Legislative Assembly of Ontario

The House resumed at 8 o’clock, p.m.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

On vote 2901:

Mr. Chairman: Item 1, the member for Ottawa East.

Mr. A. J. Roy (Ottawa East): Yes, Mr. Chairman, I have a few comments on this item. I first of all would like to say to the minister, to inflate his ego --

Hon. F. S. Miller (Minister of Health): Will it be complimentary?

Mr. Roy: Yes, I will be complimentary toward you to start with. This is always a good way to get you to smile.

Hon. Mr. Miller: You have me on my guard.

Mr. Roy: No, don’t be on your guard. You know I’m always acting in good faith.

Mr. R. K. McNeil (Elgin): You could have fooled me.

Mr. Roy: I want to say to you that if you set up -- I really don’t know what the name of it is, but it’s called health services for French, or French health services, or French in health services, or whatever it’s called.

Mr. M. Shulman (High Park): Mr. Chairman, on a point of order. I don’t like to interrupt the speaker -- he speaks so well -- but we should at least have a quorum for him.

Mr. Roy: You are not armed.

Clerk of the House: We have no quorum, Mr. Chairman.

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

Mr. Chairman: We now have a quorum.

Mr. Roy: Thank you, Mr. Chairman. I think I can have far more enthusiasm now that I’ve got --

Mr. R. Haggerty (Welland South): The attention of the people.

Mr. Roy: The attention of the -- well I’ve had the attention of the minister, but, for instance, the House leader being here, with anticipation and all these --

Mr. I. Deans (Wentworth): You and your 10 colleagues.

Hon. E. A. Winkler (Chairman, Management Board of Cabinet): I want to hear about your denticare plan.

Mr. Roy: I’ll tell you about denticare when you tell me about Krauss-Maffei.

Mr. Chairman: Order, please. Get back to the vote, item 1.

Mr. Roy: Tell me about Krauss-Maffei. Tell me about the airport. I’ll talk to you about that.

Hon. Mr. Winkler: What happened at your last caucus?

Mr. Roy: Yes, tell me about it. Tell me about Krauss-Maffei.

Mr. Chairman: Order.

Hon. Mr. Winkler: Oh, you tell me.

Mr. McNeil: The member for Ottawa East wouldn’t listen. He hasn’t said anything yet.

Mr. B. Newman (Windsor-Walkerville): You are getting to them, Albert.

Mr. Roy: Talking about switching of policies. You’ve got your nerve. Tell them about the strikes in the --

Mr. Chairman: Does the member for Ottawa East want to come to order or not?

Mr. Roy: Tell them to quit being provocative.

Mr. Chairman: Order. Item 1. Do you want to speak on item 1?

Mr. Roy: I do, but tell them not to provoke me. I am being provoked.

Mr. McNeil: Then speak on it.

Mr. J. M. Turner (Peterborough): Oh, you want special protection?

Mr. Roy: Now, I was talking about this service you instituted, what is it, about a year ago now? This question of French services within the health system. Three years?

Hon. Mr. Miller: Trois mois.

Mr. Roy: Trois mois. Three months. You are coming along with your French. If you keep pointing and using signs we’ll communicate.

Hon. Mr. Miller: We will communicate.

Mr. Roy: What I want to know basically is if this is a separate entity within your department. If it is, what sort of personnel or what sort of budget do you have for these people, and basically, what are your plans? I think my questions are relatively simple.

I want to congratulate you for embarking on that sort of programme. It’s something we’ve not succeeded in doing with other ministries, and I think a lot of credit should go to you for instituting what I consider to be a necessary programme. I think it’s important that people who are sick and who need services be able to communicate not only with their physician but can get their services in a language they can understand. I want to congratulate you about that.

Hon. Mr. Miller: I was tempted to answer in French to show that --

Mr. Roy: Go ahead.

Hon. Mr. Miller: Voulez-vous que je reponds en français?

Mr. Roy: Oui, oui.

Hon. Mr. Miller: Okay. Je pourrais faire ça. But I think I’d better not, for the sake of the balance of the audience.

Mr. Roy: Okay, you and I will go outside afterwards.

Hon. Mr. Miller: The committee is made up of representatives of the francophone population in Ontario. I think there are approximately 10 members on it who were appointed to the committee three or four months ago. They now have a full-time secretary. That was one of their requests. Their duties were simple and yet not easy -- simply defined but not easily carried out. They were to study the problems of the French-speaking Ontario citizen obtaining health care in the Province of Ontario in his or her native tongue and determine where the greatest areas of need were and what steps could be taken to resolve the lack of service in any particular areas of need.

Mr. Roy: These 10 members obviously are, what, an advisory group? They are obviously not full-time people?

Hon. Mr. Miller: No. They only meet once or twice a month,

Mr. Roy: Once or twice a month. And have they given you recommendations yet? They are just studying the situation now? Well okay, at least that’s a start. I look forward to seeing some of their recommendations.

I want to go to a point which I think is related to that, because I can’t pin it down under one of the other items in the estimates. I discussed it in my opening, the cancer clinic at the Ottawa General Hospital. I want to relate to you some experiences of people who have told me about this clinic at the Ottawa General, because this involves not only hospitals but it involves administration as well.

Hon. Mr. Miller: Could I stand for a point of order for a second, Mr. Chairman? I have no objections to talking about any point at any time, but we were talking earlier about trying to stay with the vote itself; vote 2903 item 2 is where this topic would normally be discussed.

Mr. Roy: I’m trying to be very specific and stick to the items myself, and I’ve done it. It’s the Ottawa General Hospital all right, but I’m talking about administration of a clinic. Are you prepared to deal with that at that time? I’m prepared to wait until that time.

Hon. Mr. Miller: I’ll deal with any topic, but I’d like --

Mr. Roy: My colleague from the other party was talking about community health centres -- I think I’m in the right vote here -- in answer to one of his questions you said that you were negotiating with some 36 centres across the province. I want to ask you whether included in that would be a centre in Ottawa which was started under the administration of your predecessor, Bert Lawrence. There were further negotiations with Dick Potter, and I don’t know whether they’re involved with you. It’s in west-end Ottawa, and I want to relate to you --

Hon. Mr. Miller: What’s the name of it, please?

Mr. Roy: I’m not really too sure what the name of the centre is. I know the Civil Service Association was involved.

Hon. Mr. Miller: Sandy Hill?

Mr. Roy: No, it’s not Sandy Hill; it would be in west Ottawa. I’m not sure that they had a name for it.

Hon. Mr. Miller: Clinique Ste. Anne?

Mr. Roy: No, Clinique Ste. Anne is in my riding, in lower town. This would be in west Ottawa. Are there any other clinics?

Hon. Mr. Miller: Centre town?

Mr. Roy: No, you’ve got to go farther west.

Mr. W. Ferrier (Cochrane South): By-Town?

Mr. Roy: No, you’re right in the canal there. You’re really in trouble there at By-Town.

Hon. Mr. Miller: Community Service Centre?

Mr. Roy: Do you have an address for it?

Hon. Mr. Miller: No. I can try to find one.

Mr. Roy: I know Claude Edwards and people like that from the civil service in Ottawa were involved with it. I don’t think they had a name for it, or if they did it certainly escapes me.

I want to relate to you how you can dampen the enthusiasm of individuals who are trying to set up this type of centre. Originally these people --

Mr. Chairman: I must remind the member for Ottawa East this could be more appropriately discussed under vote 2902, development of health resources.

Mr. B. Newman: We had a whole hour on it just before six.

Hon. Mr. Miller: Mr. Chairman, we spent a whole hour on this earlier.

Mr. Ferrier: He is halfway through discussing it, why don’t you let him finish?

Mr. Roy: Mr. Chairman, we were discussing this prior to the dinner hour.

Mr. Chairman: Okay, I will yield. I wasn’t here prior to the dinner hour. I really think, as chairman, it would more appropriately come under vote 2902, item. 2.

Mr. Roy: Unfortunately, Mr. Chairman, you’re stuck with the precedent established by your predecessor in that chair, and you’re going to have to be consistent. However, I want to thank you for the opportunity of continuing, Mr. Chairman.

I want to say to the minister possibly he can give me an answer on this later. This particular centre was in west Ottawa. When they set it up they were given a commitment by your predecessor, Bert Lawrence, the member for Carlton East who at that time was the Minister of Health. He made a commitment to that centre. These people, following his directives, changed the location of the centre. They were operating on the basis that they were going to receive government approval and government support. Following government directives, they were enthusiastic about the operation of this centre. When your predecessor, now the Minister of Correctional Services (Mr. Potter), came into the ministry, he put a damper on the whole situation and said the commitment was no longer --

Mr. Haggerty: He put a damper on quite a few things.

Mr. Roy: Yes, he did. That’s one of the things which I think somewhat bore out his personality, or his approach, his philosophy toward health centres.

He said the commitment made by his predecessor was no longer valid and that he had certain reservations about community health centres. He came down to Ottawa and was somewhat abrasive, which was his nature actually, and told the people down there that unfortunately he could not see any funds for the operation of it.

I understand from these people they have received more favourable support from you since you’ve been minister, but I point out to you the difficulty in certain areas of this province when you’ve had that type of inconsistent policy on the part of your ministry. I know the frustration of this group of individuals who spent untold hours, unpaid hours, who were devoting free time to set up this centre. They had received encouragement from Bert Lawrence and then the present Minister of Correctional Services came into the picture and said to them: “That’s out.”

I thought it was important to point this out, because I think it is important that if we set a policy in the Ministry of health -- I can talk about the denturists, for instance, in the way of inconsistent policies, but I don’t want to dwell on that again -- it’s important that if we do set a policy we do it for a period of time and be consistent.

I appreciate that priorities may well change; that funds may not be available for certain other things. But if in the health field we are to receive support from people who are prepared to give it without being paid, free services, who give devotion and are dedicated to the cause of health, I think it is important that we approach them on a consistent basis.

I want to ask you whether this centre is one of the 36 -- or one of the centres -- which are being given consideration. It’s a centre in west Ottawa -- I’m sorry I don’t have the name, I’m not really too sure they do have a name because of having been frustrated by the previous minister. I thought they had given up their intention of establishing a centre.

In Ottawa, I know there is a centre, Clinique St. Anne, which is in my riding. They’re establishing one now, I think, in Sandy Hill on Somerset St. -- I think you mentioned that one. There is one, obviously, in centre town and this one was in west Ottawa, southwest Ottawa. If you had the name there maybe I could be of assistance. Do you have that in your notes?

Hon. Mr. Miller: Mr. Chairman, I can’t identify the name. There were about six names for groups which were in either the active discussion stage or the preliminary discussion stage in Ottawa. I read them off at one point but none of the names seemed familiar to you. We’re assuming we’re talking about the group you’re talking about when I give this answer -- I’m not sure I am so if you can find the name, we will be specific about it.

I do recall the previous minister going to Ottawa and I do recall him stating that a certain community health centre would not proceed. This would be early 1973, I would guess.

I suppose one of the dangers in initiating discussion with a group of volunteers is that you are automatically assumed to be granting permission for the eventual creation of any hospital or community health service or whatever it is that group is studying. In this particular case and in other cases around the province too, after talking to the first group of enthusiastic people, I understand the ministry found the area was exceptionally well serviced by physicians. When this happens, we have already discovered there is often a very sharp division in the medical fraternity over the need for further services. We will gladly work with existing physicians in an area who wish to regroup into an HSO.

We find it difficult to justify setting an HSO in an already well-serviced area by bringing in more physicians who are supplementary to those already delivering service.

Mr. Roy: What does the minister call HSO?

Hon. Mr. Miller: Health service organization.

Mr. J. E. Stokes (Thunder Bay): Try to keep up.

Hon. Mr. Miller: This appears to have been the case in the area we are talking about. It also occurred in Brampton. When you already have physicians, as we did in Brampton-Bramalea, actually finding it difficult to find patients on a fee-for-service basis, it is pretty darn hard to put five or six fellows in the same community and give them a guaranteed income.

The purpose of the matter is to create services in areas of need, or to allow existing, developed practitioners to change their method of operation so they can make use of some of the other paramedical personnel who currently are limited under a fee-for-service system from doing certain things that doctors will let them do, but for which OHIP and the federal regulations will not permit payment.

Mr. Roy: Just to get back to my question. Assuming we are talking about the same centre, are there no discussions going on with them now? You feel the area is sufficiently serviced by --

Hon. Mr. Miller: If the member is talking about the same area.

Mr. Roy: Okay; I will be checking that out.

You undoubtedly read the article about the Clinique Ste. Anne in lower town Ottawa, which was published in the Toronto Star some three or four months ago. It was, I suppose, a shining example of how an underserviced area can receive quite adequate service with what we call allied health professionals, and in this case the nurse practitioners. There has been no mention during the minister’s discussions with my colleague, the critic for the NDP, about that particular centre. This was one of the first in Ottawa. I just want to get your assurance that it is operating adequately and will continue to receive government approval.

Hon. Mr. Miller: Yes, I have got a full page on Clinique Ste. Anne, and it summarizes the ministry’s assessment of it. I would say that looking at it very quickly that it is obvious in an area of need. It is serving a purpose. We have certain reservations about the management of the clinic from a business point of view, not from a health point of view.

Mr. Roy: What is the minister talking about -- the management? I understand there is a group of volunteers who act as management; is that who the minister is talking about here?

Hon. Mr. Miller: No, I am talking about employees.

Mr. Roy: The employees? I don’t want to elicit any information that might be improper or might be derogatory towards these individuals, but what staff is the minister suggesting, the nurses?

Hon. Mr. Miller: It is a bit difficult to make criticisms of an enterprise like this in the Legislature. I don’t have personal knowledge of the facts I am discussing, so I am repeating what I see here. I am sure that you would find our staff having quiet discussions with a group like this, pointing out their areas of need.

One of the things I learned early in the game, and I think it is generally accepted, was that physicians aren’t always good business managers. On the rare occasion they can write a book on how to make a million, but there are exceptions to the rule.

Mr. Roy: Even at that they make mistakes.

Hon. Mr. Miller: He even has to carry a gun to protect him.

Mr. Ferrier: What about the member for Oshawa (Mr. McIlveen), where does he stand? Is he a good businessman?

Mr. Stokes: He is not a businessman, he is just an operator.

Hon. Mr. Miller: However, the fact remains that if there is an area of weakness, it is in the administration of smaller clinics and the business management of smaller clinics; this is what I was implying.

I believe our staff have been having discussions with that group. If they haven’t, I will certainly ask them to make sure that any statements made to me for information purposes are passed on to that group.

I had a group come to see me not long ago and I believe at least one, and probably two of them were from Ottawa, suggesting that an essential part of the health service organization was a packaged management plan, almost like Harvey’s gives the hotdog stands. I hate to make that comparison on a day like this.

Mr. Roy: They talk about Col. Sanders.

Hon. Mr. Miller: Yes, I think that would be a more apt comment today.

Mr. J. Dukszta (Parkdale): Because you are concerned about all that meat?

Hon. Mr. Miller: In any event, management techniques can easily be packaged and sold, and supervised relatively easily. It’s a sad fact that not too many professionals -- and it’s not just physicians I’m sure -- make use of such techniques. We feel that might eventually become a part of the HSO system.

Mr. Roy: You mentioned that many of the centres have to rely on the services of allied health professionals, and of course that’s in line with Dr. Mustard and his recommendation for primary health care. Is the programme in relation to nurse practitioners still going on at McMaster? Is that the only place they are graduating or is there somewhere else?

Hon. Mr. Miller: McMaster is ongoing; and I’m not sure, Toronto could be phasing out. One of the problems currently is the shortage of places for nurse practitioners to fulfil their role.

Mr. Roy: That’s right.

Hon. Mr. Miller: That, to me, is a serious problem. The second problem I mentioned earlier.

Mr. Stokes: Shortage of places?

Hon. Mr. Miller: I am talking within -- not in the north.

Mr. Stokes: As long as everybody understands that, including you.

Hon. Mr. Miller: I just didn’t want to have you --

Mr. Roy: Did he sell you any tickets?

Hon. Mr. Miller: Yes, he did. I have my ticket in my pocket and if I win it I get a free ride.

Mr. Roy: Only one for the minister?

Mr. Stokes: If you win it and they get their ambulance we will guarantee you the first ride in it.

Mr. Roy: He will probably need it.

Hon. Mr. Miller: What I’m worried about is you might make sure I need the first ride in it.

I’m very interested in the nurse practitioner programme. We have an imbalance, though, in the supply of the various categories of health personnel on the medical side. With the existing over-supply of physicians in southern Ontario we have certain problems in using nurse practitioners fully.

Mr. Roy: Now you’ve decided not to go ahead with your denticare programme I wanted to talk about whether you had anything in mind about preventive dentistry. I suppose I should be talking about --

Mr. Ferrier: What happened to your denticare programme?

Mr. F. Laughren (Nickel Belt): Tell us about your denticare programme.

Mr. Roy: I have talked about it openly, I’m not hiding anything.

Mr. Laughren: Is it a priority?

Mr. Roy: It is a commitment of the Liberal Party; there is no question about it. I’m not ashamed to say it. I’m proud of it. Tell me about your policy. You guys could talk policy all day and never be in a position to implement it. That’s your problem. At least we can talk responsibly.

An hon. member: That is your leader talking.

Mr. B. Newman: Don’t let them bother you.

Mr. Roy: Tell these guys to pull themselves together, Mr. Chairman.

Mr. Chairman: Order. If you are going to talk about health protection, it is not until the next vote.

Mr. Ferrier: Explain it to them.

Mr. Roy: I suppose I should be talking about vote 2902.

Hon. Mr. Miller: I wouldn’t want to politic at this tender point in time.

Mr. Chairman: I wouldn’t want you to, either.

Hon. Mr. Miller: But it is nice to see how we can continue to win when I see such harmony opposite.

Mr. Chairman: Can we have item 1 carry?

Mr. Shulman: No.

Some hon. members: No.

Mr. Chairman: We have been all over it, right from item 1 to item 4, with the last speaker. Would the member for High Park like to speak on item 1?

Mr. Shulman: Yes, please. I want to pursue this St. Mary’s thing for a moment, because I’m quite confused at what’s happening there. I know it’s very important; everybody in the medical association -- using the term very broadly -- agrees that what’s happening there is very important.

Two sets of figures have been put out, one showing that you’re saving money and one showing you are spending more than with another group of physicians who would be in ordinary general practice. Do you have any authoritative figures to tell us what is happening in St. Mary’s?

Hon. Mr. Miller: Mr. Chairman, had the member for High Park been here this afternoon --

Mr. Laughren: He was, for a while.

Mr. Roy: He was here armed to the teeth.

Hon. Mr. Miller: He still has teeth to be armed to.

Mr. Shulman: Sorry. If the minister has already given that information I won’t trouble you to repeat it.

Hon. Mr. Miller: We went on at great length about the problems of assessment of the HSO as a cost saving or a health-delivery agency, and in response to questions from the member for Parkdale, we discussed what we were doing about it at some length. As to St. Mary’s specifically, we pay them, I think it is 82 per cent of the provincial per capita rate for medical services. I think they are getting about $5.14 per patient per month or something of that nature.

On the surface, everything looks fine. There have been criticisms about the validity of the roster of patients shown, I believe. There have been some coming to me directly, and this is one of the problems. I have had some communications with the clinic itself in the last few days. I think they were sparked by the editorial in the Toronto Star the other day which referred to this specific clinic as a good model.

I have been relatively encouraged by this one, subject to a hearing the other side of the story up to date. I can’t verify that our figures are wrong yet.

Mr. Shulman: So at this moment you are not in a position to give a conclusive answer, is that fair? Okay. Of course, this is probably the ultimate answer that you are going to have to come to on controlling costs.

In another matter, the minister may not be aware that the faculty council of the University of Toronto School of Medicine met some two weeks ago and voted, not unanimously but by a majority, to ignore everything that was said here in the House about the admitting policies at the University of Toronto, and they voted to continue in exactly the same way as they have done in previous year. They are going to make no difference between Canadian citizens and landed immigrants. In effect, they have thumbed their nose at the views expressed here. Is there anything the minister of this House can do about it, or is this a body responsible only unto itself?

Hon. Mr. Miller: No, there is nothing I can do.

Mr. Shulman: Wait a minute --

Mr. Roy: That is a Colleges and Universities matter. That is not what we are considering.

Mr. Shulman: You were going to make some representations to your colleague who has the purse strings. Have you done that?

Hon. Mr. Miller: You asked me what I could do?

Mr. Shulman: Yes, what will you do?

Hon. Mr. Miller: I told you honestly there is nothing I can do.

Mr. Deans: There sure is.

Hon. Mr. Miller: Now, it is maybe too simple an answer -- you are used to obfuscation -- but the fact remains that Colleges and Universities administers the universities of this province. Each university has a senate or a governing agency which determines the policies of that university. The University of Toronto has seen fit to have a policy for admission to the University of Toronto medical school based upon marks and marks alone. You ask me my opinion? I disagree with it.

Mr. Deans: Don’t we pay the bills?

Mr. Shulman: Okay. I will not pursue you further on this. I will go to the other minister when his chance comes. Sorry, do you want to pursue this before I go on?

Mr. Deans: I don’t know why you don’t want to pursue it.

Mr. Shulman: He says he can do nothing about it. What’s the use of pursuing him? What’s the use of hitting a man over the head if he says he can’t do anything?

Mr. Deans: Of course he can do something.

Mr. Shulman: I will let you pursue it.

Mr. Deans: Isn’t he part of the cabinet?

Mr. Shulman: You pursue that and I will go on to my own subjects.

Mr. Deans: I want to ask, why is there nothing that you, as the Minister of Health, can do about it? You are responsible, surely, for those people once they become doctors. If there is something wrong or something you disagree with in the admission policies of universities in this province that are substantially supported by taxpayers of the Province of Ontario, then surely there is something that the government -- the government, not necessarily you personally, but you as a representative of the cabinet, representing the government of the Province of Ontario -- can do.

I have been through this bit with the universities, where they tell us they run their own show and that we can keep the devil out of it, but the fact of the matter is, as far as I am concerned, that’s not the way to meet public responsibility. If you disagree with them, then surely you have a responsibility to make representations to your colleague and suggest to him that there ought to be some changes made?

Hon. Mr. Miller: It’s very tempting to assume that government in a central position should order what everybody is to do. I listen to your party day after day tell us we need to decentralize authority.

Mr. Deans: That’s right.

Hon. Mr. Miller: The authority is decentralized to the senate or governing body of the University of Toronto.

Mr. Deans: That’s wrong.

Hon. Mr. Miller: -- and they’ve made certain decisions.

Mr. Haggerty: Yes, but who appoints them?

Hon. Mr. Miller: I can’t answer that because it has nothing to do with my ministry and I don’t know.

I have never hidden my own personal opinions on the matter. They are my opinions, They are not the government’s. My first responsibility, to my mind, is to the students of the Province of Ontario.

Mr. Chairman: The member for High Park.

Mr. Deans: I don’t know whether you are right or wrong, I just feel --

Hon. Mr. Miller: I can say, in parting -- yes?

Mr. Shulman: I am not yielding.

Hon. Mr. Miller: Maybe I can’t do things, but I can talk about the problem.

Mr. Deans: I am not going to argue whether you are right to wrong in your view, but have you expressed that view, since you are the Minister of Health, to your colleagues in the Cabinet?

Hon. Mr. Miller: I believe one day the hon. member for High Park even challenged me to say it on TV, and I don’t believe I shrank away from the task then.

Mr. Deans: I am not asking you if you are shrinking from it, I am asking you if you have discussed it with your colleagues.

Mr. Haggerty: Stand up to it.

Hon. Mr. Miller: It is very difficult for me to say what is or what is not discussed by cabinet. It is not my place to do it. I offered my own personal opinions.

Mr. Chairman: The member for High Park.

Mr. Shulman: I want to continue on a related matter, which is really the most important thing. It’s the only thing I really came down to talk about tonight, this tremendous --

Mr. Roy: Good, I hope it’s important.

Mr. Shulman: It may not be of importance to the Liberals, but I think maybe --

Hon. Mr. Miller: It’s cheaper to have you here.

Mr. Roy: You are right there.

Mr. Shulman: No, you are quite wrong. If I start office hours at midnight I can charge $17 a call.

That’s really what I want to talk about, the fact that we are heading straight to bankruptcy with this budget of yours. It blows my mind to look at the amount of money you are putting out in the various areas under your authority. Yet I see you going around the province making speeches to all sorts of groups saying how we must save money. You close a hospital ward here and you refuse a heart unit in Windsor, and you put your finger in the dike here and then the water starts pouring out there and you put your finger over there; and with all your finger- putting-in-dikes, we are spending more and more and more.

You really haven’t come to grips with the major problem. What is the point of trying to save a few thousand dollars on kidney units, which is one unit in which you have cut back --

Hon. Mr. Miller: No.

Mr. Shulman: Yes, you have.

Hon. Mr. Miller: Not I.

Mr. Shulman: Your ministry.

Hon. Mr. Miller: No.

Mr. Shulman: All right. Your deputy.

Hon. Mr. Miller: The hospitals.

Mr. Shulman: The hospitals because they couldn’t get the money from you; okay, the hospitals which couldn’t get the money from you.

But here in Toronto you have not really attacked the main sources of waste, which are to this day tremendous duplication of facilities. This is a tremendous waste, involving various fields and not just medicine.

Just to digress for a moment, are there any controls yet on the paramedical? I was going to say paramilitary; I guess that’s Freudian. Are you checking up at all on the individual bills sent in by chiropractors or podiatrists or any of the others? Can you answer that before?

Hon. Mr. Miller: Yes, we had a medical review committee set up some time ago and I think it was very effective. I hope you do.

Mr. Shulman: Yes.

Hon. Mr. Miller: The practitioner review committees have been created for exactly the same purpose in the other four groups which receive OHIP payments for part or all of the services rendered.

Mr. Shulman: And as a result of those review committees have you --

Hon. Mr. Miller: They have just begun.

Mr. Shulman: Oh, when did they begin?

Hon. Mr. Miller: Just in the last month, just over the last month.

Mr. Shulman: Just over the last month. Why did it take so long? Oh, never mind, it doesn’t matter.

All right, you’ve got them now, but the fact remains that the medical system as we have it -- whether we are talking about doctors or podiatrists or chiropractors -- encourages over-use. It is set up so that every time a patient walks into a doctor’s office, the patient and the doctor are both rewarded. The doctor gets more money, the patient gets more comfort. This kind of system, no matter where it has been tried, anywhere in the world, automatically leads to astronomically increasing costs.

I agree with you it is a terribly difficult thing to come to grips with politically, but unless or until you come to grips with the problem of duplication of facilities within the hospitals, you are never going to make a dent in this budget of yours.

Every little thing you do is going to mean nothing; and the longer you stay in there three things are going to happen: You are going to be saving little tiny patches here and there; your estimates are going to go up higher and higher; and the third thing, so is your blood pressure.

I suggest instead of wasting your time and effort on these minor irrelevancies -- because that is what they really are -- you have to come to grips with the major problem, which is that the system is set up to encourage waste. In order to stop the waste you have to change the system.

I am not sure my colleague from Parkdale and I will agree entirely on the way to change the system, but I think we will agree it must be changed. There has to be a way brought in to encourage both the doctors and the patients to economize on medical care. With the greatest respect to my friend from Ottawa East, to talk of preventive medicine is really ludicrous at this stage. If you try to bring in a proper preventive medicine system in this country we will be bankrupt by next year. There just isn’t enough money for it.

Mr. Roy: How are you going to bankrupt the province if you bring in seatbelt legislation?

Mr. Shulman: That isn’t the type of preventive medicine I had in mind. That is free, that won’t cost anything but a proper system of examination. Right now what they have been forced to do, or his predecessor was forced to do, is cut back on preventive medicine.

This is very interesting. This has happened in the last year. We see a steady cutback in preventive medicine in the medical field, and it is very interesting to watch this.

The first thing they did -- they used to pay women to come in every six months to have a Pap smear; they eliminated that. The next thing they did was cut back on the payments made to general physicians for annual health exams. We used to get $15, but they did something very clever; they pay you more now if you treat a sick person and less if you treat a well person. An annual health exam is now worth $11 whereas three years ago it was worth $15. An office call, which before was $6 has been increased to $7; and a house call which was $9 has been increased to $12.

What they have done is use the carrot and the stick exactly the wrong way as far as preventive medicine goes. They are saying preventive medicine isn’t so important so we are going to pay you less for that; treating sick people is more important so we are going to pay you more for that.

As far as preventive medicine goes we are moving in exactly the wrong direction by design. It is really quite extraordinary to watch it. I say to you no matter what you do in tinkering at that part of the system, it has been tinkered at very subtly and very cleverly to get doctors to stop carrying out preventive medicine and to treat the ill instead, which pays better.

It is an incredible thing, but that is what they have done. Until he is prepared to come to grips with this problem, I suggest to the minister that somewhere along the line someone in some party will have to bite the bullet and face the fact that this particular system is going to bankrupt us. I can’t believe the minister will disagree with me. Will you comment?

Hon. Mr. Miller: I don’t disagree with you. I guess if you looked at my speeches around the province, I keep on saying just that.

Mr. Shulman: But what are you going to do?

Mr. Roy: Your two predecessors have been saying the same thing.

Hon. Mr. Miller: I think I have been saying it more consistently and perhaps with more force than it was said before, and with more certain belief that what I am saying is true.

Mr. Shulman: But what are you going to do?

Hon. Mr. Miller: All right. I think we are already setting in motion certain steps which will, I hope, put a lid on the growth in health care spending, because I am not at all sure that spending more money makes healthier people.

If I felt for sure it was going to make healthier people I would be the first to be here demanding more money. It doesn’t; there is good evidence to show it is not only subject to a law of diminishing returns, but perhaps a negative effect after a certain point in the climb.

First of all, you do not change a system rapidly. I hope you would accept that fact. You have many people practising medicine and in the hospital system of Ontario totally, absolutely committed to their beliefs. These beliefs are hard to change. I have been trying to change them because I have learned you don't really order people any more to do things; you convince them of the need to change. I feel a modicum of success has been achieved in this area.

Second, within the ministry, about 15 months ago we set out to define our own objectives more clearly; to understand better what was adding to this growth in costs in the health care system, to determine what variables were subject to management. Now that’s pretty well along the way.

A direct result of that analysis was that the cost of the health care system was a linear equation, or directly proportional to the number of physicians in the system -- at least it is within our present numbers of physicians relative to the population. I know you could extrapolate it to a ridiculous state, and sooner or later it wouldn’t be true. But within the limits of our likely knowledge it is.

So we did take the step -- and I think it was a drastic but necessary step -- of immigration control. We talked about that at some length last night. I would rather not repeat my comments, because they are now in Hansard.

But that was estimated to have a cumulative annual saving of close to half a billion dollars a year within a five-year time frame, if we could simply stop the increase in the number of physicians in Ontario past the current ratio. That isn’t a saving, it is simply applying the brakes to the growth.

Even in my wildest dreams, I have no ideas of cutting costs in health. If I can maintain the rate of growth of my budget at something close to the inflationary rate, I will think I have achieved success.

Now Ontario hasn’t been bad compared to other jurisdictions, in spite of the statements you make to the effect that it is growing faster. Even creating a district health council is an important building block. I’ve stated often that I’m not sure it's going to work, but we’ve been dealing with those areas that are willing to try it. We are trying to get local priorities set. For the first time ever, I am told, the hospitals in the city of Toronto came to our ministry with a list of priorities this year. That, to me, is certainly encouraging. Ottawa came to us with a list of priorities agreed upon by the local health council -- that’s encouraging.

Some cities -- North Bay, Hamilton, Kingston -- even without the presence of an official health planning council, have done quite a bit to start eliminating the duplication of those costly services you talked about. I couldn’t agree with you more; there is so much money spent in duplicate facilities.

In the two-hospital cities of average size around the province, it’s difficult to justify the second hospital at all, but they’re there. And when they’re there, I’m faced with the fact that we need to shift certain departments so that there aren’t two, one in each hospital, in the city. That’s the Windsor story -- with five hospitals, I believe it is, in the Windsor area -- and in the attempt to rationalize this costly duplication.

Real savings come by the complete closure of facilities. I can quote figures for a 23-bed hospital in the Province of Ontario --

Mr. Shulman: Crazy.

Hon. Mr. Miller: -- that’s running at $500,000 a year and running about 60 to 65 per cent occupancy most of the time; with a 120-bed hospital nine miles away running 40 to 50 per cent full most of the time. It's a waste of money.

Mr. E. R. Good (Waterloo North): How do they get there?

Hon. Mr. Miller: We’re taking steps. Pardon?

Mr. Good: How do they get there?

Hon. Mr. Miller: Okay, hindsight is great. I wasn’t around here, and I don’t think I would have been any brighter than anybody else if I had been.

Mr. Roy: No, but the Tories have been around for 30 years.

Hon. Mr. Miller: Yes, I am not arguing that. I think there are many things that we believed in very strongly as a community in the past. We believed that if communities were willing to raise their third share for capital, they should get the facilities they raised the money for. We believed that more hospitals meant better health care, and it’s only when we got that many that we began to realize they didn’t. Sure, it’s easy to say we were wrong.

Mr. Shulman: We were all wrong.

Hon. Mr. Miller: I think the whole province was wrong and we just have learned that a bit late. Trimming a system back that exists is much harder than preventing the growth of a system. I have that enviable job for the next -- well, it depends on you fellows, but --

An hon. member: Don’t worry about them.

Hon. Mr. Miller: -- for the next while anyway.

Mr. Roy: We will give you about three more months.

Hon. Mr. Miller: There are days when I have these Freudian slips or these paranoic states when I look across there and say: “Boy, I would love to be asking the questions.”

An hon. member: You will get that chance.

Mr. Roy: I tell you something, you wouldn’t be getting the answers we have been getting from over there.

Mr. J. F. Foulds (Port Arthur): That’s the most revealing comment I have ever heard. That is exactly right.

Mr. Chairman: Order. Can we get along with vote 2901?

Hon. Mr. Miller: We can agree upon the need for change. The question is at what rate will the population that is totally sold on health care accept it? Let me just try to get to one thing here. You keep on mentioning Pap smears and general assessments.

Mr. Shulman: Yes.

Hon. Mr. Miller: A general assessment is 90 per cent of $16, one per year.

Mr. Shulman: I am sorry, an annual health exam. A general assessment is 90 per cent of $11.

Hon. Mr. Miller: You can have both general assessment and an annual physical at $11 once a year.

Mr. Shulman: Right, but you can’t have a general assessment unless you are sick. You get an annual health exam which used to be $15 but is now $11.

Mr. Ferrier: You can’t argue with the doctor.

Hon. Mr. Miller: I think we should talk about the Pap smear issue because -- and I want to be corrected as I don’t want it to go in the record wrong -- it’s my understanding that we have not limited Pap smears ordered by physicians.

Mr. Shulman: No, may I correct you?

Hon. Mr. Miller: You can correct me but I have got the general manager of OHIP in front of me.

Mr. Shulman: Let me explain. There used to be until two years ago what was called a well female examination. A woman was allowed to come in twice a year perfectly well to have her pelvis examined and have the Pap smear for which the doctor was paid $10. This was eliminated. A woman may still come in and get a Pap smear for which the doctor is paid $3. Obviously, it’s not very economic --

Hon. Mr. Miller: That’s progress.

Mr. Shulman: Yes, progress in the wrong direction. Obviously no doctor is going to do that, so in effect the women don't come in for well examinations. They only come in if they are ill or they come in for their annual health exam.

I don’t want to make a big thing of that. I understand why it was done. You are trying to cut money. That wasn’t the point I wanted to make.

The point I want to make, if I can just say this to the minister, is that I look at your figures here and two years ago you were spending $2 billion. This coming year you are going to spend $3 billion. You have gone up by 50 per cent in two years. Eliminating the new doctors coming in obviously was the correct thing to do. I agree with the minister completely but it isn’t going to stop this tremendous growth rate. I wish I could have next year’s book because next year’s book is going to be $3.5 billion.

Hon. Mr. Miller: I hope it is only that much.

Mr. Shulman: You hope it is only that much? There are two things you can do and I will tell you what I would do if I were the minister, and I would never be able to run again as I would lose the next election. There is only one way you can really come to grips with it. There are two places you can cut. One is the hospitals.

Within one mile of this building, we have a duplication of facilities in the Toronto General, the Mount Sinai, the Wellesley and the Grace. They are all doing the same thing and, what is even more incredible, all with wards shut throughout the buildings. Surely somewhere along the line all of our past mistakes have to be admitted. I am the first to agree with the minister. We all made those mistakes.

We all had a different idea at the time because government didn’t have this tremendous financial burden and hospitals then weren’t paid for by government. There were private wards. Money was raised through charities. All sorts of different ways were used to raise money and the people who were on the boards quite literally paid their way. That doesn’t apply any more.

Surely we have to change the old system, which doesn’t work. Two or three of those hospitals should be shut down. It doesn’t make sense to shut two floors in the Mount Sinai, two floors in the General, two floors in St. Michael’s. Shut down some of the buildings. Let those buildings be used for other things. Then you will save millions of dollars. You will make a major saving. If a few people’s feelings are bruised for a short time, so what?

The other thing is you have to tackle the medical problem. You can’t allow us in the medical profession and the podiatrists and the chiropractors and all of the other people in effect to take what they want out of the candy jar. You have got to limit them. There are only two ways you can limit them. One is a deterrent fee. And if you don’t want to use the deterrent fee, the only way to do it is a panel system.

Hon. Mr. Miller: A what?

Mr. Shulman: A panel system -- St. Mary’s. You have to do one or the other. If you don’t do it these budgets are going to grow like mad. Our deficit of $1.5 billion this year will look like nothing. That’s all coming out of your department, that whole $1.5 billion. If it wasn’t for this tremendous disaster we have got into, the government would not have to run a deficit this year. You can’t run a deficit like that in this province for two or three years. Never mind a triple-A rating, you won’t be able to borrow money. Now, it’s up to you; you are the guy in charge.

Hon. Mr. Miller: I’m not disagreeing with you at all. I’d be pleased to have you write my speeches and I would --

Mr. Shulman: Never mind the speeches, give me the power.

Mr. Roy: He has already.

Hon. Mr. Miller: No, I think you would settle for the glory.

In a democratic society it is not as easy as you’ve just enunciated. I’m not afraid to make those decisions; the fact is that the people of the province don’t believe that they are correct. And I think it’s a duty of mine, and of yours as individual members, to help me when I am faced with this kind of problem.

Mr. Shulman: We are trying.

Hon. Mr. Miller: I would appeal to the member for Windsor-Walkerville to argue with me about what specific changes need to be made in Windsor. But for goodness’ sake, back me about the need for change.

Mr. Roy: I will show you where you are wrong.

Hon. Mr. Miller: I will ask the member for Ottawa East to help me when the time comes, and the member for Sudbury, because Sudbury is an area that needs some rationalization.

Mr. Roy: I have been talking costs for four years --

Hon. Mr. Miller: I am only saying that I am willing to do this. I do need understanding and I do need a lack of political -- what would the word be? -- opportunism perhaps, in siding with the apparent wishes of the public when we try to make savings that are in their interests in the long run.

Look, I have projected my budget for your interest. You’ve talked about it being $3 billion this year -- $11.5 billion in 1984? How do you like that?

Mr. Shulman: I don’t. Mr. Chairman, I’ll just pursue this point and then give up the floor to someone else.

You are quite right and I agree with you. It’s a very difficult thing to do politically -- to move against the apparent wishes of the people. But we don’t have the time. If it’s going to take five or 10 years to bring the people of Ontario around to the understanding that bankruptcy is bad --

Mr. Foulds: It is better than that.

Mr. Shulman: -- and we have to leave --

Hon. Mr. Miller: I again looked at the long-term and short-term ways of curbing that trend because as an engineer I am more interested in the management of the health care system right now than in the other aspects of it. The next minister can be a health philosopher if he wishes -- that’s not my role. Okay?

My role is to bring management to a health system that has grown in reaction to need, rather than planned in advance for need. And that is no criticism because if you can take me to a planned health system in the world, I would like to see it. There may be one, but I don’t know where it is.

Mr. Shulman: Not yet.

Hon. Mr. Miller: We have some golden opportunities in the high growth areas of this province to rectify some of these situations, simply because of the growth of those areas. For example, the new city in Haldimand-Norfolk; the new city around Pickering -- if, as and when one ever is created. Depending upon --

Mr. Haggerty: You are 20 years away.

Hon. Mr. Miller: Well, the fact remains, at least there is the opportunity to plan. At least in the Metro area around Toronto as it expands we can stop a proliferation and expansion of the errors we’ve had.

Mr. Stokes: You have got a wonderful opportunity to plan for the north. We have got nothing there now.

Mr. Foulds: Ear Falls, Sioux Lookout, Gogama, Red Lake.

Mr. Ferrier: Savant Lake.

Hon. Mr. Miller: I am speechless, but that is normal.

When one starts looking at why health services are generated in a community, the key issue is who says we need something else. I’m not talking about the north where they do lack services; I’m talking about the areas that are pretty well serviced. In many instances it is because of the inability of particular physicians to obtain privileges, or the inability of a specialist to have equipment he would like to have in the hospital he works in. That quickly becomes translated to the public, whether it’s through service organizations or women’s groups related to hospitals, and understandably the community quickly gets aroused to support this whole progress. All of a sudden you’ve got a demand for a new facility, or an extension to an existing one, that looks great on paper, but in fact it is not necessary.

My answer to that to begin with was, if the variables relate to the number of physicians, control the number of physicians. Then you should have the pressure put on the demand for services. From there on we will be able to bring some semblance of control to the overall system. That’s why I felt that I have made no more important decision -- you may think it is the only one I made -- than the decision to limit the immigration --

Mr. Shulman: It’s not going to work.

Hon. Mr. Miller: It may not. If you can suggest what will work, please tell me what will, in terms of immigration.

Mr. Shulman: I’m trying. You interrupted me.

First of all, the reason it won’t work is because you’re not letting new physicians come in but you’ve made the candy jar so big that the physicians who used to go out won’t any more. In my class, 150 graduated and 60 went out. Nobody is going to go out now.

Hon. Mr. Miller: But you stayed.

Mr. Shulman: I stayed for you. But now there is no reason for physicians to go out because there is nowhere better in the world to make a living from medicine than Ontario.

Hon. Mr. Miller: Please repeat that three times.

Mr. Shulman: I’m repeating it. Moneywise, there is a lot of money to be made here. The result is you’re not going to lose physicians as you think. The number is going to go up every year, because the ones who used to run away to the United States are not going to do so. And there are social reasons they don’t go there also.

Are you asking what should be done? I agree it is a very difficult political thing because you have people coming into the House saying, “I want a new unit for my hospital in Windsor,” or, “I want something for this area,” or “I want something for Ottawa,” or, “I want something for High Park,” and you have to resist it because you’re the guy in the hot seat who has to say “No, we can’t afford it.” And we can’t, because unless you do say it we’re going to be bankrupt.

Hon. Mr. Miller: I’ve had a good record at saying no.

Mr. Shulman: Yes, you have. But you haven’t attempted to cut back, and you’re going to have to cut back on what you’re paying out in useless care to people who are not ill. There is not a doctor’s office in this city that doesn’t have people coming in every day who are not sick. You’ve got to bring in the deterrent fee or else a panel system. It’s the only way you’re going to control it. You’ve got to start centralizing facilities in cities like Toronto, Hamilton and the other areas where there are unnecessary hospitals.

Mr. Roy: And I want to make sure it’s put on the record --

Mr. Chairman: The member for Welland South.

Mr. Haggerty: Thank you, Mr. Chairman. I want to add a few comments to this particular vote. Please, Albert, be quiet, will you?

Mr. Stokes: You can’t even enunciate your own policy.

Mr. Roy: You tell me about the deterrent fee.

Mr. Haggerty: I was interested in the member for High Park’s comments and the minister’s dialogue, in particular on the expenditure in the past decade. I think we’ve had a ball here in the Province of Ontario as long as the federal government was shoving in funds. Everybody had a glorious time spending money when it wasn’t necessary.

We talk about cutting back in the hospitals. I mentioned to the minister here a year ago about the nurses’ residences. I don’t know how many you have in the Province of Ontario now that are built and are sitting idle. There isn’t a nurse in them. Good buildings -- and when you look about the community, there is a need for a senior citizens’ residence. I mentioned one in the city of Port Colborne. I think there are 50 apartments in there that could be used right now; there is a need on the part of the senior citizens in that community. Yet we’ll have Ontario Housing still come in, make a study, and perhaps construct new buildings in that community when there is a building already there that could be used.

One of the older hospitals in the former county of Welland -- they call it the Annex now -- is perhaps one of the oldest buildings in the whole county. It’s a good thing that there is good staff in that building. It’s kept very clean, but I’ll tell you, if you look at the paint on the walls and other things in the building, it certainly does need some improvement. But there are patients in there who perhaps will never see the outside again. When I look at that and look at the number of vacancies in a good hospital building -- when they have to be put into an institution like that, I think there is something wrong with this system. It costs money to keep the heat in those empty rooms, and no doubt staff in those larger hospitals throughout the community.

You could phase out an older building like that and put some of those people back into those hospitals for chronic care. You could make use of one wing in the city of Port Colborne hospital and perhaps in the county hospital at Welland.

Now look at St. Catharines. There is a big demand there for chronic care residences. You have the MAC nursing school there. It’s empty. The building is not too old. It could be of some use today. Just think of the amount of money that you could save there alone by not building the senior citizens’ home.

I could perhaps go back to my colleague from Ottawa East, when he was talking about implementing a programme for dental care in the Province of Ontario. He said you could do it within a certain amount each year. Perhaps the savings alone there would get that off the ground floor. It could provide the basic dental care that’s required for the youngsters in the Province of Ontario.

There are savings, no doubt about it, when I look at your estimates -- particularly with your estimates now. Let’s take the first item, the ministry office. We’ll deal with the actual amount in 1973-1974 of $3,541,472; now it’s $8,055,000 in the 1975-1976 estimates. And when you look at the salaries and wages, it’s $2,905,000, and employee benefits of $1,129,500 -- and boy, that has really got me stumped here.

You can go down here to health standards, and you have salaries and wages there of $6 million; and yet the employee benefits are $771,400. Health services is $11,207,300, plus employee benefits, $1,191,200.

I would like to have the list -- if the minister could pass it on to me -- with the number of employees in each category here. But that one really stumps me -- employee benefits under the first heading there, $1,129,500. Is this something special for this particular group of Crown employees? Just take a look at that for a moment.

Hon. Mr. Miller: Yes, I think the term “ministry office” is pretty misleading, in all honesty. It’s got very little to do with the functioning of the minister’s office. The office of the minister is $336,800 of the $8 million. The office of the deputy minister is $ 1.309 million and that comes under the same budget. The Ontario Council of Health, which is included in my budget is $277,000.

The project development and implementation group, which we have been talking about at great length, creating the health service organizations, is still charged to the ministry office, even though it is a function of the ministry, at $867,000.

The policy secretariat, which works for the entire ministry, it has a staff -- and I can give you complements in any section you want -- is $171,000.

The various boards and commissions appointed by my ministry to look into various things, $575,000. Human resources, which is the personnel branch for the entire ministry, $1.1 million. Legal branch, which looks after the entire ministry, $338,000. And the entire budget for the communications branch -- that’s advertising, etc. for the whole ministry -- $3,046,000.

So when one looks through the entire budget, about $300,000 of $8 million is really the minister’s office. That might relieve your mind. Other things are really operating costs in many ways.

Mr. Haggerty: I bring to your attention that there seems to be a substantial increase from the 1974-1975 estimates; in the overall picture it is about $22 million. That’s a large increase.

Hon. Mr. Miller: Yes. It went from $5,119,000 last year to $8,078,000.

Mr. Haggerty: Are there any new employees?

Hon. Mr. Miller: Oh, not in the entire ministry, because we had a complement cut.

Mr. Haggerty: What do you mean by complement?

Hon. Mr. Miller: The complement of the Ministry of Health has been reduced by three per cent.

Mr. Haggerty: Three per cent?

Hon. Mr. Miller: Three per cent altogether; so we are actually reducing staff across the ministry.

Mr. Haggerty: How many consultants have you hired?

Hon. Mr. Miller: Oh, I don’t have that many consultants. You know, I am running a $3 billion business, and I don’t apologize for having the odd expert around to tell me from time to time where I might save some money. I had a consultant on staff the first six months of this year, and I think it was a critical thing to have him. He has been studying the reorganization of the ministry that has been going on for some time. I am satisfied now that the ministry is coming out of whatever it was -- the wilderness? -- the morale, I believe, is improving. Organizations are being clarified, and a sense of purpose is being put into some of my --

An hon. member: Speeches?

Hon. Mr. Miller: Well --

Mr. Haggerty: I want to continue, Mr. Chairman, perhaps on another subject. I guess I am not going to get too far with that topic. This deals particularly with members who are close to the American border. A number of local doctors will send their patients to hospital in the United States. I am thinking particularly of Buffalo and the Buffalo Children’s Hospital. Often the parent is left with a substantial bill to be paid. I was thinking of this recent case before the Supreme Court when Chief Justice George Gale upheld the decision of the Supreme Court of Ontario, I guess it was, in dealing with this matter of Taylor vs. the Ontario Health Insurance Plan. I was wondering, with the number of people from the Province of Ontario who are travelling and vacationing in the United States, is there not a possibility you could come in with a programme for additional coverage for those persons?

Hon. Mr. Miller: They’ve got it. It’s available.

Mr. Haggerty: Is it available?

Hon. Mr. Miller: Yes.

Mr. Haggerty: Is this information sent out to those persons?

Hon. Mr. Miller: Gosh, I don’t know how often -- it’s not available through the Ministry of Health but it is available as a purchased coverage if you’re leaving Canada. It’s something which needs a lot of publicity. I’m intrigued because -- perhaps I just hear the ads, but they’re on radio a lot.

Mr. Haggerty: I know if you take a packaged tour and you’re going to fly down to Hawaii for two weeks, usually you can buy special or extra coverage there. But people are not aware of it.

Hon. Mr. Miller: I have a certain sympathy for somebody who flew to Hawaii, but I don’t have half as much sympathy for them as I have for a guy who can’t pay his bill right here at home.

Mr. Haggerty: The point I raise is could you not make it available through the Ministry of Health if they want to buy that extra protection?

Hon. Mr. Miller: No, by law -- and I think it’s a federal requirement -- we can’t sell that kind of thing but Blue Cross does. For a very small fee Canadians travelling abroad can purchase insurance which will make up the difference -- I believe the entire difference -- between the amount we will pay at Ontario rates and the amount they are charged in a foreign jurisdiction.

The thing I’d like to stress is this: Lots of jurisdictions -- the British health service doesn’t pay one cotton-pickin’ cent if you’re in Canada and take sick. Nor does the United States. Our system pays as much as if you were at home. That is, I think, very important to realize. Our people leave the country and have their home coverage. If they’re in a country like the United States which has exorbitant fees for health care in certain cases --

Mr. Haggerty: In certain states?

Hon. Mr. Miller: In certain states, I qualify; Florida would be as bad as there is. I don’t think it’s our obligation to make up that difference. As long as I’m fighting to cover unmet needs in the Province of Ontario I think I have to set my priorities so that those are met before I cover people in Florida who are enjoying a vacation which many people never get a chance to have. Especially when for a minimal amount they can buy the coverage to cover them. If they want that coverage, just like semi-private or private care, it’s available for a tiny premium, so they should buy it.

If you go to another country where the rates are lower than Ontario rates, I believe we pay the lower of the two -- our rate or the rate actually charged by that country. At least that coverage is there.

Mr. Haggerty: Blue Cross, though, covers you if you want a private or semi-private room. I don’t think it covers the medical bill itself.

Hon. Mr. Miller: I’ll get you the information specifically because I’d like more people to know about it. I think you’ll find it covers not just semi-private and private but the uninsured part of your health care costs while you’re out of Canada.

Mr. Haggerty: I have one other point now. The other matter I raised with the minister was certain doctors will send patients over to the Buffalo Children’s Hospital, for example. They have some difficulty because there’s an extra charge for doctors’ fees and so on. The per diem rate at the Buffalo Children’s Hospital, I think, is less than it is at the Sick Children’s Hospital in Toronto.

Anyway, there is one particular case here of a fellow who has a problem with his daughter. I think she’s had some 18 operations at Toronto General Hospital or Sick Children’s Hospital, one of the two, and they are very serious operations. I think they had to remove fluid from the brain; there’s a tube which runs down the side of the neck and drains it away. He’s had the girl in hospital in Toronto about 18 times with very little success.

Finally, in a case of emergency he did the last thing he could think of. Somebody said “Why don’t you try Buffalo Children’s Hospital?" He took her over there and the doctor did a miracle for that girl. She’s still living today; she’s back in school. For some unknown reason there is a certain apparatus which is placed there -- it’s a valve, I guess -- which can stop the fluid from running. Sometimes she may go into convulsions or something like that.

Just the other day, I think, he had to rush her back to the hospital in Buffalo. He couldn’t get the medical services here and he had to rush her back over there and the doctor looked after her very well. Again there was a substantial bill; I think it was $66. You only pay a portion of it and when a person is unemployed and he has other difficulties it is a pretty stiff payment for that person. It is an exceptional case and consideration should be given.

I know the ministry has on a number of occasions been very good to persons who have been in need of special medical care in the Buffalo hospitals. I wonder if there isn’t some way you could provide some other recourse -- or pay a little bit higher fee toward this case.

Hon. Mr. Miller: I can’t judge a particular case. That is a very difficult thing to do; I have to turn it over to staff and they can assess it. I believe a policy exists, and again it can be confirmed by my staff, which says if a person has to go outside Canada for a surgical procedure or medical treatment which could not be rendered here in Canada we will pay; we will pay the costs of that procedure outside Canada. That generally requires certification of that person’s physician or somebody else to guarantee that that was the case. I think that is a reasonable point.

I think one of the things we have to realize is that if a patient is ill in Buffalo either by elective admission or emergency admission -- it doesn’t really matter for the case of the arithmetic -- the real costs to the health system of Ontario are whatever the bill is. If the bill is $1,000 that means we actually ship $1,000 to that hospital and the physicians attached to it.

If a person enters a hospital in Ontario the incremental costs may be zero because, as you know, we don’t pay hospitals in Ontario on a per-patient per-day basis for acute care. We pay them so much per year to operate and they get that whether or not there are patients in beds. If a person goes to an Ontario hospital the money we lay out to the doctor is a payout; the money we lay out to the hospital was going to go anyway and the incremental costs may be very close to zero.

Mr. Haggerty: I will send you this. Is there any one person over there I can refer this to?

Hon. Mr. Miller: Yes, send it to my attention.

Mr. Chairman: Before the Chair recognizes the member for Wentworth, perhaps we could establish some type of orderly discussion on this vote. It would seem to me that we are discussing -- on OHIP we would be under health services. I wonder if the member wishes to speak on health services? Perhaps we could carry items 1 and 2.

Mr. Deans: Let me ask the minister. I suspect what I want to raise might be better raised elsewhere but it is quite important and might be something he has to look into before he could answer it. Let me put it to him and he can answer it in whatever way he wishes.

I had it brought to my attention today that this week McMaster clinic has had to throw out 2,400 containers of the culture media it uses. Last week it threw out a minimum of 1,600 containers of it. It comes from the Connaught Laboratories and I am concerned because as it was told to me, it is already growing organisms before they can get to use it. It is costly to begin with so it might be something you should consider, but more important than that unless the people using it are very diligent it can affect the value of the tests and the outcome of the tests being run.

I am raising it with you now -- I might even have raised it as a question, before the orders of the day, in the question period -- but I am asking the minister now if he would have someone on his staff check with both the McMaster clinic and Connaught Laboratories and determine just how much of this culture media is being thrown out and how it is there doesn’t seem to be the kind of quality control that ought to be in place and whether in fact it’s possible that, if the media is not being properly examined in the hospital, this might be affecting some of the tests on some of the patients.

Hon. Mr. Miller: I don’t think it is under this vote but I will answer it because it is easy to do.

First of all, it’s a normal supplier relationship. It has not got anything to do with the Ministry of Health because that hospital, if there is more than one supplier, is free to purchase culture wherever it wishes. Like any other material purchased by an buyer, if it doesn’t meet requirements, I am quite sure there would be a responsibility on the supplier to either return the money for the purchased goods or --

Mr. Deans: That’s not my worry.

Hon. Mr. Miller: No, I am much more worried about the other aspects too. I will get you the answer even though it isn’t the Ministry of Health’s direct concern. I would trust that that hospital would be concerned enough to have taken very rapid steps to ensure a safe supply.

Mr. Deans: It doesn’t seem to be. No, I may not understand them, but that’s the reason why I am asking --

Hon. Mr. Miller: In any case, perhaps before I am back in the House the next time, I can get you that answer.

Mr. Deans: Okay. Thank you.

Mr. Chairman: The hon. member for Windsor-Walkerville wanted to speak on item 3, health services.

Hon. Mr. Miller: Pardon me, Mr. Chairman, which vote are we on right now?

Mr. Chairman: Vote 2901 -- and I am wondering if items 1 and 2 will carry?

Mr. Dukszta: No, I think at least two of us want to speak on that.

Mr. Chairman: On item 1?

Mr. Dukszta: Yes.

Mr. Chairman: The hon. member for Parkdale.

Mr. Roy: Mr. Chairman, if I could raise a point of order. You know we want to be agreeable and try to proceed with this as logically as possible so that the ministry is in a position that we don’t jump from one item to another -- so you I have to haul your people from the back row back on the chairs and the whole bit. But there have been items raised here -- in item 1, for instance, when we talked about general approach, we also talked about OHIP and of course that’s down in vote 2303. We talked about hospitals.

We are having trouble. I wonder if it would be too difficult for the ministry, Mr. Chairman, to deal with the whole item of 2901 in one --

Hon. Mr. Miller: I want to go item by item.

Mr. Roy: You want to go item by item?

Hon. Mr. Miller: Yes, it has strayed lately. I would like to stick to item by item.

Mr. Roy: lit is just that you have accepted matters that have been away off.

Hon. Mr. Miller: I have done so at the discretion of the Chair.

Mr. Roy: My colleague for Windsor-Walkervilie has been waiting to talk on item 3, health services, for a day and a hall. Actually we have been dealing with all sorts of items which are not in the ministry office.

Mr. Chairman: The Chair has been very tolerant on the broad discussions. Perhaps we could come back and deal with item by item. The Chair will recognize the hon. member for Parkdale on item 1.

Mr. Dukszta: I know and you know, Mr. Minister, there have been a series of reports commissioned by your government, your predecessors and everyone else. All the reports suggest there is something seriously wrong with what you describe as a non-system of health care delivery in the province. When you were discussing it with my colleague, you suggested that the only thing wrong with it is we find that it is costing too much money.

You have suggested a couple of things may be wrong -- you agreed with him that the physicians are taking too much out of the cookie jar. You also suggested that the hospitals may be overused. You have not suggested to my satisfaction any possible solutions to what you have said. The only solution you have come up with is you have said that we will save money by reducing the number of physicians.

I am not going to repeat my argument that I consider you wrong on the approach of stopping the immigration of physicians. However, your approach at the moment that the only way to save money is to cut down on physicians will lead us into even more problems. You should at least listen to your own reports which suggest that we are operating the health system at the limit of its capacity.

Let me just give you a couple of instances which are the way people judge whether the system operates to its capacity or not: The overcrowded emergency room with non-emergency problems, the overcrowded emergency room with emergency problems, the inability of many people to get a physician at night or over weekends -- a number of instances like that. You have ignored them, I think, rather consistently, and you now link yourself to one item -- which is that our patient-physician ratio is one of the better ones in the western world -- which doesn’t solve the problem of what is actually wrong with the system, and you are only interested in limiting the influx of physicians into this province. You’ve said that this is a non-system. It was your own term that this is a non-system. You cannot rationalize a non-system, you cannot be managerial about a non-system, you cannot bring simple managerial skills from what you call your position of being an engineer, which you are very fond of saying, to say that something is a non-system.

Mr. Roy: Are there any successful engineers?

Hon. Mr. Miller: Besides me?

Mr. Laughren: Not in the health field.

Mr. Chairman: The Chair would like to interrupt here just for a moment. The hon. member for Parkdale is talking about hospitals --

Mr. Dukszta: I am talking on policy.

Mr. Chairman: -- and it seems to me that the hospital policy would come under vote 2903, item 2.

Mr. Dukszta: No. I am sorry, I question this, Mr. Chairman. I am talking of a policy approach to health care generally, which I think fits in right now. I am not talking of the hospitals in particular.

Mr. Shulman: Alas, my colleague is right.

Mr. Roy: I think, Mr. Chairman, he is talking about total delivery there. He is mixing medicine, doctors and hospitals. You can’t deal with that in one item.

Mr. Chairman: I’ll be guided by the members of the committee, but it seems to the Chair that if we are going to discuss all of the votes in the broad sense, we might as well be dealing with it on that basis rather than item by item. I will allow the hon. member to continue.

Mr. Dukszta: I was being superbly abstract, definitely not impractical.

Mr. Roy: That he was.

Mr. Shulman: That is the problem.

Mr. Dukszta: To repeat the last phrase, the non-system is not going to be solved by cutting down the number of physicians. Why are you not prepared to look at it again from a different conceptual point of view; which is, looking at it from the point of view of the community health centres approach? That would be a system. At the moment, according to your own words, it is a total non-system. How can you try to solve it? Will you try to give me some kind of rational explanation of how it works; how you are going to solve this which is, in fact, insoluble at the moment? The member for High Park suggested that one way of dealing with the physicians is to cut down on their ability to be able to reach into the cookie jar to try to get as much as they want to.

A couple of days ago I suggested to you that the fee-for-service system as practised in Ontario is a permission to a physician to write a blank cheque for virtually any amount he wants to, because he can duplicate any service. I can give you dozens of examples in which people can just simply travel through the system. It’s not up to the patient to do this. You must create a system which doesn’t use a deterrent fee, which only injures the lower-class people, but tries to deal with the total free will of the physicians to write their own cheques at the moment.

You have attempted, indeed, to cut down the beds. But again I think the member for High Park is right. You really have to cut down in blocks, not a few beds here and there, because the services are not cut down, the number of physicians is not cut down, the technology is not cut down, nothing is cut down this way. Also, you cannot really cut down on physicians and on the usage of hospitals for emergency beds without providing alternative services, even if it costs money, because we are asking for even more trouble with our health system than we have now. It pains me to think that you consider our whole system to be perfection and you refuse to recognize the evidence of your own studies, one after another, which say that the system is, in fact, not working -- it is not delivering what it is supposed to deliver.

Hon. Mr. Miller: Mr. Chairman, I just feel you have heard one part of what I have said, the part you wanted to hear. When I taught kids at school that happened too; all they hear is what they want to hear.

Mr. Laughren: Don’t be so paternalistic, Frank.

Hon. Mr. Miller: That’s right, I am being. That’s a characteristic of a school teacher and you, as one, were very quick to recognize it.

Mr. Laughren: I wasn’t paternalistic; you were being paternalistic.

Hon. Mr. Miller: You were maternalistic, then.

Mr. Laughren: Fraternalistic.

Mr. G. Samis (Stormont): Fraternalistic.

Mr. Laughren: Fraternalistic.

Hon. Mr. Miller: For all the faults of the present system, or non-system as you like to call it, it has done not too bad a job in the past. The Sixties saw the growth of the non-system to a point where society finds it difficult to continue to support it. The great growth in costs in the last year, which have been pointed to by both you and the member for High Park, resulted in the main, as I’ve told you, from increases in salaries to the lowest priced personnel which automatically led to those others in the chain getting more money. Over a two-year period most salaries changed by between 30 per cent and 50 per cent.

The system will be created, and in my opinion is being created, not only by the manpower changes I talked about, but also by the creation of district health councils; the expansion of primary care through the HSOs -- at a relatively modest rate, but at least a start; by manpower planning on a wider scale for paramedical/personnel; by hospital bed constraints which have been in effect for two years and are continuing; by the rationalization of secondary care going on, as I’ve mentioned earlier, at some rate in some cities, and a very slow rate, if any, in others; and by the creation of alternative care facilities which were basically started under the member for Quinte (Mr. Potter).

Those have been done, and if one looks at the whole time span of health care I think they’re pretty important achievements. I feel that the course has been changed at a rate that you may not be able to notice yet, since you’re standing on the vessel at this point in time and not able to watch the trajectory of motion.

Mr. Roy: Nobody can.

Mr. Chairman: The member for Parkdale.

Mr. Dukszta: I liked your last rhetorical statement. It was obviously a play to the gallery.

Mr. Roy: What gallery?

Mr. Laughren: What gallery?

Mr. Dukszta: There are two people sitting in this gallery at least.

Mr. Roy: He is referring to your own gallery.

Mr. Dukszta: And the place is full of your officials; so at least you’re playing to them.

Hon. Mr. Miller: Then just leave the “L” out.

Mr. Dukszta: You are talking of health services centres as a major approach. You tell me there are 36 of them in the midst of being funded, a minuscule part of the whole service. You described them yourself as a health pilot project. You talked of the district councils when you said in your release of May 8 that you are in principle going to abandon them. In that release I remember you said that you were not going to implement them in the way that Mustard has suggested is the only way they would work.

You are telling me that you’re moving somewhere, that this is a trajectory to a future millennium in health care. That’s sheer utter nonsense. You have cut some beds, but if I look at the budget I can see there is no effect on the hospitals and no effect on what they’ve been spending. Your two per cent cut at the Toronto General Hospital has led to the discharge of the social workers who work on the preventive level. Is that what you call a trajectory towards the future, cutting down all these types of services? Aren’t you aware that within a year the system is going to be in even more trouble than it is now? And you are painting for me of all people a millennium coming from all those minuscule efforts you have done. That’s sheer nonsense.

Mr. Roy: Take that.

Mr. Chairman: The hon. member for Sudbury.

Hon. Mr. Miller: I would like to correct that and say crock of sheer nonsense.

Mr. Dukszta: I didn’t want to use the more usual term.

Mr. Chairman: Order, please. The member for Sudbury.

Mr. Stokes: Did you ever think of being an engineer?

Mr. Chairman: Order, please.

Mr. M. C. Germa (Sudbury): Mr. Chairman, I’d like to bring up two points together which were mentioned earlier: One by the member for High Park and one by the minister. At one point, the member for High Park was talking about the high cost of maintaining empty floors in hospitals in Toronto. He mentioned Wellesley Hospital, Women’s College and Mount Sinai. The minister then referred to the disparity of health delivery services in northern Ontario. He excluded us from the discussion because he admitted that there was a disparity of service and in fact just a negligence of service in northern Ontario.

At the same time, while we have this waste going on in Toronto with empty hospital floors, he is in the process of expanding the Princess Margaret Hospital. There he is, sinking a couple of million dollars into an expansion there, despite all of the recommendations that have come forward from a study recommending to his ministry that there should be other facilities built in the catchment area but not necessarily in Metropolitan Toronto. All of the facts and figures are there to justify an expansion in the northern part of the province, yet here is Princess Margaret Hospital serving Metropolitan Toronto and northern Ontario.

The minister has admitted that there is a disparity of service, yet he goes ahead and is putting in more hospital beds, even though it was recommended in the Kates, Peat, Marwick study that negotiations should be entered into with the other hospitals within half a mile of Princess Margaret Hospital to use their bed facilities, rather than to go ahead with an expansion of the Princess Margaret. Yet that goes by the board. Is it any wonder that our health care costs are rising to heights that the minister himself can’t even cope with?

I would like to put a few facts on the record, Mr. Chairman. Kates, Peat, Marwick, I think, did a very good study. They talked to very many people --

Mr. Chairman: I think the hon. member would be better to raise this under vote 2903, item 2, general hospitals. This is the point I raised earlier when we were talking about hospital expenditures and services.

Mr. Laughren: He’s right on.

Mr. Germa: I think what we are talking about now, Mr. Chairman, is planning -- poor planning and lack of planning.

Mr. Chairman: I think this comes under the treatment and rehabilitation programme.

Mr. Germa: I am not talking about treatment. I am talking about planning and wasting money on a facility here in Toronto, when the facility is needed some place else. I can prove that there is a patient load.

Mr. Chairman: Order, please. Hospital planning comes under vote 2903, item 2; it deals with expenditures and planning.

Mr. Germa: Mr. Chairman, it says nothing about planning in that particular vote. Now, I would ask the minister to detail exactly where his planning comes into his budget, because it certainly doesn’t come under treatment. I’m not talking about treatment. I’m talking about planning medical delivery services in northern Ontario vs Metropolitan Toronto.

Mr. Chairman: Perhaps the hon. minister would indicate under which vote and which item he would like this discussed.

Hon. Mr. Miller: Mr. Chairman, there are some issues that are not totally restricted to one vote in the estimates; that, of course, does cause some concern. I am told that this can be discussed under vote 2901, item 2, or vote 2903; either one. Is it a subsection of 2903 or just the vote 2903?

Mr. Roy: Well, that should be under vote 2903, item 2.

Mr. Chairman: Perhaps the hon. member would raise it at that time and we would consider his comments.

Hon. Mr. Miller: I will be glad to answer the questions. I am not trying to avoid them. They are important questions. I’ll give him answers. I think he is wrong, but I will explain them at that point, if I may.

Mr. E. W. Martel (Sudbury East): Oh, we are never wrong.

Mr. Germa: Oh well, we are on vote 2901, Mr. Chairman --

Mr. Chairman: The hon. minister indicated he was prepared to answer hospital planning and expenditures and treatment under vote 2903, item 2.

Mr. Germa: That is not correct, Mr. Chairman. He said either under vote 2901, item 2, or vote 2903. He gave you an option. Now I choose the option of vote 2901, item 2.

Mr. Chairman: I didn’t hear the hon. minister say vote 2901, item 2. Did he say that?

Hon. Mr. Miller: I did mention that it is possible that it would be under that vote. I am told that part of the estimates is under that.

Mr. Chairman: Are there any further discussions then on vote 2901, item 1?

Mr. Roy: Mr. Chairman, I want to discuss briefly the matter raised by the member for High Park -- and I have discussed this at length with the minister -- that is, the question of costs, and specifically the question of a deterrent fee and that type of thing. Obviously all politicians shudder over this. The last man who tried it was Thatcher in Saskatchewan; the NDP took care of him in the next election, and his loss clearly was attributed to the fact that he introduced a deterrent fee.

Mr. Chairman, I agree with the member for High Park that some hard decisions are going to have to be made, and one of them, of course, will have to deal with a deterrent fee, as suggested, I believe, by Bette Stephenson, the president of the Canadian Medical Association. She said that politicians -- and I think she included the Minister of Health in that category -- are gutless and that if politicians had any guts they would be looking at that aspect of it. I know no one wants to make a commitment in that area, but what if the measures that you are talking about do not succeed? And, obviously, you are not going to be mentioning deterrent fees before the next election -- I don’t suppose anyone will.

Hon. Mr. Miller: Would the member go on record and give me his position?

Mr. Roy: If I was the Minister of Health and had the number of officials there are sitting under the gallery -- with the galaxy of people who work for him -- I might be in a position to assess whether it is necessary to have deterrent fees or not.

Mr. Shulman: That is a clear-cut statement.

Mr. Roy: You see; but as a responsible politician I cannot say, after so many years out of power and looking in from the outside, what is really necessary. You are supposed to be the minister and the purpose of these estimates is to find out what you as the minister are thinking about this.

Has the minister replied to Dr. Bette Stephenson about whether her solution is, in fact, a solution to that? When she is talking about deterrent fees, is she talking about not only for services of the doctor, but of the hospital as well? I just wonder whether she was talking about both aspects of it. Was she talking for people who stayed in the hospital and would pay so much per day after so many days? I don’t know, in fact, what she was talking about. I would like to just leave that with the minister, whether that aspect of it has ever been given any consideration.

Hon. Mr. Miller: Yes, it has been given quite a bit of consideration. I suppose the first thing I came into the ministry convinced of was that a deterrent fee was the answer to all the problems of overuse. I am talking about my days as a parliamentary assistant. I am sure I bugged the former minister at some length about that when I was his assistant. The issue has not fallen only on the basis that it is totally unacceptable to the public -- I believe it is totally unacceptable to a high percentage of the public and not just the lower income groups -- it’s fallen on the basis that those who have tried it, claim it doesn’t work.

Mr. Roy: That it doesn’t work?

Hon. Mr. Miller: That it doesn’t work. That would be the more important reason.

I have often said whenever I have been in public and asked this question by OMA groups, that, as stubborn as I am, I find it just a bit hard to believe it doesn’t work. I have never seen the documented evidence that totally convinced me. But there is almost unanimous agreement among the people who advise me that it doesn’t work. They are not looking at the politics; they are looking at the efficiency of that move in terms of cutting health care costs. I sometimes speak loosely when I am out being asked questions, because I like to have a bit of give and take in these discussions. It doesn’t imply that I am making policy or that I am testing policy. I am simply exchanging ideas with people.

The other day I made some comment in reply to a question at the OMA annual meeting that bordered on this; that said doctors should have the right to screen their patients for the reasons we are talking about; that the patients who could afford to pay should have some deterrent by paying the doctor directly. But, more importantly -- I thought this was a very critical point the doctors brought up -- they felt it put them back into a more professional position of having to justify to a patient the value of the service they rendered.

They said: “Look, if I had to say to Mrs. Smith, ‘You have got to pay me $15 and you get $13.50 back’, I might not ask for $15 if in fact it was a borderline case of services rendered, whereas I would have no hesitation charging OHIP for that at the same time.”

There were lots of interesting things exchanged in this area.

I am looking with great interest at any practicable means of curtailing overuse of the system by the patients.

Mr. Chairman: Order, please. The Chair would draw to the attention of the hon. member for Ottawa East and the hon. minister that the item that they have been discussing, health insurance, should have come under vote 2903, item 1.

The Chair isn’t trying to curtail any debate, but we are trying to organize an orderly discussion of these estimates.

Mr. Roy: But, Mr. Chairman --

Mr. Chairman: I would like to see us deal with 2901, item 1, the ministry office. Is the item carried? Then we will go on to the other items which the hon. member wants to talk about

Mr. Roy: With respect, Mr. Chairman, there is difficulty when you are only dealing with health insurance. For instance, in item 1 we are talking about OHIP premiums -- the payments to doctors. I am talking about a general policy of deterrents in relation to doctors’ services, services from hospitals, and so on. It becomes exceedingly difficult just to deal with that under health insurance and that’s why I felt we should deal with it on the policy.

Mr. Chairman: Well the Chair would recognize the hon. member at that time and allow broad discussion, but I think we should keep it under various individual headings and items.

Mr. Roy: When we get to discussing what doctors are paid, I intend to discuss it under the item that you have mentioned, Mr. Chairman, but when you are talking about hospitals, doctors, and policy in relation to delivery services, it becomes difficult to discuss them only under health insurance.

I want to come back to the point where the minister says it doesn’t work and the advice that he gets from his officials. Are you aware of any jurisdiction where, in fact, they do have a deterrent fee for medical services, hospital services and this type? Are you aware of any, or are you aware of any private plan or something like this, that operates on that basis? Of course, just before you get up and answer the question, the point is --

Hon. Mr. Miller: I’m not aware of one currently, but I would be glad to find out if there is one.

Mr. Roy: -- people theoretically may have an impression about how something works but until you’ve seen it in practice, it’s hard to judge. Who could have foreseen the fantastic costs of health services -- obviously Pearson did -- when he brought it in 1965? I don’t think he had that in mind.

Hon. Mr. Miller: With great respect, the Ontario government did, and predicted exactly what happened.

Mr. Shulman: Not really, otherwise you never would have gotten into it.

Mr. Roy: Not really, not really. Let me tell you something about the Ontario government, if it had as much foresight as you say it did, it would have been looking at Saskatchewan which experienced the same problems as you are and have had a system since 1960, so you had enough precedent ahead of you to see how OHIP in a universal plan worked. Obviously if you are talking about a deterrent fee, in fairness, if you’re still talking about a universal system for hospital medical services and this type of thing, you’ve got to keep in mind that you would not charge that to people who could not pay it -- the lower income people and senior citizens. You could not charge it to them, because then the deterrent fee would be prohibitive to this group.

Mr. B. Newman: They do it that way with the medical card, the medical benefit card.

Mr. Roy: I come back to my point, you seem to have written it off because of the advice of your officials, and I’m not sure I know any jurisdiction where it’s been adequately tried.

Hon. Mr. Miller: We haven’t written it off.

Mr. Roy: It’s not written off?

Mr. Shulman: I just want to make one final suggestion, you must use great care in working out your new system, because sometimes it doesn’t work out the way you want at all. I’m thinking of the fact that before this whole new Medicare system came in, it was a rare, rare thing for teeth to be extracted in hospitals and yet, in your wisdom, you made people still pay for dental care --

Hon. Mr. Miller: Teeth? Wisdom teeth?

Mr. Shulman: Teeth, teeth, teeth.

Hon. Mr. Miller: Wisdom teeth.

Mr. Shulman: Yes. In your wisdom, you allowed people still to pay for dental care unless the teeth were extracted in hospitals. and there is not a general practitioner in this whole province who doesn’t have someone come in at least once a month and say, “I want to get my teeth out, book me into the hospital.” So what you’ve done in an attempt to save money has, in effect, cost tremendous amounts -- goodness knows how many thousands. I just point out that pitfall as you walk down this rocky road not to slip off the track. There is a mixed metaphor of some sort.

Mr. Chairman: Item 1 agreed to? Item 2, health standards. The hon. member for High Park.

Mr. Shulman: I just want to ask the minister one brief question. I raised a matter with him privately today about a certain individual -- I’m not going to mention his name here in the House -- who is working in the health field -- in fact in two health fields -- who may or may not be qualified to do so. Is he able to cast any light on that mystery?

Hon. Mr. Miller: Yes, Mr. Chairman. I understand he has been dismissed.

Mr. Shulman: Oh, dismissed from everything?

Hon. Mr. Miller: Yes.

Mr. Shulman: Dismissed from the hospital he is working in also?

Hon. Mr. Miller: He is working as a non- registered technician and I don’t believe he would have to quit that.

Mr. Shulman: Are criminal charges going to be laid for impersonation?

Hon. Mr. Miller: He is dismissed pending an investigation. He has admitted to the fact that his degree in engineering did not exist. He has admitted that he felt he had equivalent education but not a formal education, and that he perhaps misled the institution. The decision of the board was that he cease teaching and that he stay suspended until such time as there is a full investigation.

Mr. Shulman: Did he do any operations of any sort?

Hon. Mr. Miller: No.

Mr. Shulman: Okay.

Mr. Chairman: The member for Windsor-Walkerville.

Mr. Roy: He must have got that same doctor; the guy who was caught for impersonating a doctor?

Mr. Chairman: Order, please.

Mr. B. Newman: Mr. Chairman, I wanted to ask the minister if the ministry is developing fitness programmes such as we had during the war years -- the 5BX and the 10BX programmes -- which could be disseminated widely in an attempt to improve the general fitness of our population?

Hon. Mr. Miller: Our ministry is not directly but I’m told by my deputy that he is discussing it with the Ministry of Culture and Recreation who will take the onus for that type of programme.

I think I mentioned the other night that one brief experience we were having in our own ministry as a trial.

Mr. B. Newman: Is that going to be a responsibility of the Minister of Culture and Recreation (Mr. Welch)? Who will be developing the programme? Will it be that your ministry will develop the programme and the implementation be the responsibility of the Ministry of Culture and Recreation?

Hon. Mr. Miller: We will be offering advice on certain aspects, I’m told.

Mr. B. Newman: When can we foresee such a programme actually set up?

Hon. Mr. Miller: I don’t know. At the present time I don’t know.

Mr. B. Newman: That’s one of the problems with your government, Mr. Minister.

Hon. Mr. Miller: No, it’s fine to say that, but in a ministry the size of mine its all I can do to tell you what’s happening within my ministry and the timing it will occur. I honestly can’t speak for another minister’s programme. I know we’ll be offering advice but I think the question as to actual timing needs to be asked of the Minister of Culture and Recreation rather than of me.

Mr. B. Newman: I would have assumed, Mr. Chairman, that the development of the programme would be through the health authorities rather than through the Ministry of Culture and Recreation, I can recall back in the early 1960s when the concern for fitness was receiving more and more attention on the part of this government a committee was set up to look into that aspect. That committee did submit a report to government, costing some $35,000, yet nothing from that report was ever actually implemented.

Surely if you wish to cut down the overall health costs of our citizens the development of a good physical fitness programme or a good fitness programme -- not necessarily physical only -- should be a real top priority item. I would have hoped we could have had from your ministry at least some guidelines or a more rapid development of the programme, even if it’s only the implementation of some of the air force programmes, the 5BX and the 10BX programmes, which were set up during the war years.

Hon. Mr. Miller: I agree with your sentiments completely. I’m very anxious to see an added impetus or stress put upon fitness programmes.

Mr. B. Newman: May I suggest to you that you or your officials consult with the Ministry of Culture and Recreation and maybe give them a little prod so that this could be set up a lot sooner than we anticipated?

You’ll say it’s difficult, yet it wasn’t difficult for the Ministry of Culture and Recreation -- and I can’t criticize you for this at all -- to set up a lottery almost overnight after fighting against the idea of a lottery. I would hope that maybe your ministry could sort of take the lead in that and, if not actually develop the programme, prod the Ministry of Culture and Recreation so we could have one set up as quickly as possible.

The sooner it’s set up and the sooner it’s put into operation, the sooner, I would think and hope, our people could become more physically fit. Even if it improves their fitness only by a very small percentage, it would reduce your medical costs or your health delivery costs by that percentage.

Hon. Mr. Miller: Mr. Chairman, I’ll be glad to endorse your feelings. I’ll be glad, in the policy field, to stress the need for this.

Mr. B. Newman: Thank you, Mr. Minister.

Mr. Chairman: Does the member For Sudbury wish to comment on item 2, health standards?

Mr. Germa: May I speak about the subject matter I was talking about earlier, Mr. Chairman?

Mr. Chairman: This will be health standards?

Mr. Germa: Yes, lack of health standards in northern Ontario; lack of health delivery standards in northern Ontario.

Mr. Chairman: I’m wondering whether that would come under standards or health services.

Mr. Germa: It’s lack of services.

Mr. Chairman: I think that would come under item 3. We’ll get to it in a moment. The Chair will recognize you then.

Mr. Germa: No wonder this ministry is going in the hole. I don’t think they know what they are doing.

Mr. Chairman: Any further comment on item 2? The member for Ottawa East.

Mr. Roy: I would like to support my colleague from Windsor-Walkerville on the question of fitness because I think it may well be that the responsibility lies with another ministry, maybe the Ministry of Education, for instance, or the Ministry of Culture and Recreation, but you’d be the one to benefit the most out of this, at least when we are talking costs, if we had that type of an approach to people keeping fit.

I don’t want to repeat myself because I think I mentioned it in my opening statement but I do want to put on the record that even though you might say it -- I mentioned it to you last year, I think -- I have not seen any changes in the approach of your ministry to encourage other ministries to encourage fitness. I really don’t think you have been doing enough; you haven’t been pushing enough in relation to fitness.

I am not convinced it’s all that expensive to encourage people. I don’t know what we are talking about -- an advertising programme; we are talking about an educational programme. Obviously not enough has been done. We are all emphasizing the area of preventive health care but if something has been emphasized in this country it is the fact that we Canadians, I suppose, are the worst in the world fitness-wise and I suppose Ontario, too. I think we are, aren’t we? We certainly prove it every time we have Olympics; I don’t know whether it’s because we don’t give enough money to certain selected athletes but I think as a general rule we must rank pretty low.

Mr. B. Newman: Second from the top. We are not --

Mr. Roy: The Americans seem to be, generally speaking, percentage-wise, in better shape than we are. I think this is something that --

Mr. B. Newman: Do you have any comparative figures? Does the ministry have any comparative figures?

Mr. Roy: Yes, maybe the ministry could dispute my figures but I get very embarrassed when I see a 60-year-old Swede beating a 20-year-old Canadian or this type of thing. The other day I got a pamphlet from Blue Cross, I think, which showed what their approach to fitness is in Sweden. I would think you, as Minister of Health, would be really pushing this with your colleagues. I think my colleague from Windsor-Walkerville mentioned that when it was important politically to set up a lottery the Ministry of Culture and Recreation did it in a matter of months; they had this whole system set up.

I think if we were serious about fitness we would do something about that much sooner because we have been talking about it for a year or two now. I really can’t see anything in our schools or in Culture and Recreation or in Health to emphasize that aspect, fitness.

Mr. Ferrier: What kind of exercise programme have you got?

Hon. Mr. Miller: Mr. Chairman, our province has created a Ministry of Culture and Recreation. It has started a Wintario lottery, part of the funds of which will be used for the development of better facilities in the province. Facilities aren’t the only answer, you know that. We have already got lots of facilities which could be used better. I wonder how many of you do any exercise?

Mr. Roy: I will race you right around the block right now.

Hon. Mr. Miller: Don’t be too sure you will. A few people have been shaken up on that one.

Mr. Roy: You wouldn’t want to take me on.

Hon. Mr. Miller: I did my 20 laps tonight. I seriously challenge each person to look after his or her own welfare in what may seem likely silly ways at times to give some publicity to things like bicycle riding. Today I sent a copy of a debate, pages 4866 to 4869 Hansard, 1972, in which the member beside you and I supported a motion for more use of bicycles and greater facilities for bicycles in the Province of Ontario. I sent it over to the CBC because they were more or less challenging me to say what have I said or what will I say about these things? I am all sold on them. But we are just wealthy enough to be able to use taxis to go to the liquor store -- and I watched somebody doing just that tonight.

Mr. Roy: From this building I suppose?

Hon. Mr. Miller: I don’t want the Chair to have a guilty feeling. You may have been there, but earlier.

Look, we just find it too comfortable, too easy to take the non-athletic way out. We have a tremendous job to do to convince people to take part in the programmes we are willing to help along.

Mr. B. Newman: Don’t you think, Mr. Minister that you have a responsibility to the people of Ontario, and in turn, to the Minister of Education (Mr. Wells) to convince him that physical education in the school system should be one of the subjects that maybe even should be compulsory? Personally, I would prefer it compulsory because even though the programme may not be the best programme in the world in the various schools, at least if the individual does get some type of exercise, it is better than none whatsoever.

Those who physically cannot accept the exercise, I can really agree shouldn’t be taking it. But our students in a lot of the schools don’t take physical education today because it isn’t compulsory. So you can see where you with Education are working at cross-purposes. You want a fit people, yet your own colleague, the Minister of Education, doesn’t want to do that, doesn’t even want to follow the recommendations of the select committee on youth, that recommended that phys. ed. be a compulsory subject in our secondary school system.

Mr. Chairman: Item 2 agreed to? Agreed.

Item 3.

The hon. member for Windsor-Walkerville, and then the hon. member for Sudbury.

Mr. B. Newman: Mr. Minister, I wanted to ask you whether I could bring up the hospital situation in the city of Windsor and try to convince the minister that the proposals of his ministry are not practical, and really not money-saving to the extent his officials think. Perhaps I should discuss this with you under some other vote? As long as I have that opportunity I will be content to wait.

Hon. Mr. Miller: Vote 2903, but which item?

Mr. Chairman: I think, Mr. Minister, it should come under vote 2903, under hospital care.

Mr. B. Newman: I will accept that. Under which vote, under 2903?

Mr. Chairman: Vote 2903, item 2, general hospitals and related activity; and the Chair will recognize the hon. member.

Mr. B. Newman: Mr. Chairman, I want to straighten this out. It is vote 2903, general hospitals and related activity.

Mr. Chairman: That’s right, item 2, and the Chair will recognize the member.

The hon. member for Sudbury, item 3.

Mr. Germa: Mr. Chairman, I was talking about non-delivery of services in northern Ontario. I want to raise a particular point with the minister. That is, the money presently allocated for construction of more hospital beds in Metropolitan Toronto when we have heard there is floor after floor of empty space already built and available and wasting the taxpayers’ money. Now, in 1973. coming out of the catchment area --

Mr. Chairman: Order please. I think the hon. member concurs with the Chair that that should come under 2903, item 2, as well, general hospitals.

Mr. Germa: Not again. How can we do this, Mr. Chairman?

Mr. Chairman: I think that comes under vote 2903, item 2, general hospitals.

Mr. Germa: I think it doesn’t, Mr. Chairman.

Mr. Chairman: The Chair and the minister agree that we will allow you to consider it at that time.

Mr. Dukszta: Mr. Chairman, may I have a point of order, here?

Mr. Chairman: Point of order?

Mr. Dukszta: Yes, I think the member for Sudbury is talking on planning. You allowed what I was saying, I think you should allow him, because it is really only the second half of my propositions, except that it is from him. He is talking on what is wrong with the system generally in terms of financing, how money could be saved and what was wrong with the minister’s approach toward hospital planning.

Hon. Mr. Miller: I can perhaps read the headings that come under this vote for your information so you will know the topics this vote covers. Is that fair enough? Then at least you will know if you want to respond to them.

These are under the Assistant Deputy Minister for Health Services: Area planning co-ordinators, drugs and therapeutics, the inspection branch, the district services division, which includes the psychiatric hospitals branch administration -- I would think that is for this only -- the ambulance services branch and the administration of clinic services branch.

Mr. Germa: Mr. Chairman, I think these estimates are brought in here in this form deliberately to confuse the opposition. Now why doesn’t the minister prepare a document which will tell us what items are under discussion in any one particular matter? Who would ever suspect that ambulance planning was under this particular vote? What kind of game are you playing here?

Mr. Chairman: Order, please.

Mr. Germa: He’s usually a nice fellow, but I’ve been put off for about the past hour this evening and it can’t go on. There has got to be some order in this place. Either we are here to discuss the minister’s estimates or we are not.

Mr. Chairman: Order, please. The Chair is trying to bring some order into the discussions and the debate. I would say that we should deal with the topic of health services under the items the minister has indicated. The Chair has also indicated, as has the minister, that we will allow the hon. member to discuss his topic under vote 2903, item 2. The hon. member for Cochrane South.

Mr. Roy: Mr. Chairman, I want to rise on a point of order. I think the member for Sudbury raises a good point. I have appealed to the minister, Mr. Chairman, as a reasonable person, and I think you will admit along with him, that it is exceedingly difficult for us to know what particular items are under, for instance, health standards and health services.

I mentioned this to you at the opening of the estimates, that if we had more of a breakdown then you could have more order and even you, Mr. Chairman, would be in a better position to know if we are in order or we are on a particular item.

Hon. Mr. Miller: I accept those as valid criticisms. I am not trying to confuse you. I would be pleased at the start of each vote to read you the headings under it.

Mr. B. Newman: That will be better.

Hon. Mr. Miller: If I did that it might make it easier for you to limit the discussion at that time to those issues.

Mr. Roy: May I make a suggestion?

Hon. Mr. Miller: This is the administration of those sections of our ministry that I have talked about, not the actual transfer payments or funds for operating hospitals.

Mr. Roy: Frankly, we should have those things before the start of the estimates so we would know.

Mr. Martel: Could the minister bring in tomorrow, if his estimates are being considered tomorrow, just the headings; and under each heading the various sectors that are going to be discussed? Even if the minister reads them ahead of time, it is still difficult to remember the exact headings he has indicated we are going to have. Secondly, it gives us an opportunity in the opposition to be in our places when we want to speak to a specific item, rather than have to sit here for hours.

Hon. Mr. Miller: Agreed.

Mr. Chairman: Further to what the hon. member for Sudbury East has said, it would be some help to the Chair as well. Perhaps as the hon. member has suggested, we’ll do that tomorrow morning.

Hon. Mr. Miller: No argument. I’d be glad to.

Actually, I am just as anxious to have orderly debate as you are. I am not anxious to hide anything from you. If I can give you the topics under each vote so you can look at them in advance, I will be glad to do it.

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

Mr. Germa: Mr. Chairman, on a point of order.

Mr. Chairman: On a point of order, the hon. member for Sudbury.

Mr. Germa: I am asking the Chair to have the minister read the items which are covered by vote 2901, item 1 and vote 2901, item 2. I want to know what the headings are, what we have missed so far. Now, I would ask that he go right back to square one and let us know what we have been trying to accomplish here for the past two days.

Hon. Mr. Miller: I read all those under the ministry office for you a few minutes ago when I went down the list, I think for the member for Welland --

Mr. Germa: I am not a speed writer, Mr. Chairman.

Hon. Mr. Miller: No, I recognize that; I was answering a question directed from him at that time, and I did read the item and the amount at that time. It was the office of the minister itself; the office of the deputy minister; the Ontario Council of Health; the HSO group -- for lack of a better word -- the policy secretariat; health boards; the human resources branch, which is transferred into my language of personnel branch.

Mr. Laughren: Engineers’ language.

Hon. Mr. Miller: The legal branch.

Mr. Roy: Oh, I didn’t know that.

Hon. Mr. Miller: And communications and advertising. That was the first vote, okay? Now, under health standards --

Mr. Laughren: Are you a speed reader?

Hon. Mr. Miller: -- personal care standards and we break that down into the executive director’s office and allied health disciplines. This, I believe you will find, is the administration only of these programmes. Children’s mental health services; medical and nursing. When you see the amounts of money you will realize these are for staff in the head office. Next there is research and analysis division; administrative staff.

Mr. Dukszta: Do the children’s mental health services in total come in right now?

Hon. Mr. Miller: No, no; I am just saying that was the salary for the 10 people who are administering that programme.

Mr. Martel: Why don’t you move that over to the Minister of Community and Social Services (Mr. Brunelle)?

Hon. Mr. Miller: Institutional standards division; which is planning of hospitals, beds and so on, this is the administration of the programme.

Mr. Martel: That’s what we want to talk about.

Mr. Germa: That’s what we wanted to talk about.

Mr. Martel: There we are, Mr. Chairman.

Mr. Dukszta: It was never made clear.

Hon. Mr. Miller: Just a second --

Mr. Dukszta: That’s exactly what we have talked on for the last half-hour.

Mr. Martel: He cut it off.

Hon. Mr. Miller: If you check back through the record, we gave you two options at one point, I believe.

Mr. Germa: Yes, but the Chair ruled it out of order.

Mr. Dukszta: On your ruling, the chairman ruled him out of order.

Mr. Martel: The chairman is just as guilty.

Mr. Dukszta: It was very clear that we should discuss it here.

Hon. Mr. Miller: Then community health standards division, which included the administration for health promotion and administration for occupational health.

Mr. Martel: Oh, that is what I wanted to talk about. You see, I didn’t know it was there.

Hon. Mr. Miller: Is that your note that you sent over?

Mr. Martel: No, I asked Jan to send it over to find out.

Hon. Mr. Miller: I couldn’t understand whose initials it was.

Mr. Martel: Jan Dukszta.

Hon. Mr. Miller: Oh, is that Jan Dukszta? Excuse me, I thought it was the last name all that time.

Mr. Chairman: The hon. member for Sudbury indicated he wanted to talk on hospital planning?

Mr. Germa: Hospital bed planning.

Mr. Chairman: Well, in view of the information that was given by the hon. minister, the Chair will recognize the member at this time.

Mr. Germa: I am embarrassed, Mr. Chairman, that I am right so often, that this government is wrong so often. What I have been trying to say for the past hour, Mr. Chairman --

Hon. Mr. Miller: Would you like to take this seat and we will discover how seldom you are right?

Mr. Germa: Maybe I should sit down while I am ahead.

We are talking about cancer treatment beds, cancer research beds and the lack of same in north-central Ontario. Patients have to come to the Princess Margaret Hospital now in order to receive treatment for cancer.

The particular area I represent has a high degree of cancer due to the inadequacy of service supplied by this ministry in the occupational health branch. So they are not only deficient in supplying the services to people once they have contracted cancer, it is because of deficiency in this ministry that they are getting the cancer in the mines and smelters of northern Ontario.

So the minister has to stand condemned on two counts -- failure to protect the worker and then failure to supply him with the necessary treatment once you have ruined him.

In 1973, from that area of the catchment basin which is detailed to be treated by Princess Margaret, out of northern Ontario -- and that includes the district of Algoma, Cochrane, Nipissing, Sudbury, and Parry Sound -- there were 686 people who were transferred from that area for treatment and diagnostic service in the Princess Margaret Hospital. That comes out of a population of 582,379 people; which is the last population figure I have, for the year 1971. That figure has gone up somewhat since that time, but that is the latest figure I have; it will serve the purpose for what I want to say next, Mr. Chairman.

Kates, Peat, Marwick, as I am sure the minister is aware, did a survey in 1973 to determine what the needs were going to be in the Province of Ontario in the foreseeable future as far as diagnostic and treatment services for cancer were concerned. On page 10-2 of their report they said: “International standards indicate that a minimum of 500 new cases per year is necessary to maintain an effective treatment centre.”

I go back to my original statistics, Mr. Chairman. Where international standards call for 500 new cases, we from north-central northern Ontario generated 686 cases in 1973. So we meet that criterion, as enunciated by Kates, Peat, Marwick.

The study goes on to say: “As only 50 per cent of all cases are suitable for radiotherapy at current incidence rates, a population of 330,000 is necessary to support a minimum-sized centre.”

Mr. Martel: Bring them all to Hogtown for that.

Hon. A. Grossman (Provincial Secretary for Resources Development): Does the member mind making it Cowtown?

Mr. Martel: The provincial secretary doesn’t like that, does he?

Mr. Germa: I go back again to my original figures: If 330,000 is necessary to maintain a centre, we have the population; we have 582,379. So Kates, Peat, Marwick scored twice -- in terms of the number of patients necessary to maintain a centre and in terms of the population catchment area necessary to attract that number of patients.

Kates, Peat, Marwick went on to look into the problems that would be faced if Princess Margaret were expanded -- and I am quoting from page 2-14:

“The consensus of the research groups at the Princess Margaret Hospital is that the present research space is adequate for future needs. It is felt that the divisions of biology and physics have attained an optimum size as research groups and that any increase in size would cause communications problems and a general lowering of research quality.”

Therefore, any further cramming that is being done or going to be done at Princess Margaret is going to result in the lowering of the research quality.

Hospitals are major construction projects and, when we are planning them, I think we have to plan quite a way into the future. The study did look into that, and it came out with the following figures:

“In 1971, 4,663 new cancer patients were registered at the Princess Margaret hospital from this population. The present facilities at PMH cannot be expected to absorb the expanded case load of approximately 8,500 new cancer patients which the population would generate in 1981. We estimate that this patient-load will require a total of 285 service beds, plus 30 to 60 beds for clinical investigations, depending on their distribution. These calculations are based on 90 per cent occupancy and an average length of stay of 11 days. This latter figure was the prevailing average of PMH during 1971.”

We can see that by 1981 we are going to have to supply another 285 cancer beds in the present catchment area.

Further in the study there is a comment by the researchers at Princess Margaret: “The research workers at the PMH have stated forcibly that an increase in the size of the research group would tend to lower the quality of the research undertaken.” Therefore, we cannot continue to overload the research facilities at Princess Margaret, which is recognized now and has a good reputation internationally. I think by trying to put too much into that hospital, we could cause a lowering of the standards which they presently maintain. It further goes on in the study on page 6-5:

“Without doubt, an increase in the size of PMH to cope with the total load of cancer patients in 1981 from its current catchment population would cause substantial administrative problems.”

So they have looked ahead, and they have warned you, Mr. Minister, that you cannot increase this facility, particularly when the facility in the catchment area is so large that it causes great hardship on those people who have to come here for treatment.

Mr. Martel: You might think in human terms for a change; you just might.

Mr. Laughren: Think of it like an engineer.

Mr. Martel: Like building bridges.

Mr. Germa: They also did a study, as the member for High Park mentioned, about vacant hospital beds in Toronto at the present time. I’m quoting from page 6-12:

“We suggest that PMG begin appropriate negotiations with the Wellesley Hospital, bearing in mind the recent reductions in their hospital budget related to the use of 35 beds. If this approach is unsuccessful, the Women’s College Hospital has already offered to make beds available and other sources could be found, e.g., the old New Mount Sinai Hospital.”

So we already have the bed capacity in the metropolitan area; and here we are putting in another 30 beds at a cost which, I understand, is almost $2 million.

Mr. Martel: You won’t develop anything in the north though, God forbid.

Mr. Germa: The study also goes on to say: “The establishment of another centre in a location within the catchment area, but not within Metropolitan Toronto.” On page 8-8 of the report it said:

“A new centre could be located in northern or north-central Ontario. This would bring the services of the foundation closer to that segment of the catchment population, thus reducing the cost and inconvenience of travel to Metropolitan Toronto. In the long term, a foundation centre should be established outside Metro Toronto to provide diagnostic and treatment services, education and research facilities within the northern Ontario catchment area. We recommend that planning commence now for the construction of this centre.”

The projected figure for 1981, out of the district of Sudbury alone, is 802 cases. So even the district of Sudbury will generate enough patients by 1981 to make a centre viable.

Not only do we need the centre in northern Ontario, the facts document the case. We have to consider what impact it is going to have here in Toronto. This area is already overloaded with institutional type development. It is no secret that the north Jarvis ratepayers’ group are severely concerned about what effect further institutional expansion will have in this particular area. The two aldermen in Ward 6, in which this facility is planned to be expanded, have voted against any further expansion. The present director, Dr. John Darte, understands the problem. I quote from a news story in the Toronto Star of Wednesday, April 30, 1975, wherein it says:

“Dr. John Darte, new director of the Ontario Cancer Institute and Princess Margaret Hospital, wants to develop a way to help cancer patients stay in their own homes to ease their fears.”

He goes on to say:

“I think one thing that doctors and nurses sometimes forget is that the very fact the patient is in hospital immediately puts him at a disadvantage.”

So the director of the hospital, while he did not say what should happen, realizes and recognizes the traumatic effect it is to a patient and to his family or her family, when they are stricken with cancer and they have to leave home. Many of these people have never been that far from home in their life and for them to have to come down here to have treatment is just unbearable.

I would like the minister to respond and to determine why he would go against the wishes of the two aldermen in that particular area; why he would go against the wishes of the people of northern Ontario; why he would go against the recommendations of Peat, Marwick; and why will he not recognize that the present expansion at Princess Margaret could have been avoided if he were to establish another facility in northern Ontario.

Hon. Mr. Miller: Mr. Chairman, I think you have jumped to the conclusion we are going against the recommendations, when in fact we are following them. One of the authors of that report is sitting right in front of me.

Mr. Martel: He said build one in Sudbury, did he?

Mr. Laughren: The one who is blushing?

Hon. Mr. Miller: The one facing me so you can’t see whether or not he is blushing.

Mr. Martel: We can tell by the back of his neck.

Hon. Mr. Miller: You can tell?

Mr. Martel: Yes, it is red.

Hon. Mr. Miller: I thought there were only red-necks up in Sudbury.

Mr. Martel: No, they are all in the Tory party.

Mr. Laughren: Like Timiskaming!

Hon. Mr. Miller: We recognized the growing demand for and pressures on the cancer treatment facilities in the province. I felt that as you read the report you were confusing cancer treatment and cancer research to some degree. The report, I believe, goes on to say in some part you need a cancer facility in the 1980s in Sudbury. Is that correct?

Mr. Germa: Yes.

Hon. Mr. Miller: Okay. I don’t know that we have indicated that won't happen yet. We challenged the cancer groups in Ontario to assist us in deciding where the moneys we had for the first time ever specifically allotted to cancer -- capital moneys -- should be spent this year. I am not sure how much it is. It is about $3.5 million for cancer, capital investment in the plants around the province.

You may have heard me say the other day on this issue that they came back and said: “We can’t put priorities on our needs; build them all”. I said, “That’s great, but that is the story of health. Everyone wants everything today”. They came back with a priority list which I think pointed out that the outpatient treatment facilities at Princess Margaret should be expanded. That ties in exactly with the report which says patients should he kept in the home as far as possible.

Mr. Dukszta: At home in Toronto or in Sudbury? What are you talking about?

Hon. Mr. Miller: You know as well as I do that the treatment facilities in a specialized cancer treatment centre are highly specialized. We are fortunate to have one in the province, let alone the others. I think it also pointed out that Toronto should have a second treatment facility built within it before the Sudbury unit was built, if I am not wrong.

Mr. Martel: Well, then meet the costs of bringing them down here.

Hon. Mr. Miller: I believe there were two potential locations for that. I think the Sunnybrook Hospital location pretty well has got the nod if I am not wrong on that issue. We are heading in that direction.

Mr. Martel: Reduce the cost to the families.

Hon. Mr. Miller: I personally have a member of my family right now being treated at Princess Margaret and I am very well aware of the problems of bringing a person, who can barely survive, 150 miles.

Mr. Martel: Try it for 350, 400 or 500.

Hon. Mr. Miller: I am saying I know it because I have been doing it personally, so I am very keenly aware of what a terminal patient is like. I am not ignoring this stuff right now.

Mr. Martel: Put some money in there to reduce those costs.

Hon. Mr. Miller: I do, for your information, think humanely.

Mr. Martel: Well, prove it.

Hon. Mr. Miller: I have had the opportunity to look at hospitals from the outside and the inside in more than one occasion.

Mr. Martel: You have your say. I will have mine.

Hon. Mr. Miller: I do think I try to look at these issues.

Mr. Martel: You might put something in for room and board while the mother or the father is down here. That might help.

Mr. Chairman: Order, please.

Mr. Martel: Or transportation costs.

Mr. Chairman: Order, please.

Hon. Mr. Miller: I am sure no matter what we produce there will be some weakness in it from your point of view. In any case, we are working in that direction. I can’t promise that in the 1980s, as hoped for, we will have your facility in your area, but certainly all the statistics would indicate it should be. I think you will find we have one in Thunder Bay. I think we’re spending money this year in Ottawa, London and potentially Kingston and Thunder Bay on certain cancer treatment facilities based on the recommendations of this group in an attempt to get some facilities out around the province. Yours, hopefully, would be considered in the 1980s.

Mr. Chairman: Is there further discussion on item 3?

Mr. Germa: Mr. Chairman, further to what I was saying, I’m glad the minister recognized there is statistical evidence being established that we do need a foundation in north-central Ontario. It’s unfortunate that the report was written by a two-handed person -- on the one hand this and on the other hand that. You chose what he offered in one hand and I chose to take what he offered in the other hand, but he did make a good case for establishing a new centre in northern Ontario.

If you wait until 1980 and you know that the figures are projected there at 801 patients, then you’re going to have a crash programme on your hands. In order to get that thing into service by 1980, you should be starting today to make your plans and to get your drawings and do your research, because you can’t leave it to 1980 and then start researching.

Mr. Martel: That means 1990 delivery.

Mr. Chairman: Is there any further discussion on item 3?

Mr. Martel: Yes, Mr. Chairman.

Hon. Mr. Winkler moves the committee rise and report.

Motion agreed to.

The House resumed, Mr. Speaker in the Chair.

Mr. Chairman: Mr. Speaker, the committee of supply begs to report progress and asks for leave to sit again.

Report agreed to.

Hon. E. A. Winkler (Chairman, Management Board Cabinet): Mr. Speaker, before I move the adjournment of the House, we will return tomorrow to the consideration of these estimates, as we will on Monday if they are not completed. On Tuesday we will return to dealing with legislation, and probably on Thursday too. I would ask the members of the House to prepare themselves for other remaining bills standing on the order paper.

Hon. Mr. Winkler moves the adjournment of the House.

Motion agreed to.

The House adjourned at 10:30 o’clock, p.m.