhere between Sault Ste. Marie and Wawa. I would like to request the government to look into this matter; have officials in the department who look after the ambulance service take note of this and see if it’s possible to have some type of ambulance station about half way, so that if there is an accident an ambulance coming from Wawa would not have to take an hour to get to the scene and an hour to go back to the hospital. This is the type of thing we want to try to avoid.

Another area that has been requesting ambulance service is Bruce Mines. We have an ambulance in Thessalon, but that’s only one between Thessalon and Sault Ste. Marie, which is 50 miles. We do have one on St. Joseph’s Island, which takes care of that area pretty well. But I have had requests to see if we couldn’t get an ambulance established at Bruce Mines. That’s the second one.

I don’t believe there’s any type of ambulance service out of Missinabi. We understand the Renabie gold mining operation is going to be starting up again, and there will probably be a few hundred people in there. I would request that the ministry check into the Missinabi area -- Dalton and Renabie.

I know that if we don’t mention these things and draw them to the attention of the government, they don’t know anything about it. So I’ve been requested by my people in Algoma to bring this to the attention of the Ministry of Health and the ambulance service department. I would appreciate it very much if they would take it to heart and look into the matter to see if this is feasible.

We know it costs money for all these things, but I’m sure this is a real need. I would appreciate it if the ministry would look into this matter.

Hon. Mr. Miller: Mr. Chairman, I have to say I’ve driven the Wawa-Sault Ste. Marie trip when it had every one of the hazards you have described, including moose -- which I believe are one of the bigger hazards, especially in the fog.

Mr. F. Young (Yorkview): And any Gilbertsons along the road.

Hon. Mr. Miller: The Gilbertsons weren’t on the road that night.

We have been preparing to interview somebody in that stretch, as a matter of fact somewhere around the Montreal River section, or around that particular part -- for volunteer service so that we’d have some kind of ambulance closer to the potential sites of accidents. We’re quite prepared to see that is done, if we find the proper people to help us.

Mr. Stokes: It is needed.

Hon. Mr. Miller: Yes. As far as Bruce Mines, Missinabi and Dalton are concerned, I’m quite prepared to have staff look into these areas and give you an answer directly.

Mr. Gilbertson: Thank you.

Mr. Chairman: The hon. member for Thunder Bay.

Mr. Stokes: Yes, most of what I want to say under this vote deals specifically with hospitals, but I would be remiss if I didn’t say something about --

An hon. member: They’ll never forget you for it.

Mr. Stokes: -- the efforts of many people in the north to have a flying ambulance service. For a number of years I’ve prevailed upon successive Attorneys General to have flying police and surveillance service in the far north. Your colleague, the Solicitor General (Mr. Kerr), has inaugurated such a service; it’s just getting off the ground now. The people in the remote areas are looking forward to it with great anticipation and a great deal of hope that the service that was so badly needed in the past will now be provided, and hopefully will work well.

I haven’t done a great deal of research on areas of sparse population throughout the world with a flying ambulance service, but I know that Australia does have one that works extremely well.

Have you undertaken, in concert with federal authorities through the Department of National Health and Welfare, to inaugurate a flying ambulance service in those spread out areas of the north? Some of them are the direct responsibility of the province and some of them are traditionally the responsibility of the Department of National Health and Welfare.

It is often difficult to rely on flying services in the far north. But where that is the only means of transportation and of necessity people staff small clinics in the remote areas under sponsorship of the Department of National Health and Welfare, it is absolutely essential that we provide an adequate communication system between nurses, midwives and those who are acting for all intents and purposes as doctors’ assistants and the base hospital where they can consult with a doctor and a doctor can advise them as to whether or not he feels a particular patient should be flown out or whether some kind of paramedical attention can be given right on the spot and avoid the necessity of ordering an aircraft and flying the patient out. What kind of dialogue has gone on, if any, between the federal authorities and your ministries to see about the advisability of setting up a flying ambulance service?

This is so badly needed, because when an emergency occurs in a remote community time is of the essence; and as I say you do have difficulty with the weather. To the greatest extent possible, I think you should have this service available. If you are going to, say fly somebody out from Big Trout Lake or Winisk or Attawaspiskat or Fort Severn or places like that, I think it is absolutely essential that you have the mechanism set up whereby you can take care of any foreseeable emergency and have the kind of personnel and the kind of vehicle in place to provide maximum protection in the event of an emergency.

That’s all I’m going to say about that, other than to say it’s absolutely essential that you take a serious look at it and provide this service to the people. When you are answering that, you might say to what extent you cover the costs of these flights when they are arranged.

I know that on occasion we’ve had to fly somebody in from a remote community to a base in Sioux Lookout or a base in Thunder Bay or Geraldton and then ferry them on down to Toronto. These are considered sort of mercy flights. They engage the services of a private carrier or in the absence of a private carrier they might have to call on the air force to fly them down here. What kind of assistance do you provide and to what extent do you cover the cost of that under OHIP?

Hon. Mr. Miller: Mr. Chairman, first of all, we used air transport about 1,000 times last year for the evacuation of a patient. One way or another we pay all but $25 of authorized evacuations by air.

Mr. Stokes: Who authorizes them?

Hon. Mr. Miller: I would think a doctor in an emergency.

Mr. Stokes: In the absence of a doctor?

Hon. Mr. Miller: That is an interesting thing, I authorized one not long ago, just for your information.

Mr. Stokes: Could I authorize one?

Hon. Mr. Miller: I think under emergency circumstances --

Interjections by hon. members.

Hon. Mr. Miller: He looks honest.

Mr. Stokes: I assure you it wouldn’t be frivolous.

Mr. Foulds: Why can’t he in those circumstances?

Hon. Mr. Miller: I’m just listening to the answer if I may for a second.

Mr. R. S. Smith: Except on election day.

Hon. Mr. Miller: Normally the police would be the source of authorizing it in an emergency.

Mr. Stokes: There aren’t very many police up in Fort Severn.

Hon. Mr. Miller: I would think again the law of common sense prevails, if somebody tells us that an emergency situation exists.

I’ll give you an example. I was not too long ago flying over Attawaspiskat on a day when the weather was closing in very quickly. As you know it can. At that point in time aircraft were shuttling up and down the coast of James Bay. We got a radio call from Attawaspiskat, directly below us, saying there was an emergency case at a goose camp out on the river somewhere and could we locate an aircraft within flying range able to pick it up. There was immediate radio check of aircraft in the area. One aircraft that happened to be a Natural Resources aircraft said it would divert to that point right away, pick up the patient and fly him back to Moosonee.

That kind of service has been going on for a long time, as I’m sure you know. I have an idea that patient didn’t get out that day because of weather, but I can’t answer that. We almost got caught by snow as it turned out. The OPP had been contacted to see if we couldn’t utilize their aircraft too for the service.

The night I authorized one was rather interesting, because it was one of these cases where it wasn’t an emergency in a remote area, it was an emergency in Sudbury, where a non-Canadian was involved with a very serious health problem. The air force had been called because they are carriers of last resort and again we pay them to do the mission. They had been authorized by me to do it.

I think we ended up using a private carrier, as it turned out, because we had to fly a team from here to Sudbury with all the lifesaving equipment on board. It was easier to get an aircraft out of Toronto and get them up there, team and all, to get to the person who had, I believe, ingested something into his chest, and had a cardiovascular problem to boot.

I know that Mr. Brubacher and I were both wakened up on the morning of Labour Day or thereabouts, sometime around 4 in the morning for that emergency approval. That’s a strange thing, but because he was a non-Canadian the emergency approval was needed by somebody to ensure payment for the services.

Mr. Stokes: Are you planning to undertake an extension of that service?

Hon. Mr. Miller: The service we are using, yes. But to have our own service, no. I would say we are not planning to have our own service but to make better use of the services that exist.

For example, we have talked about Armstrong and we feel that the most appropriate means of getting people out of Armstrong is by air when weather permits. This basically would have met the bulk of the need for Armstrong, which has 10 or 12 normal cases per year of need for ambulance service out of the area. But we recognized that on some days the aircraft wouldn’t get in and the trains wouldn’t be coming by, as we had to put an emergency vehicle there to get the person out under those conditions.

Mr. Stokes: Thank you. I want to get into two separate but important problems concerning hospitals.

The first is a series of correspondence that we’ve had directly with you, Mr. Minister, and with Dr. Baldwin who is the area planning co-ordinator for health services in northern Ontario.

As you well know, the hospital in Terrace Bay was declared inadequate, below standard and badly in need of repair. Up until just recently it was a private hospital operated by Kimberly-Clark, primarily to provide medical and hospital attention for its employees, although the company did make the hospital available to people in the area generally.

As a result of this it became necessary for the company either to spend a considerable sum of money, or allow or initiate some action to declare it and make it a public hospital, so that somebody else other than the company, I suppose, would upgrade the hospital and bring it up to an acceptable standard. As a result of this, as you well know, they formed a hospital board made up of people from the two communities of Schreiber and Terrace Bay, and submitted a plan to your ministry that would meet the needs of the people in the area.

Of course, they no sooner got that plan into the hands of the ministry for approval, and approval that was given, when Kimberly-Clark announced a major expansion amounting to something like $200 million. This means almost immediately, within the next year to 18 months, there will be an additional work force of anywhere from 1,200 to 1,400 people for a period of two to three years, plus a permanent work force of close to 200. Of course, if they are family units, you are thinking of an increase of anywhere from 800 to 1,000 people in the general area.

It’s not something that we are just hoping for; this is something that will happen. I’m wondering if the minister has taken seriously a request by the hospital board of McCausland Hospital for an expansion, or for authority to provide for this expansion in the immediate plans, rather than going forward with the old plans and almost immediately having to undertake an expansion that will much more closely meet the needs of the people in the area. I know Dr. Baldwin has been working very carefully with these people, that the hospital board is working very diligently to accomplish this end and that anything that has been done by way of representation has been turned over to Dr. Baldwin himself.

Is there anybody within your staff here today who can give the hospital board the assurance that it will be allowed to proceed with the expansion on the basis of the expanded population which is inevitable, certainly within the next year or two?

I had one other problem, but if you will answer that one, I’ll get right into the third one.

Hon. Mr. Miller: Mr. Chairman, I can’t give you detail today; but I will get it for you. You know that we changed the grant structure to make it easier for these areas to raise their funds, whether it was done by the company, as I believe was the case with original hospital that was provided in the past, or by the community.

For that area only one-sixth of the money now has to be raised in the town. In so far as the request for expansion beyond those original plans is concerned I can’t answer you; if I can get the answer before the end of the estimates I will give it to you.

Mr. Stokes: All right. The third problem is one on which I have had considerable correspondence with the minister and his parliamentary assistant. It deals with an edict that went out from the Ministry of Health to the three general hospitals in the city of Thunder Bay, stating that on the basis of active treatment beds to population, they should reduce their active treatment capacity by 86 beds in the three hospitals.

A great furor went up and I am sure that you recall quite vividly, Mr. Minister, the exchange between yourself and Mrs. Averill from Marathon as a result of a very unfortunate incident. It was alleged that it was possible that unfortunate incident could have been avoided if there had been sufficient active treatment beds, and if her husband’s doctor had been able to get hospital accommodation when it was so badly needed in the case of such an emergency, and that they might have been able to save this person’s foot as a result of it.

I am not prepared to say whether or not 72 hours might have saved the foot, or 48 hours might have saved the foot; I suppose this we will have to leave to the experts. All I am saying is that I don’t think any patient or any ministry should be placed in the position where we are wondering whether or not, had there been sufficient active treatment beds, we might have avoided a very unfortunate happening and maybe one person might have been able to avoid the amputation of a limb.

As I say, I am not going to get into that fight, but that is only one indication of the kind of treatment people living in the far north will get, based on our ability to arrange the kind of emergency treatment that we need. I am talking about not only those living within the confines of the city of Thunder Bay, but about people who of necessity, because we can’t afford to duplicate emergency treatment and specialist care in every small community and hamlet in northern Ontario -- people living in the outlying areas, such as my entire riding, which is 110,000 square miles, and a good many of them west of that even, in the districts of Kenora and Rainy River -- must rely on some centre, whether it be Winnipeg or whether it be the city of Thunder Bay, for emergency services and for specialized care.

You can give me all of the figures that you want saying it is the experience of this ministry that -- what is it? -- 4½ beds per 1,000 of population seems adequate for the entire province, so that of necessity that’s fine for every place in the province. Well I don’t buy that argument at all, on the basis of information that I have been able to obtain from a number of very reliable sources, the most recent being from Rev. Canon Alvin J. Thomson, President, Thunder Bay Council of Clergy, 201 Woodside St., Thunder Bay, Ont. As you well know, clergy visit hospitals to see their patients on an ongoing basis. They have an excellent opportunity to see what the conditions are. When they walk into a hospital and see patients in beds in the hallway over a protracted period of time, waiting for admittance for elective surgery or whatever, they have every right to assume there aren’t sufficient active-treatment beds in the three existing hospitals in the city of Thunder Bay.

I could document at quite some length the kinds of representations that have been made, not only to myself but to the hon. member for Fort William (Mr. Jessiman) and the hon. member for Port Arthur (Mr. Foulds). The latest communication we got explaining the situation, was in a letter dated Nov. 1, 1974, signed by J. C. Baldwin, MD. It was sent to the three of us, so obviously we are all getting the same kind of flak, we are getting the same kind of representations for the maintenance of the existing active-treatment beds in the city of Thunder Bay.

I want to read a portion of the letter that Dr. Baldwin sent to Rev. Canon Thompson on Nov. 1. He said:

“I would like to thank you for your letter of Oct. 15, 1974, and your council’s expression of concern relative to the general active-treatment bed situation at the hospitals in Thunder Bay. I must admit to you, however, that I feel compelled to take exception to some of the facts and figures outlined in your letter.

“To date, the ministry has only requested the hospital planning council in Thunder Bay to look at the bed utilization in the city and to come up with a plan that will possibly reduce the active-treatment beds in Thunder Bay by 86 beds. As of this date, the hospital planning council has not come up with such a plan nor has there been a definitive decision in reference to the cutting of such beds until alternative facilities are open.

“In the latter part of 1973 and the early months of 1974, the ministry on several occasions requested from the hospital planning council to cut down the active-treatment beds in Thunder Bay by 25 active beds only. This was not achieved, and since the amounts of money relative to such bed cuts have already been taken out of our budget here at the ministry, we therefore had no alternative but to pro-rate the total amount of moneys for these beds and to delete this amount from the budgets of each of the three active-treatment hospitals in Thunder Bay for the fiscal year 1974.”

So that in one paragraph he says they have taken no action and they are still waiting for a recommendation. Here is proof positive they have actually reduced the budgetary ratios to the three hospitals for their failure to get down within the guidelines as recommended by the Ministry of Health. He went on to say:

“I would also like to draw to your attention that there are 100 chronic-care beds to be opened at the Walter P. Hogarth Memorial Hospital in Thunder Bay soon, and in the spring of this year the ministry approved the construction of a 150-bed nursing home facility in the city of Thunder Bay.”

It is my understanding that in the Hogarth Memorial Hospital there are only something like 15 patients being treated in a 100-bed chronic-care hospital because of a shortage of staff. So you can’t actually say those are on stream because they just aren’t. We don’t have the wherewithal to serve the number of people that it could accommodate.

On the other one, where he states in the spring of this year the ministry approved the construction of a 150-bed nursing home facility in the city of Thunder Bay; I want to tell you that the sod hasn’t even been turned on that location because of somebody’s suggestion that that isn’t the ideal location for it. That’s the information that I have.

Hon. Mr. Miller: It’s a financial problem.

Mr. Stokes: You suggest it is financial problems. All right, regardless of the problem it is unfair to use this kind of an argument to justify the reduction in the number of beds on the grounds that a facility is in place, when as I say they haven’t even broken the ground yet.

I am sure the member for Port Arthur and the member for Fort William will get up and substantiate what I have said. I think it’s absolutely essential you listen to people in the area. I see no reason why I, as a member, should be getting up and saying -- if I couldn’t justify it and I really didn’t feel strongly about it that we need those beds in order to provide the kind of treatment that people deserve and people expect.

The Thunder Bay Council of Clergy are not a wild-eyed group trying to embarrass you or anybody else. They see a definite need; they are sincere, honest and they are people of integrity who are trying to provide a service and to ensure there will be no reduction in the service. In fact they would like to see an improvement in the service.

So as I say, I hope you will take all of these representations that you are getting seriously, because they are well-meaning people, people who are reacting to a particular need, a need that you people down here take for granted -- but one that we have to fight tooth and nail for in remote areas of the province.

All I am saying is the kind of weighting factors that you are using down here don’t necessarily apply throughout the province. We think we have a good case and I, for one person -- Mr. Minister, implore you not to insist on or not to effect any reduction in the active-treatment beds in the city of Thunder Bay at the present time; not only to meet the needs of the people in the city but those for hundreds of miles around.

Hon. Mr. Miller: Mr. Chairman, I always take the comments of the member seriously and I take them seriously now. We don’t have the same planning standards for northern and southern Ontario. I don’t know if you are aware of that or not. We allow 4.5 beds on a weighted basis for age, so that can mean more in northern Ontario and four in southern Ontario. There is a different planning standard and therefore you have some 12.5 per cent more beds in northern Ontario on a basis of population than we do in the south on our planning standard basis. I think if one compares that with, say the Province of Quebec standards which are somewhere around 3.2, and with Scotland’s at 2.2, you will find we have probably more beds per 1,000 people than almost any other industrialized nation.

It’s axiomatic, whether I like it or not; beds created are beds used. The real issue then becomes whether the beds are used properly, whether the people who need the services are not getting in because people who shouldn’t be there are still there.

There has been great co-operation from the province’s hospitals in the last year and a half to tighten that situation up, to utilize the alternative care facilities to some degree; and of course it implies that we will have them. This is one of the reasons for trying to get you -- you recall, two years ago it must be, we worked on getting the chronic hospital started up there, realizing that was one of the areas of greatest need in the Thunder Bay area.

On the nursing home situation, it is not our money that’s holding it up. We have authorized the capital, but in today’s money markets, I understand the first applicant -- and I am looking to the other member for that area to tell me there were some problems with him arranging mortgage money in the area.

This is basically the issue. You know the problems of mortgage money in the markets of today, and that was one of the reasons why, in good faith, we gave the licence to the person who in good faith accepted it, believing he could build a nursing home. He, in turn, has had difficulty raising money, at least at the prices he is willing to pay. I am not sure whether it’s raising money in total or raising money at a price on which he feels he can make a return on investment of some type.

Now you are in one of the two areas of the province that currently has a health planning council. It has just begun; although it really hasn’t begun its work at all. The things you and I have been discussing within planning standards will become the kind of thing to be resolved at the local level.

I fully appreciate the sincerity of people like the Anglican minister who wrote to Dr. Baldwin. I can’t question it; it’s very hard to argue with anyone that there’s a surplus of beds when people are staying in the halls of a hospital or when you can’t get in. You know, I personally have sat in an admitting room or a recovery room or whatever it is they call it at the hospital, feeling very ill for about eight hours while somebody looked around for a bed for me. I quite recognize that it is not the nicest way of spending an afternoon.

And yet if we built five beds per thousand, or 5.5 or 6 or 6.5, as we have in certain areas, we’ll still find that in most areas those beds will be totally used by the people who are responsible for admitting patients and looking after them in hospitals. So whether we like it or not, it is one of the constraints.

I recall both your colleagues and those in the Liberal Party pushing me to say what had I done; what had I done, after my speeches around this province, to do something about increased health costs? Well one of them is to try and enforce or encourage adherence to the planning standards that we accept through the province. Those planning standards have been cut over the past two or three years, and we now find surpluses of beds in a number of places in the province where two years ago planning standards would have predicted just enough. So we’ve often had the embarrassing situation of a hospital that is virtually new with some empty beds, because we’re not using them right now.

Mr. Stokes: Okay, right there, can I ask you two questions? The first one is: Am I accurate in my assumption that the only way a person can get into a hospital is if he’s referred there by a doctor? The only other alternative is if it happens to be emergency treatment and he comes in via that route.

Now the thing is that if people are as frivolous as you would like to suggest, the more beds there are the more people will find a reason for getting into them.

Mr. Foulds: Nobody spends a holiday in hospital.

Mr. Stokes: But surely if your figures are right, you can tell me of another way a person can gain access to a hospital for a frivolous reason. He must have been referred there by a doctor.

Now the thing is, are the doctors being frivolous? Maybe they’d like to say: “Well, okay I can see 40 or 50 of my patients in two or three hours in a hospital, as opposed to the few that I can see in the same length of time at my office. So sure, we refer the majority of the patients to the hospital; and I can just run around from door to door with a nice bedside manner and everything else.”

I don’t think all doctors do that, but I think it’s implicit in your suggestion that’s what they are doing. Because as long as you have beds, you’ll find doctors with patients that will fill them and overflow them. I’d like you to respond to that.

However I want to ask you one thing in particular. Will you instruct your officials and Dr. Baldwin not to harass those three hospitals and insist they get down under those guidelines by a reduction of 86 active treatment beds until two things happen; either they get a recommendation from the newly-constituted health council; or until you have these alternatives that Dr. Baldwin speaks of in place, ready to go and ready to absorb those people who think they need medical attention -- or for whatever reason do need medical attention?

Hon. Mr. Miller: Well to answer your last question first, yes.

Mr. Stokes: Good.

Hon. Mr. Miller: To answer the other one, I don’t imply frivolity in the use of beds. It is simply that the standards for admission change as the number of beds available change. For example, length of stay of patient increases. That’s one of the ways -- 8.7 days, I think at the current point in time, is the average length of stay for a person in a hospital in Ontario.

Mr. Stokes: Yes, but the doctor makes that determination, not the patient.

Mrs. Campbell: No. The ministry makes that determination.

Hon. Mr. Miller: No. The ministry doesn’t make an individual determination of any kind. The ministry gives guidelines --

Mr. R. S. Smith: Directed to a committee in the hospital.

Hon. Mr. Miller: Yes, there’s a discharge and admission committee, I believe, in most hospitals, that basically appraises the state of patients in a hospital. We have teams from the College of Physicians and Surgeons that go around and analyse the admissions to hospital, the treatment given to a patient in hospital, the length of time he stayed, the adequacy of the care he got, and whether he was released on time or not.

Mrs. Campbell: That’s not in the teaching hospitals yet, so they say.

Hon. Mr. Miller: Well in any case, the fact remains we make these analyses. It’s quite interesting to see, sometimes, that they come up with a number of patients who in their opinion should never have been admitted in the first place.

The fact they were admitted doesn’t mean that the doctor was being frivolous, he may have had some compassionate reasons for putting a patient in. I know of one very recently -- a man who suffered from a severe stroke, who doesn’t need hospital care, but frankly his family needed a few days without him, and because the bed was available it gave the wife a much-needed one-week rest when his doctor admitted him to a local hospital and let her go away for four or five or six days. Frankly, if the hospital beds are available I see nothing wrong with it.

It is a strange thing to say in an era of great constraints, because the real cost of the system is having the hospital bed. But therein lies our problem: It is the attempt to constrain those beds by 86 beds, and by doing so perhaps to find the very staff you need in the hospital that can’t get staffed, and divert the care where it should go. I don’t know about the staffing problems up there, but except for registered nurses throughout the province, generally we have been able to find the type of care needed.

We have problems with people not wanting to look after chronic-care patients. I think this is a recognized problem in the health field today; and one I would like to encourage a change in, toward the senior patient suffering from chronic diseases. It is not an exciting business. Patients seldom get better and there is no sense of success, or whatever it is that gives a person his thrill at the end of a day, in many instances. It takes a particular kind of devoted person to work in that atmosphere. I have been in some chronic hospitals that are a joy to go into; others that are not very much of a joy to go into.

Mr. Stokes: You will give us the assurance that you won’t insist on the reduction of the active-treatment beds, nor will you reduce the grant until such time as either your health council says it or there is alternate accommodation? Thank you.

Mr. Chairman: I would like to recognize there have been several members who wish to speak on item 2. Perhaps the minister may have answered the question or the comment, but I am going to enumerate the names now so you will know I haven’t forgotten you. The members for Nipissing, Wentworth North, Kent, Ottawa East, St. George, Fort William and Port Arthur.

Mr. R. S. Smith: Mr. Chairman, I have a few questions. Actually we haven’t been talking on item 2 all afternoon, we have been on item 3, and the question I have is on extended-care units in the Nipissing area.

Hon. Mr. Miller: With respect, Mr. Chairman, we have been on item 2 -- ambulance and hospitals.

Mrs. Campbell: Ambulance services.

Mr. Chairman: Vote 2803, item 2, is the area.

Mr. R. S. Smith: Oh, you are at that one are you? Item 2. Well, general hospitals and related activities -- you are doing each part of this section? You mean I have been sitting here 2½ hours to talk on the next section?

Mrs. Campbell: Yes.

Mr. R. S. Smith: Well, I will talk on this one then, because I don’t intend to waste that much time. Anyway, the fact of the matter is that in our area we have had some difficulties very similar to those the member for Thunder Bay brought up, except that our difficulties have moved down from the active-treatment beds into the chronic-treatment beds and those that are covered in nursing homes For the first time in the electoral district of Nipissing we have had a nursing homes. For the first time in the elec- of last year with a rated capacity of 125 at the present time. There are some nursing-home beds, or beds that are covered under extended care, in the home for the aged in the city as well and some in the home for the aged at the other end of the riding in West Nipissing. The fact of the matter is that there is still a great shortage. Some other beds are in Parry Sound or Nipissing.

I have talked to the doctor in charge of the area, Dr. Baldwin, and we had some long discussions on this.

First, I would like to ask the minister if the ratio is 4.5 per 1000 for active treatment, what is it for chronic and nursing?

Hon. Mr. Miller: The chronic ratio is one per 1000, age-weighted again; and the nursing home ratio for planning standards has been 3.5 per 1000, if I’m not wrong, also age-weighted.

Mr. R. S. Smith: It’s 3.5 per 1000. Okay.

We have had a request in for an extension of the one nursing home which has been opened and has 125 beds approved. There is room there for 75 more beds, but the word from the ministry is that these can’t be approved because of this weighting factor and because of this 3.5 per 1000, which the ministry claims is available in the area but which I claim isn’t available in the area. It just depends on where you place some of the other facilities and in what area you would consider the other facilities.

Also, I don’t think there has been any consideration given to the fact that many people were moved out of the psychiatric hospital in the area into the nursing homes to reduce the cost of operation of the psychiatric hospital and because these people can be just as well treated in the nursing home setting.

I looked over the waiting list of one of the nursing homes concerned and of one home for the aged where there are nursing home beds or extended care beds. On that waiting list I found there was a great number of people. Eight of them were in active treatment beds in hospitals and three in the other, making 11. There was one in psychiatric hospital. There were 11 in homes for special care. And there were six in other nursing homes in other parts of the province who had requested movement there because they would be near relatives and that type of thing.

The total cost of keeping those people in those facilities runs between $900 and $1,000 per day. The total cost, if you accredited the other 75 beds in this nursing home, would run you about $800 per day. So if you accredited these other beds, you would be saving the government about $200 per day.

It doesn’t always follow from the fact that you accredit beds or don’t accredit beds, or you recognize beds or don’t recognize beds, that you’re going to save money or that you’re not going to spend money. I think that’s the fallacy in the methods you’ve used. Just to set numbers and say this is going to do the job is really not even close to being factual, nor is it close to what is actually happening in terms of health care services in the hospitals.

The hospitals admit and release patients on the say-so of the medical practitioner, who is judged by a committee on a weekly basis in most hospitals, as I understand, as to whether his patient should be there or not. Therefore, the actual money spent on a per diem basis in the active treatment hospitals is decided by those committees and by the individual doctors.

In this specific case I would like you to tell me how you’re saving money by not allowing these other 75 beds to open up when there is such a great demand for them.

Hon. Mr. Miller: Mr. Chairman, I am proud of our nursing home programme. I agree that we can’t plunk down planning standards anywhere in the province and assume they’ll work. I spent a great deal of time as parliamentary assistant studying this very issue. The weighted-age standards of the number over 65, which is the basic client group, heavily influence the number of beds an area needs.

We do have to take into account a number of factors. We have to consider the total bed structure of the area, and not just the chronic, nursing home or homes for the aged facilities, because we do have to allow for the beds that might be surplus in the active treatment field.

In fact, where we have active treatment beds that are surplus to our current needs it is still cheaper to utilize those for nursing home care than to transfer the patient out, in most cases. So there are a number of factors that are involved.

What I mean by that is, if I take the existing 20 beds of a hospital that may be deemed surplus -- that are being used by potential nursing home patients, for example -- and I move those people out into a nursing home and pay $17 a day each for them, then the saving in the hospital probably wouldn’t come to $17 per patient per day, if you follow me.

Mr. R. S. Smith: I don’t know how you figure that out. If you take a person out of an $80-a-day bed and put him in a $17-a-day bed there is a difference of $63 a day. I don’t care how you add and subtract, whatever new mathematics you want to use, that’s what it is.

Hon. Mr. Miller: I think you are wrong. If you will let me explain I’ll be glad to do it.

Mr. R. S. Smith: I know exactly what you are going to say. You go on the concept that the cost is there for the beds whether they are used or not. You pay the hospital, on the global budget, that much money. Maybe this is wrong. Maybe you should look at that again, look at the use that is being made of the beds in the hospital and pay on that basis.

Okay. I’ll pass that question over, because obviously I’m not going to get anywhere with you. We just go around in a big circle.

Hon. Mr. Miller: But you are wrong. You just have to listen.

Mr. R. S. Smith: I have listened to the argument from the doctor, I’ve listened to the argument from other people in the ministry and --

Interjection by an hon. member.

Mr. R. S. Smith: That’s right, and after I listen to you people I certainly will remain so, because the amount of sense we get out of some of these things is really hard to fathom.

That leads me to the other question of the provisions within this global budget that you provide to each hospital. We have a hospital in the city which is providing a special service, an innovative service for alcoholics, and it has been the decision of your ministry for two years running now that this service cannot be included in the global budget. I have never been able to fathom the reason it couldn’t be included. In other parts of the province we have the establishment of drunk tanks, we have the establishment of detoxication units, we have the establishment of similar-type services in Thunder Bay which are on the same basis, that are covered in the global budgets for health costs.

Besides that, in Toronto we have a hospital at the addiction research centre that’s totally used for treatment of addiction to drugs or alcohol. In my area we have zilch, nothing.

I’m kind of proud of the hospital you have over there, except for the large operating rooms that you put into that hospital and the waste of money in that respect, when you have similar types of services within three or four blocks in four other hospitals. There was no need for that waste of money, but it was done. Other than that, I think the addiction research hospital serves a major purpose in this community.

But in my community you are not providing that type of service whatsoever. Here we have a hospital which has funded it out of its own funds for two years and yet it is being continually refused any assistance within its global budget for that service, which is being provided on a day-to-day basis to a maximum of 15 persons on a per diem basis. I’d like the minister to reply.

Hon. Mr. Miller: I am going to get more details about the alcohol programme you are referring to. The only information I have implies it was started quite properly on local initiative but without authorized funding from us. As you know, any programme in any hospital requires approval for funding before it is started, because on this basis we would have a great number of programmes spawned in places where they may be needed or may not be needed, but above all may be created at a time when the funds aren’t available for their operation. I will get the information on it in more detail and try to answer you.

Mr. R. S. Smith: The fact of the matter is that in spite of being turned down it was started and was provided by the local people with their own local funds. But I am saying to you you are providing similar types of treatment right across this province, not under general hospitals but in other areas of health services, and I can’t for the life of me understand why it cannot be provided in that area as well. I know it’s a different type of service and it is innovative and it is a change from the norm, but perhaps it will work out better than some of the other services that you have provided -- where there is real question as to whether they have worked or not.

The other point is the detoxification centres which are to be provided if you have so many people in an area. It doesn’t matter as to how many drunks you have in the area; you have to have enough people.

Hon. Mr. Miller: No, sir.

Mr. R. S. Smith: That was the original presentation put forward by a former minister that for under 50,000 there would be no detox centres. If you can point out to me a community that has --

Hon. Mr. Miller: May I stand up on that one point a second? My understanding is -- and again I will check this -- that the detoxification centres that are planned in I think 15 or 16 localities were based upon the known incidence of alcoholism, as indicated by arrests for drunkenness in the community.

Mr. R. S. Smith: Okay. So obviously you are going to have detox centres where there are larger numbers of people, because the incidence does not vary that greatly from one area of the province to another.

Hon. Mr. Miller: Again, with great respect, Mr. Chairman, it does vary a great deal. When I was in Kenora this year I understood that there were 16,000 arrests for drunkenness in a town of 12,000; in Toronto, with two million people, there were 27,000 arrests for drunkenness. This is just an indication of a social problem, I agree, but the fact is that Kenora got its; detox unit because of its tremendous problem. Therefore, contrary to your implication, detox centres were put where the problems existed.

Mr. R. S. Smith: Where the greatest problems with the greatest number existed. But what you are not doing is providing an equalized service to all people. If you happen to live in an area where there are a lot of other drunks you are going to get the service; if you happen to live in an area where a higher percentage of the people stay sober, you are not going to get the service. That’s just what you are saying.

That’s a ridiculous way of establishing a programme, as far as I am concerned. That’s just like saying to the fellow who has cancer: “If you live in an area where there is a lot of cancer we are going to treat you, but if you have cancer and there is not too much cancer in your neighbourhood we are not going to treat you.” That’s just about as ridiculous as what you are saving about detox centres. The same applies, because they are both diseases -- whether you consider that or not, I do.

Mr. Chairman: The hon. member for Wentworth North.

Mr. D. W. Ewen (Wentworth North): Mr. Chairman, I would like to get back to the ambulances. Listening to the members here this afternoon, it’s quite obvious, Mr. Minister, that there are areas of the province that need this service. There’s no doubt in my mind that you yourself have experienced a very hazardous experience. I believe that your wife had two broken legs, there was no service in the area, and you drove her, I think, 60 miles in the back seat of a car to try to get medical aid. So no one knows the problem better than you.

I have had the experience on two occasions of riding in ambulances dispatched out of Halton region. I was very much impressed with the knowledge of the attendants and the way they looked after a person in pain. I was impressed too by the equipment that the ambulances carry.

We have a unique situation in the township of Ancaster where the Ancaster fire department have an ambulance. I’m sure the minister’s aware of the record of that department and the lives that they have saved among the 16,000 people in that particular township they serve. They have done a tremendous job at a very reasonable cost.

My question to you, Mr. Minister, after experiencing this situation, is: Why can we not encourage this in other areas, in the Hamilton region in particular, where I know you are cognizant of the problems of dispatching ambulances out of the city of Hamilton into what I call the boondocks, where the dispatchers and the ambulance drivers are not familiar with the roads in the townships and the angles at which they run?

I think this is an area, sir, where you should take really serious consideration about the dual approach. Maybe throughout the Hamilton region we will eventually be under the Hamilton fire department -- this I don’t know. But I think Ancaster is a good example of a fire department which has a dual role. Its ambulance has been called into the city when there has been a crisis -- a serious accident or an explosion. They have a record of being at the scene before some of the private enterprise units.

I wish you would take a serious look at this method of operation. I would be interested in your comments and if you would suggest to members that they encourage this dual approach in municipalities in these regions.

Hon. Mr. Miller: It is certainly one I am taking seriously. We have had some of the larger municipalities .who operated a dual service -- ambulance and fire -- opt out of the scheme lately. I can refer to Oshawa, I think, for one. Lindsay is talking about some problems. Brantford is thinking about it.

But, certainly, we have at least two that are facing some of the problems with conflict of service at that point when they need the ambulance operator and the fireman at the same time. Where volunteer brigades work, I think there is a lot to be commended for them. Volunteer brigades, just like volunteer fire departments, in the main, are more likely to occur in smaller communities, like the one I live in. And certainly there is nothing in our policy that would mitigate against a volunteer organization.

Mr. Chairman: The hon. member for Kent.

Mr. J. P. Spence (Kent): Mr. Chairman, a little while ago the Minister of Health said the Act says that ambulances under his ministry are not allowed, or not supposed to carry dead persons. Is that right? Of course, you know, many of us, or quite a number of us, have been at the scene of accidents. And of course, you see bodies on the highway or on the side of the road. Your ambulances are there, and it is quite a concern. It is a hardship on the next of kin from the time the accident happens until the time the bodies are removed. The time seems too long, and it is a concern to communities where the victims reside.

Mr. Minister, you seem to say that this Act says that those ambulance drivers must not move or transport a dead body. I want to live as long as I can, and if I were in an accident I would want to be transported as quickly as possible to the nearest hospital for the best chance to save my life. And I just want to know more about this Act which says ambulance drivers must make sure that the people are dead. I would like to hear from you if you could tell me why it takes such a length of time from the time of an accident until the dead person is removed from the scene? It’s a hardship for the next of kin to wait around for hours before the bodies are removed.

Hon. Mr. Miller: Mr. Chairman, I quite sympathize with the comments you made, and I can assure you if there is any chance you will live, we will get you there.

Mrs. Campbell: Just don’t you be the one to give that permission.

Hon. Mr. Miller: I think the implication I tried to leave before was that if there is doubt of any kind, the person was to be moved. It is only where they really felt there was no doubt at all, that the body was not to be moved; and I believe that’s policy.

The question of moving the body certainly does bother the next of kin; and I sympathize again with the people who have this problem. But if a person has been killed, I believe the coroner must make an investigation prior to the removal of that body. There is just nothing in our regulations that would permit any prior movement of the body. So, really, the issue hangs more, not upon the availability of a transfer service, but upon the need for the coroner to investigate the cause of death or to certify death, or whatever it is that he has to do at that point in time.

I am told that where there is no removal service readily available, the coroner may order -- and I assume he may order the ambulance -- to remove the body.

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

Mr. Roy: Oh, my turn, Mr. Chairman? Thank you.

I just want to ask briefly, Mr. Chairman -- and possibly if this question has been asked before, the minister could tell me and we could proceed to something else -- has anyone asked the minister about the problem which received some press about a month and a half or two months ago, about Oakville, where the ambulance was so old?

Hon. Mr. Miller: That has been discussed.

Mr. Roy: That has been discussed. Now, has anyone asked the minister whether he has looked into the situation dealing with the problem in Pembroke in the hospitals, and the squabble down there with the association? That’s been asked.

Hon. Mr. Miller: No, it has not been asked.

Mr. Roy: No, it’s not been asked. Mr. Chairman, I just wonder if the minister might advise us what he is doing now down in Pembroke. I appreciate that it appears to be an internal type of a squabble in the sense that one doctor -- and I don’t recall his name -- and the rest of the profession seem to be fighting. The community apparently has been split as well, and there have been problems about whether he should have hospital privileges or not. Could the minister give us an up-to-date report, because it seems to me that people in that area are certainly concerned about Pembroke?

Hon. Mr. Miller: I assume that it properly comes under this vote, Mr. Chairman, although I think we are stretching the vote to do so.

Mr. Roy: Oh? Aren’t we on hospitals?

Hon. Mr. Miller: It’s not really a hospital question half as much as it is a medical question within the College of Physicians and Surgeons, However, having given my caveat, let me proceed.

The issue was created when a doctor in the community in Pembroke lost his privileges as a result of a hearing by the College of Physicians and Surgeons.

Mr. Roy: Is that Dr. Sutherland?

Hon. Mr. Miller: That’s Dr. Sutherland, yes, since you have mentioned the name yourself.

He was given, I believe, a three-month suspension of licence. He was charged for the costs of the hearing, and I believe the costs of the hearing were in the range of $25,000. I may be wrong in that figure. That occurred just about the time the health disciplines bill was debating costs and fines. After the three-month suspension period, the doctor applied to one, if not both hospitals, asking for a reinstatement of his hospital privileges.

Mr. Roy: I am on the right vote.

Hon. Mr. Miller: They were denied. He prepared an appeal to the hospital appeal board and withdrew it. He then, I understand, launched a series of counterclaims in the community against fellow physicians, stating that they also were not supplying adequate services to people in the community.

Mr. Roy: You are not talking legal counterclaims?

Hon. Mr. Miller: Not legal counterclaims; simply statements, allegations, charges. I believe there were charges, in the fact that they were written, stating that based on his experience a certain physician had either carried out an improper act or had done it poorly, or whatever may constitute poor professional practice.

I heard there were very many pages of such claims and counterclaims going on in the community, and naturally a great deal of local emotion was evoked. The community did split right down the centre. There is a group called AIMS, I believe, headed by one of the outstanding citizens of the area, which is trying to reinstate the privileges of that doctor. There is an equally vocal group claiming he should not be reinstated.

This is the kind of issue that self-governing bodies are designed to solve. It is my position as Minister of Health that where the charges are from doctor to doctor about professional services, they are to be investigated and dealt with by the self-governing agencies, not by the Ministry of Health. My problem would be entirely different if. in fact, there were not staff on those hospitals able to give services to the people of that area.

I have discussed this and I have decided that it is not proper for me to be involved in what are basically personal squabbles over the quality of care in a community given by people who don’t like each other very well.

Mr. Roy: Well, Mr. Chairman, if I might have a small discourse with the minister on that point. I appreciate that originally this was clearly an internal matter and a matter that, generally speaking, when you have it between professionals of the same profession it should be solved by the association, by their own executive. The minister, if at all possible, should not intervene in what clearly appears to be an area where there is another system of solving that problem.

My first question to the minister is is he satisfied that health services in the Pembroke area are not deteriorating and are quite adequate?

Hon. Mr. Miller: Can I answer that now?

Mr. Roy: Yes.

Hon. Mr. Miller: I suspect that at the current point in time health care has never been given as carefully in the Pembroke area.

Mr. Roy: What you are suggesting is that the heat put on the rest of the members of the profession by Dr. Sutherland might have a salutary effect on the others. I take it you don’t want to say that but I am saying it for you. I take it that’s what you meant.

Mr. Foulds: Carefully doesn’t necessarily mean good.

Mr. Roy: The second point -- and I have expressed concern about this as well and I think I mentioned this to the minister in my opening remarks -- is about the question of hospital privileges to doctors. I am very concerned about that and I gave you as an example the legal profession. If someone was admitted a member of the bar and was told that he needed privileges to plead in the courts, it would be totally unacceptable. Yet you have that system in relation to doctors where a doctor is accepted as a member of his profession but often to earn a living and to earn any income he has got to go into a question of hospital privileges. You have a situation very often of the status quo, in which a hospital is not prepared to admit one individual against another.

Are you looking at that question of hospital privileges, because we know there have been problems? For instance, there was the problem here in Toronto about this doctor -- I don’t recall his name -- who appealed and all it cost him. What’s his name?

Hon. Mr. Miller: Schiller.

Mr. Roy: Dr. Martin Schiller. It becomes a ridiculous situation where, if one is going to fight the system, then the legal costs just become prohibitive even for a doctor. I am just wondering if the minister is giving it consideration.

Mr. Foulds: That stretches credibility quite a bit.

Mr. Roy: What does?

Mr. Foulds: That the expenses become prohibitive for a doctor.

Mr. Roy: Let me tell you in the Schiller case, it certainly stretched his capacity. It was something like $45,000 I think he owed.

Mr. Foulds: Six months’ salary.

Mr. Roy: I am asking the minister is he looking at the question of the granting of hospital privileges? I am saying I think most hospitals in this province have people who are responsible, who have the welfare of the community in mind, but in many areas it’s a closed shop. I am just wondering, Mr. Chairman, if the minister might comment on that issue.

Hon. Mr. Miller: Mr. Chairman, the question of open access by all physicians to all hospitals would result, in my opinion, in a degree of chaos in the system.

Mr. Roy: Why?

Hon. Mr. Miller: A hospital board is responsible for the quality and quantity of care given within it. It and its medical staff have the right to determine that the people giving that care (a) can be supported by the physical facilities of the hospital; and (b) have the competence to carry out the duties as required. In fact, they have a series of ways of auditing the care and proceedings of doctors.

In the smaller communities of Ontario, it is very seldom that a physician does not get the right to go to a hospital simply because there isn’t the likelihood of an oversupply, particularly of highly specialized people. I would say many Toronto hospitals -- I wouldn’t restrict it to Toronto -- most of the city hospitals aren’t particularly restrictive in terms of the general practitioner. Their restrictions are more likely to apply to specialists when it comes to allowing them to serve on the staff.

It is not a question of a closed shop. It’s a question of a physical plant being able to handle the people coming to it and the board accepting responsibility for the performance of their work within limits. I would support the system which makes it mandatory for a person to be acceptable to a hospital and that limits of some type may be applied to the privileges he is granted by the board on the advice of the medical advisory committee, if I have got the proper terminology there.

Now, as far as the appeal process goes, the high cost bounces the ball right back into the court of the legal fraternity, doesn’t it?

Mr. Roy: Well, you don t expect lawyers to plead the case for nothing, do you?

Hon. Mr. Miller: No. I don’t. But, surely to goodness, though, in the problem you have pointed out, the costs of an appeal through two or three levels of appeal are common to all lands of justice, are they not?

Mr. Roy: Yes, they are, but the problem is that they’re not the ones who get legal aid.

The problem here is that you have an imbalance of the parties to start with. For instance, in Dr. Schiller’s case you had a hospital board on the other side and they had unlimited funds. Where was the curtailment on the funds they could spend for an appeal?

Hon. Mr. Miller: Whenever it’s the Crown against an individual, does not the same case apply?

Mr. Roy: Well, generally there’s no money involved in the sense that they are the Crown’s cases.

Hon. Mr. Miller: Well, the Crown has unlimited resources to plead its case. I’m only commenting that the courses of justice that we feel are necessary, or the levels of appeal, inherently bring with them costs. Traditionally, the precedent system determines who should appeal. I think you would agree -- you’re a lawyer; you can tell me far more about this than I can.

Mr. Roy: Yes, probably.

Hon. Mr. Miller: In this matter, Dr. Schiller was the first to appeal to the courts. The courts reversed the decision, which is their right to do. Somebody thought I criticized the courts. I certainly do not. I wouldn’t question the judgement of a court.

Mr. Roy: You mentioned the Crown, but let me point out the differences when the Crown is involved and when a hospital board is involved. We have a system in this province -- and it’s even been changed since 1971 -- whereby the complaint is usually apart from the Crown. The complaint -- let’s say the police in relation to a charge -- complains. An independent party, the Crown attorney, comes along. They’re even under different ministers. The Crown attorney looks at it. He’s considering independent, impartial, with no self-interest involved, so you can’t accuse a Crown attorney of being partial. Our whole system works that way. Impartiality is the essence of the system. There is no self-interest involved on the part of the Crown attorney. The public accepts the fact that when the Crown attorney’s case proceeds, it is strictly on the merits of the case and not because of some personal vendetta.

On the hospital board it’s a different story. The hospital board is the one that made the original decision to refuse this man access to the hospital. If they go up to the hospital appeal board and lose, then they have a self-interest at that point to see that their original decision is restored. That, of course, is why they appeal. That’s why I say they have unlimited funds. And there’s self-interest in there, because the people on the hospital board want to see their original decision vindicated.

I’m saying to you that you should do what I think I suggested at one time in this House and put a limit on how far the hospital board can take one of these appeals. I’m convinced that in Schillers’ case, had he succeeded, for instance, at the divisional court, I’ll just bet you that the hospital board probably would have gone to the Court of Appeal and, if necessary, to the Supreme Court of Canada.

I’m saying to you there’s no limit on how far they can go, and there’s no limit on their funds. That is where the difference lies.

Hon. Mr. Miller: Well, I’d have to check up on procedures. I thought there was only one more level of appeal left at that point in time. But even so, the very fact that people learned in the law -- not me -- have decided that there should be these numbers of levels of appeal indicates the human nature of decisions, doesn’t it? As does the very fact that some people may feel that the decision rendered wasn’t fair.

I find it difficult to justify the fact that a board, made up of human beings making human decisions, should be prevented from trying to vindicate their point of view if in fact they feel they’re right.

Mrs. Campbell: At public expense.

Mr. Roy: At public expense.

Hon. Mr. Miller: At public expense. I agree it’s at public expense, and that’s a weakness in the system. The fact is they’re representing the interests of the public in spending that money.

Mr. Roy: Ah, that’s where we may well differ. Some people would say that the interests of the public are not at stake here, but rather the interests of the people on the board. That’s where there’s a big difference. I understand that you can always justify a basic decision in some way, but you’ve got to have a decision like the one in Dr. Schiller’s case to realize the weaknesses in the system, and you should look at that. I am suggesting to you that there should be a limit to how far a board can take one of these appeals.

Having made that statement, Mr. Chairman, may I proceed with the next point I wanted to raise with the minister, and that is a question of drugs?

Mr. Chairman: Not in this vote.

Mr. Roy: Oh, I am sorry, aren’t drugs that were bought for hospitals covered here?

Mr. Chairman: We are on item 2.

Hon. Mr. Miller: Are you talking about the direct line or drugs in hospitals?

Mr. Roy: No, the drugs that are purchased on behalf of the hospitals.

Mr. Chairman: We are not on that vote yet. We are on item 2.

Mr. Roy: Where would that be?

Mr. Chairman: Drugs purchased for hospitals?

Mr. Roy: Yes.

Mr. Chairman: I would I rule that that would be under related activities.

Mr. J. A. Taylor (Prince Edward-Lennox): I am wondering, Mr. Chairman, if I could say something on nursing homes, because we seem to be getting off that subject in this vote.

Mr. Chairman: Wouldn’t that be under extended care, item 3?

Mr. Taylor: We were discussing nursing homes about three-quarters of an hour ago and we seem to be getting into other areas now.

Mr. Chairman: I think we were referring to nursing homes in relation to hospital care, that it would be cheaper.

Mr. Stokes: Alternate facilities.

Mr. Chairman: Alternate facilities. It was not really debated, it was just casually mentioned; that was the Chair s understanding. I have the name of the hon. member for Prince Edward-Lennox. I am wondering if I might recognize the hon. member for Fort William and then the hon. member for St. George?

Mr. Roy: Mr. Chairman --

Mr. D. H. Morrow (Ottawa West): Mr. Chairman, are we on hospitals now or what vote are we under?

Mr. Chairman: It is item 2 in your book -- general hospitals and related activities -- which covers ambulance services, psychiatric --

Mr. Morrow: I want to take an opportunity of saying something about chronic-care hospitals. Are we under that vote?

Mr. Roy: Yes, you are under that vote.

Mr. Morrow: Am I in order at this time?

Mr. Chairman: I would ask you to defer to the hon. member for St. George. However, I have noted that you want to speak.

Mr. Foulds: Mr. Chairman. I believe you read out my name as being removed, for some reason I don’t understand.

Interjection by an hon. member.

Mr. Foulds: No, no, no. I was on the list immediately after the member for Fort William.

Mr. Chairman: May I point out that the Chair made one error here. I had the hon. member for St. George, then I had the hon. member for Fort William, whom I thought had caught my eye, and then the hon. member for Port Arthur.

Mr. Foulds: Oh, that is fine.

Mr. Chairman: So I would like to recognize the hon. member for St. George and then the hon. member for Fort William.

Mr. Roy: I wasn’t finished with my remarks, Mr. Chairman. I wanted to talk about drugs in hospitals, and I was told by you I was on the right vote.

Mr. Chairman: In that case, I recognize, the hon. member for Ottawa Centre.

Mr. Roy: Ottawa East, Mr. Chairman.

Mr. Chairman: Ottawa East. The Chair apologizes.

Mr. Roy: Mr. Chairman, I would like to ask the minister several questions in relation to drug purchasing for hospitals in this province.

I understand you have a system whereby there are different setups for the purchasing of drugs, and I am advised that you purchase drugs for hospitals in three ways. You have a plan called HPI -- hospital purchasing something else -- which purchases for some 38 hospitals. I am advised further that the Ministry of Health then purchases drugs for our psychiatric hospitals in the province. Then you have another outfit called HPP -- that is hospital purchasing plan or something -- which purchases for the balance of the hospitals.

The first question of the minister is, am I right at that point, or if I am wrong, how do you purchase drugs for hospitals?

Hon. Mr. Miller: I am just checking. The choice in the public hospital field is that of the hospital.

Mr. Roy: Pardon me?

Hon. Mr. Miller: The choice of the mechanism by which drugs are purchased is left up to the individual hospital.

Mr. Roy: But generally speaking, do individual hospitals purchase through one of these three systems, usually?

Hon. Mr. Miller: I am told that the HPI is a private organization. It does group purchasing for the member hospitals, I would assume.

Mr. Roy: In Toronto?

Hon. Mr. Miller: In Toronto.

Mr. Roy: All hospitals in Toronto?

Hon. Mr. Miller: I don’t know whether all of them are involved -- about 38 hospitals.

Mr. Roy: That is what I figure I have here.

Hon. Mr. Miller: Thirty-eight hospitals, yes. The Ministry of Health, I assume, purchases its own requirements for the psychiatric hospitals, as you commented. The HPP, I am told, is the Ontario Hospital Association’s group purchasing programme for hospitals which may wish to utilize that programme, based on the assumption that they can buy in bulk quantities for less than for individual purchases.

Mr. Roy: Okay. I understand that these groups here purchase under what is called the tender system. In other words, for instance, “We need ampicillin; so many pounds or so many dollars worth,” and they send out public tenders. I shouldn’t say public tenders, but they do it by way of a tender system. Is that so?

Hon. Mr. Miller: I am told that HPI does.

Mr. Roy: What about HPP?

Hon. Mr. Miller: I honestly don’t know.

Mr. Roy: You don’t know. But I’m getting to a point which I consider to be of importance.

Hon. Mr. Miller: First of all, they’re not ministry-run plans. I think we have to realize that hospitals, just like hardware stores, have used -- maybe that’s a poor analogy.

Mr. Roy: Not to some people.

Hon. Mr. Miller: Purchasing of goods is done collectively by some hospitals because it pays them to do it.

Mr. Roy: First of all, would not the minister, when we consider the amount of money that’s spent on drugs in this province -- I can’t imagine how much it would be, but it would be astronomical, I would imagine -- not be better off to have some central purchasing for drugs emanating from his ministry so that then the hospitals could get it from the ministry?

Hon. Mr. Miller: I think there is always the temptation to think that “big is good” and vice versa. I’ll be honest. I’ve gone around to some of our psychiatric hospitals that would have preferred to have had the right to purchase individually. I don’t know that the administrative costs that we would have on a group purchasing plan which would involve distribution would really not equal or exceed the savings to be realized by letting the marketplace determine where and how these products are delivered.

Mr. Roy: But you see, my concern is this. For instance, HPP is hospital association purchasing plan. I understand there’s a large number of hospitals getting drugs through this system. I understand that they ask for tenders. Once they get the tenders they are not opened in public. Nobody knows how much the tender is -- who is high and who is low and this type of thing. I wonder why it’s not public.

After all, these hospitals are run basically from money that they’re going to get from your ministry, and in the end result it’s the taxpayers who pay for these drugs. You may well say, “It’s not run under my ministry, and therefore I have little control,” but you’re supplying the money. We’re talking health costs. We know you’re concerned about health costs. In fact, there was an editorial the other day which said: “Who is listening to Frank Miller?” I am. I wish you would tell them that. You should tell the Toronto Star that.

Mr. Foulds: The Canadian Press is.

Mr. Roy: They weren’t listening -- not the Canadian Press.

Mr. Foulds: I don’t blame them.

Mr. Roy: No. Mr. Chairman, through you to the minister, do you not feel that you should set some guidelines? The first question to you is: Is that so, that they do it by way of tender but the tenders are not open publicly or in front of the parties to assure that the lowest tender, for instance, is accepted?

Hon. Mr. Miller: I don’t think I’m going to walk into anything without giving it some thought, because it’s so simple to say that we should have our presence at every tender opening.

Mr. Roy: Not you, just the people involved in the tendering.

Hon. Mr. Miller: Yes, I’m quite sure that steps are being taken to make sure there isn’t any hanky-panky, if that is what you’re implying.

Mr. Roy: I’d like to bring to the minister’s attention a problem with HPP which has been brought to my attention. They were asking HPP for something like $500,000 worth of ampicillin -- and I don’t even know what that is. Anyway, apparently this was a contract. The tenders for this were opened sometime in May and there were three bidders involved: Nova, Ayerst and Bristol-Myers.

Of course, they put in tenders for the drug in different forms; they had capsules, injection and liquid. The cheapest in capsule was Nova and the second cheapest was Ayerst and the highest on the capsule was Bristol-Myers. On injection, Nova did not bid because they did not have the drug in that form. Ayerst had the highest, and Bristol at that point had the cheapest for injection. You sort of need a graph to follow this, but on the liquid Nova was the cheapest, Ayerst was the highest and Bristol didn’t bid on the liquid. The drugs of all three companies apparently are approved by Parcost and there is no difference in the quality of drugs.

Apparently the hospitals were told they had a choice to buy from either Nova or Ayerst; Bristol was not in the picture, yet it had the cheapest in, for instance, injection, which Nova didn’t have, whereas Nova had the cheapest, let’s say, for capsules and liquid. But they were given a choice between only Nova and Ayerst, and of course Ayerst are the highest, you see. So we have a situation apparently, I’m told, where the hospitals are buying more from Ayerst because it is a better-known company.

Of course, you are spending more money. We don’t know how many thousands of dollars are being spent because the hospitals have a choice and are not directed toward the lowest bidder. That’s what I mean about tenders being opened not in the presence of the parties or not publicly. It leaves itself open to hanky-panky. No matter whether you are talking doctors, lawyers, judges or anything else, if there are not guidelines and if we don’t do this publicly then it’s an invitation for hanky-panky. I’d like to get the minister’s comments on that.

Hon. Mr. Miller: I am not going to make any comments because I am going to try to sort out what you told me. When I see it on paper, I’ll take it up with the Ontario Hospital Association at its monthly meeting if I’m satisfied there is a problem -- and I think probably there is.

Mr. Roy: I’d appreciate that. I’ve given you some information here which doesn’t give you very much time to get an answer. Can I expect, for instance, an answer or some comment at 8 o’clock on this?

Hon. Mr. Miller: No, I don’t think you can. It is a voluntary organization I’m talking about. I understand HPP hasn’t been very active, if the information I’ve got is correct. I would like to have the opportunity to have this researched by the sponsors of HPP, and I will ask them for information to be given to me. On a monthly basis I meet with the OHA. I’m not sure when the next one is -- in a couple of weeks -- and I’ll get that information. I’ll make it available to you.

Mr. Roy: What about the section in your department which purchases drugs for provincial or psychiatric hospitals in this province? Do they do it by way of tender? If they do, do they open their tenders in front of the parties, and are the bids or the tenders public?

Hon. Mr. Miller: Yes. Yes.

Mr. Roy: And yes. Okay.

Mrs. Campbell: Yes, yes, and no answer.

Mr. Roy: I wanted to know whether they do it by tenders. Yes? Right? Are the tenders opened in front of the parties? Yes? Are we saying yes?

Hon. Mr. Miller: I am nodding up and down.

Mr. Roy: And the public has the right to know?

Hon. Mr. Miller: I gave some negative answers; hold on.

Mrs. Campbell: Apparently the public hasn’t any right to know.

Mr. B. Newman (Windsor-Walkerville): Are they public tenders or invitations to tender? There is a difference between the two. It could be invitation only.

Mr. Chairman: May I bring to the hon. members’ attention that it is now 6 of the clock?

Mr. Roy: Can I adjourn the debate, Mr. Chairman?

It being 6 o’clock, p.m., the House took recess.