Hansard Transcripts 1976-Jun-22 | Legislative Assembly of Ontario

Mr. Deputy Chairman: Perhaps I should mention to the hon. members of the committee that seven hours remain in the committee of supply. Does the hon. Minister of Health wish to make any opening comments?

Hon. F. S. Miller: Mr. Chairman, I have just been moved to another seat and am moving my equipment.

Mr. Deputy Chairman: While we’re waiting for the hon. minister, perhaps it would be in order for the Chair to remind the hon. members of the committee that the stacked votes in the committee of the whole House will take place after the question period this I afternoon.

Hon. Mr. Welch: Mr. Chairman, if I might at this point, it was our plan after routine proceedings this afternoon to clear up the work that’s in committee of the whole House, do our third readings, put government notice of motion No. 6 before the House and then go back to these estimates until they’re finished.

There is a motion on the floor now, and I know we’re in committee, and I would like some direction from the committee that we would go through the lunch hour. That’s not really necessary today. If, in fact, we wanted to break between 1 and 2, we could decide at 6 o’clock how much more time we might need to complete these estimates. I’m in the committee’s hands as to whether or not we would like to rise at 1 and have a break between 1 and 2, or sit through lunch.

Mr. Deans: Mr. Chairman, I think we should have a break between 1 and 2 today and a dinner break as well. I think we have sufficient time today to complete all the work that’s before us and it makes no sense to sit all day as we did yesterday. I think it tends to be a bit much.

Hon. Mr. Welch: How would it be if we agree to break between 1 and 2 anyway and we could see where we are as we get closer to 6 o’clock?

Mr. Deputy Chairman: It is the understanding of the committee that we will rise at 1 o’clock. Agreed?

Mr. Nixon: There will be seven or eight people here between 1 and 2 whether we are sitting or not.

Hon. Mr. Welch: What do you want to do?

Mr. Deputy Chairman: The committee will rise at 1 o’clock.

Hon. Mr. Welch: Actually, by resolution of the House, we in fact are sitting until 2 unless we agree otherwise, so that’s why I’m raising the question now.

Mr. Deans: If I can put it this way to you, since I’m likely to be one of the seven or eight who will be here, I’d rather rise and have lunch.

Mr. Nixon: Since I am one of the seven or eight who will be here, I say let’s sit.

Mr. Deputy Chairman: Perhaps it might be in order for the --

Hon. Mr. Welch: I think I grasp the consensus to be that we will sit. Therefore, we will go from 10 to 2, and then we’ll have routine proceedings at 2 and we’ll break at suppertime in the regular way, depending on circumstances at that time.

Mr. Deputy Chairman: The hon. Minister of Health.

Hon. F. S. Miller: Mr. Chairman, it is now certain that I will be one of the seven or eight here between 1 and 2.

Mr. Deans: I thought you weren’t supposed to work that long?

Hon. F. S. Miller: I believe that was the intent of the House, to try to let me have an hour’s rest, but I don’t think it matters.

Mr. Deans: That’s what I was hoping for, but obviously the Liberals don’t care about your health.

Hon. F. S. Miller: Mr. Chairman, before I read my opening statement, perhaps I could have it distributed to the members.

Mr. Nixon: Mr. Chairman, on a point of order. I just don’t know how serious that exchange is.

Mr. Deans: Oh, it was a joke.

Mr. Nixon: Because, obviously, anytime the Minister of Health feels these proceedings ought to adjourn for a while we are more than willing to do so.

Hon. F. S. Miller: Mr. Chairman, I do appreciate the sincerity of that. I was asked by the House leader if I could, in fact, stand four hours at a time. The answer is yes I can. I will not be present during question period as a result of it, but since you will have me all day on the grill anyway, I think probably you can miss me at question period.

Before I begin my opening statement, I know the Ministry of Health estimates are sometimes difficult for the members to discuss in a sequence that suits them, because they are never quite sure under which vote a particular topic might fall.

Last year, we rushed into trying to get some printed material. This time, I have enough pieces of paper here, which I’d like to distribute, showing the vote and the item so that the members of the opposition parties and our own party will know roughly where a particular topic pops up. I think it would be wise if, in fact, albeit we only have seven hours, we try to discuss them item by item in sequence rather than doing what we’ve done in the past and that is cover all topics at one time. I hope and trust then that the items of interest will get the time they deserve.

I would like to open my estimates debate with a statement that I hope will put into perspective some significant changes that have recently taken place in our health programmes. I’m sure the members are well aware that since the 1950s there has been a steady escalation in the number of public services provided by government, particularly in the social service areas.

This quite properly was brought about by ever increasing public demand. The public felt that an industrialized, affluent society should provide appropriate hospital, medical and social services. The federal government bowed to this pressure and introduced, first, universal hospital care, and then later a universal medical care scheme, neither of which had any flexibility in meeting varying provincial needs.

As we all so well know, the British North America Act delineates federal and provincial powers. It is the specific responsibility of the provinces to provide for the legislative, regulatory, financial and service components of health care. The federal government through its national taxing scheme altered this through financial manipulation, which warped the natural evolution of a balanced health care system. The responsibility of providing services has remained with the provinces. But, until now, we have been unable totally to call the shot. This government has fully accepted the responsibility of protecting the public from health hazards, of preventing the outbreak and spread of disease and of providing for care of the sick and the injured.

As health services came under the hospital and medical care insurance plans, expectations and demands of both the public and of professionals providing health care have increasingly strained our financial resources. The situation became difficult to control and financially intolerable with large wage settlements, rising cost of products and a high rate of inflation. Under the federal shared-cost programme, services tended to gravitate toward hospitals because of the funding scheme and availability of 50-cent dollars from the federal government -- that’s on a Canada-wide basis. This overburdened the system with expensive, top-heavy hospital facilities offering a variety of services which could have been delivered in a less costly manner if they had been cost-shared.

Even though there was no federal funding, this province took the initiative of introducing insurance coverage for nursing homes. This has added to the rising costs but it was needed to achieve a balance in the system and to lessen the work load of acute treatment facilities while still providing long-term health care for senior citizens. While this was happening, the economic climate was changing and inflation began taking its toll.

There have been reams of reports and dozens of investigations and task forces looking into health care services and making hundreds of recommendations on the organization of a balanced health care system. We knew something had to be done to rationalize health care and its rapidly increasing cost. The limitations of shared-cost programmes have repeatedly been brought to the attention of the federal government without success in many rounds of our federal-provincial meetings. Federal counter-proposals were found unacceptable to the majority of provinces, because they put them at a financial disadvantage in providing health care.

Mr. S. Smith: Excuse me. On a point of order, Mr. Chairman, I apologize for interrupting but would the minister prefer to make his remarks while seated?

Hon. F. S. Miller: No. I’m fine.

Mr. S. Smith: It certainly wouldn’t matter to us at all.

Hon. F. S. Miller: Thank you, I’m quite okay. They’ve got me on a training programme these days. I turn out to have better wind power than most of you who are not suffering from heart trouble.

Mr. S. Smith: I was hoping then I could make my remarks sitting down.

Hon. F. S. Miller: In your case, you may need it. I would say prevention is the best part of this deal.

Mr. R. S. Smith: You have to start early though.

Hon. F. S. Miller: Yes.

As members are aware, the first ministers were in Ottawa last week to work out a new basis for shared-cost programmes which will be fairer to all parties. The federal government put forward a proposal of combined tax points and cash which reflects ideas Ontario has put forward over the past decade. This was a positive step toward improving the accountability and flexibility of the partners in Confederation and toward the removal of petty administrative details.

The federal proposal partially transforms conditional federal grants into unconditional form. However, it does not present the comprehensive reform we would like to see in health financing. It deals with only part of the total health programme and leaves out such vital components as psychiatric care and nursing homes. I have to point out, however, that there are a number of details to be worked out and I think it’s premature for us to prejudge the package offered. It’s a significant step forward in our opinion in any event.

[10:15]

Under the proposal, the federal government has suggested a global health review. Our Premier (Mr. Davis) had said a review was not necessary and that a more constructive approach would be to include all alternative forms of health care in the present financial base. This would be in keeping with the spirit of the federal proposal and would spare us yet another exhaustive study. I think the Premier’s words were that health has been studied, restudied and restudied in the last few years. We have volumes and volumes of studies. The time has come to act.

As members are well aware, we in Ontario are not alone in our attempts to achieve affordable health care. All jurisdictions across Canada are faced with containing health care costs.

I would like to report on the progress of our constraint programme. Initially, we estimated a total saving of $48.2 million from hospital closures and selected budgetary controls. Breaking this figure down, it meant $37.8 million would have been saved through bed closings and budget controls, and a further $10.4 million through hospital closures. With respect to hospital closures, the members are aware that four hospitals have been affected by the division court decision with respect to closure by the province. The government is respecting that decision while launching an appeal against the decision of the court. Four hospitals have closed.

During the time required for the appeal, the hospitals will, of course, continue to operate financially under the general funding principles of the ministry. Should the appeal fail, the government will consider possible legislative action. To do so now, however, would be to prejudge the appeal process, about which we are hopeful.

Because of the court decision and the adjustments in our control programme, the projected net constraint saving amounts to $23.3 million in total; or $22 million from bed closures and budgetary controls, and about $1.3 million from hospital closures.

In general, hospitals have been very cooperative and have tried to live within the established guidelines. That is not to say that these guidelines were perfect. There is room for improvement and we have been working closely with hospitals in their submissions.

I am also pleased to report that we have been successful in our constraint programme as it related to the closing of psychiatric hospitals and public laboratories. Along with the savings achieved in the public hospital sector, another $3.4 million has been saved by convening the provincial psychiatric hospitals at Goderich and Timmins. A further $375,000 net savings this year will be realized through the closure of four laboratories, even with the expenses attendant on closure.

This government is making a substantial saving, a total in excess of $27 million this year, but what is more important is that these savings will he realized annually, thereby saving Ontario taxpayers many more millions of dollars in the future.

Within the Ministry of Health itself we have made determined efforts to make savings ourselves. In fact, the ministry has reduced its staff by 2,192 persons in the past two years -- staff at all levels, including senior management. That’s roughly two-thirds of the provincial total. We have consolidated branches and divisions within the ministry to streamline operations and improve management.

Earlier this month, I spoke about the measures we have taken to strengthen this ministry’s occupational health protection branch. These measures include changes within the branch organization and management, and the “beefing up” of staff.

At the time of the original statement on occupational and environmental health I indicated there was a shortage of occupational health personnel. I am now pleased to report that my ministry has made an inventory of all occupational health manpower within the province and has contacted all health science centres to encourage them to train occupational health specialists. It is expected that by 1977-1978 there will be a substantial increase in the number being trained.

The “Interministerial Accord on Occupational and Environmental Health” was completed in draft form in October, 1975. Implementation of the accord is being effected through regular meetings of the four deputy ministers and through an interministerial standing committee on occupational and environmental health.

I would now like to discuss the Ontario Health Insurance Plan. During 1975-1976, 8,240,000 Ontario residents were covered under OHIP. There were 50.1 million claims representing a total of $728.3 million. Another $13.8 million was paid out for non-fee for service payments, which include doctors’ salaries, sessional and capitation payments. In total then, the plan paid out $742.1 million. For the record, I would like to note that administrative costs were only 5.06 per cent of the total expenditures which compares favourably with other similar health insurance plans.

Under OHIP we have active committees which review and scrutinize professional activity and billing procedures. These are the medical review committee and the practitioner review committees. The medical review committee deals with physicians and the practitioner review committees deal with chiropractors, chiropodists, optometrists and dentists. These committees monitor the professions’ billing practices.

I would also like to touch on the drug benefit plan which in 1975 covered one million Ontarians. One million prescriptions a month are filled under the programme which provides drugs to persons over 65 or on family benefit, extended care patients or home care patients, people receiving vocational rehabilitation and indigent diabetics. In September, we will be adding general welfare recipients as well. The average drug benefit prescription was 68 cents less or 16 per cent lower than the overall average paid by other drug insurance plans, like Blue Cross or Green Shield. The control features of the drug benefit plan were responsible for the savings.

Medical manpower planning is important. The ministry has supported a careful review of specialty and family-practice manpower needs by the medical profession and medical schools. The rate of physician immigration has now been brought under control in Ontario. Between July 1, 1975, and March 31, 1976, 81 immigrant doctors were admitted, nine with a landed status. This compares to 236 in the first six months of the year. The distribution of physicians is improving. The underserviced area programme has been successful in placing doctors and to a degree dentists and nurses in communities previously with inadequate health care.

With respect to controlling laboratory costs, I indicated several days ago that legislation controlling laboratories, specifically Bill 59, will remain on the order paper but will not go forward this session. We intend thoroughly to review it with a view to amending it. I would like to outline for the House today some of the specific steps this government is presently taking to control the cost of medical laboratory services in this province.

Regulations are being developed under the Public Health Act to control conflicts of interest in the ownership of laboratories. I can say that that legislation or regulation is practised and we are simply awaiting a series of appendices to it to be included in the regulations naming labs by specific location. Regulations under the Health Disciplines Act are also being drafted to eliminate kickbacks. Again, I believe those have been circulated to the various professions in the last few days. In addition, a new laboratory test requisition form is being developed to discourage unnecessary utilization of medical laboratories. I can also say that new requisition form clearly states the cost of each laboratory procedure ordered by the doctor so that he will be aware of the cost.

Reimbursement mechanisms for laboratory procedures are currently under consideration. Global budgets, tendering and other mechanisms all have strong points and, unfortunately, weaknesses, all of which we will take into consideration. The methods of reimbursement of both private and hospital labs are under review for obvious reasons. We are faced with rapidly escalating utilization and costs in the private sector, a factor that has been promoted by vigorous and aggressive marketing techniques on the part of private lab owners. Also, current mechanisms must be revised to provide some incentives to hospitals to use their laboratory capacities more fully by doing more of their own outpatient tests.

Our effort in the first instance will be geared toward the limitation of growth of medical laboratory workload while encouraging shift in volumes to the hospital labs. Sixteen regional advisory laboratory committees are studying available spare capacity in hospital and public health laboratory services to assess the possibilities of increasing their share of outpatient testing. The committee is developing proposals for a regional laboratory system which will make maximum use of resources, eliminate duplication of services and equipment and make labs more cost-effective.

I have outlined a few of the areas of current interest in the Ministry of Health and its historical financial perspective. We’ve had our difficulties in aligning health care service to meet the legitimate needs of our citizens, but on the whole we’ve had a positive response both from the public at large and those who provide health care services. Everyone recognizes the need for eliminating unnecessary costs.

We have one of the best health care systems in the world and we should be proud of it. We are in a new era of challenge and change that can ensure a reasonable, affordable and rational health care system without sacrificing quality. This government has taken effective bold steps in this regard.

Apart from the prepared statement, I wanted to refer, if I may, to the Browndale situation and the request that the auditors’ study be summarized in this House, since this is my last opportunity to do so. While I haven’t got a prepared statement, I’d like to sketch out the information given to me.

I might indulge the interest of the leader of the Liberal Party because I’m going to talk about Browndale right now and I thought perhaps he might want to hear it. As you know, the internal auditors of the Ministry of Health have looked into the Browndale situation; at the same time, I understand the Attorney General is looking at certain aspects of the Browndale operation. I can’t speak for those things taking place in his ministry because I’m not aware of them in detail. However, I can summarize our ministry’s findings. I’m going to read parts of the report to me.

Our auditors found three areas in question when they looked through Browndale’s expenditures and accounting methods. The first was the overcounting of children days. As I’m sure you know, they are paid on a certain per diem per child in care. Browndale has overcounted the number of patient days by 145 in 1974 and 161 in 1975. These were included in the days they reported to us and they were paid at the approved per diem rates. Overpayment amounts to $8,700 in 1974 and $10,600 in 1975, for a total of $19,300. As this is an incorrect count of days, we have requested the money back from Browndale and I understand it will be paid.

I’ll digress a second to point out they were counting the day of arrival and the day of departure in their days and that is not according to regulations, You count either the one or the other but not both.

The second issue was expenditures on houses in Don Vale. The auditors found that in 1974, Browndale Ontario had entered into a lease for 10 houses in the Don Vale area. These houses were on Winchester St., Sumach St. and Gerrard St. A number of expenditures were made for rent, taxes, furniture and equipment and property improvement. These totalled $368,810 on the 10 homes. Browndale Ontario paid for these expenditures out of the funds which were flowed to them on the per diem rate; they weren’t extra moneys given to them.

[10:30]

At this point, our ministry questioned whether that was the appropriate use of the per diem money. Now, as you know, if a person is paid money on a per diem there is no specific requirement that it go for a particular part of the programme. Our auditor stated to Mrs. Brown that he did not consider this to be an allowable cost under the regulations, and that a refund should be made to the ministry. Mrs. Brown has stated to us that she’s consulted her lawyer, and that, in his opinion, the amount paid on a per diem basis was a global amount as the price for their services and that Browndale had discretion as to how it should be used for the programme.

This may well be the correct assessment, but this is under discussion right now. I would have to point out to the House that there is no question our ministry encouraged Browndale to believe that some of those homes would be licensed two years ago, because it was part of our urban re-entry programme and we felt homes had to be provided for children who were otherwise in areas like Haliburton, closer to their homes and more adaptable to the city environment.

The purpose, as you know, of the four-phase programme is perhaps to get children out into the country for a while who need to be stabilized, but before they can return to their parents they often require some time in residence in a city environment. I can safely say though that the reaction of the community of Don Vale, through the Don Vale residents association and ratepayers association, was such that this ministry did not move forward with the licensing of those homes.

The last issue that the auditor referred to was the question of the management contract with Browndale National, and the possible duplication of payments by Browndale Ontario, I believe, in the Browndale budget, something in the order of $900,004 in a year is paid from Browndale Ontario to Browndale National for training services and for professional help. Our concern was that, in fact, that money may have been transferred without services being given in return. This was the point on which we were waiting for extra information.

We requested details from Browndale Ontario as to the names of the people on the payroll of Browndale National and Browndale Ontario daring the periods in question. That information was given to us last week, partially by Browndale National, partially by Browndale Ontario. I can say a quick perusal of it would seem to indicate that there was no incorrect billing. I’m going to reserve final judgement, since the last papers just arrived Friday morning, until the auditors have had more opportunity to review carefully the exact names and, if possible, the salaries attached to them so that we’re satisfied on that.

Browndale remains at a per diem rate in the range of $65.94 per child per day. The highest rate that we pay to similar organizations is $84.29 a day; the lowest rate we pay is to Youthdale at $36.28 a day, and Browndale is just about in the middle of that system. Of the $65.94 paid per day, $61.45 is for residential care, the balance is for outpatient care.

Mr. Dukszta: Mr. Chairman, the minister has more than difficulties in management of his ministry. The Ministry of Health wrought havoc in this province in its recent attempt to close nine general and two psychiatric hospitals, while at the same time demonstrating its utter disorganization, mismanagement and incompetence. It brought about this chaos, moreover, not because it had to, not as a result of a careful and studied professional decision, and not in an effort to improve the health and well-being of the people of Ontario. It tried to close these hospitals because the minister and his aides have run out of ideas because the health system is, in fact, out of control administratively, and because the ministry had to make some feeble attempt to convince the people that it was doing something. In other words, the ministry was forced to try to close these hospitals in order to prop up its own failing public image.

The ministry estimated it would save $13 million by closing these hospitals. This figure, however, is totally illusory because the so-called savings would have been largely picked up again as costs by other hospitals, the federal government and the Ministry of Community and Social Services. Indeed, it was only the action of the divisional court in ruling that the government did not have the authority to close the hospitals that saved the Conservative government from further embarrassment.

Let us look at these supposed savings carefully. As I say, originally the ministry estimated savings from closing hospitals would he a total of about $13 million, but the divisional court decision removed virtually $9 million of this. Add on to that the costs of opening mental retardation resources centres of $4 million to replace the closed psychiatric hospitals and you get a figure of $13 million. When you subtract that from the original estimate you are left with savings as a result of the closing of only $536,100.

In effect then, the most that the ministry could have hoped actually to save would have been about half a million dollars. This should be related to the total health budget for this province of more than $3.4 billion. And at what cost? At the cost of enormous inconvenience, dislocation and personal agony for the health workers involved and the people they served. This rhetorical exercise produced a flurry of spurious activity and real excitement and anger throughout Ontario. It also served to point out the main structural defects of the system that is the responsibility of the Minister of Health.

Under this futile restraint programme of closing hospitals and public labs lies a much more significant theme. Successive Ministers of Health have again and again stated that their responsibility was to clean up the Ontario health care system. But this cleaning up has always been interpreted in terms of a right-wing desire to move in favour of private decisions and high costs rather than public planning and co-ordination. What puzzles so many people in the community health field, as well as health systems analysts and even the public at large, is the minister’s determined resistance to change and his inability to reform or restructure his ministry, that is, to operate when the need for surgery is already obvious and imperative.

Mr. Warner: Resign.

Ms. Dukszta: What most casual observers and even professional people fail to understand is that decisions for change at the ministry are not based on technical and value-free criteria but on political and ideological grounds. The favourite literary conceit of the present Minister of Health is to describe himself as a simple engineer -- just a folksy systems analyst who responds according to need.

Mr. Laughren: That’s the minister.

Mr. Dukszta: Of course, the minister is nothing of the sort. He is a complicated, intransigent ideologue of the right with a messianic belief in the so-called free market economy.

Hon. F. S. Miller: I think I could rise on a point of privilege at that. That’s the nicest thing anybody has ever said about me.

Mr. Dukszta: He states repeatedly, even if all public health services couldn’t be sold off to the private sector, still nothing should be done to interfere with the present dominance of health care by that private sector.

Mr. S. Smith: Where is the member for Durham West (Mr. Godfrey) today?

Mr. Dukszta: As a result, when it comes to actually controlling the cost of the health system, the minister is really a sheep in wolf’s clothing. When the minister early this year was extravagantly journeying to and from about the province closing small hospitals, he said it was to save money, but saving on paper probably no more than a million dollars increasing the real costs by several million.

He reminds me of Count Potemkin, pointing out from a distance the painted back-drops of tidy villages to Empress Catherine II, in order to persuade her that he was competent to manage the welfare of her subjects. Our own Potemkin, the Minister of Health, closes four public labs and gives $20 million of unnecessary money to the corrupt private lab system, where the work done is often unnecessary and simply designed to line the pockets of the owners and the referring physicians, who indeed often seem to be the same people.

This incompetence, this mismanagement and this ideologically based intransigence in the face of real and pressing problems are serious enough in themselves. But the problem does not stop there. It goes much deeper. The minister, his aides, his officers, indeed the entire Ministry of Health fails to understand, and as a result to deal with, a crucial facet of the relationship between sickness and health, between illness and wellbeing. “Health” is not simply the absence of “sickness,” and “well-being” goes beyond the absence of “illness.”

Because of this, the Ministry of Health cannot, like a fire department, simply respond to illness or sickness when it occurs. It must actively seek out ways of improving people’s health and obliterating the sources of threats to their well-being. It must be proactive rather than simply reactive. The ministry is not only opposed to this under the rubric of its so-called “free market economy,” but is actually incapable of it anyway under its present leadership.

It has always been clear that not only have the greatest advances been made in preventive medicine, but that, logically, primary prevention should take precedence over any simply reactive medical system, despite whatever short-term gains may be made through that type of system. The development in western medicine toward allopathic medicine instead of towards a more holistic preventive type of approach has resulted in the development of acute illness centres and remarkable advancements in diagnosis, treatment and even success in some aspects of medicine. Meanwhile, however, the whole area of concern in health which covers nutrition, health education and occupational health has been largely abandoned.

The medical model which has resulted in such remarkable success in acute treatment cannot simply be applied to preventive medicine. Primary medical care can function only by using a different set of strategies.

Let me expand on this. The use of this medical model has led physicians to perform too many procedures on largely healthy individuals. For example, the physical examination, which is quite useful in determining the cause of a complaint once an individual already knows there is something wrong, has failed to yield expected results when the individual being examined thinks of himself as healthy. The majority of procedures such as this general examination have been quite unsuccessful in detecting disease, and in effect have been a misuse of the physician’s time.

In a significant article entitled “Preventive Medicine by Risk Factor Analysis,” published in JAMA, Oct. 16, 1972, D. G. Miller has specified that the criteria for examination should be three-fold.

1. The disease should have public health significance in the population.

2. There should be a clear benefit to the patient as a result of early case detection. There is no gain to the patient or to society in the early detection of a disease which cannot be ameliorated or whose outcome is unalterable.

3. An acceptable diagnostic procedure should be available for the early detection of the disease.

One way of estimating the benefit of early diagnosis is to compare the mortality with the incidence of a disease. When mortality approaches incidence, one can conclude that there is little efficacy in early diagnosis and treatment. For example, some malignant neoplasms have an inexorable course irrespective of what is done. In others, like cancer of the breast, the survival rate is affected by early detection, diagnosis and treatment. Here palpation can be largely done by the patient herself if she is properly prepared. This would lead to early diagnosis by a physician, then mammography, cytological tests and correction through surgery if necessary. This will affect the mortality rate.

If we have a wholly reactive medical system -- and we will as long as we have a government in power which only sees its role as the passive paymaster for medical care provided by a private sector -- overall strategies for treatment of disease like this cannot be carried out. It requires an intelligent, active and planned approach Ito health care.

In cases where highly significant diseases can be detected in the early stages and where early detection can reduce mortality, large scale screenings should be carried out. We are accustomed to this for such individual diseases as tuberculosis, syphilis, diabetes, and cancer of the cervix. In each of these cases the whole structure of our health care system moves decisively to deal with the disease once it occurs, and often quite successfully.

[10:45]

Our medical system, however, is not oriented to prevent illness before it occurs. As a result we are so far from being vigilant that our health system now appears unable to deal with important dangers to public health. We have simply accepted our inheritance of great 19th century public health programmes, like sanitation and inoculation, but we have allowed them to run down and have not been as vigilant as we should in this area. There are recent studies showing alarming gaps in our programme for inoculation of school children. Ontario is now almost alone in the world in using the Salk vaccine as a means of inoculation against poliomyelitis as opposed to the preferred Sabin vaccine.

We in the New Democratic Party have for many years criticized this government’s lack of commitment to preventive health services. This year the failure has become even more apparent. In the rash of hospital closings and hospital budget cuts, no serious consideration was given to replacing the services being destroyed with community-based primary and preventive services. At the same time that acute services are to be cut, public health services are frozen.

If one were seriously concerned about the misallocation of resources in a health system, concerned about the lack of preventive services, about the failures of the reactive medical model, surely one does not cut preventive services spending. Is it not ironic that in this era of rising health costs payments to physicians are increasing by 16 per cent this year, operating costs for hospitals by 18 per cent and operating costs to local health units by only 8 per cent? Does this not reflect the distorted priorities of our present government?

When questioned about public disease control measures, an important part of this reactive system, the Ministry of Health is typically vague. On two occasions the minister and the acting minister have been asked in this House about measures being taken by the Ontario government to isolate certain new types of highly infectious diseases which may be introduced into Canada by travellers, in particular about the extremely virulent West African disease, Lassa fever, which kills 30 per cent to 50 per cent of those who contract it and for which there is no known cure. On one occasion, the minister replied that “negotiations are under way concerning the use of the National Defence Medical Centre in Ottawa” which, in any case, can only accommodate three such cases. What is Ontario going to do? The answer apparently is nothing.

It is difficult to believe in your good intentions even in your understanding of the problems in health care, when you react as you did on another occasion, on Thursday, June 10, 1976, when I asked you the following question:

“Mr. Dukszta: A couple of weeks ago 12 monkeys died suddenly at the Metro Zoo. I want to ask the minister a three-part question about this. Does he know what the monkeys have died of? Has he isolated the virus? If not, what would he have done, if it was a Marburg virus, to isolate the 20 or 30 people who were exposed who would have been in need of treatment, in view of the fact that the ministry doesn’t have any preparations and there is capacity only to isolate about three to four people?

“Hon. F. S. Miller: I didn’t realize the member is expanding my field. [And then you went on to joke] Mind you, Mr. Speaker, I have been dealing with them across the House for some time.”

It obviously appeared very funny to you that I would ask you about the death of the 12 monkeys, and you riposted like a clever school boy. The point was of course that the Marburg virus infects both humans and monkeys. The Marburg disease virus is related to the Lassa fever which, as I have just said, is fatal to 30 per cent to 50 per cent of human contacts.

The minister should also bear in mind -- and obviously doesn’t -- that diseases of this kind are particularly dangerous to health workers. The morbidity and mortality rate for Lassa fever is especially high for nurses and lab technicians. While modem techniques for reducing risks to health workers from such diseases exist, the government hasn’t even considered introducing them. This kind of failure to protect health workers is symptomatic of the Conservatives’ general failure to act in the areas of occupational health and safety, which in turn is due in part at least to its reactive model of health care.

Let me contrast how the preventive model and the medical model work when it comes to an occupation-caused disease. Mesothelioma is a rare but very dangerous form of lung cancer. If we accept the medical model approach, prevalent now both in organized medicine and in the Ministry of Health, then early detection and treatment can be provided within our system. When an affected individual has a complaint, pain, discomfort or cough, the individual sees his doctor, a diagnosis is made and the individual enters the medical system; or possibly a regular x-ray test detects the turnover on a routine screening and the individual again enters the smooth, efficient medical system of diagnosis and treatment.

But mesothelioma, although rare, is now recognized as having a causal relationship with asbestos. You don’t have to work with asbestos to get it; you just have to be around asbestos. A study conducted at the London School of Hygiene into 76 cases of mesothelioma showed that nine out of 45 cases had not even worked with asbestos, but lived in the household of an asbestos worker. A further 11 lived within half a mile of an asbestos factory.

Dr. Irving Selikoff, of Mount Sinai School of Medicine in New York, in his address to the Ontario NDP convention on June 12, 1976, gave examples of people developing lung cancer who never worked with asbestos: “One was a daughter of a plant manager who used to bring his company’s products home. Another used to bring her husband meals at the asbestos factory where he worked.”

We can prevent mesothelioma, if we control the process of producing asbestos. This would not only reduce the incidence of mesothelioma but reduce significantly both the human suffering and the financial cost of dealing with the disease once it is established.

To give another example, money spent on purifying drinking water when dealing with typhoid is a far more humane and thrifty use of health care dollars than to simply wait for people to be struck down by typhoid and then to treat the disease.

To sum up, the ministry reacts to health problems, again and again, only when they actually occur and when they lead to public outcry. This is why the ministry is not dealing at the origin level with the problems of coke oven emissions, uranium, lead, vinyl chloride, arsenic and other noxious substances which significantly affect workers’ health.

Instead, what should be done? An active, carefully planned and thoughtful attack on these problems -- a proactive attack, rather than a reactive one -- would begin with a three level approach to prevention:

1. The primary level of prevention can be defined as an exhaustive analysis of all present and future industrial products, and control of immediately dangerous substances before they produce both short and long-term problems.

2. The secondary preventive level consists of a vigorous clinical system of detection, supervision, monitoring and treatment of health problems once they occur.

3. At the tertiary level, rehabilitation, retraining, compensation and income maintenance must be provided for the worker and his family, or the family alone if the worker is killed.

The government of Ontario fails at the primary level, where the provincial system of monitoring industrial products is minimal. We have no estimates of workers at health risk from occupational hazards in mines, factories or the construction industries, or from radiation, airborne contaminants, noise, toxic substances and direct physical hazards such as occur in construction work.

You, the government of Ontario, fail dismally at the secondary level. We lack a general reporting system in Ontario. Hence, we have no adequate data base for analysing, preventing and dealing with health problems, particularly occupation-related ones.

One obvious source for such information which is not being used by the government would be OHIP data. For instance, 8.9 per cent of separations from hospital are from accidents, poison and violence, a rate of 15.3 per 1,000. In order to accurately assess occupational health risks, what we need to know is what proportion of these accidents is due to injury or hazard at work, and what proportion of other, non-accident diseases can be attributed to conditions of work.

If OHIP subscribers were coded as to workplace and occupation, these rates could be determined for a specific workplace. Then it would be a simple matter for an employer with an unusual incidence of injury and health problems to be investigated and taxed for his failure to protect the safety and health of his employees.

One result, then, of this passive model of health care adopted by the ministry has been that the province has in effect left major decisions about industrial pollution up to private industry, and within the ministry concern for such problems has been assigned to doctors or to ministry experts -- experts who are totally involved in the passive medical model which allows only for dealing with the incidence of illness once it occurs, and not its prevention. Ontario’s government, in fact, though clearly entrusted with the responsibility for occupational health, has failed to deal with this lack of any reporting system. Each ministry passes on the responsibility to someone else.

Again, without an efficient centralized reporting system there can be no co-ordination of the workers’ own doctors. Workers from the same plant often see different doctors. Their physical problems are reported individually and thus are never seen as a collective problem arising from the work situation. At the treatment level the workers are also separated, and it is assumed that the problem is uniquely that of each individual worker and not connected at all with that worker’s environment. In this way asbestos becomes the problem of the worker in the asbestos factory and not of the management of the factory.

This tendency is aggravated and augmented by the way the ministry generally views health, that it is the individual’s problem rather than a social one. Then it naturally follows that individual causes for these problems are sought. Thus, in the face of massive evidence to the contrary, we should still not be surprised that the present minister has consistently espoused the view of patients that they are careless, greedy, and lazy. He obviously holds to the concepts of accident proneness and employee carelessness as a way of explaining work-related accidents.

The Workmen’s Compensation Board are particularly enthusiastic exponents of this attitude. An injured worker is initially and automatically assumed to be at fault. The burden is on the worker to prove he was not at fault, even when, as is unfortunately often the case in our province, working conditions are so primitive as to be unspeakable. All too often in fact it is easier to shift the blame from the working conditions to the worker. The primary result of this approach is to guarantee that the Ministry of Health and the Ministry of Labour will never have to deal with conditions in industrial plants. At the tertiary level of prevention, Ontario’s system of rehabilitation, refraining, compensation and income maintenance is grossly inadequate.

Let us now look at some horrifying statistics of the incidence of industrial-caused disease. In a study of male laryngeal cancer patients at Toronto General Hospital in May, 1974, researchers found that 23 per cent of the victims had been exposed to asbestos at some time in their lives. A report issued by the Mount Sinai school of medicine after a two-year study of conditions at Thetford Mines in Quebec showed that 61 per cent of asbestos workers with 20 years or more service were suffering from lung abnormalities and 52 per cent were afflicted with asbestosis.

The asbestos industry reacted by denial, public relations campaigns, dissimulation, dissembling and outright lying. Characteristically, attempts were made to blame workers’ smoking as the reason for lung problems. Canadian Johns-Manville Co. Ltd. recently closed an asbestos mine in northern Ontario, because the company stated it found it impossible to comply with weak provincial guidelines as to maximum permissible exposure to asbestos fibres.

In the US the National Safety Council has reported mining and agricultural work as being among the most hazardous occupations in terms of deaths or accidents. In Ontario, which has a higher proportion of workers in these areas, we have hardly begun to recognize the implications of this, much less to deal with them. The amount of money the government spends on occupational health is minuscule in comparison with the majority of European countries, even those without progressive or socialist governments.

A recent study published by the US Department of Health, Education and Welfare showed there are at least four million workers in the US who contract occupational diseases every year, with the number of on-the-job injuries exceeding 20 million per year and the number of deaths reaching approximately 28,000. If we extrapolate to Ontario, since data is not available here, the equivalent figures would be 133,000 people who contract occupational diseases every year, with the number of on-the-job injuries approaching 660,000 per year.

In 1974 there were 1,415 workers killed on the job in Canada. Many, if not most, deaths and medical problems do not come under the Workmen’s Compensation Board or the occupational branch of the Ministry of Health because there has been no calculation of the correlation between illness and occupation. If in Canada statistical data were available which would enable us to include deaths from occupation-related causes, we would find the number of deaths for Ontario alone would reach near that figure of 1,415 for the whole of Canada.

[11:00]

The Pilot Study for Development of an Occupational Disease Surveillance Method, conducted in 1975 by the department of environmental health of the University of Washington, showed that out of a total of 1,116 cases with medical conditions reported, 346 cases were probably occupational diseases and 113 had a suggestive history of being occupation-connected. For instance, out of 122 cases studied with hearing loss, 96 were connected with the patient’s occupation. Out of 128 cases with skin conditions, 64 were occupation-related; 31 cases out of 74 of conjunctivitis and other eye conditions were occupation-related.

I will just give one more example of what is happening to our occupational health field. When you compare the number of lost man-days due to injuries at work with the number of lost man-days due to strikes and lockouts here in Canada, the figures are quite startling. Twice as many man-days were lost due to work-related injuries, excluding fatalities, as were lost through strikes and lockouts; 18 million man-days of lost production due to work related injuries compared with 9.3 million lost man-days due to strikes and lockouts.

The extent to which public health and the continuous health risks endangering workers and their families are underemphasized can be understood within our social situation as being a class issue. The infinitely greater incidence of morbidity and mortality in the working class is due to the health hazards to which they are exposed at work. This, in turn, is closely related to the fact that priorities in our health spending are established by a health care system attuned much more closely to the middle, professional and corporate classes. These more fortunate classes do not suffer from occupation-caused health problems but from general health problems that beset all humanity. To cure their problems, the middle, professional and corporate classes extract much more than their fair share of the health tax dollar. For example, the health insurance division reports that 35.3 per cent of all OHIP claims are generated in Toronto, which has only 29.4 per cent of the population, while in Sudbury 5.0 per cent of OHIP claims are generated by 7.5 per cent of Ontario’s population.

It becomes perfectly understandable why in Canada neither the Liberal government in Ottawa nor the Conservative government in Ontario is prepared to study occupational health problems. To do so would compel them to collect the information which would clearly show the correlation between occupation and danger to health at work and the increased morbidity and mortality rates of the working class. The Conservatives have demonstrated they are not prepared to deal with the realities of occupational health hazards for the working class, for ultimately any such measures will only jeopardize the cause of their corporate industrial benefactors.

The way this government deals with this unpalatable data can be shown by its behaviour with the Toronto lead pollution problem. Two recent reports on the causes, extent and health hazards of lead contamination -- the report of the Environmental Hearing Board on lead contamination in the Metro Toronto area and the report of the lead data analysis task force -- clearly show that the government places the profit of the private sector over the health and well-being of its people. The Environmental Hearing Board ignores the conclusions of its own commissioned research -- conclusions long since come to by the workers and local residents -- that proximity to lead smelters is a primary cause of elevated blood levels and resulting health problems.

While concluding that the lead smelting industry is the culprit, the Environmental Hearing Board makes recommendations which leave the monitoring and control of lead emissions in the bands of the guilty party, the lead smelters. Such a distortion of the facts involved is reprehensible, especially when one considers the manifest danger to the health and well-being of workers and local residents, which could have been stopped and can be stopped at the source. A strategy of primary prevention would avoid much needless suffering and expense. But it will not happen.

The failure of Ontario to protect the health of its workers is highlighted by the efforts of other provinces in this area. A number of provinces have enacted occupational health and preventive health measures to protect better their workers from industrial disease and injury. The most important and far-reaching measures have been enacted in Saskatchewan under, I might say, an NDP government.

Mr. Warner: Long-standing too.

Mr. Conway: I hope it is not spreading east.

Mr. Dukszta: The Occupational Health Act, 1972, as amended in 1974, together with sections 68B and 68C of the Labour Standards Act, is the core of a new, worker-oriented approach to health and safety at work. The new Saskatchewan Occupational Health Act which is now being introduced will combine these two measures and will correct technical difficulties which have made for problems of enforcement. This new Act will impose a duty on the employer to actively promote the health and well-being of the worker. The key to implementing such occupational health and safety measures is to establish both acceptable and safety standards and enforcement procedures. To integrate all these diverse and administratively separate parameters a specific occupation, a health and safety division has been set up under the Saskatchewan Ministry of Labour.

Mr. Laughren: What a difference.

Mr. Dukszta: The need for such integration becomes quickly apparent when one realizes that in Ontario the Ministries of Labour, Health, Natural Resources, Environment, Consumer and Commercial Relations and Community and Social Services all deal with various aspects of the problem, six independent ministries, each with its own individual, water-tight jurisdiction.

Mr. Laughren: Non-operative accord.

Mr. Dukszta: The key to the Saskatchewan legislation is two-fold. Firstly, there is the section of the Labour Standards Act which gives the worker the right to refuse to continue work where he or she believes that conditions are unusually hazardous or dangerous to health and safety (68C):

“An employee may refuse to do any particular act or series of acts at his place of employment where he has reasonable grounds for believing that the act or series of acts is or are unusually dangerous to his health or safety.”

Mr. Warner: That’s essential.

Mr. Dukszta: Secondly, there are the provisions calling for the mandatory establishment of health and safety committees in places of employment. These committees are to be composed 50-50 of workers and management and are to be established at each place or work or shop. These two provisions are coupled with others which prohibit the employer from retaliating or discriminating against an employee for exercising his rights under these provisions.

The proposed Act not only extends these provisions but prescribes stronger penalties for employers not obeying them. Moreover, it establishes a general responsibility for employers to protect the health and safety of their workers. The possibility that workers could walk off the job with pay compels the employer to clean up the place of work.

These two key provisions of the Saskatchewan legislation are essential anywhere if an occupational health and safety act is to have any meaning: (1) the mandatory establishment of health and safety committees with 50 per cent of workers on them; (2) the empowerment for workers to walk off the job under hazardous conditions without penalty. They are also the most contentious provisions, for management and corporate owners will fight tooth and nail to avoid this encroachment on what up to now has been considered the rightful and legal prerogative of capital. Both Alberta Bill 39 and Manitoba Bill 83 have now adopted the Saskatchewan mode in word if not in deed. Neither of these two provinces, however, has actually written in sections similar to Saskatchewan section 68(c), allowing the worker to walk off the job.

There are a number of reasons why the workers should have the right to monitor their own environment, in addition to governmental and management monitoring. It would provide a useful check on the unreliable monitoring by management; it would involve the workers directly in the safety of their own workplace; finally, it would begin to establish the important principle that the place of work, whether an industrial plant or a smaller shop, is equally owned in the full legal and moral sense by all people who work there.

An occupational health and safety act, like that of Saskatchewan, is a good place to begin worker participation in this society, just as the community-run health centre is a good place to start returning health to its owners. It is the embodiment of the principle that those who pay the cost of health care and are served by it must play a major role in shaping it. Unfortunately, you, the government of Ontario, don’t believe in that.

Mr. Laughren: The minister is cowering.

Mr. Dukszta: In the words of the Leader of the Opposition (Mr. Lewis), there is an unbridgeable intellectual, political, ideological and human gap between us -- you as a conservative, and me as a socialist. Your apotheosis of the profit motive and private health care provision for the select few will always blind you to the overall human situation and the ideals of human equality and public well-being.

In summary, there are three major points that need to be emphasized again. The health care system administered by you is expensive, wasteful and organized on an inappropriate medical model, a restricted, professional and acute illness model. Importantly this system does not deliver health services equally to all the people in Ontario and fails to provide for the safety and well-being of thousands of workers at work. Criminally, it condemns many workers to wasting diseases and death from occupational diseases while wantonly spending public money on unnecessary surgery and lab tests.

I will not tolerate the continuance of this antediluvian model of organization, with its inefficiency and inequality in the provision of care. I will not tolerate a health care system in which one class bears the burden of injury, suffering and expense and another reaps the profit. I will not tolerate a health care system which blatantly denies the right to health of workers in the mining, construction and manufacturing industries. The people of Ontario will not tolerate this health care system which does not serve their interest or protect their well-being. You and your government have faded.

Mr. Warner: Resign.

Mr. Dukszta: Only the New Democratic Party has the knowledge and the will to restructure the health care of Ontario and to provide the people of Ontario with what is their right.

Mr. S. Smith: I have quite a number of remarks that I would like to make but some of them will have to be saved for later on in this afternoon’s debate since I have a long-standing engagement at another city that I have to get to. I do wish to make some general remarks, however, in response to the minister’s opening comments. The minister in addition to his own private ordeal, has had his ministry come through an ordeal the like of which we haven’t seen before and I hope we shan’t see again.

Never before has one department bungled so thoroughly and destroyed the general patterns of expectations and reasonableness that people have come to expect in the conduct of their every-day affairs in this whole health system. Hospitals are a shambles. People within hospitals are hesitant even to talk to you for fear that the numbers will be misinterpreted one way or another. The so-called regression analysis which was done has not only brought the Health ministry into disrepute, but it has brought the whole field of statistics into disrepute because of the absolutely ham-handed and inaccurate way in which these figures were dealt with.

The people throughout the province have been shocked to find that a Ministry of Health can, by directive from Queen’s Park, close hospitals with no thought in mind other than how many dollars have to be spent at that hospital and without any consideration for the organic role which hospitals play in communities. But we have been through all this before. Although one can without much difficulty raise quite an emotional lather about this, and with justification, I feel that when time is precious, perhaps we shouldn’t spend too much time on it going over old ground. That ground, however, does demonstrate one of the fundamental difficulties of the government.

Although this particular minister may be one of the better ministers in the government, he is obviously not immune from that particular difficulty. In fact, it is one which afflicts, I suggest to you, the Treasurer (Mr. McKeough) more than anybody else. That is this notion that decisions than can be made at the centre by an elite group of so-called knowledgeable people and imposed on people throughout the Province of Ontario.

This is the concept behind regionalization, behind restructuring and behind the kinds of bigness that are constantly having hymns sung to them by the Treasurer of Ontario. This is the notion that people can’t be trusted ever to make a tough decision on their own behalf, that things have to be rammed down their throats and that a gun has to be held to the head of a community before it will make any kind of sacrifice whatsoever in the common good. That notion is the very opposite of the notion that caused me to enter politics. I suspect a good many other people in this House in all parties entered politics believing the very opposite of what the Treasurer and the Minister of Health have demonstrated.

It is possible to get regional health councils to make tough decisions if you sit down with them and point out the fact that they have been spending more money than they should in comparison with their neighbours in other counties. It is possible to get hospitals to get together and share the burden of sacrifice, provided you don’t, first of all, name one as the one on which the guillotine is going to fall and then expect the rest of them to put their heads voluntarily under the axe.

[11:15]

This fundamental lack of understanding on the part of the ministry has been one of the great downfalls of the whole minority government situation. Certainly I’m not here to place personal blame one way or another but I’m afraid it has to rest with the Minister of Health because of the fact he holds that position. I think the Ministry of Health has conducted itself disgracefully and I say that without my usual hyperbole.

On the so-called savings from the closing of psychiatric hospitals, I hope the minister will admit this is a bookkeeping game which is going around. Basically, because of the federal government’s willingness to share rather generously the costs on mental retardation but it’s unwillingness, rather foolishly, to share the costs of psychiatric hospitals, the saving is a lot greater on paper than it really is in terms of dollars and cents to the taxpayers of Ontario.

On the so-called savings from the labs, how the minister could keep a straight face when pointing out how much money he saved by closing the labs, following it up five minutes later by explaining this new policy of 16 regional boards which are going to try to rationalize the private lab sector in the province by shifting more of that work to the public labs and the hospital labs, is simply totally beyond me. First of all, to shut down public labs and then go about the province trying to find out how you can increase the workload in the public labs so as to take it away from the inefficient or over-used private sector is something which only the minister, with this ability to keep a straight face while saying things that are outlandish, can possibly comprehend.

It was obvious that the private labs system was the part of the system that needed looking at. It is obvious from the fact that its expenditures over the past five or six years have gone up from $4 million a year to approximately $70 million a year this year. Even though the minister constantly avoided my questions and his replacement during his unfortunate illness did the same the fact is the ministry has had reports as far back as August, 1970, which I have here. There is just one report after the other warning the ministry of the fact that money was going to be poured into the private labs in an uncontrolled way, that it was an invitation to abuse and that money was bound to be wasted with the way in which the private labs were set up.

I have a number of documents and I’ll quote from them later when we get to that particular vote. These documents indicate that the cabinet was considering the grave difficulties in that area as far back as 1971 and that in 1972, as was pointed out by the Leader of the Opposition and I, regulations were approved giving the government all kinds of scope to do the things the minister now says he’s about to bring in regulations to do.

There is already a regulation prohibiting certain classes of people, and it leaves it totally open to the ministry to make that decision, from owning shares in private labs.

Now he says he’s going to bring in something to do with conflict of interest. He could have brought this in long ago. The idea that certain practising physicians should not be allowed to own parts of the private labs could easily have been implemented long ago. He was warned of this years ago. I’m not impressed, I’m afraid, with his present determination as he expresses it in his opening statements.

With regard to occupational health, that is another area where the government, I’m afraid, has conducted itself disgracefully. Comments were made by my colleague from Parkdale who holds a view of medicine I do not share -- namely, he wants a totally socialized model and I don’t agree with him on that -- I do agree with him when it comes to occupational health. I think it simply staggers belief that in this century we, an industrial province of this kind, can have half a dozen or so inspectors supposedly safeguarding the health of our working people at a time when we’re adding 500 to 1,000 new potentially toxic chemicals to our industrial processes each year, frequently with no knowledge of what harm these can do. How it is that we can sit here and allow the United States and other countries to invest enormous sums in doing proper investigations of each of these chemicals? We sit here and sort of shrug our shoulders and say we’ll wait for the results. I think that’s fundamentally immoral, Mr. Chairman. It’s something I can’t accept as a member of this Legislature.

I come from an industrial city, and it’s just inconceivable to me that the working men and women should go off to work every day and be shortening their lifespan by the inhalation of various substances which we already know in many instances to be lethal and in other instances we don’t know but we have reason to suspect might turn out to be such. I think this is fundamentally immoral. It’s something I can’t accept.

When we brought up these matters -- and certainly the New Democratic Party, to my right, has done excellent work in bringing them forward as well -- the answer we got from the Ministry of Health, and in private chats I got the same impression, was that they felt that a proper system of inspection would be akin to a police state. If I may quote his exact words, “There would be an inspector at every desk, sitting there all day.” That’s absurd. The fact is that we need a proper system of inspection. I want to know why it is that the minister has not answered the letter of Dr. Newhouse, who I can assure you is not a political colleague of mine. I don’t even know what his politics are, but I can guarantee you he is no associate of mine in that sense.

Mr. Lewis: Nor indeed of ours.

Mr. S. Smith: I don’t even know. Frankly, I have no idea what his politics are.

Mr. Nixon: He could be a Conservative.

Mr. S. Smith: He could be; I don’t know.

But he asked these questions on May 14:

“How many inspectors there are for industrial health protection; how often each business employing more than three or four employees is inspected with respect to safety in the workplace; how many firms in Ontario are not being inspected on a regular basis and are using hazardous materials; and what legislation is available to assure that the penalty for this sort of contravention of threshold limit values is severe enough that the industries themselves will want to find out what hazards exist in the workplace and do something about it.”

These are not unreasonable questions. The man deserves an answer. And yet a month or six weeks have passed and he hasn’t received an answer. He is very upset about that.

I bring this up to point out that the ministry is going off totally in the wrong direction. The indication that the ministry has given us is that they are going to have industries responsible for policing themselves. They feel that is the way to avoid a police state or something like this.

Presumably, there is some merit in the idea of industries policing themselves if they have powerful unions with enough technological expertise to make sure that this policing and monitoring is done properly, but for the vast majority of workplaces in the Province of Ontario no such unions exist and no such expertise is available. The ordinary working man and woman have to depend on the government to have a proper set of investigations, a proper set of monitoring devices and data available that can be understood and translated into language that people can know.

It is unthinkable that in 1976 we should expect working people in this province to subject themselves to hazards without even knowing what those hazards are. Surely people have a right to know what it is they are subjecting themselves to. I suggested back in November that we should have a form of organization similar to the Food and Drug Directorate so that anybody who wanted to bring in a new process or a new industrial chemical had to have it approved, and the burden of proof would be on them to show that it was not harmful.

I’ve also said that we should have the kind of thing in this province that they have in the National Institute for Occupational Safety and Health in the United States. For instance, when they found that there was a higher incidence of birth defects where people lived around a certain type of plant -- I think it was synthetic rubber plants -- or that leukemia was higher in places that were making synthetic rubber, what they did was looked at each of the employees who had been employed for the last many years in any of these plants, plus people who lived in the neighbourhood, tracked them down all over the United States of America, got hold of their medical records and compared the incidence of various illnesses that these people then suffered from with the incidence for the population as a whole.

That is the kind of study we should be doing in Ontario, but we don’t have the facilities for that kind of work. None of the private universities can do this on their own. We have only one direction to go in: We must set up a real institute of safety and health which has enough money to do the job and frankly, I think it could be centred on places like McMaster University, the University of Toronto and possibly others.

Mr. Shore: Western.

Mr. S. Smith: No, no. The point is that, particularly in the industrialized cities, the universities could be part of this. I think it is really shocking that the ministry has simply not seen fit to move ahead in that area. And if they are going to leave it to industry to police themselves, then that really is entirely hopeless.

I want to make a few comments about Browndale; but that’s a subject we should go into at some length and I’m afraid the time doesn’t permit me to do so. I do want to say that the report given to the House this morning by the minister doesn’t do too much to reassure me. As far as the houses in Don Vale, in which $368,810 was spent, it is not clear to me from whom these houses are being leased. I would like to know, for instance, whether the houses were being leased from Browndale interests or from the interests of people who themselves were instrumental in setting up Browndale. I think it’s also important to know about this management contract, which is sending close to $1 million a year into Browndale interests. Why should such a contract be acceptable here in Ontario and not acceptable in places like Illinois? It seems to me inconceivable that the government should be paying a per diem to an organization that farms out its management. I don’t think we’ve heard proper answers on this. I’d also like a little more about the audit itself, how far back it went, whether it dealt with the 1973 situation, in which the salaries were listed for creating the per diem rate -- and a number of other issues?

I would like to read the letter that Karl Jaffary -- who, as you know, is certainly not a member of our party -- wrote to the Globe and Mail, in which he said:

“Browndale is a non-profit corporation which leases houses it occupies from companies controlled by the original promoters of Browndale. The houses are frequently bought specifically for the purpose, and the result has been that the principals of Browndale have been able to buy very expensive real estate holdings, which have been paid for out of the rents that are in turn a part of the $7.3-million a year paid by the taxpayers to Browndale. If that is the consistent method of operation you’ll appreciate the reasons for the delay --”

And he was going on discussing the delays in relocating the children.

We have now, of course, the Haliburton situation where there has been a mass resignation. I wonder if the ministry is planning to let that excellent staff carry on on its own in a separate situation and take over the Browndale quota in that area?

I also wonder if we can be guaranteed that Browndale will be given no increase in its per diem and how the minister can stand and say that $65 is a bargain when Youthdale can get away with $36, or it’s in the middle -- or whatever. Youthdale can get away with $36, and Community and Social Services have many places that have people just as disturbed as the ones in Browndale, getting just as good care for half of the $65.

So basically, I’m afraid the minister’s opening remarks raise more questions and answers, and I hope later on in the debate to go into great detail in each of these areas that we’ve touched on. But with these particular remarks I’ll conclude my comments for this morning.

Mr. Deputy Chairman: Does the hon. minister wish to reply before we go into the vote by vote?

Hon. F. S. Miller: Mr. Chairman, I could, and yet I suspect that each of these points brought up by the speakers or the critics of the Health ministry in the other two parties will come up during the votes, and it’s perhaps better than me taking a lot of time now to deal with them as they are specifically mentioned. I have made a number of notes.

I would say just to the member for Parkdale that, really, if I am to keep a totally serious face at all times, then I think all of us would have to abide by the same rules. We’d have a very strange House if there wasn’t a bit of repartee here from time to time. I don’t think any one member or any one party has the corner on making the odd humorous comment. While I made a humorous comment on monkeys, the fact remains I took the time to get a very thorough reply for you, and I can gladly read that into the record when the time comes.

Mr. Deputy Chairman: Before we start the vote by vote scrutiny of the ministerial estimates, I would draw to the hon. member’s attention that the Minister of Health did provide each member of the committee a breakdown of the areas of responsibility as far as the moneys for each vote are concerned. Consequently, while I realize there will be some policy discussion under the minister’s office, item 1 of vote 3001, I would hope the members of the committee would attempt to direct their remarks on the spending of the various areas as outlined by the minister’s paper, which he circulated to the members of the committee this morning.

[11:30]

Mr. Dukszta: Mr. Chairman, on a point of order, I’ve discussed the question of estimates with the leader of the Liberal Party and within our own party and, if you can bear with me for a minute, we thought we could divide it into two hours for the first item, 2½ hours for the second item and 2½ hours for the third one so that we will make an attempt to cover as much as possible of the health estimates in the limited time we have. I’m just mentioning it -- I’m not sure whether you agree -- that we have two hours for the first, 2½ for the second item and 2½ for the last one.

Mr. Conway: Mr. Chairman, that certainly is the understanding we have. Given the fact that we are now 1½ hours into the first section, I think it probably advisable, given the fact there are a considerable number of speakers, that with half an hour left we consider all the items in the first vote together, if that does not --

Mr. Deputy Chairman: Is it the intention of the committee, tentatively, to take half an hour on the first vote and divide the remaining time between the two votes equally? Agreed?

Mr. Dukszta: Mr. Chairman, we have another half an hour for this whole vote, 3001, and 2½ hours for votes 3002 and 3003.

Mr. Deputy Chairman: I would draw to the hon. members’ attention that I assume this doesn’t limit any debate from any of the government members; they can take part.

Mr. Breithaupt: I am sure they are welcome to join in, Mr. Chairman.

Mr. Haggerty: Mr. Chairman, if you will permit, for clarification, where do I find occupational health in the minister’s estimates? Is it listed there this year?

Mr. Deputy Chairman: Which vote does occupational health come under? I think that’s item --

Hon. F. S. Miller: Vote 3003, item 3, I think.

Mr. Deputy Chairman: Yes.

On vote 3001:

Mr. Deputy Chairman: Is it the wish of the committee that we take the vote in its entirety?

Agreed.

Mr. Swart: Mr. Chairman, I want to make a few comments, very briefly, on item 2, specifically the Ontario Drug Benefit Plan, and perhaps solicit a reply from the minister on this. There are just two comments, really, which I want to make. The first is, I would ask the minister if he would consider -- I believe the government can do it by regulations; it may well not he his ministry -- extending the drug coverage to spouses, aged 60 to 65, who get the federal spouses’ allowance. I suggest there is a very real need there, first of all because the total income of the couple when one or the other is aged between 60 and 65 is less than when both are over 65. If they don’t get the drug coverage there is real hardship.

Secondly, many of these people receive drug coverage from the social services department of the region or the local municipality until this year but because of cutbacks in the money, the assistance, from the province to the municipalities, the municipalities have in turn cut off many of these benefits. There is greater difficulty, greater hardship, in the situation now than there was a year ago.

Therefore, I suggest the minister should give consideration to that extension. I suggest we can afford it. If we can afford to waste the money we have wasted on private labs -- or that the government has wasted on private labs -- if we can afford to pave the Spadina extension, if we can afford a quarter of a million people unemployed in this province, we can afford the few million dollars to extend drug coverage to spouses between the ages of 60 and 65.

The second point I want to make is one pertaining to administration. I admit quite frankly I’m confused about the administration of the drug plan. Apparently it is paid out by the Ministry of Revenue while the legislation is under a welfare Act -- it’s a longer name than that but it’s a welfare Act -- yet apparently the Minister of Health has final jurisdiction over it. Maybe it’s this complication of administration that is causing the problem.

First of all, there is a one-month delay. The drug cards are supplied in the month following the month in which they get their first old age security cheque. I understand from inquiries in the ministry that they get a computer list from the old age security department and they supply the cards on the basis of that list. However, there is a breakdown because, the computer list is apparently compiled sometime during the month and after that list is compiled cheques are issued manually. Those do not come through to the provincial ministry and as a result those people who get the manual cheques do not get the drug cards in the following month. We have found there are a large number of these in our area. Perhaps the great majority of them are never heard from, but there are a very large number who come to us.

If there is some foul-up and a person doesn’t get his old age security cheque for three months, while it is retroactive the drug benefits are not retroactive. There is a real difficulty in trying to get retroactive payments. Most of those we have had have been’ refused. Even though by the regulations they are entitled to payments for the drugs, they are refused.

I would suggest to the minister that if he’s unaware of this problem he should check it out fairly thoroughly and make some sort of liaison with the OAS so that these foul-ups in the administration do not occur. I suggest to him this is not just the odd case. If he wishes, I can give him names and times to prove this is taking place in a large number of cases. I would ask him to investigate it thoroughly and to comment on it.

Hon. F. S. Miller: Mr. Chairman, I am just wondering how the members want their answers. It sometimes is easier to discuss quickly the points brought up by a specific member than it is to let them pile up and lose track of them. Also, I realize that it may well be that some of these members have to be somewhere else today too.

Mr. Breithaupt: Oh, yes, please do.

Hon. F. S. Miller: If I may, I will just quickly try to summarize the points brought up.

Mr. Deputy Chairman: Agreed.

Hon. F. S. Miller: Certainly one of the areas we have to consider for expansion of the drug benefit system is to the spouses of those who are under 65 when one spouse has reached that age. As you know, OHIP has always covered that spouse for general benefits. Right now with so many restrictions on my budget, it’s a difficult time to add a benefit. I certainly am not going to rule it out as either being unfair or unlikely. I’m just pointing out that it’s not a year in which I’m looking for ways to spend more money.

Mr. Swart: It is the year in which they need it worst.

Hon. F. S. Miller: One can argue that. In the fall, the general welfare recipients, I’m told, will start getting drug benefits. I think I mentioned that in my original statement so that those who have been dropped perhaps by municipalities will end up getting the Ministry of Health coverage.

As far as the cards go, I’m sure every member of the Legislature has faced this kind of problem from some constituent who has not received a direct card on time. Without duplicating an enormous staff in Ottawa, we are dependent upon them for the eligibility criteria. There are ways and means by which we can speed up the process and get a person a card when he may not otherwise get one. I’m sure many members have called our ministry to get a temporary card for a person.

Retroactivity is a little different thing. I suspect a number of plans don’t have a retroactivity clause. I think Canada Pension is a good example. I believe if you don’t apply on time you just don’t get it. I believe the old age pension is the same way, if I am not wrong. If you miss your first date of application or don’t fill the papers out soon enough, I don’t believe you get retroactive payments.

Mr. Gaunt: Yes, for a year.

Hon. F. S. Miller: Up to a year? In any case, retroactivity is something that would have to be considered very cautiously before we agree to it.

Mr. Swart: Can I just pursue that one question further? Would it not be possible to get a supplementary list from Ottawa up to the end of the month? Those cheques, and there are a large number, that are issued manually don’t come on that computer list and they lose their benefits for one month. I wonder if there wouldn’t really be some simple way of working this out so they don’t lose that month’s benefit.

Mr. Conway: I have just two or three very brief comments arising out of the first vote and the minister’s opening remarks. One is moved, in a sense, to compare what the minister has said on this day, in June, 1976, with what he said in November, 1975, in the concluding portion of his estimates for that year.

In his opening remarks at that time he found it wise and useful to begin by pointing to the success of the negotiations of the Ontario Nurses Association in the public health nursing field. I wonder, today, how the minister feels about talking about the success or the obvious lack of it with respect to the ONA negotiations and the complete breakdown in the public health field as a result of that?

It was interesting too at that time that he signalled the institution and the impending success of the Council of Health as a senior advisory body to the Minister of Health. One wonders today, six or seven months later, how this particular body has been able to react to the significant changes in this particular regard. The third point the minister made at that time was the relationship to the impending institution of an occupational and environmental health establishment. I would wonder, given his commitment of seven or eight months ago, how he feels about that at this particular time.

I would have just these few comments by way of comparison. There was one thing he said then that perhaps is most significant. In that debate the hon. minister said something in response to an urging from my good friend from Parkdale. This relates to the general administration and to the way in which this ministry has been doing its business. On Nov. 12, 1975, in response to something said by the member from Parkdale, the Minister of Health said:

“To show the openness of my ministry, I think you must admit that we never try to deny you any information you want, do we?”

I think it is truly regrettable that the indictment of the past six or seven months is simply that this government, and particularly this ministry, has chosen to operate in the fashion it has with respect to the hospital closings and I realize that that is an item for the second vote, 3002, but I would like the minister reflect upon that at this point in time.

I think it was interesting too that four or five days following that remark in the emergency debate on the Chesley Hospital closing you were urged to comment in response to a point made by the member for Grey-Bruce (Mr. Sargent) and you said:

“I have no intention of seeing the 24 hospitals closed. The member asked me how many were on the list. Each one in turn will be told in negotiation if it is being considered. Each one will have the option and the opportunity to discuss the merits of closing with me and they will learn it in order only after I have decided there is some good reason for the action which we take.”

I think that clearly there must be some explanation, not necessarily on the specifics of the hospital closings, but on the manner in which this ministry has decided to conduct its business. I would particularly like some comment from the minister in that regard.

I would also like to take this opportunity to ask a question under the heading of item 1, the policy co-ordination secretariat, with respect to the document released, I think two days after the conclusion of the Health estimates in November 1975 -- and I refer to the report of the special programme review which makes in a series of 20 or 25 pages a number of most interesting statements and suggestions. I wonder how the minister and his policy secretariat are interpreting and perhaps moving to the implementation of the recommendations with respect to health care in Ontario made by the special programme review?

[11:45]

Hon. F. S. Miller: On the first point of the nursing negotiations, any time two parties to negotiations fail to get their own way and a strike results there is a great temptation to demand government intervention at once. Because a negotiated agreement wasn’t arrived at before a strike took place it does not imply that the system doesn’t work in most eases. It does.

I was struck by the paradox last week of the members of the public health nurses’ association, members of the ONA, coming down here and, in effect, demanding compulsory arbitration and removal of the right to strike when really one of the major issues, I guess, CUPE was facing the next day was the right to strike and its reluctance to be forced into a position of compulsory arbitration. It’s a question of how you see your particular problem on a given day.

People who haven’t got the right to strike feel denied a privilege which society has given to most people. Those who do have it often feel it isn’t a potent enough weapon to get their way in negotiations. We’ve talked about alternatives to the strike and I would dearly love to find one but to date it has been the ultimate weapon of the employee if negotiations break down with the employer.

Those nurses were exerting their rights last week. I didn’t like them being on strike. Some management is exerting or using its rights this week by locking them out and I don’t like that. I clearly told the association of the health units last week that I would recommend, and so did the Minister of Labour, that they not lock out employees. This would escalate the whole situation.

Mr. Haggerty: Appoint new members to those boards. You can do that much.

Hon. B. Stephenson: They are elected.

Hon. F. S. Miller: Listen here, let’s not start appointing people arbitrarily to boards which, in the main, have represented their areas well. In most cases they have been named by either municipalities or people at large and I think they have done a pretty good job of --

Mr. Nixon: Representation from the government on each one, is there not?

Hon. F. S. Miller: Yes, there is. There is always representation but it’s a very minor --

Mr. Nixon: That is what he is talking about; he’s not talking about replacing the board.

Hon. F. S. Miller: It’s usually a question of one or two members on each board who represent the province depending upon the area they serve in.

Mr. Haggerty: They carry out your policy.

Hon. F. S. Miller: I would suggest to the hon. gentleman who interjected that if any board member has been given policy to follow, I would like to know about it. We leave those gentlemen and ladies there to act as independent members on that board. They do not have to follow government policy and they are not told what government policy is to follow.

On the Council of Health, I lost the import of your question altogether. The Council of Health is alive and well and able to give me advice whether I solicit it or not.

On the institute on occupational and environmental health, I think I answered a question in the House this week from the Leader of the Opposition when he asked me what point we had reached on that. We did ask for the advice of the advisory council. That advisory council did give us a recommendation on the formation of an institute and that’s been in my hands for only approximately 10 days. It would appear, I think, to be reasonable advice and probably will be followed.

Mr. Lewis: When would it happen?

Hon. F. S. Miller: I don’t know that it has to wait for any particular school year; in other words, I think one could organize a base in a university or two quite quickly. I suspect, as I think I mentioned that day, the University of Toronto, in looking forward, had decided to make certain organizational changes so that it could offer a package. I don’t know whether any other universities did. Do you know of any?

Mr. Lewis: I think McMaster is one.

Hon. B. Stephenson: I think McMaster is trying.

Hon. F. S. Miller: McMaster is trying, I am told.

Mr. Lewis: Are we heading for the fall?

Hon. F. S. Miller: I would like to think so. It is an area in which we are very anxious to get that kind of advice. I’ll get into occupational and environmental health when we get to the note on it and I certainly want to stress how important it is to me. I think that’s really all I would like to reply to on this member’s comments right now.

Mr. Nixon: Mr. Chairman, there are just three things that I want to deal with in the first vote and I guess the first one might as well be the institute to which the minister was referring. I, too, want to urge upon him as strongly as I can the establishment of something of an advanced research basis, to university level hopefully, which will mean that on not so many occasions will the attention of the minister be brought to matters that have arisen in other jurisdictions, perhaps by members even of this House.

There is quite a frightening feeling sometimes that the whole thing is moving so quickly. It really gets considerably beyond the membership of this House, perhaps even including the Minister of Health himself, to understand and grasp the importance and the ramifications of these matters. I thank my lucky stars that I live out in South Dumfries township with only a hog farmer living to the west of me who uses a liquid manure process. Maybe there ought to be a question on what the long-range far-reaching effects of that are to human and other organisms. I simply want to urge upon the minister the establishment of some kind of an organization which is going to be on top of these changing aspects.

I don’t know who it was -- it may very well have been the Leader of the Opposition -- who said that the politics of environmental health is going to be one of the most important aspects of our responsibility during the next decade and perhaps much longer than that. It’s obviously very much a fact of our existence here when every question period includes questions to the minister on some little-known or unheard-of organic chemical which may, in fact, have tremendous effects and influences on our environment and to the individuals living within it. I would like to join with others who urge the minister to take definite action in this regard and I can assure him of strong support in this connection.

The second thing I want to put to the minister is the continuing problem which I am experiencing as a member of the Legislature. In his opening statement he referred to the history of the establishment of hospitalization and a programme of universal health care. The minister knows that while it’s almost universal, it is, in fact, not universal. The people do not have to belong to it and every now and then somebody will come to me too often for my peace of mind who is not a member of this or their membership has lapsed because of some problems in the transfer of premium responsibility.

I would hope that we could pass a statute making it quite clear that everybody living in this province is a member of our medicare programme and that there is no possibility that anyone is going to go to the doctor or go to the hospital and not be properly covered. We all know it is not possible for an individual to go into one of our hospitals in this province and pay for any reasonable care himself in any way. It may be that the advisers to the minister wish to keep it this way so that there is some compulsion or some pressure on the individual, particularly in the pay-direct field, to pay direct and on time. But I believe we are approaching it in the wrong way.

My own experience is that you can usually give some kind of justification for the lapsing of the coverage and I don’t recall anybody ever having to go into the hospital where they had to pay for it themselves when they didn’t feel that they could do so. But I believe we should have a universal programme here and I would hope that we move in this Legislature to accomplishing that.

The last point has to do with the legal status of the hospitals which were visited by the minister in that great tour across the province some months ago. We are waiting for the Supreme Court of Ontario to tell us whether or not in their legal opinion the government acted properly and legally. I would not expect the minister to make any predictions as to what might come about but could the minister give us some predictions as to the actions that the government might take? I have heard that the minister or representatives of the ministry have said that whatever the outcome, whoever wins this reference, it will go to the Supreme Court of Canada.

Really, I am not so sure that it’s sensible for the government of Ontario to take it beyond the Supreme Court of Ontario. The remedy, if they feel they have to have it, is a clear one and that is a reference to this Legislature which is open to them at all times. There is a small political problem, that we are all aware of, that probably they could not get the authority to close the hospitals from this Legislature. But a reference beyond the Supreme Court of Ontario by the government, it seems to me, does not seem to be a sensible procedure. The government should surely have accepted the ruling of the divisional court in the first instance, and either --

Mr. Bullbrook: Right, exactly right.

Mr. Nixon: -- decided not to go forward with this policy, which is extremely unpopular and wrongheaded in my view, and has been turned down by the courts, or to take the other remedy that is democratically open to them.

I would also like to ask the minister if he would comment on the present negotiations with the hospitals which are on this formerly black list and now kind of a greyish-pink list. For example the hospitals that I know of -- Willett particularly -- is continuing to function as an active treatment hospital. I feel the board there is acting most responsibly and it has been dealing with the minister’s deputy and others, trying to find some common ground. But I really would hate to think the ministry is simply putting off the Willett board and the other boards until such time as the cudgel is restored to its quivering fingers, and they can beat the hospitals into submission once again. I believe the boards of the hospitals have been acting most responsibly. They have not been assuming that they are not going to have to at least discuss a change in their present powers and responsibilities.

More and more I am getting the impression that this thing is being left in abeyance, without definite answers forthcoming from the officials in the ministry charged with this affair until such time as the good old reliable majority government powers are restored. In that case we will be back to the bad old days when the government would act in an autocratic and high-handed manner. I would hope the minister could give me some assurances in that regard, that I can pass on to some others who are concerned as well.

Hon. F. S. Miller: Mr. Chairman, there is one thing I want to point out. Inadvertently I have read some wrong figures into the record in my opening statement. As soon as I have them corrected I will correct them for the record. I had my statement being revised this morning and, in the rush to get here at 10 o’clock -- whether the press knows it or not -- I picked up the wrong copy of my statement. I had it edited --

Mr. Lewis: No, that is not true. You just had one regression analysis and then you got another and they conflicted. Happens to the ministry all the time. Perfectly predictable.

Hon. F. S. Miller: Well, I have some errors in it, apparently. In any case the moment I get the correction --

Mr. Nixon: Who is to say which is wrong?

Hon. F. S. Miller: -- on the arithmetic I will give it to you.

Mr. Lewis: Depends how much you regress.

Hon. F. S. Miller: It was caught just this morning.

Mr. Breithaupt: We will accept your regrets.

Hon. F. S. Miller: The hon. member for Brant-Oxford-Norfolk talked about making OHIP compulsory. I suppose that is a valid point. Yet we do have people who choose not to join and they choose knowingly, not in ignorance.

Mr. Nixon: I don’t think they should have that alternative.

Hon. F. S. Miller: That, I think, is an honest difference of opinion. To date this province has used a premium system for part of the costs --

Mr. Nixon: We need their premiums to provide an overall programme.

Hon. F. S. Miller: No, I don’t think so. We are getting five-sixths of the money from them anyway in taxation. In many cases they are the people who are contributing a heavier amount toward the overall plan than the rest of us.

Mr. Nixon: Don’t worry about Gordon Sinclair.

Hon. F. S. Miller: You and I both know that if a person is at the low end of the income scale, it is an academic argument -- they get the care under any circumstances. If they are at the well-to-do end of the scale and they go to hospital and have to pay it and they haven’t paid their OHIP premiums, tough luck.

Mr. Nixon: You used the word “universal” and that is incorrect.

Hon. F. S. Miller: All right, as long as you have a premium as a requirement for coverage then it is very difficult to make it compulsory. We could do it. I simply say that I think there are some people in this province who still feel they have the right to make that choice. The percentages are a very minuscule number. As a matter of fact every time I’m given the total number of registered people on OHIP it exceeds the population of the province.

Mr. Nixon: It does?

Hon. F. S. Miller: It does.

Mr. Lewis: That speaks to the accounting within OHIP.

Hon. F. S. Miller: No, it doesn’t. What it speaks to is the fact that we cover all members of a family automatically without having them go through a registration form, simply by using the family coverage number and going to see the doctor. Very often we have discovered people are inconsistent in their own use of names. They may have three names and chose to use two on one day and two on another day and unfortunately they will be enrolled under those separate names. It is interesting. But in any case the family member is covered, whichever name he or she chooses to use when they go to see the doctor.

[12:00]

Mr. Godfrey: Fortunately most people have only got one appendix.

Hon. F. S. Miller: Yes, or you would have found a way to take out two.

As to the group action or the government action, at least, in response to the court, I touched on that briefly in my opening statement. I really don’t feel that this government would want to go to the Supreme Court of Canada if we lost the next round.

Mr. Shore: Why didn’t you go in the first place?

Hon. F. S. Miller: I’m speaking personally now -- there’s not a government policy formulated on this basis. I think at that point we have to face our responsibility, if we lose in court.

Ms. Lewis: That’s right.

Hon. F. S. Miller: Now that responsibility, in my opinion, is to come back to this House with legislative changes -- if we lose.

Mr. Lewis: You won’t do that, I am sure.

Hon. F. S. Miller: I’m quite prepared to.

Mr. Lewis: Excellent.

Hon. F. S. Miller: On the other hand, that is not a decision, as you know, that the Minister of Health will take all by himself.

Mr. Lewis: That’s true.

Hon. F. S. Miller: I will be guided by my colleagues in cabinet --

Mr. Conway: And Eddie Goodman.

Hon. F. S. Miller: No. I’ll be guided by my colleagues in cabinet.

Mr. Nixon: Who will be guided by Eddie Goodman?

Mr. Lewis: Who will be guided by the last survey?

Hon. F. S. Miller: I suspect you have some surveys yourself.

Mr. Lewis: We don’t. I wish we did.

Hon. F. S. Miller: If, on the other hand, we win in court I suppose there is always the right of the hospitals to consider the appeal process. Again, we’ll be faced with a decision: Should we wait for an appeal or should we consider clarifying what may have been deemed an unclear law?

Mr. Bullbrook: It is not a question of winning or losing. You missed the point. You don’t win that case or lose it.

Hon. F. S. Miller: In the case of the hospitals such as the Willett in Paris, we are continuing to finance them and I think it’s very unfair to talk about their long-range plans until such time as we’ve really clarified the whole issue of their future. In your case, it’s compounded by two things: (a) they are not a party to the case in court; (b) there is a long-term-care study going on in your area to help us decide what the chronic needs are in your area.

Mr. Nixon: It surely has nothing to do with it. Didn’t the Premier say it was the policy of the government to treat all of those hospitals the same, whether they were party to the legal reference or not?

Mr. Breithaupt: I believe so.

Hon. F. S. Miller: We continue to fund them, as you know, and we’re going to keep on funding them.

Mr. Nixon: Of course, you are not in the same group.

Hon. F. S. Miller: There’s no argument about the need to fund them. There are all kinds of ways of being nasty in the meantime while the court cases went through. The fact is --

Mr. Nixon: They were not open to this minister.

Hon. F. S. Miller: They were open to me if I wanted to use them. I’m simply saying --

Mr. Nixon: Not to this minister they were not open. You are not a mean person.

Hon. F. S. Miller: -- we felt they should be funded on a normal basis until their future was determined either by the courts or this Legislature. That is the basis I want to keep it on.

Ms. Gaunt: Mr. Chairman, I would like to make a few brief comments on this vote. We’ve talked in a general --

Mr. Acting Chairman (McCague): Order, please. I understand there was agreement that the debate on vote 3001 would conclude at 12 o’clock. Could we follow that agreement?

Mr. Gaunt: All right, Mr. Chairman. I am quite agreeable to that. The remarks I had actually referred in a general way to the hospitals which come under another vote and I can make those remarks at that time. I wanted to tie that in to the hospital insurance, the general OHIP insurance programme, which comes under this vote but I can do it under the second vote with your permission, sir.

Mr. Nixon: Stay on your feet. He’ll put it right up and you will be right in order.

Hon. F. S. Miller: On a point of order, Mr. Chairman, I think OHIP doesn’t really come under this -- just the doctors’ section of it does; the medical --

Mr. Gaunt: I wanted to talk about the doctors’ section but I can tie it all up, I am sure, in the second vote.

Hon. F. S. Miller: I am sure you can.

Mr. Acting Chairman (McCague): Shall vote 3001 carry?

Vote 3001 agreed to.

On vote 3002:

Mr. Angus: I would like to refer again during these estimates, as I did last time, to the ambulance services, particularly those services which are not yet paid for by the ministry under OHIP; those which my constituents find themselves in the unfortunate circumstances of having to use; those which my colleagues, any of the northern members, or their constituents find they must utilize just to get basic medical services. I am referring to the air ambulance service which will allow a doctor to transfer a patient from a hospital to a hospital in an emergency situation, but will not allow OHIP to reimburse the parents or the patient for returning to the community they come from.

I’d like very briefly to read into the record, just to make my point, a letter I received from a constituent of mine who like myself, had the circumstances to travel to the Hospital for Sick Children for treatment services for a child:

“I am writing concerning an article that was in the newspaper last November. It stated that you were in favour of the government paying for parents in Ontario who had to take their children to the Hospital for Sick Children in Toronto. I agree with you 100 per cent because my husband and I have gone through it. We had a child last February who was born with congenital heart disease. He was flown to Toronto two days after birth, which social services at the hospital paid for. He was there for a month-and-a-half. We couldn’t afford to be down there with him, and when the time came to go and get him we had to pay for the trip there and back.

“In October he had to go back again. The doctors here were certain that he would need heart surgery then because he was doing so poorly. We had been saving for six years for a down payment on a house, and because of this money I couldn’t even get my way paid to Toronto. I went to social services at the hospital, the welfare office and Kiwanis, but no one would help. Therefore, we ended up paying again. If everything would have gone all right I would have only had to stay there 10 days, but complications set in and I was there for five weeks, all of which we had to pay for ourselves.

“Although they have places down there for $5 a day, it is only for mothers. If the fathers come it would mean staying at a hotel. That is why we are still renting and almost back to where we started from.

“Parents who have children with heart problems or any defect that they have to go to Toronto for have enough problems and worries without being concerned about a gigantic bill. It’s not their fault that they had children born with things wrong with them, and most of the problems have no known reason for happening. I have great concern for these parents. Although it wouldn’t do us any good (our child passed away in November), I hope something can be done to help pay the expenses for parents who have to go to Toronto.”

That is not an unusual case. In fact, unfortunately, it seems to be more the rule than anything else.

We talked about this before in estimates and I realize that your concern is for preventive care, or at least at that time that’s what your concern was. I would like to add again a request that your ministry undertake the examination of this situation with a view to paying for transportation costs whether it is for children or adults who must leave their home community and fly to Toronto or to Hamilton or to any of the other major centres in Ontario to obtain the medical services that they require to survive or to function.

I’d like to change my approach just to a certain extent and offer you a proposition. I think if you have the OHIP computer working these days, or if you can get it working, that you instruct your staff over the next three or four months to pull out -- I’m not sure how they would do it but I’m certain the programmers would find a technique -- to enable us to understand how many people we’re talking about. How many people from northwestern Ontario are travelling to Toronto, whether it’s to the Hospital for Sick Children or to any of the other major hospitals? Have them pull that out of the computer and have your own staff run a check as to the length of time that those patients are in Toronto hospitals or are in other hospitals in this province or elsewhere in Canada or the United States.

I think once we can understand, in terms that this House will accept, in dollar figures, the cost for providing this service, the cost of ensuring that everybody in the Province of Ontario has equal access at equal cost to the medical services that they need to survive, then I think we’ll be doing something for the people of Ontario. As your staff are compiling this -- and I hope, Mr. Minister, you will accept this suggestion -- I would also ask them to take a look at why so many patients find it necessary to travel to the United States for medical services; services they don’t feel they can obtain in Ontario or obtain competently in Ontario.

I leave those two requests with you. I know that the Thunder Bay District Health Council will be more than happy to receive the basic data, to be able to pull it together and to assist your ministry in ascertaining the extent of the problem and in providing some costing.

Mr. Conway: I would like to add one brief footnote to the ambulance question, and perhaps the minister could answer my query in addition to that of the member for Fort William.

In the November debate I brought to the minister’s attention a particular problem that my people in the Deep River area were experiencing with the ambulance review study that was under way. At that point in time I was informed by the minister through his staff that that study probably would be prepared and presented within six to eight weeks, meaning that we could have expected it at the end of January.

I was called this morning by some very concerned officials at the Deep River and district community health organization, and at this point they still haven’t heard what is going to happen to the ambulance situation in their particular area. I am just wondering, in answering the general question about ambulance services raised by the member for Fort William, whether the minister might direct specific attention to the problems of the people living in the Deep River area and what, if anything, we can expect by way of the report presently being prepared.

Hon. F. S. Miller: Mr. Chairman, on the first point, I suppose it is like almost all government plans, where does one draw the line and what are your priorities? The very fact that we have an air ambulance system, and that we have a tremendous ground ambulance service in the Province of Ontario, puts us leagues ahead of many jurisdictions. I hope the hon. members recognize that. That doesn’t mean it covers every conceivable need.

Think of what these people would have been involved in if they were in the States of New York or Vermont. I know personally, because we had an accident in that state. I had to take my wife, who had two broken legs, 60 miles in the back seat of a car, because there wasn’t even a for-hire ambulance available, let alone one paid for by the state. It is only when one runs into this kind of problem elsewhere that one appreciates the Province of Ontario’s excellent service.

It is a question of priorities. Under what circumstances do you pay for the transportation of other people? Under what circumstances do you pay for pretty expensive return of a patient by air? What could you have used those dollars for in other parts of your programme? These are the kinds of sawoffs and decisions you always have to make.

I can’t offer the member any encouragement that we are suddenly going to become more generous. We are looking at the overall problem of transportation of the physically handicapped as well as the transfer of people with other problems to centres of treatment.

I have no idea of how many people are involved in this way. I am sure there are quite a few. I know that in a riding like my own, 150 miles from Toronto, there are lots of people transferred here for care and the families often are quite busy running back and forth to visit them. Again, I can speak to that fairly personally.

The hon. member for Renfrew North asked me about Deep River --

Mr. Angus: Before you go on to that, could I just reiterate a couple of my requests?

I appreciate the fact that we don’t know how many people there are and that we really don’t know the dollar figure we are talking about in terms of what it would cost to provide free transportation for medical services. But what I was asking you before was, would you be willing to instruct your people who handle the OHIP computer to draw up a programme, over the next three or four months, that will provide us with that information -- at least in terms of the numbers of people, the lengths of stays and the home origin. In that way, in the fall, we can have that information and we can send it out to the regional health councils and ask them to cost it as to their particular area. Then we will know, at least a dollar figure, what we are talking about and then you, as the minister, and your ministry, can assess it, in the words that you use, in terms of priorities and in dollars.

[12:15]

Hon. F. S. Miller: One of the things we can tell you, on any given population base, is where they are getting their health care. For example, when we went to the hospitals that were closed, we were able to say in the town of Bobcaygeon, to be specific, 22 per cent of the people who entered hospitals from the village or area of Bobcaygeon go to the local hospital; and 78 per cent go to other hospitals. We were able to say these are the hospitals they go to, these are the days of stay they have and within Bobcaygeon the following people came from elsewhere, etc. etc. That kind of data is available. We have to adjust every population base for a hospital to reflect the true references to it. Rather than saying four beds per thousand people, we have to say four beds per thousand referred people, not resident people. This is often one of those contentious areas. People are often unaware that a great part of the provision of health service in a given geographic area is provided in another geographic area because of either specialized services or custom.

To reply to the question of the member for Renfrew North, we’ve been looking at the overall ambulance programme and each year we make significant improvements, I think, in the organization of it. Of late, some of these have been objected to by some communities. As a result, we’re pausing and considering some organizational changes, particularly amalgamation or a change back to volunteer from fully-paid services.

In the case of Deep River, I’m told that the operational review of service demand in the area is presently being completed. Recommendations will be consistent with service levels in the other areas, etc. In other words, we had not got that report as of about June 1 or a little earlier than that.

Mr. Conway: On a point of clarification, did you say that that report is now in your hands?

Hon. F. S. Miller: It is not in my hands yet.

Mr. Gaunt: I’ll be brief. Much has been said about the hospital closings throughout the province and I don’t want to go over that same ground again. The comment has been made that our system is expensive and in some cases wasteful and I agree with that. No doubt the ministry was faced with a situation where it had some surplus active treatment beds and the decision was made to replace the scalpel with the meat axe. I think that’s exactly what happened with respect to hospital closings across this province and, in particular, in rural Ontario.

The ministry has not come to grips with some of the serious problems within the ministry, in my view. The ministry hasn’t come to grips with the overbilling and abuse of the system by the doctors. The ministry hasn’t come to grips with the overuse of the system by some patients, and that second point is tied directly into the first. The ministry hasn’t come to grips with the private lab problem. All right, what can we do? What suggestions can one offer to the ministry in some of these problem areas?

The first thing is the matter of what I call a health credit card system. This was a matter that was raised with Dr. Potter when he was Minister of Health. I talked to him personally a number of times about it. He said he agreed with it so much so that he was prepared to take it to cabinet and try to get approval for it. That’s the last we ever heard of that until the issue was raised by the hon. member for Algoma-Manitoulin (Mr. Lane), I believe, several weeks ago.

In my view, that’s a good system. It’s a good system for a number of reasons. If all of the people in the province who are currently enrolled in OHIP were given a card with their OHIP number on it, similar to a credit card, then when the doctor was visited by that patient, the patient would simply hand that card to the doctor who would put it through his little machine. The patient signs it and is givers one copy, the doctor keeps a copy and the other copy is sent into OHIP. This then becomes the basis upon which payment is made. The same is done with a hospital visit. If a patient goes to the hospital, he or she presents the card to the hospital and it’s handled in exactly the same way.

In my view, that exercises some control by the patient over overbilling by the doctor and perhaps it has some other uses as well.

At the very least, the patient knows when the doctor is billing for a procedure and I think that’s helpful. It’s helpful from the point of view of the patient and it is also helpful from the point of view of OHIP, because they at least know the patient is exercising some control over that procedure, In my view I think that’s a good system. It’s simple to enact and in my view -- and obviously that view is shared by a number of other people in the House -- it could be done very easily and very quickly and without a great deal of expense.

The minister may say yes, that’s fine, but under certain circumstances one may be faced with a patient who isn’t well enough to sign the slip. I think that can be overcome very easily. I think a member of the family could sign the slip under those conditions. I am sure that situation may be presented from time to time and it’s something that could be overcome very easily.

The other thing that strikes me, and I pass it along to the minister for his comment, is I think the ministry could very easily institute a crackdown on unnecessary abortions in the province. I understand last year that about $10 million was spent in that area. I believe only about two per cent of those abortion procedures were what one might term necessary. I think there’s a great deal of saving to be effected in that area and I would certainly suggest that the minister take a look at it. With those comments, Mr. Chairman, I will take my seat and I invite the minister to respond.

Hon. F. S. Miller: Well, I seldom find much to disagree on with the member for Huron-Bruce, really.

Mr. B. Newman: He always makes constructive suggestions.

Hon. F. S. Miller: He’s a very reasonable man.

Mr. Bain: He would make a fine Minister of Health.

Hon. F. S. Miller: Yes, he would. He only needs to change parties and I will give him the job.

Mr. B. Newman: He is a poor hockey player.

Hon. F. S. Miller: He is a poor defensive hockey player. As a matter of fact, I want it on the record that I never did have a heart attack. I was losing that game so badly that it was the only honourable way out.

Mr. Gaunt: I have got my skates sharpened now.

Mr. Sargent: You have just lost your next year’s contract.

Hon. F. S. Miller: It takes more than equipment to make a hockey player. The question of overbilling by doctors and overuse by patients remains a prime concern of the ministry. I think most doctors will tell you the illegal overbilling by doctors is almost a thing of the past, because the medical review committee, which is an arm of the Ontario College of Physicians and Surgeons, has become very effective in its means of auditing and checking upon doctors whose profiles of practice don’t conform with the norm.

As I mentioned in my opening statement, we have just recently been able to extend to this to four other fields and we feel we will have the same kind of audit capability there that really prevents illegal or even improper billing. There’s a tendency for some doctors to charge for a general assessment when there is an office visit. If we notice that they are charging for too many, the auditors will go in and ask to see the records and we get the money back. The amount of money we get back is quite considerable under this process.

Mr. Gaunt: Several millions?

Hon. F. S. Miller: Well, let me say I think the curve has gone like this. As time has come on, the doctors are aware of the capability of the ministry, and OHIP in particular, to detect anomalies and I believe you will find much more careful billing practices as a result. There are honest differences of opinion between medical auditors and practitioners, but these will continue to go on and I think can be tolerated. The real question is, was the service rendered and was it billed for as rendered.

The next point, again -- the credit cards for health -- is an issue that I felt as strongly about and feel as strongly about as Dr. Potter. As a matter of fact, he sent me to the Province of Quebec back in 1973 to see their system and to talk to them. They suggested to us certain changes that they would have effected had they a second chance. I think their suggestions were very reasonable. First of all, don’t try to use the SIN for the policy-holder as the basic number. Use the SIN of the individual.

To begin with, as you may know, the federal government wouldn’t let us give out SIN numbers in Ontario. We found a high percentage of people didn’t have them; much higher than you or I may have expected. So in the short time frame between deciding that there would be a universal number and the time it had to be implemented, we couldn’t get the SIN number issued to everybody. I think the time is coming though when the House and the government will certainly have to consider it, I’m sure, when we talk about giving just one number at birth. It’s the logical time to do it.

We would eliminate one number we give them already, called the birth identification number. We’d eliminate a driver’s licence number. That founders on a couple of drawbacks -- the credit card and the unique number. It isn’t as easy to get billings made as it sounds.

First of all, doctors have a habit, and quite properly so, of putting a number of services on one card. I think that could be coped with. It means once a month, perhaps, you’d sign, rather than each time you went to the office.

Secondly, little kids coming in perhaps, or young children without parents, may take that along and may not have the authority to sign.

Thirdly, there are the problems in the emergency area. But I think there are also some perceived drawbacks that are going to give us more trouble than the technicalities. Those perceived drawbacks are the rights of the state to have a number attached to your name which by the push of the button, pushing that number into a machine can cause information to be divulged that people shouldn’t have about you. Therein lies the real problem we face with unique identifiers. That’s really what’s slowed up the progress.

I think we can cope with the costs; $7 million, $8 million, $9 million, $10 million would be roughly the range of costs for that programme to get it started with another $2 million or $3 million a year to keep it operating. In terms of the convenience it would be worthwhile. The card, I think, would have a multiple purpose. It wouldn’t only be an OHIP card. It may even be the identification-type of card we talk about for teenagers who are wanting to enter a licensed establishment -- that kind of thing.

Those are issues that pass the boundaries of the Ministry of Health and obviously will have to be discussed by government. I can only tell you this: Our ministry is currently requesting that review right now. I think the issue will be discussed at length before too many more months pass.

As far as the private labs are concerned, there were a number of points we could take and I think I touched upon them in my opening remarks. I am not against private labs; I keep on stressing that. I’m sure the people over here are; I hope your party isn’t. There’s a place for the private lab. It may well be there is a place for the private lab even in the hospital at times, because there are savings when private enterprise performs certain services. I suspect you will not get highly-skilled technicians to work for a minimum wage or less.

Mr. Bain: That is why quality is so poor.

Hon. F. S. Miller: Oh come on -- the quality. It would be interesting for you to see, and I’d be quite happy to have you look at it some time, that the LETP programme, the Lab Efficiency Testing Programme going on in the province right now under the jurisdiction of the OMA, is really determining which labs are analysing samples properly and which ones aren’t. Its whole purpose is to determine where the weaknesses are, to make the people aware that they are not doing a good job in certain tests, to train them how to do if possible and if not to cancel their licence. It’s as simple as that. I think the third alternative, the third chance, is essential about any programme. Give them a chance to pull up their socks once they are proven to be doing things not up to standard,

The fact remains, one will find that survey will paint its finger at all types of labs in a fairly even way. It doesn’t say that the hospital labs are all top-grade and the private labs are all lousy. It will tell us that we have problems in each sector; problems that exceeded our expectations. That’s really all I wanted to reply to the member for Huron-Bruce.

[12:30]

If I can just refer back to a comment I made earlier, the discrepancy between the figures I read into the record and the figures in the statement that was actually ready for me to read. I had given gross savings instead of net savings. I think I will wait until after 2 p.m. to correct this and make sure I have it all right. But I don’t want to leave any misapprehension, I think we will end up in the same boat when we are all through, the same number of dollars.

Mr. Grossman: I need not launch into a continuation of my defence of and argument on behalf of the Doctors Hospital which I was doing the night before the minister suffered his heart attack. What I do want to do is to address myself to the situation in which the ministry, and I suppose government, finds itself at this particular point in time, and that is with the six-month funding being given to the hospitals whose lawsuits are now under appeal into the court. I would like very strongly to urge the minister to attempt to use this period of time to instill some credibility into the decisions taken by the ministry.

I am not, at this point in time, going to get into a discussion with the minister with regard to the merits of the closure with which I am intimately involved. He and other members of this House I think very well know my feelings on that subject and, just to reiterate, I am totally unconvinced that the closing was either proper, right or justified.

In any event --

Mr. Sargent: Nevertheless.

Mr. Grossman: -- if the ministry and the minister believe that I am wrong and that the initial decision was right, then surely in this interim period the ministry ought to be looking to satisfy the citizens affected by the closings, the doctors affected, the 600 staff that will be out of jobs. In order to do that, I suggest very strongly that rather than try and trot out new, different, or first-time regression analyses or computer printouts or whatever they are being called these days, that it is very important that some sort of review be made by persons who run in no way be associated with those persons who initially drew up the list of 24, 11, 10 and finally nine hospitals that did arrive on the list for closure.

Mr. Sargent: The Premier said there was no list of 24 hospitals.

Mr. Grossman: It is very important, in the context of the history of the closures, especially as it relates to the Doctors Hospital, that this be done in order that those persons who have been affected understand that the closure did not result from an immediate decision, a callous decision, one which was made, as has been alleged, for political purposes. If it was not, and I trust and hope it was not even though the decision was wrong, if it was not made for those reasons, then for what reasons was it made?

More importantly, rather than getting into a rehash of those reasons, this is the precise point in time at which the ministry ought to investigate the rationalization of all hospital facilities in Metropolitan Toronto. There is not the slightest doubt there is a duplication of a lot of facilities. There is a duplication of some of the very fancy, expensive but little used equipment. Heart transplant machinery for example. Why need it be done in two or three or four different hospitals? What is the competition? Surely one unit is sufficient in one hospital.

Likewise, there is no question but that there is a surplus of obstetrical beds. Why deal with it on a gross bed count basis? Surely, some sort of study ought to occur to determine whether there should be one, two, three or four units -- hospitals -- to deal with obstetrics rather than spreading them out? I don’t know what the answer is but surely the fact that there are obstetrical vacancies in very many hospitals seems to indicate that some sort of review, some sort of analysis of the effectiveness of the system, most occur. There has got to be staff in many hospitals that are under-used in the obstetrics area, as there is certainly a duplication of equipment. Perhaps it should be consolidated -- almost certainly not into one hospital, but into fewer hospitals than is new the case.

I feel a particular sense of frustration with the continuing operation of the Grace Hospital, which has an extensive obstetrics function, when that hospital is doomed to be closed certainly within four or five years whereas there is a large problem with obstetrical vacancies in hospitals surrounding the Doctors Hospital. Yet the Doctors Hospital, because of a surplus bed problem, allegedly, is doomed to be closed itself.

So those types of situations should certainly be dealt with right now. Let’s look at it. There is probably the potential for effecting a lot greater saving than is being held out and purported to be the case by the ministry with the Doctors Hospital closure. But the only way we are going to know that is to have a study -- not of one or two or three hospitals -- not to look at regression analyses for one or two hospitals, and not to start to dispute those analyses -- but to get down to a study of the availability of those facilities, the duplication of those facilities, throughout all of Metropolitan Toronto.

In other areas of this province there are district health councils which have been set up. In some cases they have been effective in telling the ministry there are some alternative ways to effect savings other than those ways which have a very serious, dramatic and immediate effect on the community. If the ministry is going to satisfy the public of this city, not to mention the province, that the same sort of forethought and consideration has gone into the closing of the Doctors Hospital, surely something in place of the district health council, which is not in place in this city, ought to be struck on an ad hoc basis at this point in time. Then it could perform the function that district health councils have been doing in other localities and will be doing at some point in time in Metropolitan Toronto. Now is surely the time to do it.

The assistant deputy minister unfortunately was quoted in the press in February as saying -- and I quote from the Globe and Mail, Feb. 13:

“I think there comes a time when the government has got to come in with lead boots and say, ‘We’ve asked you people, we’ve pleaded with you, now we’ve got to take some action.’”

I understand the sense in which that statement was uttered -- that is that the time has come to effect some real savings. I never have agreed that the closure of the Doctors Hospital will effect that saving. But I think, very importantly for the integrity of the entire programme, is the fact that there are very many people affected by the closure of the Doctors Hospital who have lived under the application of lead boots in the countries in which they were born and countries from which they escaped. How is the ministry and the government going to explain to those persons that this government didn’t really mean to roll in with lead boots? It’s a very difficult problem to go out and explain to those persons affected that this programme is not that sort of ad hoc immediate decision made for whatever purposes, political or otherwise, particularly when they see some very big expensive facilities in the surrounding areas. These are persons who obviously don’t understand too much about the operation of our system, nor can they understand some of the explanations put forward by the ministry. Indeed, very many of us who have a lot better command of the English language cannot understand some of the rationalizations put forward. It is important to satisfy these people that the lead boots comment was really far too callous: Really, I hope, it wasn’t meant to say what it appeared to say and that behind that quote there was a heck of a lot more foresight and though than appears to have been the case at the present time.

Part of the problem is that since the closure -- since the announced attempted closure -- there have been four or five different explanations given. Generally speaking, the first explanations about the hospital closings, before the specifics were announced, hinged on efficiency. When it came to the Doctors Hospital, the position moved to one of it being an old building. Therefore, when the ministry was looking to close down beds it obviously went, it says, to hospitals which were old and obviously needed replacement.

When the Doctors Hospital showed that the building could operate for eight or 10 years yet to come with its present plant, that position had to sort of take a back seat. Then the emphasis shifted to the surplus bed argument -- there are surplus beds and that may well be the case. It is hard really to analyze that argument although, as I have said before, I can’t walk around this city and point to very many surplus beds except in obstetrics. I can’t locate them; I can’t find them.

Because that answer was forthcoming from very many members in the hospital field, the argument then shifted to the Parkinson’s law argument which is that we have to reduce the numbers -- never mind the argument about four beds per 1,000 -- we have to reduce the numbers of beds because wherever there are beds they will be filled. We have to reduce the numbers of beds. That’s the argument, generally speaking, which the ministry has drifted to at the present time.

Mr. Grande: Not a good one is it?

Mr. Grossman: I know the minister will take some exception to my analysis of how the arguments have wound their way down in the last two months. Because I am not satisfied with the drift of those arguments, I say to the minister that it is time to use the six-month pause period -- which, I suppose, is down to about 4½ now -- to satisfy the public that there has been an objective study done of all the facilities in Metropolitan Toronto.

Mr. Bain: They never do an objective study; they do it on whim.

Mr. Grossman: There should be an objective study conducted at this particular time in order that these three or four arguments need not be trotted out from time to time; in order to dispel the lead boots argument, the lead boots scare, the worry and concern of these people who have come to this country and unbelievably see something happen here which they never saw happen in their own country. That is a hospital -- a couple of doors away from where they live -- close its doors, slam tight, shut. It appears to the person living on Brunswick, Major, Robert -- the streets surrounding the area -- as though the decision were an arbitrary one. The government suddenly decided it needed some money, had to cut back somewhere and therefore rolled into Brunswick Ave., to an old community hospital and said “We will just have to shut those doors.”

Mr. Bain: Do you know something? Those people are right.

Mr. Grossman: If you want to satisfy those people, unlike the member for Timiskaming -- although I am probably a heck of a lot more familiar with the operation and funding of hospitals than he is -- I am not prepared to stand here and say conclusively that there is an entirely rational system or allocation of hospital facilities in Metropolitan Toronto. I would like to find out.

My belief in the importance and value and efficiency of the Doctors Hospital is on record. I say to the minister if he and the ministry believe I am wrong, the hospital is wrong and that what I and others are saying about the duplication of hospital facilities in Metropolitan Toronto is not the case, let’s just test it. Let’s have a study conducted with the proper persons put on that board to let them report -- as district health councils have in other municipalities -- and say Miller is half right; Grossman is half right; you are both wrong; you are both right, whatever. Let’s use this 4½- or five-month period in order to tell the people who have been so dramatically affected by this and other closures.

[12:45]

But I am dealing now particularly with the Doctors Hospital closure, that that closure was done on a certain basis and rationale. Let me go on record right now that I believe that study would come back and say the Doctors Hospital ought not to have been closed. I do believe that -- regardless of who is put on that committee; regardless of who would study it.

Mr. Warner: What are you going to do about it?

Mr. Grossman: But I would like to see the study occur, and I would just like to see that outcome. I would like to see what an independent board would report. Just as importantly as its results is the fact of its existence as a high-profile study. It could be taken out on Brunswick Ave. --

Mr. Warner: He is not going to do that, and you know it.

Mr. Grossman: -- and throughout this city, one could say: “Look, it was not arbitrary; it was not political.” The report would, I suggest, say that some of the university teaching hospitals have been overspending and that there are certain rationalizations of other facilities, of equipment, of people, of manpower, which can and must occur, together with the continuance of the Doctors Hospital, or the change in use of the Doctors Hospital.

When the April 12 statement of the Premier discussed the changing of the use of that facility into an ambulatory clinic, there were those who argued that that decision was not a good decision, that the ambulatory clinic would not work on that site. Obviously this is one of the alternatives that such a committee could discuss at the same time and determine just how valid that sort of institution would be on that site.

The reason I have faith that the Doctors Hospital would do well in such a study is that the now famous 1971 role study, conducted in part by the now famous deputy minister, did result in the subsequent approval in 1974 and 1975 of the construction of a new building on the Doctors Hospital site, with approximately 100 fewer beds. This facility was to be more towards a community health care centre with fewer acute treatment beds and different levels and types of beds, and a lot of outreach programmes into the community. It was anticipated in that role study that this would result in very substantial savings in health costs per patient treated.

I am confident that such a conclusion would well be reached, not only with regard to the Doctors Hospital, but other hospitals in the Metropolitan Toronto area, by a committee reviewing the situation over the next several months.

May I say that the importance of dealing with this thing on a rational basis, using this period of time to find out exactly who is going to go where, what services are going to be performed at which hospital, is even more crucial in view of this very serious employment problem. No one can kid anyone about the employment problem which is going to be created by the closure of hospitals throughout this province.

I noticed an article in the Globe and Mail, May 29, datelined Kitchener. I quote:

“Officials of Texas hospitals, citing a desperate shortage of nurses in their state, were in Kitchener and other Ontario communities last week attempting to persuade nursing school graduates to take jobs in Texas.”

The article says later:

“Mr. Snider said the visit from officials of the Texas Hospital Association and other associations followed a report from the Ontario government to hospitals in the southern United States about Ontario’s surplus of nurses.”

There is no question that a surplus of nurses is caused by a lot of factors, but the fact is that surplus still exists and can only be compounded by the closures. I am not going to get into the argument today about whether there is any real dollar saving involved when they turn up on other rolls, on welfare rolls and unemployment insurance and so on. We’ve been through that argument. I’m convinced that the alleged savings of these hospitals cannot be properly calculated without taking into account not only the dollar costs but the very serious social costs of having these persons become unemployed.

But the point I wanted to make, and it is very important, was the need for such a rational study of what’s going to be happening in the hospital field in Metropolitan Toronto which has a budget of some $450 million in Metropolitan Toronto is that crucial. In fact, on May 6, 1976, an official in the Ministry of Labour, Mr. Harry Shardlow, reported there were very few jobs available in the health field at the present time, and there possibly would be considerable retraining requiring in this field, but that his department would of course do everything possible to assist in that regard and also in respect to unemployment insurance. That’s not much solace to the 600 employees that are going to be out on the streets if the closure of the Doctors Hospital goes through.

For the information of the House, I would like them to know that in May, according to the OHA referral list, in all of Canada there were 28 jobs available. Twenty-eight jobs available -- that’s a pretty serious situation. I could take the time of the House to read those jobs -- they go from administration to admitting, central supply, housekeeping, medical records, medical technology, nursing -- six. Six nursing lobs, two in southwestern Ontario, one in Newmarket, one in Thunder Bay, one in Edmonton and one -- “no location,” it says. Twenty-eight jobs, a very serious situation.

Finally, Mr. Chairman, may I say that I noted one of the concepts being discussed throughout this province is the concept of graduated beds within hospitals. This is something in which the Doctors Hospital led the field earlier this year when it agreed to close down a couple of dozen beds and replace them with only 12 in a very good, far-reaching outpatient, ambulatory type of wing for the hospital which would serve as a sort of test run for this type of programme.

It is anticipated by some people that by having three types of beds within hospitals: acute, medium-care and minimal-care, you could shift patients as they progressively improve, or conversely -- after they have been admitted for tests and move toward the operation -- you could save substantial dollars by moving them to the appropriate portion of the hospital. For example, a minimum bed, it has been estimated, could cost as little as $15 per day, with the medium-care bed providing facilities somewhere around $50, and this is very important in view of the fact that acute beds now run somewhere in excess of $100.

I note that this was reflected in Time magazine, not always my favorite source, of May 3, 1976, in an article entitled “No-Frills Hospitals.” I’d like to quote a paragraph or two from there:

“Few expenses have climbed faster or higher than hospital care. The cost of a semi-private room in a typical US hospital is now more than $113 a day, three times as high as a decade ago. In some metropolitan areas such as New York City, Washington and Los Angeles, semi-private room rates have risen above $200.

“Most hospital officials agree that the greatest single factor in this inflationary increase has been higher salaries for long-neglected employees whose wages now account for 70 per cent of hospital costs.”

I believe in Ontario it’s 80 per cent.

The article goes on to talk about the setting up of self-care units which have been set up at approximately 288 hospitals in the United States. I don’t know how many hospitals in Canada have experimented with that sort of programme, but I do know that the Doctors Hospital was, I believe, the first in Metropolitan Toronto.

The article concludes as follows:

“And she might have added the happy mood [that is at the hospital] is not entirely soured when it comes time to pay the room bill which is 40 per cent less than it used to be.”

In essence, what they’re saying in this article and in some of the other articles which I’ve read and were published in Ontario, dealing with the graduated bed-care system, is that if you go in for tests only, you can be in a minimum-care bed. Obviously, you don’t need a nurse coming around taking your temperature every hour. You don’t need your food brought to you. In fact, you can make your own bed. You can walk down to have your temperature taken whenever you have to have it taken, and you can certainly walk down to the cafeteria. It’s almost like a motel setting. In I fact, it is a motel setting. It’s a motel operation. You’re there because you can’t be at home, but you sure don’t require the use of an acute bed with all the attendant labour that goes with it.

Minimal care, then, can be very cheap. Medium type care. Obviously there’s that stage between a patient being totally self-sufficient where he can make his own bed to that of a patient who is well on the way to recovery and on his way out of the hospital but still needs some care. Perhaps he can go to the cafeteria, but still needs some nursing attention on wounds and so forth.

The breakdown of beds between acute, medium and minimum care is the type of thing which surely ought to be studied. Is it a practical system to put into effect in Metropolitan Toronto? In how many hospitals can it be put into effect? Because of the structure of the hospitals, can this system effect the substantial dollar saving which has been effected in some places in the United States, in some cases up to 40 per cent?

I don’t think there is any question that every member of this assembly has seen people lying in acute care beds who did not need to be in that acute bed. But, at the same time they need not, or could not have been sent home.

Some sort of graduated use of those beds may be a very great part of the answer in Metropolitan Toronto. I say to the minister, that the budget in Metropolitan Toronto this year will be somewhere around $450 million for hospitals, so surely no harm can be done by having an analysis of the rationality of the facilities, the effectiveness of the work force and the breakout of beds, obstetrics and others in all of those hospitals. If we can effect a very small percentage saving as a result of such a study then your savings in terms of gross or net dollars, whatever you want to call them, is enormous.

Equally important is the fact that it will say to those persons in Metropolitan Toronto: This decision has integrity. This decision is the result of a lot of study. There is an entire rationalization of facilities going to occur in Metropolitan Toronto.

No one will criticize the ministry for taking a longer period of time to have a more reasonable and rational restraint programme as it applies to hospitals, provided that they are satisfied that it was not a “lead boot” type of decision that occurred.

It’s as they always say when you talk about conflict of interest, justice must not only be done but must seem to be done. I say to you, sir, that in the Doctors Hospital case I do not believe that justice has been done. If you believe that justice has been done then, please, I say to you, do what you have to do to make it appear to be well done. That’s most important to those persons who have been dramatically affected.

Mr. Bain: What happens if it hasn’t been done?

Mr. Godfrey: Cover it up, by all means.

Mr. Grossman: Let it be done. Let justice be done and make sure that it appears to be done also. It doesn’t at the present time.

Mr. Bain: What happens if it hasn’t been done?

[1:00]

Hon. F. S. Miller: Mr. Chairman, I am sure the member is aware that advice was given to this ministry on Doctors Hospital in a study prior to our decision. It was some years prior. But that study by the Metropolitan Toronto Hospital Planning Council did recommend the closure. I’m sure you know that the study was made to that effect. So it wasn’t just a rabbit out of the hat type of decision.

I’ve been intrigued at the criticisms from all sides of the House, my own and the other side, on our willingness to experiment with budgetary approaches this year. Regression analysis, I think, was the first thing you referred to. One understands quickly why politicians in authority seldom are willing to try new things.

Mr. Godfrey: Particularly Conservative politicians.

Hon. F. S. Miller: This politician, of course, tried some new things. Whether you agreed with them or not, I tried them.

Mr. Nixon: Do you call closing hospitals a new thing?

Hon. F. S. Miller: No, I’m talking about regression analysis in attempting to find some better way of chopping back on budgetary strain and then simply saying, as is traditionally done: All of you can have this much more, all of you can have that much less, treat you all the same even when you’re not all the same to begin with.

Mr. Warner: So you close the hospitals.

Hon. F. S. Miller: We recognize acutely some of the shortcomings of our attempts, but at least we tried them. Anybody who has been in the experimental research field knows that’s how you learn. Whether you like it or not, you assemble the best possible means of correlating data. You do it; you draw your conclusions and if you have enough courage to go from there, you take your action. Well, we took some actions and we discovered very quickly from some hospitals that we didn’t have all the data in. I don’t even feel badly about that in retrospect.

I found representatives of hospitals, where you couldn’t have cut a penny off last year, coming in and saying: “Look, the half million you took off us is a bit steep. Don’t you think $300,000, for the following reasons.” Now, at least, we were talking about a cut. We were not talking about an addition. At least they recognized there was a basis for a cut, and until we took that selective approach, none of that willingness to be treated differently from the rest was evident from any of them.

Mr. Nixon: Well, you scared the wits out of them.

Hon. F. S. Miller: Every single hospital that had a budgetary cut applied against it either accepted it or had a thorough discussion during which, in many instances, we amended our figures or they amended theirs. In retrospect, I don’t have any regrets about the fact that we tried a more specific approach to either additions or contractions in budgets for hospitals.

Certainly, Metropolitan Toronto with its huge health costs and its huge hospital costs remains the most fertile part of the province for major dollar savings. I can’t argue that. And yet one must remember -- those of us who live in rural Ontario -- that about 80 per cent of the savings in this last round were taken out of city hospitals, not out of rural hospitals. That 80 per cent of the dollar savings is a fact that was missed by a lot of people. They said we attacked rural Ontario and not the city. Sure, there’s good reason to consider a study in Toronto and we may do it in this interval.

I only caution you that I don’t think any study of the Metropolitan Toronto hospitals will be quick, clean or easy. I don’t think a six-month period will come up with answers when years and years of trying haven’t come up with answers. We had three planning groups in Toronto: The University Teaching Hospitals Association, Metropolitan Toronto Hospital Planning Council and the Hospitals Planning Council of Metropolitan Toronto. There are two of them that sound so much the same that I have to be prompted each time I use the words. We’ve eliminated one this year and of course, our final hope is to have a district health council or councils in the Metro area.

I would say that from a report I just recently saw from some of these groups, more work has taken place. I think the two remaining councils sent me a report, a week or so ago, saying that more progress has been made in the formation of the health council in the last year than they have seen in a long time and that they are shortly going to be willing to recommend means of forming a steering committee for the major problem in Toronto.

That won’t necessarily detract from the suggestions you’ve made. I’m actively going to look at them and try to give you an answer if it will achieve something.

You went on to say that you went around the city and didn’t see many available beds and Parkinson’s law or something applied. I’ll stand up and defend the fact that the control of the total number of beds is still the most effective deterrent to over-utilization of the hospitals in the province. Good arguments could be made that we’re still away too high in our numbers of beds.

Mr. Nixon: It certainly said something about the beds in the province.

Hon. F. S. Miller: It said something about you and me, too, as patients.

Mr. Nixon: We don’t sign ourselves in -- maybe you do.

Hon. F. S. Miller: How many times have individual members come to me when a family has objected about the removal of a patient from a hospital who the doctor thought was inappropriately there?

Mr. Nixon: Is there something you can do about that? You would reverse a doctor?

Hon. F. S. Miller: I don’t reverse a doctor. But I could tell you a good many members quietly come to me, and I would say more members are approached by their constituents. Is there a member here who hasn’t been called on a Saturday or a Sunday by an irate family member who says: “They’re going to take mother out of the hospital and I don’t want mother out of the hospital.” I got called in the middle of the night not long ago by a man who wanted to get into a hospital. He said to the doctor who was looking after him and who refused to admit him -- and I give that doctor a great deal of marks -- “I know the Minister of Health.” He happened to be talking to my surgeon.

Mr. Nixon: He obviously wanted to go into an Ontario Hospital.

Hon. F. S. Miller: My surgeon said: “I know the Minister of Health too. Why don’t we phone him?”

Mr. Godfrey: How come you have a surgeon?

Hon. F. S. Miller: I think it’s normal for people of my rank to have their own retinue, is it not?

Mr. Nixon: Idi Amin had one.

Hon. F. S. Miller: No, that’s ad idem; that’s the country right beside Idi Amin.

Mr. Nixon: Ad nauseam.

Hon. F. S. Miller: The nursing surplus was touched on, and the number of jobs in the province in the health care field was touched on. There is a nursing surplus -- not caused by the current constraint programme but aggravated by it, not caused by the graduation of more nurses but aggravated by it -- but caused by two things.

The tremendous increase in the salary of nurses in the Ontario hospitals is one. We had a pool of about, I’m told, close to 40,000, either inactive or part-time nurses in this province. About 55,000 or 60,000 were working. Many of them were housewives who hadn’t put their hands at the nursing profession more than the odd day for a long time. When salaries went from the $6,000 range to the $14,000 range in a period of two years, for many the temptation to go back to work became very real.

Secondly, the sag in male employment opportunities in this province caused many a woman who was a nurse and who had not worked to be faced with the alternative of having no family income or her getting back to a job she could take. I can tell you in my own home town that occurred with a number of nurses when Corning Glass closed its plant. Nurses who were quite happy to have been at home suddenly became the breadwinner of the family. So we had this tremendous number of people available to perform the service who returned for one of several reasons.

When salaries were in the $6,000 and $7,000 range, the doctors and the administrators in the Toronto hospitals will tell you, it was hard to stock Toronto hospitals with nurses for a while. We actually had employment agencies providing shift nurses and being paid a premium for finding them. That’s within two years. That’s so completely changed now. But the apparent shortage then did encourage government to step up the training of nurses. Those nurses will be coming on the market very shortly.

Mr. Nixon: They are going to like it in Texas.

Hon. F. S. Miller: As far as jobs are concerned, obviously, the vacancies posted -- and they’re only 28 -- reflect not the number of people entering the system, but reflect the number of people who cannot be found within the application lists for a given institution. So we have lots of people getting jobs; lots of people changing jobs but very few hospitals having to say: “We are in need of the following kinds of people.” They can find them on their own application lists right now.

Let me try to emphasize my responsibilities as the Minister of Health because it’s been touched on by one or two speakers, vis-à-vis employment. First, to those people displaced from a hospital job, we have, as a government, a responsibility -- whether they are a floor cleaner or a head nurse -- to help them find another job in the system. They should have, in my opinion, the first right of access.

Secondly, though, it is not my responsibility to create jobs just to provide employment. My job is to create jobs that provide necessary services efficiently; no more, no less.

Self-care you touched on and we have a number of experiments in sell-care. I suspect that the one at your hospital was done at the overt request of our ministry to assess it. Self-care is only useful if you replace acute beds with the self-care beds or if you would have had to build acute beds that could be prevented by the use of a self-care unit. Our basic problem remains too many acute beds highly staffed right now.

With that, Mr. Chairman, I’m pretty awake for the next speaker.

Mr. Godfrey: Mr. Chairman, I enjoy commenting upon the Ministry of Health estimates once again, and realizing that most of the things I said at the last session, I could repeat this session. Apparently, they were either not heard or not valid. I suspect it was the former. I have little trouble wiping off some of the feathers from the albatross which is around the member for St. Andrew-St. Patrick’s neck as all this shaking goes on in the back ranks of your desks. I’m afraid that albatross will remain there. It is a little discomforting to see him making pleas across three --

Mr. Nixon: It is not a monkey on his back, that’s for sure.

Mr. Godfrey: -- banks of benches when he could easily have your ear. I am going to talk about private labs. This is just a preamble, Mr. Chairman.

I was interested in your sally into the field of research and I enjoyed it very much. I appreciate that the research tool of the regression analysis may have some validity. Like many research tools, though, it is a cold knife which does not take consideration of what is cut. I would suggest to you the hospitals are not subject only to regression analyses when you’re considering closing them. Hospitals are a vital part of the community. They are a living, pulsing part of the community as you found out, much to your discomfiture, I’m sure.

Hon. F. S. Miller: I stand on a point of order, Mr. Chairman. The regression analysis had nothing to do with closures. Nothing.

Mr. Godfrey: I see. I had understood one of the main reasons for saying we would save money was that the regression analysis shewed certain inefficiencies were in the system and, therefore, we could proceed on that, and that proceeding on the data which flowed from the regression analysis -- eight or 80 per cent, it doesn’t matter -- savings could be prognosticated. Therefore we would close down this, this, and this. I believe I am valid on that.

The only question I would put to the minister inasmuch as he’s now got into the field of research, all research requires a permission from an ethical committee when it is dealing with humans that says you may conduct this research if the humans are not damaged by your research process. I suggest very strongly to the minister that he stay away from using the word “research” when he talks about closing hospitals unless he gets that permission from an ethical relations committee. No respectable researcher would think of doing it without that permission.

However, to go on to the private labs. I would remind the minister that the regression analysis was used for the budget reductions and for staff reductions. Certainly they involve humans and I do think the ethical relationship does arise once again.

Speaking directly to the point of the private labs, which is the order on the budget here, I would preface my remarks by pointing out that not all private labs have been tarred, I hope, by this rush of kickbacks and other things like that. I realise there are many ethical private labs and we are in the process now of weeding out those where there have been some inconsistencies from the reasonable rule of normal behaviour. I was delighted to see that the minister withdrew Bill 59. It was unfortunate that in that Bill 59 there was nowhere laid out the role of conflict of interest in the operation of private labs.

[1:15]

In 1972 we urged the Minister of Health at that time, Dr. Potter, to do something about the private labs in which doctors had a vested interest -- those vested interests might lie in outright ownership or might lie in the fact that the doctors sat on the boards of directors of the private labs and had a particular private interest. However, today I would speak more of those who own and operate labs.

As you know, Mr. Chairman, private labs are a profit-making business as opposed to hospitals -- hospitals are not involved in profit-making enterprises. There are many examples -- at least in Ontario five or six -- of large conglomerates of private labs which have been formed into one particular area -- MDS Laboratories Ltd. is a very good example. This lab complex was founded in 1969 -- the first full year of OHIP’s coverage, very interestingly. Between 1970 and 1974 they showed an increase in gross revenues from $2.3 million to $15.8 million, and a net income from a deficit of $652,000 in 1970 to a profit of $804,761 in 1974, the last year for which we have full figures.

This complex owns some 90-plus labs and other large numbers of specimen-collection centres -- known as bleeding-stations -- in Ontario and Quebec. In June, 1975, the report to their shareholders read:

“Gross revenues for the first six months of the fiscal year 1975 were $9,517,000, a 26 per cent increase over the same period in the fiscal year 1974. While net income for the same period decreased slightly to $438,000. Earnings per common share remain constant at 20 cents. Effective May 1 the payment schedule for laboratory medicine in Ontario was increased 12 per cent. [continuing from the report:] It is expected in the second half of the fiscal year 1975 a continuing programme of efficiency improvements plus the upward adjustment of fee schedule will allow MDS to keep up the higher salaries and material costs of this inflationary period.”

This is just to demonstrate the fact that some people have a very vested interest in how laboratories, and particularly private laboratories, are conducted about the country because quoting from their syllabus from 1973 -- this was in 1973, Mr. Chairman:

“The Ontario government has expressed concern about rising health-care costs in the province, and although laboratory fees are only a small proportion of the total dollars paid annually by OHIP [In 1974 that was between six and nine per cent. Going on further with the quotation] it may be assumed that the cost of laboratory services will be given careful scrutiny by the Ontario government in any effort to improve the effectiveness of provincial health-care expenditures or to reduce the cost to the province of such services. [They then go on to say:] The company also faces competition from hospitals and from government agencies, such as public health laboratories, which provide services similar to those provided by the company.”

Here we have an example of a private association which is in competition with a government-provided facility frankly admitting that, and frankly making plans to expand its particular share of that business. I put it to you, Mr. Minister, through the Chairman, whether something could not be done toward a little more containment in the amount of services flowing to the private labs at present.

Indeed, you have already received a great deal of support for that type of thinking from members of the medical community as a whole. You have already had several projects -- for example, the Hamilton project under Dr. Haggar which I will talk about later -- which clearly demonstrates the advisability of putting more money into the public sector from OHIP or other funding agencies and less money into the private sector.

I would point out to you, sir, and remind you, Mr. Chairman, that there exists an establishment called In-Common Laboratories. The In-Common Laboratories act as a clearing house for hospital laboratory work. It is a method which encourages maximum use of facilities in hospital and development of high expertise. Hospitals which send in work are billed at approximately 50 per cent of the OMA plus 10 per cent overhead. Hospitals which do the work receive 50 per cent.

It would seem there is a real use for the In- Common Lab type of operation, far more than at the present. I am sure Mr. Chairman, the minister is well aware of the letters that have passed between himself and the In-Common Laboratories urging that more be done for the In-Common Laboratories. The saving in actual fees is, of course, tremendous.

For example, the private laboratories bill and receive at a separate charge to the government as compared to the In-Common Laboratories. The In-Common Laboratories, for example, bill cholesterol at 54 per cent of the In-Common percentage of OHIP, triglyceride tests at 36 per cent, TSS-uptakes at 42 per cent and T4 totals at 44 per cent of what would normally be charged by the private laboratories.

Working on this basis you will realize the fantastic profits which the private laboratories are making from OHIP at present. I would point out in passing that if we combine those four tests which I have just mentioned, which are just four of a whole series of tests, then in the last year on an estimation of the amount of lab tests being performed -- and these are all current tests which are being done mainly for hardening of the arteries, if you can put it in that term, and for thyroid dysfunction -- from cholesterol, triglyceride, TS3-uptake and T4 totals the saving to the government which funds it would have been somewhere in the neighbourhood of $1.7 million. Just on those four tests alone and against a galaxy of possibly 250 laboratory tests against which you could put that saving. The saving would be multiplied at least 40 times if we did a much more in-common laboratory operation.

Mr. Warner: Better than closing hospitals.

Mr. Godfrey: In addition to which, the in- common laboratories at present have far more facilities to do the work which is available. I would ask that the minister consider the down time on the expensive equipment which is already in hospitals and not being used on a fully operational basis; the down time on the weekends when only emergency laboratory work can be done; the down time in the evenings after 5 o’clock.

Now, this is not news to the ministry, I am sure, Mr. Chairman. They are aware of these things. I do not come as a messiah, pointing out the way to stop closing hospitals. But I may be a bit of a tocsin who says, for goodness sake, let’s take this route rather than the other route.

The down time that applies to weekend work and evenings alone could absorb a great deal of the work which goes to private laboratories. Yet the ministry will not fund hospitals in order to put on that type of weekend staff. The ministry won’t even fund in-common laboratories to set up bleeding points so they can withdraw blood in a particular area, rather than having to have it shipped in from hospitals or other areas.

These are all reminiscences to the minister, he is well aware of these facts. He is well aware of the fact that he is not taking any action on them. Sure, he is going to devise a new laboratory form for the labs which will say, you can do this, do this, do this, but don’t do that, and that’s fine, that may save us a few dollars, may rationalize the system. But when we get around to talking about a real cost saving in laboratory fees, then we have to talk about something more definitive.

I would point out to you -- and the minister already has these figures -- we should look at the runaway inflation which is going on with lab costs. Here we have payments to private laboratories by OHIP: 1972, $27,700,000; 1973, $35 million; 1974, $54 million; 1975, $75 million. It will go up and up unless something definitive is done with this wastage of public funds. The minister is well aware of this, Mr. Chairman. He has already read the excellent article which I believe he may have partially commissioned, or at least is aware of, from Drs. Brain, Haggar, Moore and Cameron of the Hamilton district, who did a Hamilton district programme in laboratory medicine and ended with these following statements which I would like to read into the record.

“Commercial laboratories bill the government for all the tests they perform and their revenue rises in direct proportion to volume. The fee schedule makes no allowance for the volume of tests performed and therefore does not reflect the low incremental cost achieved by most up to date automated equipment. The hospital laboratories, on the either hand, operate with fixed budgets and have no control over the demands for their services. This is especially invidious for the outpatient diagnostic services where insufficient funds are provided to pay for the additional costs associated with continually increasing demand.”

They go on to point out the importance of centralizing laboratories and make another plea for in-common laboratories ending with the recommendation:

“A change in the funding so that the actual cost of diagnostic and laboratory services is met by an appropriate, realistic level of support for public hospitals and commercial laboratories, taking into account the different nature and true cost of the services they provide.”

I was interested to hear that the minister is taking part in an LPT test which will examine the efficiencies of private laboratories and public laboratories.

He mentioned in passing -- he sort of let it slip out -- that private laboratories can pay more for their technicians; therefore, they can deliver a higher level of expert service. You may deny that, sir; that’s the inference I took from it.

Hon. F. S. Miller: On a point of order, the insinuation came from your side of the House that private labs made a profit by paying minimum wages or less. I simply said I found it hard to believe that people of that kind of skill would be going to the private sector and taking low wages.

Mr. Godfrey: Thank you for the clarification. I wish I had similar clarification on other contentious matters which are put forward by the minister.

The point is that if you are going to go to do a comparison I would insist the comparison take into consideration the effect that the private laboratories are in a profit-making situation and are rewarded for doing more work. Hospitals are not in a profit-making situation and are not rewarded for doing more work. As a matter of fact, in many cases they are penalized for doing more work because their staff is overrun or overworked.

Mr. Warner: You save money and you close them.

Mr. Acting Chairman (Gregory): Prior to the response from the minister I have been handed a bulletin that Ottawa’s peace and security bill passed second reading at 1 p.m.; 133 voted for and 125 voted against.

Mr. Minister, on that happy note?

Hon. F. S. Miller: On that note, yes. The member for Durham West and ourselves are not at odds quite as much as he would like to make out. We agree -- first of all, we brought in Bill 59 and your party thoroughly denounced it and said it wouldn’t support it because it was a nothing bill. I don’t know where your leader got that opinion because the nothing bill gave this ministry the kind of authority that, in my opinion, the ministry should not have. That was the right to cancel licences without any appeal whatsoever.

Mr. Nixon: You withdrew that bill?

Hon. F. S. Miller: No, I haven’t withdrawn the bill. I am holding that bill, as I said in my opening statement, until I have amendments to it which I can live with. Those amendments will require some type of appeal mechanism, some kind of review to determine where surplus capacity exists and who should lose the capacity which is surplus.

Mr. Nixon: You must have thought the bill was inadequate also; is that right?

Hon. F. S. Miller: I simply say it was too forceful vis-à-vis the arguments being lodged by the NDP. It gave me the authority to cancel out anybody I wished to without any appeal.

I would point out that we have draft regulations, as I mentioned again earlier today, defining the classes of persons who may not own laboratories. They are very simply defined. Legally qualified medical practitioners are designated as a class of persons who shall not be owners of laboratories or have any interest therein. Laboratories designated in a schedule and which are operated on a financial basis which has been approved by the ministry are exempt from that section 1 and a few special labs will be exempt also. I think you will find that is a very sweeping regulation and I believe it is in the right direction.

[1:30]

Mr. Dukszta: Excuse me, on a point of order, Mr. Chairman. I don’t quite follow you. Is the minister saying that this is now the law?

Hon. F. S. Miller: No, that’s a draft regulation right now that has not, as yet, proceeded. I am letting you know what we are thinking before we bring forward the regulation as law.

Mr. Godfrey: It is in direct response to our request.

Hon. F. S. Miller: It is in direct response to our study within the ministry. If it happens to correspond with your direct request then, for a change, we are on the same wavelength. That’s what I was trying to say to you in the beginning. We recognize many of the problems you are discussing as being valid ones. We don’t accept all your conclusions. That’s the difference. In other words, is there a place for the private lab or not: Yes, there is. Is there a place for the public lab: Yes, there is.

Mr. Makarchuk: Well, why do you close the public ones and not the private ones?

Mr. Dukszta: Because the public ones are not his friends.

Mr. Acting Chairman (Gregory): Through the Chair please.

Hon. F. S. Miller: The areas of utilization of existing publicly owned facilities and hospitals, whether by the hospitals themselves or any other people, will require a fair amount of study and a funding mechanism that is fair. The last is a very difficult thing to evolve. I quite agree that volume-price relationships have to be established for certain tests. I think it should be realized we have both an OMA rate for automated tests and a manual rate for those same tests, where the company is, in fact, able to do automated work and they are paid on that basis.

In summary, apart from your perhaps traditional fear that “proper” means ripoff, I have many feelings in common with you and we are going to rationalize the laboratory system in Ontario.

Mr. Riddell: I would like to take this opportunity to associate myself with and endorse the remarks made in this debate on the Health estimates by my leader and Health critic.

As a member representing the people of Huron-Middlesex, I am also determined not to relax in my efforts to stress the importance which those of who live in the riding attach to our community hospitals and the dismay and concern with which we have witnessed the government’s apparent vendetta against us.

On April 15, the Clinton News-Record carried an editorial which, to a great extent, reflects the feelings of the majority of the people I represent. The headline read, and I quote: “Democracy has suffered here.” The editorial continued:

“Even though few people realize it, democracy has suffered a severe setback in the Province of Ontario. Didn’t they teach us in school, just a few years ago, the definition of representative government was government for the people, by the people? But after the fiasco here in Clinton in the last several months it appears that it is government by the government and to hell with the people.

“Premier William Davis’ decision to close the Clinton hospital without any real compromise is a first-rate example. Not once did they ever consult with the people. Sure, they put on the big act that they were listening to our beliefs and reading our letters which poured in by the thousands but where did it get us? Nowhere.

“All so Mr. Davis could save face; all for the sake of public relations; just a political farce. Sure, the Premier made it look like they compromised. But really what is left? -- an x-ray unit and ambulatory care service and a few doctors’ offices which weren’t there in the first place. There are no active treatment beds. There is no place for sick people from Clinton and area to go when they really need it. Just as important, there are no jobs for nearly all the 110 persons who worked there. What kind of compromise is that?

“To those who say he is saving money, I say hogwash. Instead of paying $75 a day and travelling a few miles we’ll have to pay $150 a day and travel 50 miles to London. The nearest hospitals, namely Seaforth, Goderich and Wingham, have indicated they are full and can’t accommodate the patients from Clinton and surrounding area.

“As has been said in this column before, Davis’ Tories have used Clinton and the other small-town hospitals as a sacrificial lamb, a sort of scapegoat in a farcical game he is playing with the voters in the name of restraint.”

That’s a strong indictment of this government and I feel that it is completely justified. From the outset of the announced restraint measures, including hospital closures, it’s been seen that the riding of Huron-Middlesex had been singled out for very special attention -- the kind of attention which we could well do without. First Goderich Psychiatric Hospital was threatened with the Health minister’s axe. This was a hospital which over a period of some ten years has provided excellent and very comprehensive mental health care. Some 90 per cent of the 200 or more patients at the hospital participated in training and rehabilitation programmes with only 10 per cent receiving purely custodial care. The hospital had one of the highest admission rates in this province for a hospital of comparable size and capacity with something like 50 to 60 admissions and discharges each month. This alone is testimony to the quality of the treatment provided.

The closing of Goderich seemed particularly incomprehensible in view of the fact that only a few months before, the hospital had received from the Canadian Council on Hospital Accreditation one of the highest accreditations of any hospital in Ontario. In the area of rehabilitation, Goderich is considered one of the best in Canada. It’s true that, largely as a result of protests from the opposition in the local communities, supported by respected members of the medical profession, Goderich was not actually closed. Nevertheless, only 20 beds were retained for psychiatric care, the remainder of the facility being converted to the care of the mentally retarded. Thousands of the people of Huron-Middlesex wrote letters and signed petitions of protest.

I would quote from one letter to the Minister of Health, of which I received a copy:

“If you and the cabinet are humanitarian to any degree, you will reconsider your decision and if progress is the name of the game, do not slide back 20 years in time. Goderich Psychiatric Hospital is recognized as one of the leading mental health resources in Ontario. God help us if we are forced to give up when we have come so far. It will then be not only recession but rather regression.”

Again, from an open letter to the Premier:

“One suspects the real reason for the closure of the Goderich Psychiatric Hospital is a petty matter of financial juggling of differential federal grants with respect to psychiatric hospitals and mental retardation centres. Government today appears to be carried out by politicians rather than statesmen. I think we would nevertheless do well to bear in mind the words of at least one statesman, George Washington who said: Government is not reason. It is eloquence. It is force. Like fire it is a dangerous servant and a fearful master. Never for a moment should it be left to irresponsible action.’”

The case of Clinton Public Hospital was appealed in divisional court and the closure of Clinton and three other hospitals was ruled invalid and rightly so. Centred on two major highways, Clinton is virtually the hub of the county. The hospital’s emergency department is very busy, with many emergency surgical procedures carried out as a result of motor vehicle accidents. It is the only hospital in the area with five certified active specialists on staff, with four highly trained anaesthetists.

The hospital has a long and excellent history of surgical achievement and the volume of surgery carried out is comparable to much larger hospitals. No other hospital in the area has a laparoscope for diagnostic and therapeutic procedures and patients come to Clinton from miles away for this service. There is a first-class remote cardiac monitor and resuscitation team available 24 hours a day with successful resuscitation rate of 100 per cent for 1975. The hospital specializes in the treatment of haemophilia and was asked by the university hospital in London to establish a renal-peritoneal dialysis unit for patients in the area. It is functioning very successfully and is, in fact, the only one in Huron county.

There is no possible justification for closing down a hospital of this calibre with this kind of record. Had we the time I could table in this House statistics and reports which would prove beyond a shadow of a doubt that Clinton should and must continue in operation. However, in view of the fact that it has been agreed for some extraordinary reason that the Health estimates should be debated in a comparatively limited time period, in spite of the enormous sums of money involved, in spite of the medical and public issues at stake, I feel my best procedure at this point is to quote a letter from Doug Coventry, the administrator of Clinton hospital, a man for whom I have the highest respect. He has described the closing of the hospital as a tragedy for Huron county and on April 16 he wrote to the acting Minister of Health, the Hon. B. Stephenson. I would like to quote his letter.

“Dear Dr. Stephenson:

“Two years ago I remember attending the OHA section meeting at which you were the guest speaker. I remember then how you talked to us about quality care and how impressed I and many others were by your strong convictions. I wonder if you realize what you are doing to the people of this community, good, honest, hardworking people, so proud of their small, rural hospital. You are destroying what they had come to accept in the past as something that was always there to give that quality care, with someone who cared always there to greet them when they were sick and needed help.

“Frustration and anger has given way to disillusionment and disbelief that such a thing could happen in this great province of ours. Thomas Paine, in ‘First Principles of Government’ wrote, ‘He that would make his own liberty secure must guard even his enemy from oppression.’

“I ask in all sincerity, without rancour and with great respect for you, how can you reconcile your Hippocratic oath with decisions that you are now making as a politician?

“I am the administrator of Clinton hospital, writing you as a citizen of Clinton not as a hospital employee. I am convinced that this decision is wrong and plead with you to reconsider. Come to Clinton and see for yourself.

“As someone who has spent over 30 years of my life working in the health field as a general duty nurse, or supervisor in hospitals of up to 400 beds, director of nursing and now as administrator, I can say, in all honesty, that this hospital is second to none. To close it as an active treatment facility would be a tragedy. It took courage to do what Frank Miller had to do. Courage is also that virtue which champions the cause of right. We all know that you have this virtue. Please do what you know is right.

“I realize the ground which I have just gone over is ploughed ground but I firmly believe that this ground must be harrowed in order to give the seed an opportunity to germinate.

“I hope that I, along with the people in the riding which I represent, have implanted the seed in the mind of the minister and I do hope that the minister will give that seed a chance to germinate and will give our small communities a chance to continue to function.”

Hon. F. S. Miller: That was a very eloquent speech and there is nothing I need to say back to it, of course. I can only tell you I had some nine weeks during which the germination process took place.

Mr. Bullbrook: Very good.

Mr. Bain: The questions I would like to raise today with the minister cover two areas. I listened with interest to the comments made by the member for St. Andrew-St. Patrick and the difficulties he has experienced with the government’s decision to close the Doctors Hospital. There was some question about the government listening to properly constituted hospital boards and he felt that once you had listened to these boards in a rational, attentive manner you would come to the right decision and that all that remains for you to do is explain to the good citizens of his riding why you made that decision; once this was explained fully they would be in accord with that decision.

I’d like to remind the member for St. Andrew-St. Patrick that well over two years ago there was a decision made by the Timiskaming hospital board as to the location that would be chosen for a new hospital. Surprisingly enough, the minister disagreed with the decision made by that hospital board; whether that decision was the right one or not, it was made by duly constituted hospital board. When the minister disagreed with it he appointed six -- I believe it was --

Hon. F. S. Miller: Four.

[1:45]

Mr. Bain: Four? He appointed four new members to that board, members for whom it could be said that one of the most distinguished contributions they had made to their respective communities was their allegiance to a particular political party. Even for these four people who were appointed, there was a considerable amount of strain and stress for although, as I said, they seemed to have been chosen for their political allegiance and dependability, they nevertheless were good people who I feel were conscientious and wanted to discharge their new duties, but they found it difficult to do this because they didn’t know quite what was expected of them.

Consequently, with the four new appointees and the amazement on the part of several communities that were represented under this board, there were a number of communities that refused to elect members to the board because of the minister’s stacking of it, and I believe even today there are some communities that still are not represented. For a considerable length of time it was uncertain exactly what this reconstituted hospital board was to do, other than to rubber-stamp the decisions as made by the minister.

The point at stake, I feel, is that when you have a locally constituted board, whether they decide on a course of action that’s in total agreement with the minister or not, they should be given the right to make that decision. Surely to goodness we see in this House time and time again that the government makes irrational decisions. Closing of rural hospitals is one example that sucks in all our minds, but the government makes that kind of a decision. The government seems to have an idea that the government is invested with certain decision making power.

Does the government also maintain that it is the only body in this province which should make decisions? If you have a locally constituted hospital board, let that hospital board make decisions that are within its jurisdiction and let the local people, through a little give and take, come to a decision on their own part. By interfering with local decisions, it would seem that the only level of government that’s allowed to make any decisions in the area of health care is the minister and the government.

If that’s true, then why don’t you just disband all the hospital boards and run everything from Toronto? At least be honest with people. If there are to be locally constituted hospital boards, let them know exactly what it is they are supposed to decide, let them know what their area of jurisdiction is.

I personally believe that hospital boards should be constituted on the same basis as municipal council and school boards, elected locally by the people to serve and make decisions in certain areas. I know in our area the hospital board is somewhat unique in that all the municipalities represented under the area of the board have as members all the people within each of those municipalities. This is a step that apparently hasn’t been undertaken in many other areas. I think it’s a step in the right direction, a step toward a democratization of hospital boards.

Without going over a lot of the ground that has already been covered by the minister in the past, I would simply like to ask him two questions. I have outlined for him some of the problems that I think have been inherent in the decisions that have gone on on the part of the ministry in regard to the locating of a new hospital in the Tritown area. I am afraid we will all have to live with those mistakes. Some of the local feelings will be very difficult to overcome in the years ahead but I feel that you can do this if you will make two commitments:

1. I think you should make a definite indication to the people in the area that the exact jurisdiction of a hospital board is, what rights it has and what duties it can be expected to discharge.

2. What is to be done with the Haileybury unit of the Timiskaming hospital and the New Liskeard unit of the Timiskaming hospital when the new hospital is built? We have a situation in Haileybury where there is a good facility, the old Haileybury hospital. Is it to remain vacant? Is nothing to be done with it? Or will it be used as a facility in the overall field of health care?

If you can make a progress report for us on the exact status of the new hospital that is to be built on Radley’s Hill, as well as to what is going to be done with the old hospital in Haileybury, I am sure all the people in the area would be interested to hear your reply.

The second major matter I would like to raise with the minister today concerns the old Kirkland and District Hospital. No doubt the minister is aware that upon the local community being concerned about this building remaining vacant, a petition was presented to him in this House; pursuant to that, a study was undertaken by the institutional planning branch of his ministry as to the overall health care needs of the Kirkland Lake area, specifically as to whether a chronic and semi-chronic care facility should he made out of the old Kirkland and District Hospital. Before this study was presented to the local community -- indeed, I would ask whether the study has been completed -- the community received a letter from the Ministry of Government Services advising them that the hospital was for sale for $1,185,000, and if they wanted to buy it they should send in their cheque. This was before your ministry had advised the local community that your study was completed. Has the study been completed? If it has, what are its recommendations? If it hasn’t, could you kindly advise the Minister of Government Services (Mrs. Scrivener) not to sell the old hospital at least until your ministry and the Ministry of Community and Social Services has come to a decision as to the overall need in the community for chronic and semi-chronic care facilities?

I feel that the minister and the ministry in this particular area are not really aware of the need in a northern Ontario community. In a city there are many auxiliary kinds of health care services, and people fit nicely into nursing care, meals on wheels and all the other programmes that the ministry has undertaken, but in a northern Ontario community there are very few of these programmes in place. You might tell people in a northern community they shouldn’t be in a chronic or semi-chronic care facility, but there is no alternative for them. The nursing home is full; in fact, almost a majority of the people in Teck Pioneer Residence require chronic care, and that isn’t the kind of facility it was designed to be. There is a tremendous need for chronic care and semi-chronic care facilities.

You might even get into some sort of arrangement with the Minister of Community and Social Services (Mr. Taylor) whereby a little bit of innovation would be undertaken. There are many people, especially elderly miners, who for various reasons have no family and live by themselves in rather deplorable conditions. There are no facilities for them to move into. Maybe they are not classed as requiring chronic care or semi-chronic care, but there is a tremendous need there.

One example that was brought to my attention by Dr. Rumball -- and it is not an isolated example by any means -- involved an elderly minor, living in a boarding house, who was becoming bed-ridden and couldn’t get up very easily. The owner of the boarding house would move him every day to a place by the window, and he would sit there for the day until he was moved back to his bed. By the time they took that man to the doctor, his leg was so inflamed that they had to amputate; that man is still in hospital and when he is discharged, he will have been reduced to a level where by now he certainly does need chronic care help. But if he had been helped earlier this situation would not have arisen.

The kinds of people who could also be included in an overall health care complex, may not need the traditional definition of chronic care but they do need some regular attention from a nurse in an institutional setting. The utilization of the old Kirkland and District Hospital as a chronic, semi-chronic and kind of open-ended area where elderly miners and other people could live out the rest of their lives with dignity and self-respect is something that I think your ministry should undertake.

Mr. Hall: Mr. Chairman, I just want to make a brief comment to the minister. This is in connection with a relatively recent organizational change in the field of health in the establishment of district health councils.

Mr. Bain: Mr. Chairman, on a point of order, could I inquire if the minister will be answering after the member asks his question? Will he answer me?

Hon. F. S. Miller: I can answer very quickly right now and get it over with if you want me to. I think the member exhibits a simplistic view when he says that there isn’t a local input and that we ignore all the advice we get from boards. The fact is, boards are subject to the Public Hospitals Act and the authorities are pretty clearly spelled out. It requires the minister’s approval. I am, as I keep on pointing out, the person elected -- so are you -- to represent your constituents here to discuss health costs.

Rightly or wrongly, both accommodation and advice from the former resident member, and advice from my staff, indicated that the wrong location had been chosen in the Haileybury-New Liskeard area for a hospital. You know I visited that board at least three times and discussed the problem with them. You know it was a totally geographic vote of seven to six every time on the choice of a location. If there had even been one person from each town willing to see your point of view I could have believed that there was something other than a geographic vote on that choice of location. There was not

Mr. Bain: Maybe these people were Conservatives.

Hon. F. S. Miller: Yes, and I put them in there too. They were not chosen because they were Conservatives. I wouldn’t have the foggiest idea what they were or who they were. The fact is that we determined after real consideration to reject, for a change, the advice of a local board that seemed to have made a biased choice. We had a number of visits. I quite properly delayed affirming my decision until I went to the area and saw the site. That visit made me think I was all the more correct.

On the Haileybury hospital, I think the decision has been made that it will not be a chronic facility. In the case of Kirkland Lake, we still haven’t got the results from its latest study. I think you’re aware that in Kirkland Lake the study was carried out on behalf of the community and I am led to believe that that study said that there is no need for a separate chronic facility in Kirkland Lake; that the new hospital is adequate for the provision of chronic facilities, and that the best means of achieving chronic care, if extra beds are needed, would be through an addition at the present site. Okay?

Mr. Bain: On a point of clarification: What purpose does the study that is presently being undertaken by the institutional planning branch serve if you’ve already made the decision at Kirkland Lake?

Hon. F. S. Miller: I’m telling you what the previous study said, I am told. It wasn’t done by this ministry.

Hon. Mr. Welch moved the committee rise and report.

Mr. Deputy Chairman: Before I put the motion, the Chair will attempt to recognize the hon. member for Lincoln when we resume our debate on the estimates, as he was interrupted.

Motion agreed to.

The House resumed, Mr. Speaker in the chair.

Mr. Deputy Chairman: Mr. Speaker, the committee of supply begs to report it has come to certain resolutions and asks for leave to sit again.

Report agreed to.

Mr. Speaker: Statements by the ministry.

MERCURY POISONING IN IRAQ AND JAPAN

Hon. F. S. Miller: Mr. Speaker, while I haven’t a prepared statement, I wanted to say that after the question period today, I will be tabling copies of the mercury reports. They are still in rough draft form. I have to point that out to the hon. members. There may be editing errors; there may be minor corrections to be made because we rushed this typing. We’ve already found some minor errors, but at least the bulk of the report and the recommendations will be before this House. I would be prepared, during the continuation of my estimates debate this afternoon, to have answers to, or try to answer questions arising from it.

[2:00]

COW-CALF PROGRAMME

Hon. W. Newman: Mr. Speaker, I am pleased to inform the members that the province’s beef-calf income stabilization programme is open for 1976 registration. Producers who are participating this year for the first time will be able to get contracts and enrolment forms from their local agricultural representatives after July 12. Producers who participated last year will receive their enrolment forms through the mail in the next few days. All contracts will expire in June, 1980. Enrolment closes this year on Aug. 16 and only cows in the producer’s possession as of today, June 22, may be registered.

The support price is calculated on the basis of 100 per cent of the producer’s operating costs. This calculation gives a support price of 51.1 cents for 1976, but we are not raising the support price above 50 cents, because we would then be obliged to raise the premium per cow to nearly $9. For every cent we raise the support price, we would have to raise the premium another $4.

The premium for 1976 remains unchanged from 1975 at $5 per cow. Since the cow-calf business is still in some difficulty, the government did not feel that a premium increase was warranted at this time.

Premiums must be paid upon enrolment or the farmer may ask that the premium be deducted from his support payment cheque.

Again this year, all beef-calf producers resident in the province are eligible, regardless of the size of their operations. Cream shippers are also eligible.

Although the price being supported by this programme is that for calves, the payments are made on a per-cow basis. Payments are made for each cow registered in the programme, and monitoring will be carried out to ensure that applicants are bona fide beef-calf operators or cream shippers.

The payment is based on four factors: the support price for calves, which is 50 cents a pound this year; the weighted average market price for calves, which will be calculated from fall sales; the average number of calves from 100 cows, which when calculated for the whole province is 85; and the average weight of the calves in the fall, which is 450 lb each.

I might point out that the farmer is not obliged to sell his calves. He may keep them and sell them later, or not at all, while still qualifying under the beef-calf programme.

I wish to stress that the programme is based on averages. All producers receive the same payment per cow regardless of the individual selling prices of their calves or their individual costs of production. We do it this way partly to simplify the programme for all concerned, but more importantly because we feel that this method interferes least with a farmer’s decision in the management of his farm, while at the same time guaranteeing him a reasonable return for his investment and effort.

Members will recall that this programme was introduced last July to stabilize the incomes of beef-calf producers and to encourage a continuing supply of Ontario-produced beef. It is a voluntary programme; producers who do not wish to participate are under no obligation to do so.

The programme was well received by producers last year, with 12,000 farmers registering more than 300,000 cows. With a weighted average market price of 29.8 cents a pound, farmers received a net payment of $72 per enrolled cow, for a total of $22.5 million.

CLOSURE OF ARENAS

Hon. B. Stephenson: Mr. Speaker, during question period yesterday, I undertook to make a statement concerning arenas in the Province of Ontario.

I wish to assure all members that the government, and particularly the Ministry of Labour, is well aware of the concerns expressed by many members of the House and by some constituents about our recent actions under the Industrial Safety Act pertaining to arena safety. As members must know, our concerns about safety are not theoretical; two collapses in 1959 -- the arena in Listowel and a curling rink near Ottawa -- caused the deaths of 11 people, seven of them young children.

It may be useful to review the province’s involvement in this area. I realize that local municipalities have had, and continue to have, substantial responsibility for building safety. However, for some years, the province has had a share of that responsibility.

In 1971, with the passage of the Industrial Safety Act, the province acquired additional responsibility, not only for the safety of employees working within buildings but, particularly in the case of arenas, for the safety of the public who use the buildings. Since 1971, officials of my ministry have expressed their repeated and continuing concerns to local municipalities about the safety of their arenas, urging them to obtain professional engineering assistance in making inspections and recommendations.

Despite these efforts to obtain compliance, the responses were anything but complete, nor were they very reassuring. Accordingly, last December, in accordance with the Provincial-Municipal Liaison Committee’s recommendation, I authorized my officials to direct professional engineering appraisals to be made of some 350 arenas. Roughly 200 arenas have been inspected since that date. Reports are still being received and, as I’ve already reported to this House, in those where reports are in and hazards have been shown to exist remedial directions have been issued. It is hoped that the inspections will have been completed and all appropriate directions issued by the end of this month or early in July.

I am well aware, Mr. Speaker, of the potential effect upon local community life in these cases where arenas have been ordered demolished or closed pending repairs. In some cases, the only solution seems to be to remove the roof structure and, perhaps, use the arena as an open air facility until the new roof can be constructed. I am advised that this is already being considered by several municipalities.

Mr. Lewis: Except in northern Ontario.

Hon. B. Stephenson: Other arenas have been found to be substandard but still in such a condition that they may be safely used as they are, or with relatively inexpensive repairs. In many cases, repairs can be carried out during the summer months, allowing the arenas to be reopened in the fall.

I wish to emphasize the nature of my ministry’s responsibility in this area under the Industrial Safety Act. First, where an arena is suspect, the minister may require the owner to have it appraised by a professional engineer. Where, as a result of the engineer’s report, it appears that the structure is not in compliance with the Act, and that it constitutes a danger or hazard to an employee or a user, the ministry is obliged to issue directions requiring the owner to remove the hazard. However, it should be understood that the ultimate responsibility for remedial action rests with the owner.

It may be useful to note, Mr. Speaker, that the Association of Professional Engineers of Ontario, in the report of a committee on arena structures in 1971, set out the following guidelines for their members engaged in the investigation of arena structures; and I quote from the report.

“It is recognized that many existing arenas do not conform to the current standards of the National Building Code. Some of the arenas were properly designed and constructed to the appropriate standards at the time of construction, but these standards have since become obsolete. Other arenas were inadequately designed or improperly constructed and did not meet the standards appropriate to the time of construction. Still others have deteriorated with use and with the passage of time.

“The criterion of acceptability will be, desirably, conformance of the arena structure with the standards of the current issue of the National Building Code. When, however, a professional engineer in his own lodgement accepts a condition somewhat lower than National Building Code standards, but without restrictions or limitations as to use, he should specify future inspection procedures or routines, and the required frequency of such inspections.”

Thus, the professional engineers association’s report recognizes that there may be instances where an arena can be operated, even though it may be substandard in the strictest sense, if, and only if, appropriate inspection procedures or routines are specified by the inspecting engineer.

Now that I am more fully aware of the magnitude of the problem -- and I must frankly confess that none of us realized last December how many of our arenas would be found to be substandard -- I would urge municipal officials and consulting engineers to consult with the professional engineers in my ministry to attempt to arrive at acceptable solutions -- solutions which will ensure that safety of those who use the arenas while interfering as little as possible with the important role which they play in community life.

Mr. Breithaupt: There goes Wintario.

Hon. B. Stephenson: In making this suggestion, I wish to make it clear that I have no disagreement whatever with the inspection procedures which have been carried out, nor with the directions which have been issued by my officials. However, it may be that some interim accommodations are possible without in any way endangering public safety.

Let me give an example: It may be found that under certain conditions of snow and wind load, an arena roof structure will be stressed somewhat beyond standard limits. Nonetheless, through a combination of regular monitoring by the consulting engineer and continuous control and surveillance by the authorities in charge of the arena, the building may still be used without risk of collapse and, therefore without risk of danger to the users. In such a case, the owner, in order to be permitted to continue to operate the arena would be required to have an acceptable design prepared and to have commenced work to permanently rectify the hazard, and to be subject to monitoring inspection procedures and routines as prescribed by a professional engineer.

I am sure that all members of this House will agree that we cannot afford to ignore contraventions of the Act and to run the risk of tragic accidents. At the same time, the inhabitants of particular communities should not be denied a place to skate, to curl or to play hockey next winter if alternative and safe arrangements can be made. I must emphasise that our paramount concern, both morally and legally, under the Industrial Safety Act, must be the safety of the users of the arenas.

Accordingly, I cannot bargain, nor can I barter, on a matter of safety. The proposal which I have suggested for permitting some arenas to remain open, subject to close monitoring and the institution of an acceptable renovation programme, meets the two concerns which I have mentioned. To that end, I have instructed my officials to work very closely with the affected municipalities and their consulting engineers to find solutions acceptable to this government and appropriate to the particular problems of the local municipalities.

ASSISTANCE FOR ARENA REPAIRS

Hon. Mr. Welch: Mr. Speaker, as my colleague, the Minister of Labour, has just indicated, the government is ready to help the municipalities repair their arenas right away so that they can be safely used.

Fortunately, the Ministry of Culture and Recreation has both the Community Recreation Centres Act and our Share Wintario programme in place so that we are able immediately to offer assistance amounting to at least half the cost of these necessary repairs in most areas.

Although most municipal councils are familiar with these two programmes -- indeed most arenas and community centres in the province were originally built with provincial assistance -- we will be reminding them this week of the resources available from us and the special arrangements we have made to expedite applications for assistance.

As members know, under the amendments which this House made to the Community Recreation Centres Act a year ago, we are able to provide an outright grant covering 25 per cent of the cost of such repairs up to a maximum of $75,000 for each facility affected. Under the Wintario programme, we can provide grants on a matching basis, to cover one-third of the balance in communities in central and western Ontario and one-half of the balance in eastern and northern Ontario.

We recognize, of course, that many of these arenas are the cornerstone of local recreation programmes and we are anxious to have them put back into use as quickly as possible. We have already assigned professional staff in our capital support unit to deal specifically with applications and requests for assistance from communities affected by these orders and I can assure them that there will be no delays at our end.

Mr. Speaker: Oral questions.

CLOSURE OF ARENAS

Mr. Lewis: May I begin with a question of the Minister of Labour. In the process of inspecting these various facilities, finding them under standard and requiring alterations or closure, has the minister made any overall estimate as to the cost factors involved; what we are talking about in terms of dollars?

Hon. B. Stephenson: Mr. Speaker, the inspection process is not completed as yet, and as a matter of fact it is probably a little more than half way completed. It would be, I think, inappropriate to make an estimate of the overall cost at this point.

I think we could probably say that if every single arena which is substandard were to be replaced totally it could cost us somewhere in the region of $60 million. I think that is probably not the case and it will be substantially less than that amount of money. I would think that by early July we will have a fairly accurate prediction of the overall cost.

Mr. Gaunt: Has the minister given any thought to removing the legal liability from the engineer when the engineer makes an inspection of the arena?

Hon. B. Stephenson: Mr. Speaker, he doesn’t have a legal liability when he makes the inspection of the arena. He has a responsibility to make a report, and it is upon that report that the decision is made within the Ministry of Labour.

Mr. Gaunt: With respect, that doesn’t cover the problem. When the engineer signs his name to that report is he not legally liable? The answer to that is yes. What is the minister doing to resolve that problem -- because that is really the crunch problem in this whole matter?

[2:15]

Hon. B. Stephenson: Might I ask the question legally liable for what? He is making a report and that’s it.

Mr. Gaunt: Supplementary: would the minister not agree that the only recourse the engineer has in making the report is to make the report against the requirements of the National Building Code? That’s what they do under the circumstances. I don’t blame them.

Hon. Mr. Handleman: What else could they do?

Hon. B. Stephenson: Mr. Speaker, it seems to me we are asking the professional engineer to use his expertise and his professional capability to make a judgement about a structure --

Mrs. Campbell: No.

Hon. B. Stephenson: -- as related to the standards established by the National Building Code and the standards for that specific arena in terms of the roof structure as far as arenas are concerned. He doesn’t have any legal liability.

Mr. Lewis: I have another question of the Minister of Labour, if I may.

Mr. Yakabuski: Mr. Speaker, I would like to interrupt that question.

Mr. Lewis: I’m sorry, I seem to be having difficulties.

Mr. Speaker: The member for Renfrew South has a supplementary.

Mr. Yakabuski: I have a supplementary question of the Minister of Labour. In view of the statement the minister made in the House yesterday that the Association of Professional Engineers of Ontario had done the work insofar as the local levels were concerned, we have a stinking suspicion --

Interjections.

Mr. Speaker: Question?

Mr. Yakabuski: -- that there is a plot with the professional engineers to do what they did in the years gone by insofar as the --

Mr. Speaker: Can we have a question, please, based on the original question?

Interjections.

Mr. Lewis: I have a sneaking suspicion that the member is in trouble in Renfrew South.

Mr. Yakabuski: No way.

Interjections.

Mr. Speaker: Will the hon. member ask his question, please?

Mr. Yakabuski: The little people will decide that on election day. The little people, not the people in the --

Mr. Warner: Let’s hear the question.

Mr. Cassidy: He has the elves all locked up.

Mr. Breithaupt: Those are ones only two feet high.

Mr. Speaker: Will the hon. member ask his question? Order, please.

Mr. Yakabuski: Mr. Speaker, my question of the Minister of Labour is this: We just have to be assured that there is no plot whatsoever within the association of engineers that they want to extract extra business from the government of the Province of Ontario.

Mr. Deans: That’s a statement; that is not a question.

Mr. Nixon: Can the minister assure us there is no plot?

Mr. Speaker: Order, please. Will the hon. member ask his question?

Mr. Yakabuski: I have.

Mr. Speaker: All right.

Hon. B. Stephenson: From my very long relationship with a number of professional bodies, the oldest as well as some of the newer ones --

Mr. Breithaupt: The anti-professional member for Renfrew South.

Hon. B. Stephenson: -- I am convinced there is very seldom, and certainly in this instance no evidence whatever of any kind of a plot to undermine or to accost either the government or the people of the Province of Ontario.

Mr. Cunningham: On a point of order.

Mr. Speaker: No, we’ve spent enough time on this question. Order, please. Does the Leader of the Opposition have a further question?

Mr. Cunningham: On a point of order.

Mr. Speaker: Oh, a point of order. I’m sorry, I couldn’t hear for the noise.

Mr. Cunningham: I was just wondering if there’s a chance we can get two or three minutes back on question period to cover this inanity?

Mr. Speaker: That’s rather a smart remark. The hon. Leader of the Opposition.

CLAIMS FOR LUNG CANCER

Mr. Lewis: I have a question of the Minister of Labour. How does the minister reconcile the very serious conflict between what the chairman of the Workmen’s Compensation Board has put in writing to a number of people around the province, including my colleague from Sudbury East (Mr. Martel), in the latter part of 1975, saying that the working level months standards at Elliot Lake were not delineated for the determination of claims for lung cancer, and then finding claim after claim emerging from the board with the statement: “To receive entitlement under the Ontario Workmen’s Compensation Act for lung cancer it must be established that the exposure is in excess of 120 working level months”? That is in direct contradiction to the guarantee given by the chairman.

Hon. B. Stephenson: Mr. Speaker, I have not seen the information contained in any of the three claims mentioned. It’s not claim after claim after claim but there are three specifically at the moment.

Mr. Lewis: There are several of them.

Hon. B. Stephenson: When I have examined those documents I will be very pleased to discuss this with the chairman of the Workmen’s Compensation Board. I have no idea why there should be such an apparent contradiction. Whether there is a real contradiction or not I do not know at the moment but I shall explore this and discover it.

Mr. Lewis: When the minister examines the three claims and the others which are presently in contention before the board, will she endeavour to explain why the Workmen’s Compensation Board is accepting a number of working level months solely on the basis of company information and refusing, incredibly enough, to recognize that the company figures never take into account the enormous amount of overtime worked in the late 1950s and early 1960s which put most of those men at risk 10 years ago, well before they contracted the disease? Can she explain what now appears to be a very serious injustice visited on the families of the deceased workers?

Hon. B. Stephenson: Mr. Speaker, in the newspaper report, I gather, it was stated that it was not possible to establish the overtime claims of certain gentlemen who had been working within those mining situations. It would seem to me entirely possible that somewhere in the financial records or the payment records of the company there must be some information which would be relevant to this specific subject. I have asked very definitely this morning to see if we can’t find that kind of source of information in order to --

Mr. Breithaupt: Tax records are also a possibility.

Hon. B. Stephenson: Tax records are also a possibility. I have no idea whether there is a statute of limitations regarding the time these must be retained but I would think it would be very well to verify the claims of the workmen that they had been working long hours of overtime in those years. If that can be verified, of course this must be taken into consideration in establishing their working level months.

Mr. Yakabuski: How long is it going to take you to learn? Never ask the minister a question.

Mr. Lewis: I have one other question. When the board chairman says to my colleague, Mr. Martel, on Sept. 5, 1975. “May I reassure you that the board’s policy of giving the worker the benefit of reasonable doubt will apply equally to such cases,” doesn’t the minister think that when men have died of lung cancer after many years in the mines of Elliot Lake the benefit of reasonable doubt should provide for compensation to the families?

Interjections.

Hon. B. Stephenson: Mr. Speaker, I think even the hon. Leader of the Opposition would be hard-pressed to find very many instances in which the board, under the hon. Michael Starr, has not given the workmen the benefit of the doubt.

Mr. Lewis: It is not true.

Interjections.

Hon. B. Stephenson: He has worked very diligently in order to ensure that any benefit of the doubt accrues to the workman. I think it is certainly not his usual characteristic fashion --

Mr. Philip: You are not doing any constituency work.

Hon. B. Stephenson: -- to deny the benefit of any doubt to the workman. I think it’s a matter of finding the actual and factual information regarding these instances --

Mr. Martel: We have been after that for years.

Hon. B. Stephenson: -- in order to ensure that the board has a rational and logical basis upon which to establish the claim.

ELLIOT LAKE RETRAINING PROGRAMME

Mr. Lewis: I have another question on a related matter. Is the minister not concerned about and has she asked for information on the apparent virtual collapse of the retraining and relocation programme at Elliot Lake, which many of the workers appear reluctant to engage in because of the very large wage differential? Might that wage differential be overcome by government initiative?

Hon. B. Stephenson: Mr. Speaker, I am very glad the hon. Leader of the Opposition has asked that question. I would refer him to the Letters to the Editor -- I would hope in tomorrow’s or Thursday’s Globe and Mail -- in which I think the initial paragraph from the board representative will begin: “I am appalled at the story in your June 21 edition. Your story was laden with false or outdated statistics, innuendo and misquotations.”

Mr. Breithaupt: They are not bound to print it.

Hon. B. Stephenson: I hope they will. The situation regarding the current retraining programme at Elliot Lake is as follows: Thirty-nine of the miners have chosen to remain in exposure; 14 are employed and receiving wage differentials; four are undergoing training at Sault College; 12 are undergoing training on the job; three have other employment with the original employer at no wage loss; one has been relocated in the Province of Quebec at the board’s expense; and two have changed their minds and returned to underground work.

There are a number of miners who have not made the decision as yet about whether they will undergo the retraining programme, but the report as printed in the Globe and Mail was certainly not factual in terms of the information that is available to us.

Mr. Martel: You are talking 50 per cent.

Mr. Lewis: With respect, knowing that I’ll read the minister’s attack on the Globe article in a day or two, if 180 miners qualified, 39 have chosen to remain underground or in exposure, a small number are being retrained elsewhere and all the others have not yet decided to take part in the programme because of the wage differential, how can she call it a success? How does that invalidate these figures?

Hon. B. Stephenson: That isn’t what I said. I didn’t say all the rest; I said some have not as yet made the decision.

Mr. Lewis: The difference up to 180.

Hon. B. Stephenson: Twenty-five are not interested at all in refraining or moving at the moment; 39, not 56, are still working in exposed conditions and they are being withdrawn as rapidly as possible. The implementation of the programme has gone very well. It is supported wholeheartedly by the United Steelworkers union locals at both mines; both of those gentlemen categorically deny making the statements which are attributed to them in the Globe and Mail and they further state that the board’s programme has their full support.

Mr. Martel: Supplementary: Is it not a fact that if every underground worker who has received overexposure over the years were to come out, there wouldn’t be enough employees left to operate the mines at Denison?

Hon. B. Stephenson: No, I cannot say that is a fact, because I have not seen that information.

Mr. Martel: The minister should check her figures again for a change.

FREEDOM OF INFORMATION LEGISLATION

Mr. Lewis: A question of the Premier: Given the support in this Legislature for the freedom of information bill put by my colleague from York South (Mr. MacDonald) for two years running now, can the Premier indicate whether it is his intention to introduce legislation to that end?

Hon. Mr. Davis: Mr. Speaker, I can’t say to the Leader of the Opposition it is our intention to introduce legislation. At a very important gathering of one of the significant political parties in this province a few weeks ago this whole question was discussed at some length --

Mr. Angus: The NDP convention.

Hon. Mr. Davis: I was being very charitable today and I was saying one of the significant political parties.

This matter, of course, is being considered by the government. There were certain recommendations, some of which I believe have been implemented as a result of the COGP. I cannot undertake to the Leader of the Opposition that there will necessarily be a bill, but this matter is being assessed by the government at this time.

HOSPITAL CLOSINGS APPEAL

Mr. Nixon: Mr. Speaker, I’d like to put a question to the Premier. In the event that the government loses its appeal to the Supreme Court of Ontario having to do with the government’s powers to close hospitals, can the Premier assure the House that he will not take the appeal further but accept that judgement and govern the policy of his administration accordingly?

Hon. Mr. Davis: Mr. Speaker, on this occasion I cannot undertake that the appeal will not be taken further. I think it would depend on the decision and the reasons for the decision; it may be that there will be certain matters of principle on which, in the interests of the Legislature, it might be wise to get final decisions. I can’t give that sort of undertaking until we see what the decision may be.

What the minister or the acting minister said, and I reiterated it on two or three occasions, was that if the decision of the court is delayed, and this creates a problem in terms of the functioning of the five institutions, I believe it is, as far as the timetable was concerned this would be taken into account and there certainly would be sufficient consultation and lead-time as a result of any decision that may be made.

I really can’t say to the hon. member, or prejudge what might be said in a particular decision, as to what our course of action might be afterwards. I would have to await (a) the decision and (b) the reasons that are in it.

[2:30]

Mr. Nixon: Supplementary: Would the Premier assure us that the negotiations between the Ministry of Health and the hospitals concerned are not simply going to be left on the shelf until the final disposition in a court case which may be decided by the Ontario Supreme Court or, as the Premier indicates, it may not be, and may be appealed to the Supreme Court of Canada, in which case the whole thing is going to be dislocating to the communities concerned?

Hon. Mr. Davis: Mr. Speaker, I certainly am quite prepared to say to the hon. member that the government, the ministry in particular, will maintain its communication with those hospitals that are potentially affected by this litigation, and in as constructive a way as possible. It was our intent to do this, and it will continue to be that way.

Mr. Bullbrook: With a supplementary, Mr. Speaker, may I ask the Premier, through you, living as we do in a parliamentary democracy, why does this government think it’s more important that there be judicial review than legislative approval?

Hon. Mr. Davis: Mr. Speaker, with great respect to the hon. member for Sarnia, I really don’t think I said that.

Mr. Bullbrook: By way of one final supplementary, may I put the question to the Premier directly? On this matter of extreme importance with respect to policy and practicality, does the Premier think it’s more important that his government has judicial review, or some debate and legislative approval in this chamber?

Hon. Mr. Davis: Mr. Speaker, I think it’s important that perhaps we have both.

Mr. Lewis: By way of supplementary, does the Premier share the view the Minister of Health conveyed to us in estimates, I guess this morning, that were the government to lose at the Court of Appeal level, the more appropriate mechanism at that point would be to bring legislation before the House, which the minister said would be his personal preference.

Hon. Mr. Davis: Mr. Speaker, without commenting on my colleague’s particular point of view, I guess I do go back to some limited training I had in a particular profession and make the observation I did to the hon. member previously that I think a lot would depend on what were the reasons for judgement contained therein before I would make any judgement.

Mr. Yakabuski: Mr. Speaker.

Mr. Speaker: Supplementary; the member for Renfrew South.

Mr. Lewis: Do you think it is a plot?

Mr. Yakabuski: Supplementary to the Premier.

An hon. member: Thirty seconds by the clock.

Mr. Yakabuski: In view of the fact, Mr. Speaker, that this morning I was talking to someone who recently visited Czechoslovakia --

Mr. Cassidy: Be careful. Watch out for the Polish vote.

Mr. Yakabuski: -- I was wondering, do we want to bring this province back one generation like they have done in that jurisdiction?

Interjections.

Mr. Nixon: That is a supplementary?

Mr. Peterson: Answer the question, it is a good question.

Mr. Speaker: Order; order please.

Hon. Mr. Davis: Mr. Speaker, I find that because of some of the noise here, and my colleague being without question one of the more articulate members of this Legislature, I wonder if I could ask him to repeat the question so I can totally understand it.

Mr. Speaker: In the form of a question, please.

Mr. Yakabuski: Well, Mr. Speaker --

Mr. Lewis: This is what you call a blue smear!

Mr. Yakabuski: Mr. Speaker, I would be pleased to repeat the question, because this morning I was talking to someone --

Mr. R. S. Smith: What time was that this morning; about 5?

Mr. Nixon: Was it before lunch?

Mr. Yakabuski: -- who recently visited Czechoslovakia and some of the central European countries, and we were talking about conditions in the western world and there --

Mr. Lewis: About socialism?

Mr. Yakabuski: -- and in Britain, too, by the way.

Interjections.

Mr. Speaker: Order, please.

Mr. Yakabuski: I said, “Where do we stand?” And he said, “Do we want to slip back to a generation behind?”

Mr. Conway: Only in Renfrew South.

Mr. Yakabuski: And I ask the Premier today: Does this province want to slip back to where Britain, Czechoslovakia and the other countries are today?

An hon. member: No way.

Mr. Singer: Answer that.

Mr. Peterson: Most intelligent question you have produced.

Hon. Mr. Davis: Mr. Speaker, that was a very provocative sort of question. But I say this to my very distinguished colleague that I am delighted to have information about other jurisdictions in the world, which I sometimes use in this House myself. I’m interested in one thing only, and that is the maintenance of the very excellent quality of life we have in this province, which, given the support of all members of this House toward this excellent government, I’m sure we can maintain for many years to come.

ALCOHOL CONSUMPTION

Mr. Nixon: I’d like to put a question to the hon. Minister of Consumer and Commercial Relations --

Interjections.

Mr. Speaker: Order, please.

Mr. Nixon: -- on a very germane subject.

Mr. Lewis: I have a supplementary, but I’m not going to ask it.

Mr. Nixon: Is he concerned and is he prepared to formulate some statement of government policy in response to the papers and factual material presented by the delegates to the convention on alcohol and drug addiction convened by our own provincial foundation, particularly the statement made by Dr. Wolf Schmidt -- Dr. Wolfgang Schmidt -- that the consumption of alcohol in this province might very well double by 1985?

In other words, what is he doing about, let us say, the age problem as far as alcoholic consumption is concerned and, more particularly, a ban on alcohol advertising in cooperation with the government of Canada and the other provinces?

Mr. Peterson: Start with your own benches.

Hon. Mr. Handleman: Mr. Speaker, I don’t know how germane the question was in view of the fact the hon. member gave some free advertising to a brand of vodka -- a slip of the tongue, of course; I quite recognize that was a slip of the tongue.

The government is reviewing the matter and as the hon. member knows there was a report presented to us dealing particularly with underage and youthful drinking. The Provincial Secretary for Social Development (Mrs. Birch) is co-ordinating the total government thrust in this area -- and I am quite sure we will be able to come up with policies which will be announced at the appropriate time.

Mr. Nixon: Have I asked the wrong minister? As a supplementary, I would ask the minister why he is not giving some further consideration to removing some of the problems his own Liquor Licence Board is experiencing, particularly in awarding special occasion permits which, in the view of many objective observers --

Mr. Yakabuski: Careful; you may want one some Saturday and you are not going to get it.

Mr. Nixon: -- leading to an increase in consumption rather than any control of consumption. Would he give that some consideration, particularly in those areas which have not accepted the right under local option legislation to have legal outlets? Will he accept the recommendation that they be permitted a vote in view of the fact that the regulations under the Liquor Licence Board have been changed rather dramatically in their enforcement in recent months?

Hon. Mr. Handleman: Mr. Speaker, I don’t know how germane that is to the convention which is taking place at the present time. If anything, I think the question would be counterproductive to the aims of that convention.

Mrs. Campbell: The word “germane” --

Hon. Mr. Handleman: On the other hand, there has been no recommendation made to me, other than that made by the hon. member --

Mr. Nixon: Where could you get a better one than that?

Hon. Mr. Handleman: -- to change the local option legislation and regulations. However, as he is well aware, we have them under review. It does require a change in the legislation and I would suggest that at 2:40 on, perhaps, the last day of this part of the session, it would be a little late to bring that in.

Mr. Nixon: A supplementary: Is the minister aware that the confusion associated with these regulations is, if anything, removing what residual controls there are in the communities in this particular area? It is germane and it is important. Is the minister not aware of the need for the changes in these regulations in so many of the communities across the province?

Hon. Mr. Handleman: Mr. Speaker, I am not aware of any confusion at all. When an area, by local option --

Mr. Nixon: You should speak to your officials downtown.

Hon. Mr. Handleman: -- and through the exercise of its local autonomy has denied the right of the people in that area to buy liquor, by the drink, there is no confusion whatsoever. There cannot be any sale of --

Mr. Nixon: Instead, give it away to groups of 800.

Hon. Mr. Handleman: -- alcoholic beverages in areas where the sale has not been approved by local option.

Mr. Nixon: It is a ridiculous law.

MILK PRODUCTION

Mr. Nixon: I would like to put a question to the Minister of Agriculture and Food. What has he found out from his communications with the federal Minister of Agriculture yesterday about the situation having to do with the milk industry in this province? Could he comment further on the fact that he has withheld the payment of the penalty deductions instead of sending them to the federal authorities? Is he contemplating using those fairly large and substantial payments as some sort of interim support measure to assist those farmers who may very well be forced out of business because of the regulations?

Hon. W. Newman: Mr. Speaker, with your indulgence, I think this is a very serious matter and I think it might take me longer than usual to answer this question because I think this House has a right to know what’s happening.

I wrote to Mr. Whelan on March 4, and first forewarned him, before he announced his dairy policy for this year, of the problems he could be facing. He made a news release on April 13 and he raised the price of butter; he raised the price of powdered milk. He also said there would be an $8.60 deduction automatically on overproduction of milk. He also indicated that the quota allocation should be done on a percentage of the monthly total quota per producer in the Province of Ontario. He said it should be done on a monthly basis but the $8.60 was automatic; the $1.35 deduction was automatic.

At that point in time I made my own statements in this House regarding IMPIP. The Milk Marketing Board received a letter and there was a lot of correspondence from Ellard Powers, chairman of the Canadian Dairy Commission, who said, in effect, you must do it on a monthly basis, and this is where the problem lies today. He said, “You must do it on a percentage of your quota on a monthly basis and you’ll deduct $8.60 per hundredweight.”

After meeting with him in our talks about IMPIP, I sent Mr. Whelan a Telex pointing out the problem he was going to be faced with, saying the 18 per cent cutback was too much and it should be six per cent. I suggested that he take the powdered milk and do something with it and give it back to the farmers. That was in May I did that.

I met with the Ontario Milk Marketing Board and the Milk Commission last Friday. I’ve confirmed by writing to the chairman of the Milk Marketing Board that they put a hold on the $8.60 they have deducted at this point in time until the other provinces have remitted their over-quota levies to Ottawa, and that will be one of the points we’ll be discussing in Ottawa this Friday.

I talked to Mr. Whelan last Saturday. I asked for a meeting. I talked to him on Monday by telephone. We’ve been back and forth. We now have a firm meeting, providing we can get there, Friday morning at 9 a.m. with the Minister of Agriculture for the Province of Quebec, because about 80 per cent of Canada’s total industrial milk production comes from those two provinces.

I will be trying to persuade Mr. Whelan to reduce the $8.60 per hundredweight levy at this point in time and to reduce the monthly percentage payment which would mean an immediate payback of some of these funds that are held to the dairy farmers of the Province of Ontario, and I think it is very important that we do that.

I will be meeting later this week also with the Bankers’ Association to discuss the dairy situation in this province to persuade them the dairy industry is a healthy industry and what we are experiencing is a temporary situation.

I’ve also pointed out that we are overreacting to this dairy situation. I pointed out several times to the federal people in Ottawa that they have overreacted and we’re going to be in a difficult situation.

In the Province of Ontario we have made the necessary cutback. Our production is down in May of 1976 as compared to May of 1975 and we anticipate, by the figures we’re looking at now, it will be down in June of 1976 as compared to 1975. So we have made the effort in the Province of Ontario, and this money should be released, as far as I’m concerned, as quickly as possible.

I did call Mr. Whelan again and we’ve got this meeting confirmed for Friday morning to see if we cannot persuade the federal government and the Canadian Dairy Commission, which have told us what we have to do, that we’re going on the wrong route and we’ve got to ease off at this point in time, because any number of factors could affect the supply of milk in this province.

Mr. Nixon: Supplementary, Mr. Speaker --

Mr. Speaker: That was a very general question, I must point out. It had about 14 parts to it and the answer was necessarily long. We’ve spent 30 minutes now on the two leadoff questioners. I just point that out.

Mr. R. S. Smith: Yes, 20 over there and 10 over here.

Mr. Speaker: That’s all right. There were about 12 minutes on this side and the rest has been partly due to supplementaries, but --

Mrs. Campbell: Mr. Yakabuski is out of order.

Mr. Speaker: Order please. I point out that when the same question is asked four times in the one question that takes up unnecessary time, and that has been the experience this afternoon. Now, if we have a supplementary, I’ll allow the member for Brant-Oxford-Norfolk --

Mr. Nixon: Mr. Speaker, I certainly do not want to take longer than you would permit. What the devil are you talking about, the same question being asked four times in one question?

Mr. Speaker: I think if the hon. member would read Hansard, he’ll know what I am saying. Is there a supplementary?

Mr. Gaunt: Mr. Speaker, supplementary to the minister: In view of the fact that we have our overproduction in this province under control, would the minister be prepared to use that as a lever to try and get the federal dairy commission and the federal Minister of Agriculture to switch the quota allocation from a monthly basis to a yearly basis?

Hon. W. Newman: Hear, hear. That’s why I am going to Ottawa to try and do!

Mr. Speaker: Order please. When the same question is asked over again, it also wastes time. The hon. member for Stormont-Dundas-Glengarry.

Mr. Nixon: He doesn’t even understand the question.

Mr. Villeneuve: Mr. Speaker, this question is along the same line. Representing one-eighth of the industrial shippers of Ontario in the three counties, this is a very very serious problem. I have in my hand here a duplicate --

Mrs. Campbell: That’s the same question.

Mr. Speaker: Order please.

Mr. Breithaupt: Give it to him.

Mr. Villeneuve: I want the minister to take this to Ottawa with him and ask how it works and get answers, because I can’t answer it and I find nobody who can. This shows that a man has $2,800 for the production of milk in the month of May and he ends up, when the punishment and penalties and transportation is taken off, minus $216.89 that he owes the milk marketing board. I would like to get an answer to that. I have only got grade 11 education and I haven’t found anybody to give me that information.

[2:45]

Interjections.

Hon. W. Newman: This is exactly the kind of problem we were talking about, which imposed on the individual producer how much he shipped over quota and the penalties that went with it at $8.60 a hundredweight and also the other shipping and carrying charges, the storage charges of $1.35 a hundredweight. All I can assume in that particular question is there was a great deal more milk shipped than there was within his quota allocation. Remember, this is a two-month deduction for April and May, not just for one month. That is why I want to get to Ottawa to talk to Mr. Whelan to tell him his policy was too strict, too soon and too fast and we have got to get some money back into the producers’ hands so they can pay their bills.

Mr. Speaker: We will hear the hon. member for Huron-Bruce.

Mr. Gaunt: Can the minister assure the dairy farmers in the province that the deduction of $8.60, which was not only taken on overproduction quota but was also taken on part of the in-quota allocation, will be returned to the producers in the month of July, at least that portion which was in quota?

Hon. W. Newman: When the member is talking about in-quotas, he is talking about the in-quota within the sleeve where it was deducted, I assume, from the five million hundredweight which was in-sleeve when they took the deduction from it. We will also be discussing that in-sleeve $8.60 deduction at the same time.

VINYL CHLORIDE LEVELS

Mr. Burr: I have a question of the Minister of Labour related to vinyl chloride and occupational health. Is the minister aware of an Ohio department of health report that an unusually high frequency of birth defects has occurred in children born to wives of vinyl chloride workers in an Ohio community?

Mr. Good: Ready for the late show tonight?

Hon. B. Stephenson: Mr. Speaker, I have read only a brief abstract of that article which has been published in one of the occupational health journals and I am intending to read the entire article. I do not know the contents specifically and completely at this point.

Mr. Burr: A supplementary question: Has her ministry or the Ministry of Health the procedures to detect a similar pattern, if there is one, occurring in Ontario? Have they the procedures, either a computer or any other method, for recognizing a pattern developing in Ontario, if there is one?

Hon. B. Stephenson: There is a method of investigating congenital birth defects or neonatal defects which can be employed in order to investigate such potential problems.

AIR TRAFFIC CONTROL DISPUTE

Mr. Sargent: I have a question of the Minister of Transportation and Communications. In view of the fact that this is the third day of the air travel shutdown and that this government remains silent, why doesn’t the minister and the Premier get together to prevail upon the Prime Minister of Canada to quit politicking and, if they don’t stop politicking will the Premier arrange to have Italian communications in air travel in the Province of Ontario?

Hon. Mr. Davis: My driver will agree with the member.

Hon. Mr. Snow: I can certainly understand the hon. member’s concern regarding the situation in the aviation industry in the Province of Ontario and in Canada today. A great many citizens are very concerned over this matter and about the whole effect this situation is having on aviation safety. I have had an awful lot of people contact me. All I can say, as I said last Friday, is that this whole issue is a matter of safety for people using the aviation services within Canada. It should not be a bilingual matter and it should not be a political matter. The pilots and the controllers have a very genuine concern, I think, from at least one figure I have seen published in the press that this proposed federal programme is costing $1 billion when money is needed very badly for other matters that could improve aviation safety, such as additional radar facilities and backup facilities that would help the controllers and the pilots make air traffic control more efficient and safer within Canada.

I am very disappointed that this matter is going on for the time that it is. I do not support any illegal action on behalf of either party involved -- the air traffic controllers or the pilots -- as far as the legality of the thing is concerned. I do certainly support the controllers and the pilots in the issue that they are taking with this matter.

Mr. Cassidy: Supplementary?

Mr. Sargent: Supplementary, Mr. Speaker?

Mr. Speaker: Order, please. Supplementary. The member for Grey-Bruce first of all.

Mr. Sargent: Very briefly, Mr. Minister, in view of the fact it is costing many millions of dollars a day for eight million people in this province, someone should speak up for us.

Mr. Speaker: Order, please. Is there a question?

Mr. Sargent: -- and now you and the Premier should tell --

Mr. Speaker: Order, please. The hon. member for Ottawa Centre, I think, wishes a supplementary. This will be the final supplementary.

Mr. Cassidy: Mr. Speaker, supplementary to the minister: Since his answer displayed concerns other than the question of safety, can he say whether that attitude reflects the fact that Ontario does not yet have bilingual drivers’ licences from this ministry?

Hon. Mr. Snow: Mr. Speaker, again the hon. member is trying to --

Mr. Speaker: The minister with a very, very short answer.

Hon. Mr. Snow: I think that remark deserves an answer because this hon. member is again trying to muddy the issue like his friends in Ottawa are doing and mixing a bilingual matter with a matter that should be looked at totally as a safety matter -- no other way.

Mr. Speaker: Order, please. The hon. Minister of Education has the answer to a question that was asked previously.

AIB RULING ON TEACHERS’ CONTRACT

Hon. Mr. Wells: Mr. Speaker, last week the hon. member for Port Arthur (Mr. Foulds) asked if I could explain why it took over two months for the Provincial Schools Authority to make its submission to the AIB after the agreement had been arrived at and could I explain why the AIB had to phone the employees to find out what the employer’s submission might be.

I would like to tell the House that the agreement between the Provincial Schools Authority and our teachers was concluded on April 14 and, as the procedure laid down by the AIB, it is the responsibility of the employer to fill out certain forms and submit these to the Anti-Inflation Board.

These forms were filled out by the Provincial Schools Authority and submitted and mailed to Ottawa on April 28 along with a copy of the agreement between the Provincial Schools Authority and its teachers. The forms were sent directly to the associate executive director of the compensation branch of the AIB with a special request that this agreement be reviewed expeditiously. There was also a direct phone call to the AIB requesting an urgent response to the submission.

The forms that were submitted to the AIB were shared with the teachers to enable them to prepare an accurate proposal of their own to the Anti-Inflation Board. The teachers’ case, I understand, was mailed to Ottawa some days after the Provincial Schools Authority mailed the forms on April 28.

There were some statistical calculations that were not right in the forms submitted by the Provincial Schools Authority and this resulted in a telephone call on June 10 to correct those miscalculations. During that telephone call, the officials of the Anti-Inflation Board informed our Provincial Schools Authority that there was a great backlog of cases and they couldn’t expect a decision until the week of June 14. Yesterday afternoon the Provincial Schools Authority received a call from the Anti-Inflation Board that they had made a decision and that a letter with the details would follow. The decision was approximately a three per cent rollback in the terms of the agreement.

TELEPHONE SOLICITATIONS

Mr. Mackenzie: To the Minister of Consumer and Commercial Relations: Is the minister aware of the sales pitch being made to Hamilton area residents via a telephone recording? And would he comment on the feeling of many of these people that this is an invasion of their privacy and ties up their telephone to their possible detriment? And would he also comment on the reaction of Bell Canada, which when contacted, was simply to say: “Get hold of your elected member”?

Hon. Ms. Handleman: Mr. Speaker, the answer is no; I’m not aware of it. It’s not been brought to my attention. I have no details of any legislations being violated, and I’d be pleased to look into it.

TAXI INSURANCE PREMIUMS

Mr. Peterson: Mr. Speaker, to the Minister of Consumer and Commercial Relations:

Is the minister aware that the average taxi rates in London, Ont., in 1975, which averaged about $650, PL and PD, with no deductible, are now for this year about $1,300 with $500 deductible, which is an effective increase of 175 per cent? Is the minister aware? And, secondly, what is he going to do about it?

Hon. Mr. Handleman: Mr. Speaker, I’m aware of the fact that taxi insurance premiums -- not taxi rates, as I understand it -- have increased considerably over the past few years. This reflects the claim experience, the loss ratio incurred by insurance companies, and, of course, the lowering of the competitive level. There are fewer companies now offering this insurance. However, I’d be pleased to look into the situation in London to see whether or not anything can be done.

Mr. Peterson: Supplementary: Is the minister aware that already independents have been driven out of the business because of the exorbitant premiums; and there’s expectation in July and August, when a lot of premiums are coming up for renewal, that a lot more will be driven out of the business? Is the minister aware of this, and could he take some action?

Hon. Mr. Handleman: Mr. Speaker, I don’t think the situation in London is any different from any other city in Ontario. The rates the hon. member has mentioned seem to be the average rates which are being quoted to taxi drivers in this province. Some are higher and some are lower. And if there are any cases of unconscionable rates which are driving people out of business, then I can only take a look at the market situation and see what we can do in individual cases.

Mr. Breithaupt: Where there are independent taxi drivers who are unable to get insurance placed at any price, what is the minister prepared to do to ensure that they are able to remain insurable?

Mr. Laughren: What is free enterprise coming to?

Hon. Mr. Handleman: I’m not aware of any case of a person not being able to get insurance at any price. And if a case of that nature was brought to me I would assume that somebody’s trying to pass the message on to that particular driver. But I’m not aware of anybody who can’t obtain insurance in this province. If those cases are brought to our attention we spend a considerable amount of time finding markets for them.

Mr. Speaker: The oral question period has expired.

Petitions.

Presenting reports.

Mr. Morrow presented the second interim report of the select committee on the fourth and fifth reports on the Ontario Commission on the Legislature.

Hon. Mr. Welch moved adjournment of the debate.

Motion agreed to.

Hon. Mr. Wells presented the annual report of the board of governors of the Ontario Institute for Studies in Education.

Hon F. S. Miller presented the report on mercury poisoning in Iraq and Japan.

Hon. B. Stephenson presented the annual report of the Workmen’s Compensation Board for the calendar year 1975.

Hon. W. Newman presented the annual report of the Ministry of Agriculture and Food.

[3:00]

Mr. Lawlor from the standing administration of justice committee, reported the following resolution:

Resolved: That supply in the following amount and to defray the expenses of the Office of the Ombudsman be granted to Her Majesty for the fiscal year ending March 31, 1977:

OFFICE OF THE OMBUDSMAN

Office of the Ombudsman programme ............ $2,300,000

Mr. Lawlor from the standing administration of justice committee reported the following resolution:

Resolved: That supply in the following amounts and to defray the expenses of the Ministry of the Solicitor General be granted to Her Majesty for the fiscal year ending March 31, 1977:

MINISTRY OF THE SOLICITOR GENERAL

Ministry administration Program ..... $ 2,334,000

Public safety program .................... 10,055,000

Supervision of police forces programme ...... 6,146,000

ONTARIO PROVINCIAL POLICE

Management program ....................... 3,297,000

Criminal and general law enforcement programme ......... 57,236,000

Traffic law enforcement programme ...... 49,795,000

Mr. Speaker: Any further reports?

Motions.

Hon. Mr. Welch moved that when the House adjourns today, it stands adjourned until a date to be named by the Lieutenant Governor by her proclamation.

Mr. Lewis: Have you any idea of when that will be?

Mr. Speaker: Order please.

Motion agreed to.

Mr. Speaker: Any further motions?

Hon. Mr. Welch moved that the select committees of the House be authorized to release their reports during the recess by filing the official copy with the Clerk of the House, which filing shall be reported to the House on the resumption of the session.

Motion agreed to.

Mr. Speaker: Any further motions?

Introduction of bills.

LEGISLATIVE PAGES

Mr. Speaker: Before the orders of the day, I would like to draw to the attention of the House that this is the last day in which this particular group of pages will be with us. As we’re not sitting tomorrow, or next week presumably, as is customary we will read their names into the record and they will each receive a copy so that their names will be seen to go down in history.

The following young people have served us very well, I think, over the last seven weeks: Geoffrey Beatty, Hamilton; Cindy Bradt, Aylmer; Elizabeth Brown, Dundas; Jennifer Ciemiega, Mississauga; Scott Colbourne, Toronto; Jeffrey Earle, Gananoque; Pamela Goltz, Espanola; Mark Harper, Etobicoke; William Hunter, Kincardine; Alice Lambrinos, Weston; Janda McEachern, Whitby; Craig Maltby, Orillia; Torsten Manahan, Scarborough; Melissa Morris, Bracebridge; Gregory O’Donohue, Toronto; Sean Phair, Scarborough; Gail Reddick, Toronto; Fiona Scott, Cobourg; Jeffrey Steiner, Toronto; and Anna Wright, Toronto.

ANSWERS TO WRITTEN QUESTIONS

Hon. Mr. Welch: Mr. Speaker, before the orders of the day, I wish to table the answers to questions 56, 94, 95, 106, 114, 120 and 122 standing on the notice paper.

Mr. Speaker: Orders of the day.

CONCURRENCE IN SUPPLY

Resolutions for supply for the following ministries were concurred in:

Ministry of the Solicitor General; Office of the Ombudsman.

Clerk of the House: The second order, House in committee of the whole.

Mr. Deputy Chairman: There are several matters to be disposed of concerning various bills -- stacked votes that have taken place in the committee in the last few hours of debate.

Call in the members.

ENVIRONMENTAL PROTECTION AMENDMENT ACT

The committee divided on Mr. Renwick’s amendments to section 1 of Bill 81, which were approved on the following vote:

The Clerk Assistant: Mr. Chairman, the “ayes” are 71, the “nays” are 31.

Mr. Chairman: I declare the amendments carried.

Section 1 agreed to.

Bill 81, as amended, reported.

EDUCATION AMENDMENT ACT (CONCLUDED)

The committee divided on Mr. Foulds’ amendment to section 1 of Bill 87, which was negatived on the following vote:

The Clerk Assistant: Mr. Chairman, the “ayes” are 32, the “nays” are 70.

Mr. Chairman: I declare the amendment lost.

Section 1 agreed to.

Bill 87 reported.

MUNICIPAL AMENDMENT ACT (CONCLUDED)

The committee divided on Mr. Swart’s amendment to subsection (c) of section 10 of Bill 89, which was negatived on the following vote:

The Clerk Assistant: Mr. Chairman the “ayes” are 32, the “nays” are 70.

Mr. Chairman: I declare the amendment lost.

Section 10 agreed to.

Bill 89 reported.

ONTARIO NEW HOME WARRANTIES PLAN ACT (CONCLUDED)

The committee divided on Mr. Renwick’s amendment to section 2 of Bill 94, which was negatived on the following vote:

The Clerk Assistant: Mr. Chairman the “ayes” are 32, the “nays” are 70.

Mr. Chairman: I declare the amendment lost.

Section 2 agreed to.

The committee divided on Mr. Renwick’s amendments to section 13 of Bill 94 which were negatived on the following vote:

The Clerk Assistant: Mr. Chairman the “ayes” are 32, the “nays” are 70.

Mr. Chairman: I declare the amendments lost.

Section 13 agreed to.

Bill 94 reported.

Hon. Mr. Welch moved that the committee rise and report.

Motion agreed to.

The House resumed, Mr. Speaker in the chair.

Mr. Deputy Chairman: Mr. Speaker, the committee of the whole House begs to report four bills with certain amendments and asks for leave to sit again.

Report agreed to.

THIRD READINGS

The following bills were given third reading upon motion:

Bill 81, An Act to amend the Environmental Protection Act, 1971.

Bill 87, An Act to amend the Education Act, 1974.

Bill 89, An Act to amend the Municipal Act.

Clerk of the House: Bill 94, An Act to provide Certain Protections for Purchasers of New Homes.

Mr. Renwick: Mr. Speaker, as we indicated when we supported the bill, we did so because the principle of the bill was basically good. There had been a lengthy delay in the government bringing it forward and we indicated that we would support it in anticipation that at least some of the four major amendments which we proposed in committee of the whole House would be adopted by the government. Each of those amendments has now been read and each one of was them has been lost and we will therefore divide on the bill.

The four areas were the nature of the corporation which would administer the new home warranty programme and its direct responsibility to the minister; the length the warranty periods provided; the inability of the government to accept the provision that a major structural defect would lead to a right in the owner to repudiate the contract and to reject the home; and the inability of the government to insist that an inspector’s certificate be the document which would lead to the commencement of the warranty period. We will therefore divide on third reading.

Mr. Kerrio: Flip-flop.

Mr. Speaker: The motion is for third reading of Bill 94.

[3:30]

The House divided on the motion for third reading of Bill 94, which was approved on the following vote:

Ayes

Nays

Auld

Belanger

Bennett

Birch

Breithaupt

Brunelle

Conway

Cunningham

Davis

Drea

Eakins

Eaton

Edighoffer

Ferris

Gaunt

Givens

Good

Gregory

Grossman

Haggerty

Hall

Handleman

Henderson

Irvine

Johnson

(Wellington-

Dufferin-Peel)

Jones

Kennedy

Kerr

Kerrio

Lane

Leluk

MacBeth

Maeck

Mancini

McCague

McKeough

McKessock

McNeil

Meen

Morrow

Newman

(Durham-York)

Newman

(Windsor-Walkerville)

Nixon

Norton

O’Neil

Parrott

Peterson

Reed

(Halton-Burlington)

Ruston

Sargent

Scrivener

Shore

Singer

Smith

(Nipissing)

Smith

(Hamilton West)

Snow

Spence

Stephenson

Stong

Sweeney

Taylor

Timbrell

Villeneuve

Welch

Wells

Williams

Worton

Yakabuski--68.

Angus

Bain

Breaugh

Bryden

Burr

Cassidy

Davidson

(Cambridge)

Davison

(Hamilton Centre)

Deans

Di Santo

Dukszta

Germa

Gigantes

Godfrey

Grande

Laughren

Lawlor

Lewis

Lupusella

MacDonald

Mackenzie

Makarchuck

Martel

McClellan

Philip

Renwick

Samis

Sandeman

Swart

Warner

Young

Ziemba--32.

Mr. Breithaupt: Mr. Speaker, on a point of order. The Minister of Transportation and Communications is within the precincts of the House. Should he not, in fact, formally vote?

An hon. member: He supports us.

Mr. Speaker: Anyone in the chamber is supposed to vote. Will the hon. Minister declare his intention?

Interjections.

Mr. Speaker: Is it an aye?

An hon. member: He doesn’t know.

Mr. Speaker: Are you supporting the bill?

Hon. Mr. Snow: Why certainly, Mr. Speaker.

Mr. Laughren: On a point of order, I don’t believe that I was recorded.

Clerk of the House: Mr. Foulds, yes--no, Mr. Laughren. Is Mr. Foulds not there? Mr. Foulds was called instead of Mr. Laughren, Mr. Speaker.

Mr. Speaker, the ayes are 68 and the nays 32.

Mr. Deans: Mr. Speaker, on a point of order, I want to ask you to consider something. It is necessary for all of the members who vote in a vote to be in the chamber before the vote commences. In fact, the Minister of Transportation and Communications was not in the chamber prior to the vote commencing. He entered the chamber through the door to the Speaker’s office. And I would ask you if you would, in future, require that that door be tiled as all other doors are required to be tiled during the time the vote is being taken.

Mr. Speaker: I hadn’t noticed that but that is the way it is supposed to be.

Hon. Mr. Snow: On a point of order, that was exactly the reason why I did not come to my seat and why I did note vote.

Mr. Deans: I understand that.

Hon. Mr. Snow: I understand --

Mr. Lewis: You shouldn’t have forced them to drag you to vote.

Hon. Mr. Snow: But I was only too happy to come and support the government.

Mr. Speaker: Order, please.

Mr. Breithaupt: I am sorry I raised the whole thing.

Mr. Speaker: Order, please. I think the Speaker was misled twice.

NOTICE OF MOTION NO. 6

Hon. Mr. McKeough: Mr. Speaker, on notice of motion No. 6, standing in my name, which I moved, it has been suggested, and I am quite agreeable, that the date be changed to Oct. 31, 1976 and I would so move.

Mr. Breithaupt: Mr. Speaker, with respect to that motion, the suggestion has been made with respect to the four-month term. It has been brought to my attention as well that on page 16 of the second interim report which has just been presented to the assembly today, under government motions and resolutions, the four-month term is also suggested. So I am certainly pleased that the minister has accepted the suggestion that October should be the date.

Mr. Speaker: Hon. Mr. McKeough moves an amendment to the resolution that the date of March 31, 1977, be withdrawn and the date of Oct 31, 1976, be inserted.

Motion agreed to.

Resolution concurred in.

ANSWERS TO WRITTEN QUESTIONS

Hon Mr. Welch: Mr. Speaker, I wish to table the answers to questions 71, 92, 100, 118, 123 and 131 standing on the notice paper.

I am wondering if I could seek some direction from the House? There are remaining to be done the estimates of the Ministry of Health in committee of supply. There is standing on the clock, I understand, about three hours and five minutes. If, in fact, the House would concur, we could start those estimates now and carry on even though we went past six. Once they were completed that would, in fact, look after the business which we agreed to do before the recess.

Mr. Nixon: We could do them next October.

Hon. Mr. Welch: But we have three hours and five minutes and if it is agreed we would just --

Hon. Mr. Davis: Nov. 1.

Hon. Mr. Welch: -- do them now, get them completed and then rise for supper. If that would be the wish of the House we would now go into committee of supply and stay in committee for the three hours and five minutes to finish the Ministry of Health and then rise and report.

Mr. Nixon: No way. We can do them in October.

Hon. Mr. Welch: No, I think it would be nice to get them done now. The Minister of Health is eager to do it now.

Mr. Breithaupt: It is the House leader’s intention, then, to call the concurrences directly at that point and complete the term?

Hon. Mr. Welch: The concurrences have been done and the third readings are now done. We would finish the Ministry of Health. We would finish those estimates in committee of supply. We would rise. We would go and get the Lieutenant Governor and ask her to drop in and give royal assent.

Mr. Nixon: Tell her to bring in a dissolution with her.

Hon. Mr. Welch: Is it agreed that we would do that?

Mr. Speaker: Is that agreed to?

Agreed.

ESTIMATES, MINISTRY OF HEALTH (CONCLUDED)

Mr. Deputy Chairman: We were dealing with vote 3002 when the committee rose at 2 o’clock and it is my understanding that there is approximately half an hour left to consider vote 3002 as agreed earlier this morning by the three House leaders.

On vote 3002:

Mr. Bain: Before we leave the point the minister and I were discussing before we moved into question period. I’d like to ask him a couple of things.

The minister mentioned the recent survey being done in Kirkland Lake regarding overall health care and specifically regarding the possible utilization of the old Kirkland and District Hospital as a chronic and semi-chronic care facility. He mentioned in that regard that this study was not being done for the purpose of determining what would be done with the old hospital.

I would like to ask him, if this is not the case, why is it that the council in Kirkland Lake believes that the present study being undertaken by the Ministry of Health and the Ministry of Community and Social Services is specifically for that purpose? I’ll read one sentence to you, referring to two ministries -- “is conducting a survey of the need for chronic care services in the area as a possible use for this building.”

Because time does not permit I will not read the whole letter but if you would like I can send you a copy of the letter. They are definitely referring to the old hospital. Why is the council under the impression that the present study is being done to determine whether or not the old hospital will be used as a chronic care facility? Would you communicate with the council on that matter and clear this up?

The second item I would like to ask you about -- would the minister like to answer that or would you like me to give you the two at the same time?

Hon. F. S. Miller: Maybe my answers were construed to be for two different towns. In talking about Kirkland Lake, the study going on in Kirkland Lake is a valid study and we are, in our ministry, awaiting the outcome of it as we said we would. I understand that the Ministry of Government Services has said that the sale of the building will be held up until such time as the study is complete.

The study I referred to before lunch as indicating that you probably wouldn’t need to use that hospital for chronic care was, I understood -- because I never saw it -- done for the local municipality by some consultants. That’s what I was told -- that they had received a copy of a report commissioned by them some time ago which said, in effect, that there would be no need for that facility In Kirkland Lake to function as a chronic hospital. That had nothing to do with our study. That’s what I was trying to imply.

We were asked, as a result of your request to me and to my ministry, to send some people up to talk to the council. That was done. It was agreed a study would be undertaken and that is being done. That’s our status there. We advised MGS the moment we understood they had this place offered for sale that our study was going on and we would like the sale withheld until such time as we had results. Okay?

Mr. Bain: Thank you very much for that clarification.

The second item I would like to discuss briefly with you is you have mentioned the appointment of four people by your ministry to the Timiskaming Hospital Board. I won’t go over the old ground we discussed this morning. Suffice it to say, what were the criteria for choosing those particular four people?

Hon. F. S. Miller: I didn’t lay out any criteria for choosing those four people. I asked that four people’s names be submitted to me from the area as people --

Mr. Bali: By whom?

Hon. F. S. Miller: I went to the board itself, as a matter of fact, and asked if we could get some people who would be willing to sit in the area. I didn’t go to the PC organization or go in any other hidden way.

Mr. Bain: Are you sure?

Hon. F. S. Miller: We were given four names. I couldn’t tell you whether they were NDP or PC. I think these people will tell you, under oath if necessary, that this ministry never approached them in advance to see how they would even vote on the issue.

Their names were submitted. We accepted them and they were put on as our representatives in the hope that they would break this deadlock. I had told the board in advance that it was one of the minister’s prerogatives and that I would exercise that prerogative if I had to. I did, after a stalemate developed.

Mr. Bain: Could you tell us who was the chairman of the hospital board who made that recommendation?

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

Mr. Deputy Chairman: Order, please. The hon. member for Niagara Falls has a point of order.

Mr. Kerrio: Mr. Chairman, at two or three minutes to 2 o’clock, one of our Liberal members had the floor and he was to have the floor again after question period. I’m surprised at this interjection and that Mr. Chairman isn’t aware that that’s what has happened.

[3:45]

Mr. Deputy Chairman: According to my notes here, the hon. member for Lincoln (Mr. Hall) started to speak, and then the minister indicated that he was going to answer the hon. member for Timiskaming. But I wasn’t aware there was going to be any further continuing debate.

Hon. F. S. Miller: Mr. Chairman, I have to be honest and say the hon. gentleman is correct, in fact, we had terminated our debate. I thought the member for Lincoln had the floor as we adjourned.

Mr. Bain: Mr. Chairman, on a point of order. I was under the impression during committee that, for the sake of brevity, one can ask questions of the minister rather than giving a long oration to start with. This is why I didn’t make all my remarks. I simply asked a few questions. I thought the minister would give his answers and I could ask a few questions to clarify them. I just have two questions left.

Who was the chairman of the board at the time those four persons were recommended? Secondly, is the Ministry of Health going to buy the old hospitals from New Liskeard and Haileybury? If so, how much is it going to pay for them?

Hon. F. S. Miller: Mr. Chairman, what direction am I under from you?

Mr. Deputy Chairman: I would assume you could very quickly answer those two questions and then go to the member for Lincoln who had the floor, but who was interrupted by the minister to answer the question.

Hon. F. S. Miller: The answer would be no.

Mr. Bain: Who was the chairman?

Hon. F. S. Miller: The chairman of the hospital accounts in Haileybury?

Mr. Bain: Who recommended those four names?

Hon. F. S. Miller: Mr. McKay Clements was chairman of the hospital board, but I believe at that point he was one of the ones who had absented himself from some of the meetings. It seems to me there were a couple of meetings when the people who represented the south end of the area did not turn up. You could go back into the records and see if I’m right or wrong.

Mr. Bain: You accepted the recommendation from people who had a particular point of view?

Hon. F. S. Miller: It’s very possible. In the first case I rejected a recommendation from people with a particular point of view.

Mr. Deputy Chairman: The hon. member for Lincoln. Order, please, the hon. member indicated I that there would be two quick questions, and the minister has given two quick answers. Now we’ll listen to the hon. member for Lincoln.

Mr. Hall: I just want to briefly comment on a recent organizational change in the field of health -- in the establishment of district health councils.

Eventually I feel that this can be a progressive move. But I do wish to caution the minister. Mr. Minister, please take every step to see that these councils are and will be constituted by people who represent different interests and facets in the districts, and not merely municipal appointees to yet another committee. Rather, they should be those with experience and involvement in many different volunteer ways and with a real feeling for all the many health care services that are needed in our communities.

I ask the minister not to use these councils for unpleasant tasks only. Please don’t have centralized control and decentralized blame. If you really want to work with these councils in an important way, I hope that you will use your influence to build strong councils by getting the right people and by having a flow of people with new ideas joining the boards on an ongoing basis year by year. In that manner you may be creating an excellent agency acting in a responsible manner.

But if these boards were to be just another committee with the same old faces, then they will be a sham and will set back public confidence and public interest. Volunteers will gradually lose interest in their fields of work and the boards will be without representation, without input, without recognition of the problems. So I ask the minister, please do the very best on this. Thank you.

Hon. F. S. Miller: This is a very important point and I would like to say that you and I agree completely on the function and the choice of district health councils. If I’ve been blamed for anything in the district health councils -- and when one’s in the government party he sometimes gets blamed by his own colleagues -- it is that it is a totally non-political process. A steering committee is set up, and once that steering committee is set up to choose members for the district health council, it goes about trying to get a geographic and a professional, a governmental and a lay mix of people for the council. I don’t know that they’re always as successful as they should be.

I know in your area we did refuse to accept a couple of names on the first submission of the steering committee. I think they were not questioned on the basis of the integrity or the ability of the people, but the jobs they held in the community.

In our opinion, -- I believe one at least was a hospital administrator and I believe perhaps there was an MOH; I’m not quite sure -- there were one or two people we deemed to be, as I say, mercenaries. Now that’s not a nasty term, it was simply an indication that they worked for one specific part of the health system as employees and therefore could not necessarily be expected to look at the rest of the system. I know you brought up to me privately the point that at least one member appears to have that conflict right now. Is that not right, in your area?

Mr. Hall: Yes, but that is not the point I am speaking about.

Hon. F. S. Miller: Once we’ve cleared the composition of the board, the question is what dirty jobs do they get? It is interesting. As I went around the province closing hospitals, you notice that we didn’t ask any embryonic health councils to close hospitals or make that choice did we? When I sat in the city of Kitchener the only criticism I got that day was from the steering committee of Brant county, etc., health council who said they felt they should be involved in the closure of the hospitals right at the beginning.

Mr. S. Smith: Of course they should.

Hon. F. S. Miller: No, I beg to differ, and agree with the gentleman behind you -- you don’t give them the dirty jobs until, in fact, they’ve had time to organize. If I were waiting for 1978 or 1979 to close those hospitals, I think it would have been quite fair to ask the council to work toward the objective of reduction of services. I was given a requirement to meet a commitment in said closures and budget cuts this year. A council that is not yet formed or a council just formed would have been given a very nasty job.

We chose one community to give that job to and that was Hamilton, as you may recall. We chose Hamilton because Hamilton’s health council, in one form or another, had several years of operating experience, and I believe that health council was unwilling to accept the duty and asked this ministry to step in and offer the advice. That disappointed me a bit, but I quite understood that on paper at least they were only a month or so old, and they felt it was better to let us do it. So we tried to take the dirty jobs off them in the beginning and we hope that in the future they would have the time to study these things before they had to take any such actions.

Mr. Makarchuk: Mr. Chairman, I’d like to continue on the matter of the Brant county health council. I think, to set the record straight, the Steering committee of the proposed Brant county health council was under the impression that it would have some say in the relocation of health services in the county. They certainly were not in any way prepared to close any hospital. In fact, some of the members of the steering committee at that time indicated that if they were put in a position where they would have to close a hospital they would rather not be on that committee and certainly not on the health council.

What bothered me about that incident was the fact that the community was led to believe that it would have some say in the health care in Brant county, and of course you came along and you pulled the rug out from underneath them. I just wonder at this time what is the status of the Brant county health council? Is it in the works? Has it been postponed until you resolve the legal problems you have with the hospitals, or are you going to go ahead?

Hon. F. S. Miller: The creation of the health council and the problems in the hospitals are not related at all. I opened one in Sudbury last week. I’ll be opening one in Chatham tomorrow night. The week before that it was Essex. We’ve been opening them at the rate of about one a week of late.

Mr. Haggerty: Keep closing one a week too.

Hon. F. S. Miller: There is no need to delay it. I understand the steering committee is still preparing the names in your area and we would be prepared, as far as I know, to move as soon as the steering committee’s reports were in and the routine has gone through.

Mr. Makarchuk: Mr. Chairman, as far as I understand it their names have gone in, and you have had the names for some time now -- you’ve had them probably since about February of this year -- so I just wondered where the holdup is and for what reason.

Hon. F. S. Miller: You are probably more accurate than I in this case. I only know that I haven’t as yet been told, or seen the order in council approving it. I’m trying to think -- there were two that were ready to go last week, and it could well be that Brant county was one of those that we were prepared to bring to cabinet within the next few days. I can get the names for you in the afternoon, to see if that is one of them.

Mr. Makarchuk: Yes, I would appreciate that.

The other item is the matter of the Brant sanatorium, and this was a letter that was referred to you from the board of governors of the san. The letter was also sent to the Minister of Community and Social Services (Mr. Taylor). It appears to me that here you have an institution that’s available and which has all the facilities that you need. There is really no capital investment required to put it into some useful operation in the community.

The long-term care study for Brant county indicates that there is at this time, or when the study was completed March 1, a need for about 57 patients needing home care or residential or extended care services in the county. I just wonder why the reluctance to do anything with the san? Why is there no movement in the ministry? Is it a matter that you are trying to decide which ministry would probably be involved with this thing or are you just steering clear of the whole thing altogether?

Hon. F. S. Miller: No. There is a long-term care study going on in the area right now. It was going on prior to the decision to close the Willett Hospital in Paris, and in fact we were going to keep the chronic patients at Willett until the study was complete.

Let’s not jump to the conclusion that because it looks like a modern, ready-to-use facility, that money doesn’t need to be spent. I will give you two examples: 550 University Ave., the old Mount Sinai Hospital -- to you and I, as lay people, it looked like you could have moved patients in tomorrow. It has taken a good many millions of dollars to convert it from active care purposes to chronic purposes.

The second example would be the sanitarium in Thunder Buy. I can recall Dr. Potter visiting that in, I think, late 1972 and listening to the demand for chronic care needs in Thunder Bay. He quickly said “Fine, we will use that hospital; we will move patients in,” based upon the same kind of eyeball approach. It cost us one heck of a lot of money to convert that hospital over until it met these standards for fire and other purposes involved in chronic care needs. So what looked like a good facility has to often have a lot of money spent on it.

Now to answer your other question: Brant county health planning council is on my desk today and --

Mr. Makarchuk: And when is it expected that you will make the formation of the council formal then, Mr. Minister?

Hon. F. S. Miller: Traditionally I have to get the order in council, and I don’t think that has passed through cabinet. Four weeks, I am told.

Mr. Makarchuk: I am sorry, Mr. Chairman, I am not finished yet. I am just starting.

Getting back to the san, Mr. Minister. Perhaps you are quite right that certain things can be done, but before you make that kind of statement it might be appropriate for somebody from your ministry to go up there and look at it and see whether these things are really needed. There is a good body of opinion in the area that indicates that you probably will not need to do a major refurbishing.

And talking about refurbishing, I think there is an item that should be raised here. It is the matter of the Auchmar Building, which is part of the psychiatric hospital in Hamilton completed in 1961. It is rather a new building with supposedly new facilities and so on, and now you are going through the whole building again. You’ve been going through it for a couple of years.

This is the kind of wasteful spending I think that your government really is involved in. It indicates some of the problems within the ministry. You have a set of architects who drew up the original plans for that building, then you decide it’s not adequate, it’s not what they wanted, or somebody in your ministry figures there should be a change. So who do they call on to do the redesigning? They call on the same firm of architects to do the same thing they did before really. I wonder what is the rationale for selecting the same people who are, I think, responsible for some of the problems in the first place?

[4:00]

The other item on that situation involves the local staff, who could have a considerable input. Even though some of your people in Toronto may not give them credit, they certainly have some knowledge of what is required, what changes would be useful, what changes will be adequate, and what should be done to serve the needs for which that hospital is designed. Once again, you refused. The architects came to the staff, laid a chart or some plans on a table and walked off. Absolutely nothing was done to take into account the input from the staff of the hospital. It is really unexplainable why you do those things or the reason for these situations.

When you do proceed to build it -- I will give you an example -- you put up Gyproc, very nice panelling. What happens, of course, is that the patients walk around and kick holes in your panelling, so you have a man with mortar and tape going around filling the holes and another man following him with a can of paint and a brush to paint them over. This isn’t very profound; it doesn’t require a great deal of thought. Why do you do it?

One of the other things you have done in that particular hospital involves the treatment of staff. In that hospital you had able staff -- mostly RNAs, who were trained in group therapy, who had a knowledge of psychodrama and so on -- who were really the kind of people that provided the health care you needed for the patients in the area. Incidentally, in many cases, if not in all cases, the government paid for their training. So what do you do? In your rather intelligent way of going about the health services in Ontario, you go and you fire these people. You dismiss them and leave a staff that has been there for a longer period of time -- adequate but certainly not as well trained, and not as adaptable to new techniques in psychiatry.

The other item which I think is very foolish is that what you are doing in the process of cutting staff -- and this is borne out by people who work there -- is you are increasing the possibility of the incidence of either suicides, you are increasing the possibility of violence in the wards and you are increasing the possibility of various other types of deviant behaviour because you do not have adequate staff. There, have been occasions when you had a fight in the ward and you had to go and get staff from other wards in order to be able to prevent this sort of thing -- and the reason that was done was that you did not have the staff. If you had the normal staffing that is required there, this wouldn’t have happened. Could you kindly reconcile for me why you do those things? Just exactly how much dollars and cents is it really going to save you in relation to the consequences of your actions in that area?

Hon. F. S. Miller: You have some very naive beliefs about psychiatric hospitals. I don’t know who you have talked to, but the staff at that hospital did have input into the change. Secondly, the design of hospital is usually a result of present thoughts in psychiatry. I can tell you, I have gone to some of our psychiatric hospitals, such as the ones in Goderich, Owen Sound and Timmins, and I would like to know what the architects were thinking of in those days, but they were following doctors’ directions.

These hospitals, with their three corridors beside each other, are probably the biggest waste of space I have seen; so are the hospitals with partitions half the height of the wall so that every patient could be observed at all times. These were ideas that doctors held a few years ago when those hospitals were designed. They are not the Ministry of Health’s opinions; they are medical opinions. In this case, the staff vetted the plans, and the plans were left up for staff comment.

You wouldn’t have any -- no, I wouldn’t say that -- you wouldn’t have any inside information on this hospital? You wouldn’t have a wife on the staff, would you?

Mr. Makarchuk: Yes, I have.

Hon. F. S. Miller: Well, check with her later. Does she believe that seniority should apply?

Mr. Makarchuk: Oh, absolutely.

Hon. F. S. Miller: Then why do you think the changes were made the way they were?

Mr. Makarchuk: In the first place, yes, they have consulted the staff, and the staff at other hospitals have discussed these things --

Hon. F. S. Miller: Well, why were you making a stink?

Mr. Makarchuk: The staff at the hospital are really talking about some of the problems at the hospital, and they have not been consulted. Despite what you say about them having been consulted, they have not.

I will give you an example: You stuck in shower heads there upon which a person could hang himself, when the effort was that this should not happen. You didn’t put windows in the doors in the side room -- something very ordinary, very natural that should be there. You know, if you consulted with the staff this, of course, would not have happened. Obviously, it seems to me that you haven’t consulted.

Certainly we believe in seniority; there’s no question about that. What I’m trying to tell you is that in the so-called process of economy you have eliminated it. You’ve really injured the provision of health service in that area. And in terms of the dollars and cents, or the benefits to you, what you’ve done is really a detriment. It is a detriment to the hospital in terms of providing the kind of care that should remain there.

Now, there is another little item of concern. There are certain rumours going around the area that one of your surprise announcements after the House adjourns is going to be that the hospital will be transferred over to the control of the Hamilton health council and so on. Is this the case? If it is, I --

Hon. F. S. Miller: I understand that that discussion has been quite open in the area.

Mr. S. Smith: Of course. It’s been in the paper for weeks.

Hon. F. S. Miller: It’s one of the discussions between Chedoke, I think, and that hospital that have been going on for some time. No decision has been made, but most certainly we’re deciding whether the both hospitals should be under one board.

Mr. S. Smith: And it will be a very progressive move if it is made.

Mr. Makarchuk: My concern in this case is not which board operates it. My concern -- and this is the matter raised by the member for Hamilton -- is whether the succession rights of the employees of the hospital will be preserved and continued. Or will they be terminated and the employees may have to go under new pension schemes or would lose their seniority or would lose their pension rights because of the transfer to another board. Would you care to comment on that?

Hon. F. S. Miller: Those are always very difficult things, and when we have two unions representing the workers in two different hospitals I think it becomes more difficult to resolve than when only one union is there. We have managed to negotiate those types of problems in the past. We will do our best to negotiate them satisfactorily at this time too.

Mr. Makarchuk: Would you at this time give some assurance to the people there that if you do transfer the hospital, those people’s rights will be preserved?

Hon. F. S. Miller: I can only give this assurance: We’ll do our darndest to make sure that the rights in both hospitals of senior staff be preserved.

Mr. Makarchuk: I’m not too happy with just the assurance that you’re going to try. In the past, this government has a record of trying various things and the people in the end get shafted. Hopefully you’re trying, in this particular case, to ensure that they do not lose their rights. I think that’s important.

Mr. S. Smith: Mr. Chairman, I want to take up a few points which have been raised, and also a few that I touched on earlier before I had to leave, and give the minister a chance to answer some of the points I raised then and some of the ones I’ll mention now.

To begin with, the matter of health councils and whether new health councils should be asked to take on difficult or, as the minister terms it, nasty jobs: I feel that we have here a very fundamental difference between the minister and myself. I want to be sure that this is articulated. Certainly, it is my view that the decisions that have to be made in government ought to be made, wherever possible, as close as possible to the people who are affected by these decisions and to the local communities. That’s why I support the efforts of the ministry to arrange local and district health councils which will then be able to spend the health dollar in a way that is determined by the people in the area affected.

I think the sad thing is that most of the regionalization which this government has done within health and outside of health has never had with it the real power to spend the tax dollar, and the real power to make the decisions. As a consequence of this, we have had people regionalized in a way which has given them no more local autonomy and no more genuine local input into their own lives. Rather, it has just given another waystation on the way to dealing with the various ministries and has given the ministry a handle by which to take hold of any given community.

With regard to the regional health council that was touched on by the member for Lincoln (Mr. Hall), I disagree profoundly. I wonder if the minister would consider seriously the possibility that all decisions, be they nasty or not, should be made at the local level and that he wouldn’t have got in the trouble he did get in if he’d gone to each of the areas in the province, if they had health councils, and even if they didn’t, if he had called them together into a makeshift temporary ad hoc arrangement and had said to them: “Look, your spending per capita on health in this county or in this area is so much and so much and that’s really higher than it needs to be, or higher than the other areas in Ontario, therefore you must reduce it. We would suggest that you might consider reducing it by closing beds, or you might consider reducing it by taking one hospital and closing it, but whatever ways you can think up to reduce it, let us know. I would like to give you a lot of time to do this. I know you’re new in the job, but time is of the essence. You only have three months or whatever to do it.”

Don’t you really believe, Mr. Minister, that you could have accomplished the job without this kind of misery and hardship, that you could have got local involvement, co-operation between villages instead of a situation where village is now fighting village to see which hospital is going to be closed; that you could have got an informed populous who would have been part of the discussion; and that you wouldn’t have given the impression that somehow your government operates with lead boots and so on, which I’m sure was never your intention?

That’s the first point I want to make with regard to councils. Next may I touch on what I think is a rather irrelevant point made by the member for Brantford (Mr. Makarchuk). There was one point which he almost touched on which I know about from my own work in the area -- the trend in psychiatric hospitals. This has been, as the minister well knows, away from in-patient care toward out-patient and community care, halfway houses, rehabilitation centres and so on.

Surely the writing was on the wall long ago that many of the people who now service in-patients would have their jobs in jeopardy as time went along and if this trend continues. This was no surprise. In fact, it was only the freeze on hiring that caused the staff to become rather bottom heavy at a good many of these centres, but everybody knew that the in-patient load was going to go down and this was not news to anybody.

Surely retraining efforts of a much greater sort should have been undertaken. In retrospect, I wonder if the minister would agree that a greater job could have been done retraining many of these nurses aides and orderlies and so on who work in psychiatric institutions so that they could, in fact, do some of the work in the out-patient settings -- in the halfway houses, in the various rehabilitation centres and so on.

Some of the community work could have been taken on by these people if properly retrained. I would hope that as these trends become obvious that the ministry would be a little more alert to them and would operate accordingly.

I want to make a few comments about the regression analysis business and I hope the minister will enlighten us and perhaps answer some questions in this matter. We have been attempting to call the ministry to see if you would be issuing an updated erratum to the errata which have already been issued. I gather that you’re not going to be issuing an update, so we’ve called five or six hospitals in the last couple of days and every one of them has appealed the ministry cuts based on your regression analysis, and they’ve all had very critical remarks to make.

It’s clear that the analysis could be useful in some circumstances, but the input, or lack of input, has been criticized. Several hospitals noted that 1975 budget estimates were used when in fact the budgets actual were available. Several hospitals noted that statistics for such things as paid hours were taken from two particular months, September and October only, and in some cases those months were not representative of the general activity taking place in those hospitals.

In another instance, it fails to represent such things as the caseload mix or the specialized activity. For instance, whether there be special cardiovascular out-patient services and so on which were not counted fairly. In addition to that, the chronic patient days were excluded from the regression analysis and this led to very big problems, for instance, St. Thomas hospital. We understand also that some hospitals noted that when they contracted services such as food or laundry, that the regression analysis automatically excluded these items from consideration. We would like to know if that is true and if so, why?

[4:15]

We were also told that there is one hospital in Toronto, a rather large one, that has gone over the regression analysis inputs as they actually were -- not the ones they would like them to be, but the ones that the ministry used -- with people from the ministry. They sat down together with people from the ministry and tried to figure out sort of manually what the figures ought to be and they still came out with figures that were significantly less than what the computer printed out. I would like to know whether the ministry is aware of this problem and what explanation there is. What I really wish to know is what has happened to the section of the ministry that came up with this brilliant regression analysis? Has it, in fact, remained intact? I would like a report on that from the minister.

I want to move for a moment back to the question of the children’s mental health services branch and make a little clearer some of the comments that I touched on earlier in the day, regarding the situation in Browndale with the tremendous leases that are involved. I would hope that the minister is prepared to answer the question about these leases.

Is it not a fact that the ministry has had to approve all the Browndale leases? Isn’t this something which goes as part of the arrangement with Browndale? Did the audit indicate any conflict of interest in the leasing? In other words, would you not agree that many of the leases were, in fact, being arranged with people who were the same principals as those who are operating Browndale and receiving a salary for doing so?

I notice you say that in looking at the per diem money there is the question as to whether the people in Browndale National were the same people who are on the list of Browndale Ontario, and that’s the only comment you make with regard to this business of contracting out the management. Are you convinced, Mr. Minister, that when Browndale Ontario contracted out its management to Browndale National that it was, in fact, getting management services for this worth $1 million a year?

Are your suspicions aroused at all that the houses being leased by Browndale are frequently being leased from other Browndale interests, and that they were, in turn, purchased from other Browndale interests, which in several instances in turn were purchased from several other Browndale interests? Are your suspicions aroused at all about this? There is a so-called management team that operates in the Browndale situation in Browndale Ontario. I am just trying to find the list of people on that. Here we are. Brown Camps’ residential and day schools in Browndale Ontario, and there are some names on this management team that are certainly involved as far as we can make out with Browndale National and we wonder whether in fact you have taken any steps to follow these particular names.

There’s, of course, Debbie Brown herself and Marvin Brown, it goes without mentioning, and then there’s one Earl Heiber and Leonard Marvey who might in fact be involved with that as well. Basically, I have a list of the so-called members of the management team of Brown Camps’ residential and days schools. Can you really explain to me, and through me to those interested members of the public in the Province of Ontario, why it is necessary for the Province of Ontario to do business with a group that contracts out its management, that is allegedly a non-profit group and yet leases its facilities from clearly related individuals?

Surely if this were the case in any other situation you would have acted long ago? When I operated a unit at St. Joseph’s Hospital, if in addition to my salary I was also making sure that all the bed sheets at St. Joseph’s Hospital and all the parking facilities at St. Joseph’s Hospital were all dealt with by my other companies, and if these other companies made sure to charge prices that were based on our expenses, and if these expenses were based on the fact that we bought the bed sheets from several other of my companies, I suspect that you would have raised a fair amount of furore about this.

This is supposedly part of the health branch, this is supposedly a treatment service, and I think it’s really shocking that it should be permitted to carry on without the proper scrutiny. The Leader of the Opposition (Mr. Lewis) at one point said he would like to see the results of the audit. I want to see the audit itself. I want to see the actual figures in that audit. Your refusal to do so is about the same as the refusal of the Attorney General (Mr. McMurtry) to act even weeks after we had presented him with information.

Can the minister tell me whether this audit takes into account 1973? Can the minister tell me whether, in 1973 when Browndale was coming up with a figure for a per diem and listing its salaries and expenses, those salaries and expenses were checked against 1972 and early 1973 to see whether there was any unusual change in the figures to justify a higher per diem?

With regard to those centres which are charging less than Browndale, is the minister able to tell us that those centres are treating people who are less disturbed or are they giving less beneficial treatment? How is it that they can manage to function for less money than it costs Browndale? What is the minister’s explanation for that? I will wait for answers on those particular matters.

I personally feel that plenty is rotten in the whole children’s mental health services branch if they can spend $65 and $85 a day on these services without any proof that the children there are getting much better care or are much more disturbed or need much different or more complex care than those in some of the group homes under Community and Social Services for $32 a day. I think it is shocking that this should be persisting in this way.

I want to know why the interministerial report which has looked into precisely this matter -- and which I suspect exonerates Community and Social Services and points the finger of blame at Health -- is being suppressed and kept from this House. Perhaps the minister would care to answer same of those questions.

Hon. F. S. Miller: I will have to know how much time I have left on the vote because I had some idea that I was to be through at --

Mr. Chairman: For your guidance, there are two hours and 21 minutes left for supply. I was told by the previous chairman that this vote, 3002, was to carry at 4:15. I am in the hands of the committee.

Mr. Dukszta: Mr. Chairman, we had a discussion with the House leader of the Liberal Party. We agreed we would go on with this item for another 20 minutes and then we will switch for the last two hours to occupational health.

Mr. Breithaupt: That would suit us, Mr. Chairman. There are a number of my colleagues particularly who have brief comments on a certain number of items. I understand you have their names and perhaps they can be called so that the matter can be resolved.

Mr. Dukszta: One more remark. We agreed also that as we don’t have any speakers on this side the Liberals will go successively. They will pay us back by doing the same thing on the next item.

Mr. Chairman: You are saying that you want the remaining 20 minutes of the two hours and 20 minutes to be used up on vote 3002?

Mr. Dukszta: Yes.

Hon. F. S. Miller: Successively, but perhaps not successfully.

Mr. Laughren: Not progressively either.

Hon. F. S. Miller: That is reserved for one party alone. That’s us.

Mr. S. Smith: The frontwards-backwards party.

Hon. F. S. Miller: At least we know which way we are going on any given day of the week.

Mr. S. Smith: Yes, down.

Mr. Kerrio: Point of order, please. I heard the remarks of the critic from the NDP and I wonder, on the next vote, is there some guarantee that we will get reasonable equal time on it?

Mr. Dukszta: Yes. What we meant was there are three Liberals speaking on this thing and we will have the same number speaking on the next item, then we will return to the normal approach.

Hon. F. S. Miller: Whatever that means I am back here anyway.

Mr. Chairman: The minister may continue.

Hon. F. S. Miller: All I know is I have to answer anybody who speaks, no matter what party they are in.

The one thing I would like to say to the leader of the Liberals is this: I share many of his hopes about health councils and their ability to guide and make decisions -- at least, not make decisions but give advice to us for the time being -- in the long run to start making the decisions once they’re responsible fiscally for budgets -- if that ever happens. That’s been studied by a lot of people and I think it was determined that you have to work your way into that area. It’s not something that happens overnight.

As I open a new health council in any given city, or a community, usually the press is there to meet me. The press often believes that because we have named the health council on that day, the next day problems will be solved and I will be given a long list of solutions and action will start at once. Our experience has been that it takes a long time to do this. I would say Ottawa is just now reaching the point where it will be able to take a more active role.

First, even those people who are professionals have to start thinking in a more global sense. Second, those people who aren’t professionals have to learn a fair amount, if not all, about the health system. Third, there are already in place a whole bunch of bodies who purport to represent special interests in the health field. They all want to be tied into the new health council. Lines of communication have to develop before, in effect, the health council has the confidence of the group it represents.

Therefore, it will take time for any health council to do the things you feel that we should have challenged them to do at the very beginning. We only differ on the time that it takes for the decisions to flow back to us, rather than us having to act in their stead.

Mr. S. Smith: It sounds like the dissolution of the British Empire.

Hon. F. S. Miller: No, I’m quite satisfied.

Mr. S. Smith: The natives require more time before they can take on these complex functions.

Hon. F. S. Miller: Show me where we did that with functioning health councils working somewhere. We, at least, are trying to get them to work. They’ve been studied, as you know, by four or five groups of people -- right from the Committee on the Healing Arts, I think, though to the Mustard report on medical education -- all of whom said it should work. Our ministry said it should work. So, finally, we said: “We’ll make them work or try to make them work, but it’s going to take a good deal of patience.”

Most of them start out by thinking themselves as advocates for everything in their area. They don’t try to prioritize; they just want. We have to change that thinking, too. They’re going to have to make the tough decisions, and most of them don’t want to.

Mr. S. Smith: Make them responsible and they will.

Hon. F. S. Miller: You may be sure I will do it.

Mr. S. Smith: It’s the old colonial argument.

Hon. F. S. Miller: Okay, you ask that we chance it. This morning I had an opportunity in your absence to talk about the regression analysis -- and I can only say, sure.

Mr. S. Smith: I will read it in Hansard.

Hon. F. S. Miller: I didn’t answer one specific point. There were two things that we had done. The first is admitting that obviously inadequate input was used. We are having a fairly competent outsider look over the input data and give us advice on it.

Second, yes, staff changes were made. I think it’s understandable that there would be. I don’t know that I would try to lay blame at staff’s door. I said this morning that, in fact, it was a new venture. It was an attempt to be specific rather than using an across-the-board cut for everybody. We think it had its failures, but it also got us a number of specific savings that the old approach would not have achieved.

You got on to Browndale and a good deal of your argument centres around the arm’s-length or the non-arm’s length nature of the leases. Today, we no longer are concerned about the rents they pay for homes, because we’re not basing the per diem on them. We’re simply taking last year’s budget and giving them a small increment on that basis -- and I would think quite small in this case this year.

Mr. S. Smith: How much?

Hon. F. S. Miller: It hasn’t been negotiated yet.

Mr. S. Smith: More than 5.5 per cent?

Hon. F. S. Miller: Eight per cent is the Ministry of Health’s guideline.

Mr. S. Smith: But they are competing with ComSoc’s housing?

Hon. F. S. Miller: Okay. As far as the different rates go I think a good argument can be made for some standardization of rates across the field. But up to date, people like yourself, who are specialists, claim that each model is different. They’ve argued strenuously for the uniqueness of the model they function with. I’m not willing to argue that I believe that. I’m quite willing to say that I think some standardization should occur, and try to work towards those ends.

I think the question of whether or not the prices paid for rent to Browndale interests for properties rented is properly the subject of the Attorney General’s investigation, and I think he will be reporting on that once he’s finished.

You asked one last question. Our information is that Browndale, in fact, does take more children with severe emotional distress than some other groups although you know how hard that is to assess sometimes.

[4:30]

Mr. S. Smith: Just a last brief point on Browndale. Is it true that the Browndale quota in Haliburton -- I asked this this morning and perhaps it has been forgotten -- might be reduced to 30 from 50 and that there might have been letters sent out to parents in Ottawa saying that an Ottawa Browndale programme might be started? Why should they be allowed to expand their quota as long as the present situation exists? What are the chances of a new programme in Haliburton?

Hon. F. S. Miller: I don’t know anything about Ottawa except that I talked to one of the unhappy Browndale employees from the Haliburton area who was attempting to move to Ottawa with the staff which had quit in Haliburton, and set up a competitive venture there. That’s all I know; it had nothing to do with Browndale itself. It was competitive to Browndale.

Mr. Spence: Mr. Chairman, I would like to ask a few questions of the Minister of Health with regard to nursing homes. I had one nursing home, the Golden Acres Nursing Home, in the county of Kent. The owner came to see me and brought to my attention the concern to make ends meet there and also at the Bobier Nursing Home in the county of Elgin, which was left by one of the highly respected citizens of that area to the two municipalities.

This nursing home had asked me to sit in on one of their meetings because they weren’t breaking even with costs. I must say, Mr. Minister, I am not returning here to look at the pay sheet and to have a union there. It looked as if the pay sheet was very reasonable.

Of course, there was an increase of $2 for nursing homes in April, where the ward-care patients’ cost was increased by $1.75 per day. The contribution that your ministry gives to each patient in nursing homes is 25 cents a day. This meant that the ward-care patient paid $7.90 a day, and the province paid $13.20.

Of course, Mr. Minister, this nursing home pays no taxes in these two municipalities. They were not breaking even; the expenses were higher than the revenue. It was a concern to the board which operates this very fine nursing home. There was a select committee set up in Ontario to look into nursing homes across the province. After the select committee went across this province, the chairman wrote me a note and said that this Bobier Nursing Home was one of the best nursing homes they had visited.

Is it true that nursing homes are not able to break even with the increase of $2 for ward-care? And if they are not, what approach are you taking to solve this problem that these boards are facing in the operation of nursing homes?

Hon. F. S. Miller: Mr. Chairman, we have only one rate for nursing homes in the province as you know; $21 a day for a ward room, of which, I think, the patient pays a co-payment fee of $7.40.

One can go to semi-private or private accommodation if it’s available and pay a premium for that. We require just about half of the beds to be in ward state even if they are, really in design, semi-private or private. The statute requires that.

Individual homes vary very much in their operating efficiency. They asked us for more than a $2-a-day increase, naturally, but an analysis of the data given to us by the nursing home groups made us believe that the efficient nursing homes could make a profit at the $21 level. I guess there is always a problem when a municipality runs a business. It doesn’t necessarily look at things, let’s say, in as tight-fisted a way as a person trying to make a profit. This would indicate that this particular nursing home isn’t even retiring debt. And you know, the average person, at $21 a day, is paying perhaps $5 a day for capital cost allowance out of that.

So your municipality owned nursing homes have an advantage right off the bat there -- no taxes, no capital debt retirement. I would have thought they had a great big safety margin in terms of operating costs. Perhaps the safest thing for us to do would be to send one of our specialists down to see them and, if you’d give us the name afterwards, give them some advice on areas within the management structure where they could improve.

Mr. B. Newman: Mr. Chairman, I wanted to raise a few issues with the minister concerning my own riding, but before I do I wanted to bring to his attention something that has happened within the last three months on three different occasions and that is where constituents visited me stating that others had been using their medical cards, their OHIP cards, to get service.

In discussing this with the individuals involved, they made mention that to prevent that happening the use of both the OHIP card and a social insurance number would prevent someone else from using the card.

The parties who brought this to my attention in all three instances happened to be elderly ladies. I know that more than likely they wouldn’t have social insurance numbers, but I think there would be no problem for them to get a social insurance number to prevent this type of abuse and use by another individual. Maybe that is part of an answer. Could I have the minister’s comments on that?

Hon. F. S. Miller: This ties in somewhat with the comments of the member for Huron-Bruce (Mr. Gaunt) this morning, who talked about the use of a plastic card for the individual; that, of course, would be the best solution of all.

I’m intrigued at this. Frankly I have never heard that complaint made before in a province where something over 99 per cent of the people in the province have their own OHIP number. I just wonder what motive there is for someone to use somebody else’s number to begin with.

Mr. B. Newman: Mr. Minister, I would never assume that someone would do that, but I live on a border town and I sort of put two and two together. I immediately assumed that maybe the party who was using it was an American citizen trying to get free health services in the Province of Ontario.

Hon. F. S. Miller: That could easily be and that would almost require collusion, I would think. You know, there’s one other alternative that’s maybe possible. It is possible a doctor is falsifying the records, and I think that’s certainly an alternative that would have to be explored. I’m curious to know, for example how the ladies knew somebody used their OHIP cards. The only route I can imagine is they got the audit trail reports that we send out from time to time saying: “The following charges have been paid on your behalf. Please let us know if these services were rendered to you,” or words to that effect.

It is their duty, as we see it, to report anything incorrect on that statement to OHIP so that OHIP can then find out why somebody else is using their number, or why the doctor may be billing for services that the patient can’t recall receiving. This has been a very effective way of uncovering fraud in the past, and I would think in these cases if you would give me the information, or the people’s names, we could very quickly do a rundown to see if there’s any, for example, similarity -- are the same doctors doing it, etc.

Mr. B. Newman: I will try to provide you with that, Mr. Minister. The thing that struck me is that I happened to have three, sort of one after the other. I had never heard of a thing like that at all, and now, if I tell you the individual, Mr. Minister, maybe you also will understand what has taken place here.

The other issue that I wanted to raise with you, Mr. Minister, is concerning the rationalization of hospital services in my own community. Are you going to phase out Riverview as of March, 1977, or are you going to allow it to remain as a result of the appealing of the four hospitals to the courts?

Hon. F. S. Miller: No, they aren’t the same kind of issue, Mr. Chairman. The decision had been taken, and I thought agreed upon, by your hospital council down there and we are phasing Riverview out on April 1, 1977.

Mr. B. Newman: I said the end of March, 1977, so we are both right. No consideration is going to be given to the extension of the use of that hospital? It is going to be phased out completely by the end of March, 1977?

A thing that also has taken a bit of my attention recently is constituent calls concerning inability to get hospital services. The hospitals seem to be booked completely and they don’t have hospital beds available. The latest one I got by letter from a woman who was extremely critical because her husband had to stay out in the hall of the hospital while there are wings or parts of the hospital which are closed. Would you reply to that?

Hon. F. S. Miller: First it could be for any number of causes. We had recommended -- pardon me, your council recommended to us -- the creation of an assessment and placement service as an essential part of the overall utilization of hospitals and other facilities in your area. That is not functioning yet.

Secondly, it is difficult to change the admitting practices of physicians in a given area. When we cut down on the number of beds there is naturally some pressure put upon the whole system because doctors and patients who previously could get in for, let’s say, minor ailments no longer can. I think this explains exactly why you are having your trouble. A more serious side effect can sometimes be that those people who shouldn’t get in do and make it difficult for a true emergency to find suitable accommodation.

Mr. B. Newman: Because of the constraints on time, I am only going to ask one other question of you and allow other members of my own caucus the opportunity. Is the decision on the burn unit in the community going to be a decision of your ministry? Or is it going to be a decision of the local health council as to where it is going to be located? The best information that I have is it is going to be located in Metropolitan Hospital. Do you decide or does the health council decide?

Hon. F. S. Miller: I lost the first part of your question; I am sorry.

Mr. B. Newman: It’s on the burn unit the firemen in the community were going to set up in one of the hospitals. They have raised all the funds for it. You will recall that at one time we met in your office concerning that.

Hon. F. S. Miller: You will also recall that the reason the burn unit wasn’t in place was that it wasn’t the highest priority at the local level.

Mr. B. Newman: Right.

Hon. F. S. Miller: We accepted that yet again we were blamed for the lack of implementation of that particular unit with which we agreed. It is one of those cases where we did exactly what people told us to do. We accepted the local priority. We are accepting local advice on that and will continue to.

Mr. B. Newman: The decision has not been made as yet; am I correct?

Hon. F. S. Miller: I thought it was to go to the Metropolitan, as to its location. I think the question is when?

Mr. Kerrio: Mr. Minister, the last time we were in a contest we were on the same team.

Hon. F. S. Miller: Now we are opposed.

Mr. Kerrio: I have been traded.

I have two areas of interest and one has to do with public labs. I am a proponent of the free enterprise system and I would protect that particular theory which I have in regard to this society of ours but only to the degree that there exists real and honest competition. I think it goes without saying that in my jurisdiction I would like that particular aspect brought into focus in view of what has transpired in hospitals and health care in the province.

I would make a strong point in that particular area. The minute we allow monopolies and we license particular people in certain areas to operate to the point where they can and will take advantage of the public, we all pay quite a large price.

[4:45]

The other area I would touch on briefly has to do with my interest in the closing of hospitals in this province and how it relates not only to your ministry but to the cabinet and to the government. Where I would criticize them is the fact that in the estimates with your House leader I pointed out in my submission, and I would just read this into the record in regards to Wintario funds, that the first day I stood in the Legislature I criticized the fact that Wintario funds were being used in a frivolous way. I will quote directly from Hansard:

“Many members of this House stood before you, Mr. Speaker, and suggested that all sides of the House supported this particular feeling -- that is in regards to using Wintario funds as they are -- but I would make one comment I think would be very valid. I would suggest to you, Mr. Minister, that all members on all sides of the House supported Wintario before we started closing hospitals. I think it’s time to reconsider our priorities and get our house in order.”

Now, the Minister of Culture and Recreation (Mr. Welch) replied and I would quote him:

“Many people have come to me, I am sure, as they have come to you, just remember, and raised some questions about Health and other related fields. I am sure the entire net proceeds of Wintario would in fact go for 2½ days to operate the Ministry of Health.”

Well, Mr. Minister, the very fact that your House leader made that comment indicates that he wasn’t tuned into what I was trying to suggest -- that this government itself is to blame for the over-expansion of hospitals, staffs and that they have to accept the responsibility. I would suggest to you that greater respect would have been gained by using Wintario funds during the term, that you might cut back across the whole health field instead of just zooming in on these particular hospitals. And I think that the people of Ontario feel much that way. I would like to put those comments in the record on behalf of my constituents and myself, and I would just like to hear your comments on those matters.

Hon. F. S. Miller: I will answer both questions quickly. Of course, I defended the private lab system as such, but I also agree it is not a truly competitive system in that we don’t call for prices, we call for delivery of services from one purchaser at one price, in effect. The doctors in many cases really decide where the lab tests go.

One of the problems has been, whether we like it or not, that the private labs have given better service than some of the publicly owned hospitals do, and doctors have tended to go there.

Mr. Martel: It works in reverse though, the same thing in reverse.

Hon. F. S. Miller: You know it has been a very quiet day; it was a very quiet day until you got here. I will ask the chairman to stop interjections.

Interjection.

Hon. F. S. Miller: Mr. Chairman, watch the interjections please, away over on the far side.

Mr. Martel: There was no invitation for the local members at the big bash the other night.

Hon. F. S. Miller: What big bash?

Mr. Martel: In Sudbury.

Hon. F. S. Miller: I never invite the local members of any party to those big bashes. There have never been any Conservatives at one and there has never been any NDP or any Liberals. It is a non-political meeting with the people who are elected or chosen.

Mr. Martel: You would like to make it political by appointing them all.

Mr. Chairman: Order, please -- the hon. minister may continue.

Hon. F. S. Miller: I expect the firmness with him that I expect with others, Mr. Chairman. Okay, the question of --

Mr. Godfrey: Free enterprise labs.

Hon. F. S. Miller: Really, we are finished with that one. We are going to be working on methods of making the labs give us better prices on an overall system of volume-price relationship insofar as we can. And we are going to try to make the hospitals utilize their spare capacities -- the member for Durham West pointed out all those hours of the day and week when lab capacity sometimes remains under-utilized; I think we have to take those into account when we work on them.

As I remember the last topic he talked about -- I had it on my mind before the interjections --

Mr. Kerrio: Wintario.

Hon. F. S. Miller: Wintario, yes. Now let’s be honest, a good deal of Wintario money is going into projects that are related to physical activities in the community. For my money, that’s preventive medicine to a large degree.

You know the real savings in health care will come from changing the lifestyles of this country, not from more medicine. I would suggest to you in its own discreet way anything that encourages physical activity in the community prior to illness will prevent illness. It seems a bit ironic to me, now that I have had this heart attack, that I now am doing all the things that you should do today --

Mr. Swart: Especially him.

Hon. F. S. Miller: Yes, especially you. Think of the six reasons why you might suffer a heart attack. Do you smoke?

Mr. Kerrio: No.

Hon. F. S. Miller: Are you overweight?

Mr. Kerrio: No.

Hon. F. S. Miller: Now, now. You have got to look at that one again.

Are you under stress?

Mr. Angus: He is a Liberal.

Hon. F. S. Miller: Do you have diabetes and so on? Do you take daily exercise? Most of us don’t. I am now on a 16-minute mile once a day, and I am going up to five miles in an hour very shortly, but seriously we need to encourage our people to change their lifestyle before any meaningful change in the level of health care takes place. Frankly, I hope some of the seed money from Wintario for local community centres and things like that will have a real bearing on it --

Mr. Laughren: Are you listening to the NDP health committee?

Hon. F. S. Miller: -- but the fact remains that Wintario was set up to fund those things that were not normally funded from the general revenues of the province.

Second, my attempts to save dollars were not because we couldn’t possibly raise them on the tax base of Ontario, because we could, but in the sincere belief that we were spending money without getting benefits for that money in certain areas of the province and therefore we shouldn’t waste it. They are quite different issues. Why should I waste Wintario money any more than I should waste tax money?

Mr. Kerrio: You would not waste it if you kept hospitals open with it.

Mr. Chairman: I have the names of three speakers from the Liberal Party -- the hon. members for Grey, Erie and Kitchener. Do you want to share the seven minutes remaining until 5 p.m.?

Mr. Breithaupt: Yes, carry on.

Mr. McKessock: I have a few questions and a few comments.

In your opening remarks you said that we have a health system in Ontario that we should be proud of. I would just like to bring to your attention again that some 9,000 people in the area served by the Durham Hospital are proud of that part of the system mainly because it is the part of the system that satisfies their health needs on a local and personalized basis.

If you were really serious about saving money, I wonder why you didn’t leave the hospitals open and cut all hospital budgets by 10 per cent and save five times the amount of money? When you close a hospital, the hospital learns nothing, and when you don’t cut the hospitals’ budgets, they go on spending the same as ever.

I suggested to you, while speaking on health cost restraints, that you should implement an OHIP card similar to a credit card for the people in Ontario so that doctors can’t make a bill for you unless you are there and able to run it through a machine. The way it is now, all they have to do is have a record of your number and then you can be billed any day of the week. I am not suggesting that doctors are doing this, but no doubt some of them are. With the credit card system, you would know that nobody was billing you if you had the card.

Another suggestion was that a small fee be charged to the patients using the system.

I would like to know when you are going to implement some of these suggestions.

I don’t want to thrash old straw either -- being a farmer, I learned a long time ago that it’s futility in doing such -- but the government is doing just that when it makes an application to appeal a court decision that said it acted wrongly in its decision to close the Durham, Chesley, Clinton and Doctors hospitals.

I might say that the newly formed Grey-Bruce health council was very surprised that you still seemed to have a hard-nosed approach to hospital closings when you met with them in Owen Sound a few days ago. Why you did not take the decision of the courts as final is hard to understand. If the government appeals and loses the appeal, and brings the question before the Legislature, it will have to learn the hard way that its actions are not only illegal, but are not supported by the majority in this Legislature.

Hon. F. S. Miller: I have answered the credit card issue twice today, and I think the answers are in the record.

The question of deterrent fees has been discussed many times. I am told by experts it doesn’t work. I reserve the right to change my point of view on it because I have always felt it might.

On the question of a hard-nosed approach in Grey-Bruce, I have talked to a lady who is on the council from Durham and she literally hit me -- she didn’t just almost hit me -- supposedly in good will, but I must admit that when she pats you on the back it’s not easy. I made a very clear statement, and I’ll say it here again, because I don’t say things in private I won’t say in public. I believe, first of all, that we had the right and the duty to appeal the lower court decision to a higher court. That is normal in the procedures of justice. If we win this one, I’m sure the hospitals will feel they should appeal, and I said that earlier today. If we lose at that point, I, as Minister of Health, could not stay in my job if my government was not willing to bring in legislation.

Mr. Deputy Chairman: I understand that there has been some consultation and agreement between the House leader and the whips that the Liberal members will conclude their comments by 5 o’clock. The hon. member for Erie.

Mr. Haggerty: Thank you, Mr. Chairman. I can’t see the clock from here. A look at my watch says I’ve got five or 10 minutes to 5.

Mr. Laughren: Stop wasting time, Ray.

Mr. Haggerty: I was interested in the comments of the leader of the Liberal Party this afternoon concerning the Browndale operations here in Ontario and, in particular, as it relates to the audit. I was most interested in the information that was given to him by the minister as it relates to the per diem rate for the care of the youths at this particular institution of $65 per day. I thought that was rather high in comparison to the Durham Hospital, as I understand the per diem rate there is $70 and you’re getting nursing care 24 hours a day.

It just seems there’s no justice in the system here. Perhaps the leader of the Liberal Party was right in asking for a complete review of the operations of Browndale. I suppose if one looks at the figure of $65 a day, for a youth to be in that institution for perhaps one year would cost almost $25,000 a year, and that raises a question.

I have a newsletter from concerned parents in the Niagara Peninsula about the facilities at the Niagara Centre for Youth Care, and that deals with the emotionally disturbed child or student or youth in the area. It’s a letter from D. N. Teasdale of the Ministry of Health, directed to Dr. G. M. Poulakakis, chairman of the Niagara Centre for Youth Care at St. Catharines, Ont. The letter goes on to say:

“Thank you for your letter of March 8, 1976, regarding the Niagara Centre for Youth Care. I am responding to your inquiry on behalf of Mr. Chatfield, assistant deputy minister, who is out of the city and in my new capacity as general manager of the direct services division.

“I have conferred with Doug Finlay, director of the children’s mental health services branch and he has strongly reaffirmed his support of your proposal for a teenage service system in the Niagara region. Unfortunately, the Minister of Health has been subject to rather serious financial constraints and I regret very much that all expansion plans in the children’s mental health sector have had to be curtailed.”

[5:00]

I find this letter rather disappointing. If there was ever an area that needed additional facilities dealing with mental health services, it is the Niagara region. When I look at the picture that’s presented here this afternoon in the Ontario Legislature, that it could cost $25,000 a year to look after a youth under the Browndale system in Ontario, I would have to question that most sincerely. There must be something wrong with the operations there. That $25,000 would go a long way to help in the Niagara region with a centre there, which is lacking. Thank God that we have had LIP grants that provided assistance in this particular programme in the area. But I say this much, there is definitely a need in the Peninsula for additional health care services for the youth of the area, particularly those who want to go to a centre for perhaps two or three hours a day or something like that. I mean people who really need help, mental help. I find that there is very little in services that are offered to them today. I would appreciate if the minister would take into consideration some of the suggestions that I have presented to him this afternoon and provide the Niagara Peninsula with additional funding.

Hon. F. S. Miller: Mr. Chairman, first of all we had approved in principle the Niagara programme, but I wonder if the member knows that the original budget was in the order of $1 million a year.

Mr. Haggerty: That was for a new centre.

Hon. F. S. Miller: That was the annual operating budget.

Mr. Breithaupt: I have a number of items I would like to review briefly with the minister and I will take about a moment for each of them.

First of all, with respect to the matter of podiatry services, I am wondering if the minister can now advise us when I we might expect to receive the new and comprehensive Act which has been promised to the podiatrists operating in Ontario. I understand that they are operating under the original Chiropody Act of 1944 and that at the present time there are a number of services which they are providing that, in fact, are much more expensive when done in hospital.

I had particular information with respect to some kinds of services, for example, where independent minor procedures are defined that show that services, in this instance for a bilateral ontoplasty, will be paid for at $240 under the OHIP programme to a physician, but the same procedure which might well be less than $20 within an office is not paid for. I am wondering if the minister can advise me when the podiatrists can expect to have new legislation which will enable them to provide services at much less expense than appears otherwise to be the case.

Hon. F. S. Miller: I think the member has obviously been spoken to by certain segments of the professional group. I am fairly familiar with this particular problem. I would think if you check the rates per hour in the health field no one is making the money podiatrists are. The podiatrists are really doing very well.

We have two categories of people qualified to provide health care -- podiatrlsts who are American-trained; chiropodists who are British-trained; we have, in fact, just gone through the description of the scope of practice and I think it is no secret to say that it’s our opinion that the podiatrists’ training is in excess of that needed.

In fact, the services rendered by them are much more costly than the same services rendered by a physician. If one looks across the records and sees the assessments and the work performed by them, sometimes one wonders if everybody suffers from the same problem. They will come into a nursing home, for example, particularly in the border cities and go through it and sometimes make, I am I told, as much as $2,000 in an hour. You are aware of this, I am sure.

Mr. Godfrey: Why do you permit that?

Hon. F. S. Miller: Well, this is the way the Act reads right now, and this is one of the reasons why we feel that we have to provide more providers of health care for the foot, and it can be done at a much lower rate by those people who are called chiropodists. I assume that the new scope of practice which will be incorporated in the health disciplines bill as quickly as I can get it there -- hopefully in the fall -- should define clearly who can do it, what can be done, what training is required, and a new rate structure would then evolve from it.

Mr. Breithaupt: Just two other brief matters. First of all, can the minister advise us of the response that he has made to the letter from the physiotherapy association with respect to the rate structure and situation in which they find themselves? The information we had received, as members, was that the fee level has been held at the same for the past 10 years. No applications for opening new practices had been granted and the billing privileges could not be transferred. At least, that is the information which came from Miss Jean H. Scott. I am wondering if you can give us any update as to the current situation with respect to physiotherapy?

Hon. F. S. Miller: Again your sources of information are giving you some truths and some not-so-truths. First, the rates have been changed at least three times that I know of in the last four years. Okay? They were, as I recall, about $3.25 per service rendered -- $3.45? They’re $5.45 right now -- a difference of $2 or 60 per cent.

Secondly, we haven’t licensed any fee-for- service physiotherapists for the last while because we believe that’s one service best given in a hospital under the direction of a doctor. I expect no argument from the member for Durham West on this one --

Mr. Godfrey: You can get an argument from me on any subject.

Hon. F. S. Miller: Then I’ll clearly state my position. We are providing adequate services at a theoretical book value in the hospital. There’s been some argument from the physiotherapists that the figure we use in the hospitals -- which is $5.55, and their figure $5.45 -- give the hospitals an advantage. That is not true. We do not flow funds to a hospital at $5.55. It’s what we call offset revenue. It happened to be 10 per cent on $5.05 which brought it to $5.55, whereas the increase for physiotherapists in fee-for-service was eight per cent. All hospital services including physiotherapy theoretically went up 10 per cent this year for offset revenue purposes. It’s a bookkeeping error that I am going to rectify before the year end, because I want the rate to be the same both for the fee-for-service or in hospital.

Mr. Breithaupt: The final point I wanted to review with the minister is simply the experience they have had with respect to dental procedures in hospitals since June 1. As I recall, the circumstances were such that the ministry felt that various dental procedures were being unnecessarily attended to within hospital. However some information that has come to a number of the members, and certainly a letter that has come to me from a dentist in the Kitchener area, has been that there are many procedures which are simply not being attended to now because the dental surgeons are far too busy for the work that has to be done. This dentist refers to a series of examples which I will not go into at this point, other than to remind the various members that the procedures which apparently are now in place are at least said to result in less work being accomplished. This is work that in fact should be done, and work particularly dealing with younger people.

Can the minister advise me his response with respect to how these procedures are working out and when he expects to have an overall view on this particular situation?

Hon. F. S. Miller: It’s too early, of course, to tell what’s happened between June 1 and now. I just don’t have any data. I can say, though, that in the main the dentists agreed with the change. It was their feeling that under the old system there was a very real incentive for pressure to be put upon the dentists by a patient who insisted that a certain number of teeth or a certain number of procedures be carried out that would be insured if done in hospital. Often this involved removing teeth that didn’t need to be removed. Dentists often did it because they knew that if they didn’t, their neighbour would or they’d lose their patient.

In effect we still pay for hospital services, not the dental surgeon’s services, where it is deemed medically necessary.

Vote 3002 agreed to.

Mr. Deputy Chairman: Before we start vote 3003, the Chair would like some direction. I have an indication from the caucuses that there are various members who would like to speak on the three items. Is it the wish of the committee that we take them in order?

Mr. Breithaupt: Mr. Chairman, there are a number of speakers, I realize, on this. However, we had the advantage on this last vote of having a number of our members speak one after each other. I think that that opportunity should be afforded to the New Democratic Party, under the direction of their health critic. I presume that in the next 50 minutes or hour or so that can be attended to, so their members can get their comments in on this vote. Then we can agree to share whatever time is left over.

Mr. Deputy Chairman: Perhaps I should mention that I understand there’s one member of the government caucus who might like to speak on this estimate, so we would have to alternate.

On vote 3003:

Mr. Deputy Chairman: Order, please. The hon. member for --

Mr. Kennedy: I think you put the question or asked the advice of the members should we take the three items together in this vote. That wasn’t answered.

Mr. Deputy Chairman: Agreed?

Mr. Kennedy: Will we take them together?

Mr. Deputy Chairman: Agreed.

Mr. Conway: Give him hell, Floyd.

Mr. Deputy Chairman: Incidentally, we have one hour and 33 minutes left in this debate on the estimates of the Ministry of Health.

Mr. Laughren: Mr. Chairman, I’d like to spend a few minutes talking about the problems of occupational health in Ontario. During his leadoff, my colleague from Parkdale (Mr. Dukszta) drew some pretty heavy lines between the government’s attitude towards occupational health and our own attitude. I’d like to not only endorse his comments but expand an them a little.

My colleague made the point that occupational diseases are a class issue; that of course is true. I suspect that is one reason the government has such difficulty dealing with the problem. It must be very difficult for the Progressive Conservative cabinet ministers, in their aristocratic splendour, to understand what it is that a worker goes through when he’s faced with the problem of health on the job. It must be very difficult for this minister even to understand what a man goes through when he’s told that his employment is unsafe.

I’d like to give you a very brief example of a man who worked at the Reeves asbestos mine in northeastern Ontario, which just happens to be in the riding of Nickel Belt. I know this man very well. He was a member of the New Democratic Party, had been for some time and knew why he was a member of the New Democratic Party.

When the Reeves mine closed, this man, in a moment of despair, frustration, anger and desperation in the local pub one night, took his NDP card out of his wallet and set fire to it in the hotel. There was great chuckling by some people when he did that. Of course, the reason he did that was that he saw the New Democratic Party as having cost him his job when Reeves asbestos mine was closed, because it could not meet the dust standards set down by the Ontario government.

I’m sure there are members of the government who will get some pleasure at that. As a matter of fact, the member for Algoma-Manitoulin (Mr. Lane) made what he considered mileage in Elliot Lake prior to the last election when he warned people that if the New Democratic Party formed the government in 1975, the future of Elliot Lake would certainly be cloudy. Well, that’s the kind of shoddy politics that the province doesn’t need.

I wonder if the minister can really understand what a man like that goes through when he’s given that kind of choice -- either to continue to work under unsafe conditions, go on unemployment insurance, go on welfare, try and find another job. When you have a family and you live in northern Ontario that’s not always easy. Their options are extremely limited. Unlike the options of the minister or most of us in this chamber, the options of these people are extremely limited and they’re faced with a Hobson’s choice of not being able to win. A combination of free-enterprise exploitation for profit and government endorsation of that principle forces the workers to make a decision that none of us should ever have to make.

No single issue in my 4½ years in Queen’s Park has so fortified my commitment to socialism as the whole question of occupational health. No other issue presents in such stark relief the underlying morality of the economic system in the Province of Ontario. Because we all know that if the costs were not so high, not so great, if the stakes were not so high, that the conditions could be cleaned up.

We know that the conditions at the asbestos mines could have been improved and could have been improved a long time ago. We know that both the government and industry would not have allowed those conditions to continue if the stakes had not been so high in terms of profits.

[5:15]

It’s clear to us as well that the government’s intention to co-ordinate the various ministries in a new accord is a wrong approach. Even putting the Ministry of Health in charge is the wrong approach. That indicates that the government still regards occupational health as the problem of identifying diseases or injuries and then trying to treat them. This perpetuates the emphasis on disease and on accidents rather than on prevention and ways to avoid these dangerous conditions from arising in the first place.

Surely we should be concentrating on occupational health as an engineering problem, and not as a medical one. That’s where it all begins. And that is what my colleague was saying in his leadoff when he talked about the whole question of preventive care as opposed to curative care.

I am personally very much worried about the future of occupational health, not just in this jurisdiction, but in all others as well. I’m worried that we are going to continue to have a series of post mortems -- such as we’ve had on asbestos, such as we’ve had on uranium, such as we’ve had on the coke evens, the nickel sintering plants, and so forth. I can tell you, without fearmongering, that Sarnia scares the wits out of me. The petrochemical industry in Sarnia really terrifies me as to what the story is going to be in the years to come, because of the gestation period of the various cancers. We simply must have a major commitment on this problem from government.

We know that already other jurisdictions are ahead of us in the occupational health field. In the United States, the mining safety administration, which sets up and enforces standards for mines, already states that no new mine space can be developed until ventilation plans are approved. In Ontario, we tend to look at the problem and say: “Well, if there is dust there put on a respirator.” Respirators are not the answer. Most people knew that a long time ago, and I’m not too sure this government realizes that.

In Great Britain, the Health and Safety at Work Act in 1974 had some very specific regulations in it. Each employer is required to produce written statements of policy on health and safety. The government establishes threshold limit values and a code of practice for each hazardous chemical. The industry must get approval for its code of practice and handling of toxic substances. And the government enforces both in-plant and out-of-plant standards. That’s Great Britain’s approach.

Mr. Conway: Sounds like socialism.

Mr. Laughren: I was going to tell you about the Saskatchewan government’s approach to occupational health, which my colleague mentioned as well.

There are three basic principles of a good occupational health model. I would like to suggest to the minister that he seriously consider it and that he implement this in Ontario, rather than this accord he talks about. We’ve already seen how the accord works -- plain and simply it doesn’t work. In Saskatchewan there are three basic principles.

The first is the consolidation of responsibility for all health and safety matters within the occupational health and safety division of the Department of Labour.

I think it is important that it is in the Department of Labour there, rather than the Department of Health, because they, too, see it as a problem of prevention, not of cure.

There is also the mandatory establishment of a joint employer-employee occupational health and safety committee at every work place where there are 10 or more persons employed -- I would refer the minister to the private member’s bill introduced by my colleague from Sudbury East (Mr. Martel). These committees were given the primary responsibility for identifying and solving health and safety problems in the work place. This government hasn’t done anything about that.

The third principle is that an employee may refuse to work under conditions he believes might be dangerous to his safety or health. Surely, that right should be basic. That should be a civil right in the Province of Ontario.

What is so crucial about the Saskatchewan plan is the involvement of the workers themselves. In Ontario you can bet your bottom dollar that this government will never ever see that.

I wonder whether the minister understands that he cannot possibly hire enough inspectors to conduct the inspection across Ontario. You can’t do it. And as long as you are saying that it is government inspectors who must carry out the inspections, you are going to always be faced with a backlog; you are always going to be under fire and suspicion.

Hon. F. S. Miller: I don’t say that.

Mr. Laughren: You stood up one day and said that you would hire these new people in the ministry. It was the same thrust as previously with occupational health.

The workers are right there in the work place. They can identify the problems; they can bring them to the attention of the occupational health ministry, or the particular ministry that is responsible for occupational health. And, probably more important than anything else, the workers have more at stake than any government inspector ever will have. I don’t know what more you could ask than that the people who are doing the inspecting have a great deal at stake.

So once again it’s a class distinction and this government just cannot seem to bring itself to believe that workers can be perceptive, intelligent, honest, and even objective. You don’t believe that, do you?

Hon. F. S. Miller: Mr. Chairman, I just have to interrupt here because the idea that somehow I come from one class and you come from another class is absolute baloney.

Mr. Laughren: It is not baloney.

Hon. F. S. Miller: My father got to grade 2; that’s it, period.

Mr. Martel: It is your government.

Hon. F. S. Miller: I am the one member of the family who got to university by my own hands.

Mr. Dukszta: What has that got to do with it?

Hon. F. S. Miller: I am tired of this talk about class versus class. You have as much responsibility in this as I have. I don’t want a class confrontation in resolving this problem, and as long as you fellows try to manipulate the workers --

Mr. Martel: Oh, no, we’re not.

Hon. F. S. Miller: -- that way you will have a confrontation between management and labour. I agree with you, the best guys on the job to help us are the workers. Let’s enlist them.

Mr. Martel: Bring forward my bill then.

Mr. Laughren: Mr. Chairman, it’s interesting to see the Liberals applauding the minister when he decries the presence of a class system in the Province of Ontario, and I ask him to explain how it is that only the working class in Ontario suffer from occupational health diseases and accidents? How does he explain that? Is it a coincidence? Besides, I am not talking about the minister, I am talking about the government he represents.

Mr. Conway: Frankly, I think that stuff annoys him.

Mr. Laughren: Well, I know the Liberal Party doesn’t like to think about things that way. As for the minister’s suggestion that we are manipulating the workers in Ontario, I find that most offensive, and it is just a way of avoiding the whole problem of occupational health.

Hon. F. S. Miller: Are you saying I am?

Mr. Laughren: You know what it’s like saying? It’s like the Minister of Labour saying that the workers in Ontario are using occupational health as a bargaining tool. I want to tell you something, if the government of Ontario did the job they would never have to even have occupational health on the bargaining table. But you don’t let them do that. You make them bargain for it. You make them fight for healthy working conditions. That should be their right, it should not be something they either have to bargain for or that they have to come on their knees to the Legislature for, and yet this minister doesn’t seem to understand that.

Hon. F. S. Miller: I understand it very well.

Mr. Martel: Do something about it then.

Hon. F. S. Miller: We have done more than any other government ever has.

Mr. Laughren: Well, you know, you talk of --

Mr. Martel: Oh, in Ontario, but that doesn’t mean very much.

Mr. Deputy Chairman: Order, please.

Mr. Laughren: Well, Mr. Chairman, the minister agrees that the workers know more about problems on the job and have more at stake with occupational health. Why doesn’t he implement the worker committees, with 50 per cent representation by workers, and 50 per cent by management? How can he sit there and say that we don’t have a class system and that the workers are the victims of that class system, when we have the examples of the Reeves mine, Matachewan, Elliot Lake, the sintering plant in Sudbury, the Johns-Manville plant in Scarborough? How can you say that?

And you know what, there was even a separation of the drinking water at Elliot Lake. Now if you can tell me how that’s not a class system, then you are going to have of -- some long explanations to give us. Every time I think of the mines in Ontario, and I think of the Ministry of Natural Resources, I really have difficulty being civil.

Mr. Hodgson: They are doing a great job.

Mr. Laughren: I tell you something, I am glad you said that because the Minister of Natural Resources (Mr. Bernier) is not doing a fine job.

Mr. Hodgson: Yes he is.

Mr. Laughren: I want to tell you something, the Minister of Natural Resources manifests everything in Ontario that is stupid about occupational health, and everything that’s on class lines, which the Minister of Health so strenuously objects to.

Mr. Kerrio: You just drove the minister out.

Mr. Laughren: Do you really think it’s a coincidence that Elliot Lake, the Reeves mine, Matachewan, the sintering plant, all fall under the jurisdiction of the Minister of Natural Resources? Do you think it’s a coincidence?

Mr. Hodgson: Do you think we should shut them all down?

Mr. Laughren: Do you think it’s a coincidence that the ministry had access to all those dust counts and exposure figures for years and did absolutely nothing about it; didn’t tell the workers about it, didn’t tell the union about it?

Mr. Martel: Didn’t clean up a damned thing.

Mr. Laughren: They didn’t clean up anything until they were politically embarrassed about it. That’s the height of political cynicism. I am glad that the member for Algoma-Manitoulin is here, because he has been a party to it.

Mr. Conway: Did Steve Roman not give you money for your campaign?

Mr. Laughren: No, I am glad to say he didn’t.

Mr. Lane: On a point of privilege.

Mr. Deputy Chairman: Would the hon. member state his point of privilege?

Mr. Lane: The NDP would not even allow the ministers to tell the people at Elliot Lake what we are prepared to do for them when we went there a year ago last summer. They have no room to talk. I have done more for Elliot Lake than all those people put together.

Interjections.

Mr. Martel: That’s right.

Mr. Deputy Chairman: Order, please. The hon. member will continue.

Mr. Kerrio: I believe that.

Mr. Hodgson: They don’t have to do much either.

Mr. Deputy Chairman: Order.

Mr. Laughren: I would like to make a couple of comments about Elliot Lake because that’s the place where at least 41 miners have died of lung cancer and more than 150 are suffering from the effects of silica dust. The Minister of Natural Resources had readings of exposure to dust and radiation which were never ever revealed to the miners.

Mr. Martel: That is your government, John.

Mr. Laughren: Tell me how you justify that? There is no justification for that at all. It demonstrates a morality I cannot bring myself to say any more about.

Mr. Lane: You fellows think that everyone within a radius of a few miles of Elliot Lake has silicosis.

Mr. Conway: Is it immoral for them?

Mr. Laughren: It demonstrates the morality of a clam.

At Matachewan, workers were allowed to work in dusty conditions for seven months despite Ministry of Natural Resources inspectors’ reports citing the dangers of the dust -- for seven months. Given the history of asbestos in the United States, how in the world could the Ministry of Natural Resources sit on those reports without doing anything about them?

Mr. Dukszta: And the Ministry of Health.

Mr. Laughren: And the Ministry of Health, the occupational health branch?

Mr. Martel: That’s with Bernier.

Mr. Laughren: It really is a sad tale. At the Reeves mine -- probably the saddest tale of all is at Reeves mine -- the ministry took readings or dust counts for eight years and never told the workers how high they were although the readings were as high as 40 times the level accepted by the Ontario government.

I would like to say a word about the levels because they are really mind-boggling. The level of acceptance in Ontario is two fibres per cubic centimetre of air. At two fibres per cubic centimetre of air, in an eight-hour shift a worker would breathe in 16 million fibres.

If the count was 225 -- there was a dust count at Reeves mine in which there were 225 fibres per cubic centimetre; I am using the top count deliberately -- the worker would inhale 1.6 billion fibres in an eight-hour shift. Once those fibres are in the worker’s lungs, they never ever leave. The Ministry of Natural Resources knew that.

There could be no excuse for that kind of negligence. I wish a class action for criminal negligence could be brought against the Ministry of Natural Resources, the minister himself, Rio Algom, Denison, Johns-Manville and United Asbestos because they all had to know. Their own standards were being violated so they all had to know.

With uranium, since 1926, the experts have known the dangers of uranium mining from both silica dust and uranium exposure.

At Elliot Lake, the silica dust readings were exceeded as late as 1974 and between 1958 and 1974, I think it was, of the 120 silica dust readings at Rio Algom only two were below the recommended level. At Denison, only eight out of 202 readings were below the recommended level. That was in 1974. Between 1958 and 1974 dust levels never once averaged below the 200 particles per cubic centimeter of air. That standard was set by the industry itself.

You have a situation in which the industry itself sets the standard and then exceeds it continually on an average from 1958 to 1974. The government knew but never told the miners. That’s the kind of negligence which simply cannot be tolerated.

[5:30]

The Minister of Natural Resources is supposed to be the steward of the resources of Ontario. I would just say to this minister, while it is not his responsibility, thank God that no more authority is moving into the Minister of Natural Resources’ field, because to have sold out our natural resources is one thing, but to sell out the workers is an entirely different matter.

I am sorely tempted to talk about the role of the Workmen’s Compensation Board, but I will restrain myself. I will just say that they are another shining example of ineptitude

They have tended to act as a buffer between the workers and the companies, and that’s a sad commentary on the Workmen’s Compensation Board. Sometimes I think if it weren’t for the Workmen’s Compensation Board, the resource corporations in this province would be in court continually defending themselves against criminal actions. And when I hear the Minister of Labour (B. Stephenson) stand up and make the kind of fatuous statement she made today about the Workmen’s Compensation Board, I hate to say it but it really does turn my stomach, because we have had too much exposure to the Workmen’s Compensation Board and the heavy-handed, ham-fisted way that they conduct themselves.

I would like to make some very specific recommendations on occupational health. I would say that the minister could start by looking at the Saskatchewan model, which is what at least some of these recommendations are based on. No. 1, there should be workers’ committees in all places of employment where there are more than 10 employees and, as well, training courses should be set up.

Mr. Haggerty: You wouldn’t support my bill. You turned it down.

Mr. Laughren: No. 2, the workers should have a right to refuse to work in conditions that they regard as being unsafe. No. 3, there should either be a separate ministry of occupational health or it should come under the Ministry of Labour. No. 4, the threshold limit value concept should be very closely examined. Certainly as it relates to asbestos, the threshold limit value should at least be down to one now, but I can tell you that I don’t like the whole concept of threshold limit values because, as sure as shooting when you get down to two, then the companies stop looking for ways of making it better. There is a report from the Health Policy Advisory Centre in the United States about threshold limit values -- and I think the minister would be well advised to heed this; it’s talking about lowering the threshold limit value for asbestos from five to two:

“There is no assurance that workers will stop dying from this level of exposure any more than they stopped dying when previous levels were lowered. There is no scientific evidence to suggest that two fibres per cubic centimetre exposure is not hazardous to the health of workers. Indeed, many experts believe that the only safe level of exposure is no exposure at all.”

That really should be the goal of anybody working with occupational health in Ontario.

No. 5, we should adopt the Great Britain model, which requires that when new products are introduced, the companies must indicate how they are going to handle them, particularly toxic substances.

No. 6, there should be a research institution established along the lines of the National Institute for Occupational Safety and Health in the United States, and their reports should be made public.

No. 7, we need a combination of incentives and fines for industry to make sure they do adhere to the new rules.

And, No. 8, there should be proper compensation and rehabilitation. Despite the comments of the Minister of Labour, rehabilitation in Ontario is a joke. How would you like to lose a foot and get compensated at 25 per cent of 75 per cent of your pre-injury earnings? Imagine a construction worker getting a foot chopped off and then being put on a pension of 25 per cent of 75 per cent of his earnings. What could be more ludicrous than that kind of compensation?

The Minister of Labour has the gall to stand up and say that we have a good rehabilitation and compensation system in Ontario. It truly is a joke.

In the final analysis, the problem of occupational health is indeed a class problem. Workers are suffering from industrial accidents and diseases while our health system concentrates on more other middle-class problems. Only when we allow workers to control their own work environment will we make meaningful strides. You as a government will not make those meaningful strides, because you don’t believe that workers should have that right. Also, safe working conditions are not something that should be bargained. Safe working conditions should be a right.

I would like to say a few words about health care in northern Ontario, which comes under this vote as well; I will try and be very brief.

There was a report done by the Ministry of Health on health policy for northwestern Ontario and a review of the northwestern Design for Development: Phase 2. In that report they are very specific. I want to tell you that there’s a heck of a difference between the contents of that report and the contents of the northeastern Ontario regional strategy which was published. One dealt with the northwest; the other with the northeast, but this was a working paper. This was for public consumption. This became a political document, a highly suspect political document. The report documents the shortage of health care in northwestern Ontario and I have no doubt but that the same applies to northeastern Ontario having some experience in that way myself. The report indicates that there is a shortage of doctors, dentists, nurses, chronic hospital beds, psychiatric hospital beds and nursing home beds.

Using the statistics, using a physician-to- population ratio, the provincial average in 1973 was one for every 595 persons. In Algoma it is one for every 968; in Cochrane, one for every 1,100; in Sudbury, one for every 1,085; Thunder Bay, one for every 774; Timiskaming, one for every 1,013; Manitoulin, one for every 1,816; and in Kenora, one for every 1,206. In Toronto, I might add, it is one for every 438. That’s physicians.

For dentists, the provincial average is 42.67 dentists for every 100,000 population. That’s the provincial average. In Algoma it’s 25.62; Cochrane, 20.9; Sudbury, 22.78; Timiskaming, 19.31; Manitoulin, 18.35; and Kenora, 22.60. In York it’s 55.75, or twice as many as any region in northern Ontario.

That’s the kind of health service we have in northern Ontario as implemented by this government and I suspect that these figures underestimate the problem in the smaller, more remote communities. It is time the government realized that the physician model is not sufficient for small communities in northern Ontario. Why don’t we get into the paramedical field? Why don’t we train nurse practitioners to work in the small communities? Why don’t we have some more clinics -- dental and health clinics -- to travel across northern Ontario? Surely that’s not asking too much.

Once again I don’t like to criticize without giving you some constructive alternatives. I know the minister is waiting for that. This is what we would do and what we suggest you do in the interim period while you are looking after the affairs of the Province of Ontario:

1. Priorities to be placed on training primary-care workers who are committed to working in non-urban centres. These workers may not be doctors.

2. Both McMaster and the University of Toronto should be encouraged to expand the programmes of visiting specialists with an emphasis placed on using the same group as regularly as possible to improve continuity of care.

3. The province should be willing to undertake to build and staff some primary-care centres in the north and perhaps several, using different combinations of personnel.

Again the development and use of alternative primary-care workers, both medical and dental, is essential. Those are some of the things that we think you should do to improve conditions in northern Ontario. We know, for example, that there are some communities that haven’t had a dentist visit them for as long as seven years.

Finally, and I know I am taking up too much time, the Ministry of Health has a task force on mercury poisoning. I would just like to suggest to the minister that he implement at least the three -- well, more than that -- but the three recommendations in chapter 10 of that report the task force did. It has to do with fishing. This is to do with the Whitedog and Grassy Narrows reserves:

1. Fish from the Wabigoon and lower English River systems not be used for human or animal food.

2. It is recognized that the most effective method of achieving recommendation 1 is to close the waterway to all forms of fishing. In particular this would protect the fishing guides who are the population most at risk.

3. The commercial fishery remains closed in the English-Wabigoon system until the mercury levels in the fish reach acceptable levels from the health viewpoint.

There are other recommendations but a lot of them deal with the responsibility at the federal level of government. I’d sure like to know from the minister, not only in response to the question on occupational health, but also when can we expect an announcement as to what he intends to do about the fishing in the Grassy Narrows-Whitedog reserve area?

Thank you, Mr. Chairman.

Hon. F. S. Miller: Mr. Chairman, I’ll try to be brief, because I know there are a number of other speakers on that side of the House who’d like to talk to me about this programme.

You and I have the same goal, and if you’re sincere I think we can do a lot toward resolving some of the occupational health problems. I do sincerely want to remove them from the political arena and from the class arena, and I say that with every bit of sincerity I can muster. Look, I’ve worked in those kinds of plants, therefore I’m not unaware of the problem.

I have a son right now in one who has to wear earplugs, masks and special protective clothing to keep the dusts and the hazards away from him. And that’s not in this province, it’s in another province where I can tell you from having visited the plant -- it’s BC -- the risks are a lot worse than they are here. A lot worse. I have a son who’s a farmer, and I don’t know how you put that in the category of classes, but they’re certainly at the low end of the income scale.

I’d like to put the thought, though, that it’s a three-way problem rather than a confrontation. Government has a role to play, labour and management have a role to play, and all three have to work together.

Mr. Haggerty: You’d never know it.

Hon. F. S. Miller: I do not like the fact that the current regulations, I believe, prevent me or even the Minister of Labour at times from divulging test results without the consent of the companies, and I think both she and I are agreed that full disclosure of hazards is the first step toward confidence, the first step toward getting co-operation between the workers and the management. They need to talk about mutual problems. If they don’t resolve it, both sides lose. It’s not only the health of the worker, which is critical, but in this day and age you know we’ll be forced to move to eliminate job opportunities if those problems aren’t resolved.

So I can only say that just as the Advisory Council on Occupational and Environmental Health contains an equal number of management and labour people and I believe is working sincerely to set the standards and to look at the problems we have from our ministry’s point of view, so I can see that the workers’ committees and the management committees in the long run may be the way to resolve the problem. I’m not going to argue with you at all.

Mr. Laughren: Would you permit a question?

Hon. F. S. Miller: Sure.

Mr. Laughren: Did I understand you correctly that the regulations of your ministry -- your ministry’s regulations?

Hon. F. S. Miller: No, not my ministry.

Mr. Laughren: Which one?

Hon. F. S. Miller: The Ministry of Labour.

Mr. Laughren: The Ministry of Labour regulations prevent the release of data without approval from management?

Hon. F. S. Miller: Yes. Right now --

Mr. Laughren: Incredible.

Hon. F. S. Miller: Somebody can clarify it for me. The Minister of Labour and I were talking about this outside the House here today and she has discovered -- I think she can release them. Is it the chief inspector in her ministry? Yes, the chief inspector in her ministry can make a discretionary decision, so I should say I’m wrong on that point. I can’t release them. Labour can. Okay?

But the tradition has been, I understand, to request that the information could be made public. Of late, we’ve not been following that procedure, as you probably know. We’ve been divulging information at United Asbestos and other places as soon as it became available to us or the Ministry of Natural Resources.

But, no matter what, I think it’s critical that full disclosure of test results be made. I don’t think you’ll have the confidence from the working place until you do that. I also think that one has to be as impartial and as scientific as one can be in appraising the risks involved in working in a given atmosphere.

You talked about the two particles of asbestos versus the five. Ontario did accept two particles per cc and you know the States hasn’t. The States is still at five.

[5:45]

You say Dr. Selikoff or some other authority has claimed that there’s no evidence that two ccs is safe, and quite properly you quote an astronomical number of fibres inhaled per day. What you forget is an equally astronomical number are exhaled or caught within the systems of our bodies and, therefore, don’t get to the lungs. What you forget perhaps is that the two particles per cc standard was based on a scientific study that certainly good authorities looked at. I believe it was a British study, I believe it was in 1968, and I believe it showed that workers working in that kind of atmosphere for a 50-year period of time had a one per cent chance of contracting asbestosis. Does that sound right to you, doctor?

I would suggest to you one has to relate that risk of a one per cent chance. Dr. Selikoff has the right to disagree. I’m only telling you that the weight of scientific evidence accepted right now and being reviewed by our advisory committee says that study appears to be valid. There’s no study insofar as I know that talks about the 0.5 level.

What may not be admitted too often is that we haven’t got a documented case that I know of of cancer of the lung in an asbestos worker where the worker wasn’t a smoker. This is one of the things we have to stress over and over and over again -- that cancer of the lung, in certain work sites like the mines and the asbestos plants --

Mr. Dukszta: That’s not true.

Hon. F. S. Miller: All right, I’m only making a statement and I’m not claiming to be categorically correct. I am told it is correct.

Mr. Moffatt: It’s not right.

Hon. F. S. Miller: I’m qualifying it, and as long as I qualify it I think that’s fair. The information I have says it. Please, bring me your counterproofs, okay? I’m willing to look at them. That’s all I suggest to you.

Let’s tackle this thing not as you against us. We are not opposed to you. We are doing something about this better than most areas. It’s great to talk about Saskatchewan -- Saskatchewan doesn’t have the industry we have up to date.

Mr. Haggerty: In comparison they do.

Hon. F. S. Miller: They’re also, by the way, making major cuts in their health programme this year -- something which people don’t seem to talk about on that side of the House too much.

You talked about the north and quoted figures on doctors. We admit the north is under serviced, and you know we’ve done a pretty good job of attracting doctors to that area. The fact remains though that Toronto has a very high concentration of highly trained specialists. I would say the ratio of GPs to the population needs to be somewhere in the range of 1,200 or 1,300 persons per GP. If you use that as a round figure that’s not too far off, and that’s including all the doctors in the area, not necessarily just the doctors working full time at practice. And when one allows for 10 per cent or 15 per cent of the physicians in Ontario who probably aren’t in full-time practice, the ratio would probably be closer to 1,500 people per GP in a normal serviced area.

There should be roughly one specialist for every GP in the province. We say 55 per cent GP and 55 to 45 -- 45 per cent specialist -- is the desirable ratio. That doesn’t mean the specialist must be in the area where you did your head count, as long as you understand that. So, a one to 1,300 ration or one to 1,500 ratio of people per physician where that physician is a GP isn’t bad.

You referred briefly to nurse practitioners programmes and paramedical programmes. We have a couple of them going. I would say to you that our biggest problem is not so much to get more nurse practitioners but to get a better distribution of physicians within the province, and that’s what we want to aim at. We already have more physicians than we need in total -- we just don’t have them in all the localities.

Mr. Laughren: Never can get physicians --

Hon. F. S. Miller: You know, I went and opened a clinic in the smallest community in Muskoka last Saturday -- the village of MacTier. You know it, I’m sure -- it’s on the CPR main line. It’s a community that hasn’t got much of an economic base of any kind, I think you’d agree. It’s got more poverty perhaps than most of the Muskoka communities, and none of them are rich in terms of average income.

Mr. Laughren: Is that your idea of a remote community?

Hon. F. S. Miller: I’m not talking about it as remote, I’m talking about it as a small community that’s perhaps 30 miles from Parry Sound. It’s probably 40 miles from Bracebridge, and those are the two hospitals to which it can relate. It was one of the last ones for us to designate for medical services. I was there helping them open their new medical clinic and meeting their new doctor last week. It’s got to the point where south of the French River we really don’t have a shortage any more. North of the French River we have enough doctors in training or committed to fill every designated need right now.

Dental problems are a little different. We are short of dentists and we are going the paradental route. We are training three categories of technicians to multiply the effectiveness of the dentists as they graduate, rather than increasing the number of dentists to supply all our needs. The service will be better and I think cheaper in the long run following that route.

Mr. Laughren: For just a second, could I ask the minister if he intends to make a statement, and when, on the problem of fishing in the Wabigoon?

Hon. F. S. Miller: I’m sorry. I didn’t mark the note down and I should have at the end there.

You know I rushed this out today and, if you perused it, you’ll see that there are still editing errors in it. We didn’t try to say that every word in the final printed version would be the way it is. We felt that this was the best form for discussion, albeit on short notice. I have to tell you, my staff had to work miracles to get it here today.

We’re going to take seriously the recommendations here. They fall under the three main types. First, the dietary problems of trying to educate the Indians to eat other than fish as a part of their diet, or a bigger part of their diet. The federal report of a week or two ago stressed the problems in this.

The second thing is the study that we need to perform to see whether, in fact, we have a serious problem or not. I think the report categorically says: “No single case of mercury poisoning has been diagnosed yet.” But it qualifies and says: “Indians in that area have mercury levels in the blood in the range of people in Iraq who exhibited some of the symptoms of mercury poisoning.” We say there is a risk therefore we should, obviously, make sure that the people at risk limit their overall intake of mercury. The report goes on to point out that it’s not the quantity of mercury in a given fish that matters but the total amount you ingest per week. So you might be talking 0.5 fish and still be eating enough to cause the problems to the individual.

I don’t think we would carry out the study, albeit that I would recommend it and sure our government would recommend it, until we felt we had the understanding and co-operation of the Indians. I think it’s essential to talk to them and the federal government before doing it.

Mr. McClellan: You’re going to have to win that.

Hon. F. S. Miller: I understand that. I understand that you would have to win it back too. It’s not a bias against the Conservative government or the Liberal government. It’s a bias against the white man, and a very understandable bias. We have to work to resolve that.

Mr. McClellan: You should close the fishing.

Hon. F. S. Miller: Just a second. May I please talk?

Mr. Deputy Chairman: Order, please. We’re running out of time.

Hon. F. S. Miller: As far as closure of the fishing goes, I would endorse it in a second if, in fact, we can break the lifelong habit of the Indians who net the pickerel in the river and eat it. That, to me, is the key thing. Will we really stop them? I’m pessimistic because we haven’t succeeded in breaking any of their other lifestyle habits yet.

Mr. Laughren: Despite all our efforts.

Mr. Deputy Chairman: Order, please. Before we continue on this vote, I should draw to the attention of the committee that there are still 50 minutes left for debate on this vote. We have the following members who have indicated they would like to speak: The hon. members for Durham West, Sudbury East, Mississauga South, Niagara Falls, Brantford, Wellington South and London North.

Mr. Mancini: Also Essex South, Mr. Chairman.

Mr. Deputy Chairman: Those are the only names that I have here so far.

Mr. Mancini: On a point of order, Mr. Chairman.

Mr. Deputy Chairman: The subsequent chairman who will be taking over right away can add as time permits. The hon. member for Durham West.

Mr. Godfrey: Thank you, Mr. Chairman. I will not comment upon the absolute futility of having to discuss a budget of $3.6 billion in the course of six hours. I will comment that I’m delighted to see that the Minister of Health has become converted and with all the fervour of a sinner converted he is now indulging in exercises which he didn’t do before. I presume he will now be thoroughly entranced with rehabilitation and will be able to carry out some of his commitments which he has made to previous statements with regard to rehabilitation and prevention of diseases. I congratulate this sinner who has entered the fold and welcome him to the exercise class.

Hon. F. S. Miller: I hope you do it every day.

Mr. Godfrey: Of course, I get my exercise fustigating the minister, sir.

Hon. F. S. Miller: That is a word you used in my riding.

Mr. Godfrey: Yes, sir. Fustigating is an old practice which was indulged in in medicine. There was a recent case in Ontario. When a doctor wished to treat some patients he used literally to beat the devil out of them and I propose to do this with the minister, sir. All in the aims of therapy.

I do hope that he will also join with us in protecting non-smokers and their rights because this is preventive medicine, and when the bill is introduced by the Ministry of Health, I can assure him we will support it without any qualms.

Interjection.

Mr. Godfrey: I would hope, sir, that your commitment to rehabilitation in this area will also include other points. I must say, Mr. Chairman, I am constantly bemused and irked by the attitude of the minister who is such a reasonable fellow and by his very reasonableness implies that there are nothing but young turks on the other side of this House. I can assure the minister that if he remains reasonable in what he does, besides his acts, he will find the members of this side of the House equally reasonable.

If he will bring in effective legislation which will bring Jerusalem to the satanic mills, I can assure him that we will cooperate and we will applaud him. But let us see by his actions that he is as reasonable as he is with his words.

Proceeding from that, I would point out that we have been reasonable in our requests, that we have asked for a reasonable programme of rehabilitation in the province, which means that the advisers to the ministry will be the kind of people who have expertise in rehabilitation. His whole rehabilitation section as yet does not have sufficient advisers with input as specialists who work in rehabilitation to be able to mount a programme which would prevent him from getting into the debacle with the member for Kitchener (Mr. Breithaupt) with regard to the physiotherapists’ fees.

I will not belabour this because the hon. member for Kitchener has already mentioned it and you have already given a commitment that you are going to raise the $5.45 fee to $5.55. You have not given that commitment?

Hon. F. S. Miller: My commitment was that they both be the same.

Mr. Godfrey: I would hope that you would attempt in this class warfare to bring all classes up to the same level and give the private physiotherapists exactly what the hospital physiotherapy plants get as over-cost dollars. I would also hope that you would make it retroactive, as your committee promised, to Jan. 1. If you are going to reduce the hospitals to $5.45 and coverage for outpatient physios, then I would hope you would also make that retroactive to Jan. 1. Then we will see how long it remains that way after the complaints come in.

I gather it is now announced government policy that they want to wear down the private physiotherapy plants by a process of attrition. They will not grant any more licences except the licence which they granted in the Flemingdon Park physiotherapy operation which was an offshoot of Sunnybrook Hospital and has since become a semi-private operation. I would think that it would be fair to the private physio section to announce to them in fulsomeness and in the frankness and the reasonableness which you display in this House, that there will be no more licences and they can never sell licences and then we can have that firmly on the table.

Hon. F. S. Miller: Mr. Chairman, we are permitting, as far as I know, physio licence transfers, but we haven’t been permitting any new licences. I’ll double-check that, but that’s my understanding, that is my deputy’s understanding of our policy.

Mr. Godfrey: May I ask, are you permitting the selling of practices in the free-enterprise tradition of the Progressive Conservative Party?

Hon. F. S. Miller: I would assume there is a quid pro quo.

Mr. Godfrey: Well it’s not very quo as far as the therapists are concerned, sir.

If I may move on from that, I would point out that in several other areas in rehabilitation there is still a good deal to be done and one applies particularly to the detoxification centres under the vote which we are speaking to at present. I would hope that the minister -- I’m sure he is -- is aware of the problems attendant on alcoholism.

[6:00]

I would point out that there is a certain amount of hypocrisy in our approach to the massive alcohol health problem. On one hand we are spending $655,000 per year for posters, pamphlets and broadcast advertising as of last year -- it may be increased this year -- which promotes temperance or at least reasonable drinking. On the other band, we realize it’s a small fraction of the money spent by the alcohol industry to promote the consumption of its products and increase its products. While some companies are beginning to adopt campaigns for more moderate drinking habits, those campaigns will be effective only with the people who do not need them.

I would point out to you that I hope the Ministry of Health has been alerted to the Hereford cow. As you know this is a new drink which is appearing on the market in the States; it will most likely appear here. It is milk which is adulterated with alcohol. For those who cannot stand the taste of alcohol, you can now buy a quart jug of Hereford cow which has Scotch or another type of alcohol added to it.

All of this is being done to promote drinking -- cow’s milk being almost as sacred as mother’s milk which in our society still bias a certain pre-eminence of virtue -- and encourages the young drinker to get more into the drinking field. The question arises as to whether the purveyors of alcohol will not now expand their field. They have now got into the milk field and I imagine that in the very near future they’ll be putting vodka in the ketchup and calling it “muddy Mary” or possibly in milk of magnesia which will be dispensed in order that it be more freely available.

I say these things without levity because the simple fact of the matter is that opposed to your $655,000, which you are devoting to temperate drinking, there is a massive arrangement of funds which is being devoted to the worker particularly. It’s aimed at the worker who is under stress, who is seeking a way out of his stress, to relieve mental pressures which are building up in his job. He is a person who is not going to have a reasoned approach to the use of alcohol.

What will happen to that worker? He will most likely end up in one of the detox centres for which you have budgeted $2 million to prevent or try to stave off the downhill course which threatens workers who are at risk.

The United Steelworkers of America possibly has more effective programmes to prevent this trend toward alcoholism which we’re seeing. This is called “lifeline” and I’m sure you’re aware of it. It has been organized by the United Steelworkers and a counsellor in this area, Mr. Lloyd Fell, and Mr. Don Montgomery, the supervisor of the area, have done a great deal of work in the last five years to rescue workers who have become prone to alcoholism.

They have pointed out that a typical picture of a member who is at risk from alcoholism is that of a man between 35 and 45 years old with five to 10 or 20 years of company seniority. He’s usually been a good employee, well liked by his fellow workers and management but has been drinking heavily for five to 15 years. The lifeline group can move in and give him support.

It is a curative type of support and it can be mobilized by this group and working in close co-operation with Donwood and other organizations in the province, often these persons can be rehabilitated after it has happened. But there is so little going into the pot before alcoholism comes on, what with all the stresses, that I would urge you, as part of the Ministry of Health, to speak to your colleagues in cabinet to do something very soon with regard to the amount of advertising which goes on for alcoholic beverages.

Mr. Conway: Not to say anything about the parliamentary assistant.

Mr. Godfrey: The parliamentary assistant, of course, should be involved in that and I’m sure you can get his ear if you ask nicely.

The problem, though, with the rehabilitation of the alcoholic is there are only three or four major centres where this can be carried out. The Addiction Research Foundation offers a good programme as does Lakeshore and Whitby in my riding. There is a good programme there for the physical restoration and rehabilitation of the alcoholic. One of the major problems is that Donwood, which is an excellent centre, is funded only partially and the person who becomes an alcoholic finds suddenly that he’s no longer covered by his OHIP insurance. The cost benefits at the Donwood centre are that while you’re in hospital costs are covered by OHIP insurance and medical charges are also met by OHIP insurance. For continuing therapy, which is a very important part of the programme and is carried out by ARF, Whitby and Lakeshore, there is a cost of $400 for two years with the person himself has to pay, in addition to which there is a $50 orientation fee for individuals or groups which the individuals or groups have to pay.

Mr. Minister, the question I would put to you is why is there this cost differential? Why doesn’t OHIP or other government agencies pick up that $450, which is a large amount of money when it comes to a person who has had to have treatment for alcoholism and most likely has had his savings cleaned out? Why can that amount of money not be met by the normal government agencies?

Moving on from the consideration of the detox centres, I would like to move to another area in which I would put a question; namely, tuberculosis prevention, $504,000 per year. I am concerned about the facts of morbidity which have been emerging during the past few years and I am sure are no stranger to yourself. As you know, there have been several reports with regard to the influence of immigration on tuberculosis in Ontario.

One of the more recent ones done by Ashley and LeRiche points out that there is an increasing morbidity in the immigrants who come to Ontario from high-incidence areas. Indeed, by 1971 -- and these are the figures that are given in this particular article -- one out of five of all new active patients had come to Canada within the last five years, 90 per cent of immigrant and 84 per cent of recent immigrant cases were less than 45 years of age.

It was noted there was an increase in the foreign-born in recent forms of disease. On looking over the statistics there is a very high incidence of this problem concerned with new immigrants who come to Canada from Asia. The problem is that although the vetting services with regard to immigrants who are coming to the country are reasonably clear -- am I in order, Mr. Chairman, you are looking at me very severely there --

Mr. Chairman: No, it’s okay.

Mr. Godfrey: Oh, thank you. Once they have been cleared for tuberculosis there is no follow-up after they come to the province. In view of the fact that we are seeing an alarming increase in the morbidity associated with primary and secondary cases of tuberculosis in recent immigrants to Ontario -- and this applies across Canada as well -- certain recommendations have been made which I do not think have been followed by your department.

These recommendations are that there should be an adequate follow-up service for all people coming from a high-incidence area when they come into the province, particularly if they have tuberculin positive tests. This should be a programme which we would urge would be initiated immediately in order to decrease some of this morbidity.

I would move on the last subject which the member for Kitchener already alluded to; namely podiatric care. As you know, I have addressed several questions, Mr. Chairman, during the year to the minister with regard to podiatric care. The last one was on Jan. 16 when the minister was not present, but I had the pleasure of addressing it to the Premier (Mr. Davis). He replied: “I would be delighted to discuss this matter with the Minister of Health.”

I presume he has discussed it with the Minister of Health. It dealt mainly with the amount of fees which are being charged by podiatrists. I was quite taken aback to hear the philosophy, and I would be happy to hear you expound it again, that if you provide more podiatrists the cost of foot care will go down. Would you correct me on that?

Hon. F. S. Miller: I would gladly correct you on that. We have a demand for more people able to provide footcare. We don’t think, in my opinion anyway, and I believe in the paper we are discussing, that it would appear to be necessary for them to be trained to the level of American standards, where they are taught certain surgical procedures that we think can adequately be done by physicians in Ontario, and probably done for less money by physicians in Ontario

Mr. Godfrey: May I suggest, Mr. Chairman, that would be a good idea, but I think you are going to have to provide more physicians, because every person over the age of 50 has 10 toes and of those three out of 10 have corns, There’s an awful lot of corns --

Hon. F. S. Miller: Corns are subcutaneous tissue, aren’t they?

Mr. Godfrey: Yes, sir.

Hon. F. S. Miller: I think within the definition we will be permitting certain minor surgery of that nature.

Mr. Godfrey: Then you are going to provide more podiatrists to take care of the ailing feet of the geriatric population?

Hon. F. S. Miller: I like the word chiropodist better.

Mr. Godfrey: Well, chiropodist or podiatrist, I won’t get into the trade warfare that goes on there. But I am surprised to hear you say that because when you provided more nursing aides it seemed we needed more nursing things done and the cost didn’t go down.

When you are providing more physicians’ aides, I suggest that possibly you will find the cost still goes up. When you provided more physios and physio aides, the total cost of physiotherapy care still went up. I am intrigued by your philosophy that you are going to be able to cut costs that way; however, I will be reasonable and await the results, which I am sure will come.

Going on from that, I am concerned about what it costs the older patient in Ontario to have his or her feet taken care of. I would point out to you, as you are very well aware, that OHIP subsidizes or pays the cost of the chiropodist for a certain amount of his care, and then the chiropodist is allowed to overbill the patient on top of that. Indeed, a bulletin put out by the Podiatry Review Committee, points out that when chiropodists’ services are being billed:

“This committee [the one in charge of podiatry] is not concerned with gross fees or with any schedule of fees. It is concerned solely with fees billed to OHIP by podiatrists. Any other financial arrangement [and I underline that phrase] between podiatrist and patient is beyond the terms of reference or statutory duty or authority of this committee.”

That is a gold-embossed hunting licence as far as I am concerned. These gentlemen receive their fees from OHIP, and on top of that they then bill the patients. I don’t have to point out to you what some of the billing may be.

I have a sample billing here from a patient; it is dated approximately one year ago, and it points out that corns and calluses were pared -- they are subcutaneous tissue, for your information, sir -- for which OHIP was feed $5 and the patient was feed $5. That was on Jan. 17. On Feb. 14, corns and calluses again, with OHIP being feed $5 and the patient $5. On June 15 OHIP was feed $5 and the patient $5. On Sept. 5, OHIP was feed $5 and the patient $5. Then, on Nov. 14, there was a slight acceleration: Depressed longitudinal arches -- therapy (whirlpool therapy, for example) -- OHIP $18.50, patient $22. I won’t bore you with the other details, but within the course of a year, OHIP was charged $80.50 and the patient was charged $97.

It would seem only reasonable to me that the recommendations of Pensioners Concerned (Canada) Inc. should be accepted -- you have a copy of this communication -- and specifically that the present practice with respect to the billing of the patient, in addition to claiming a fee for service from provincial health services, should be abolished. Many people with limited financial resources cannot afford the extra fee for foot care, which therefore becomes a luxury.

Hon. F. S. Miller: I’ll be very brief.

Mr. Breithaupt: The minister is being provocative.

Hon. F. S. Miller: Alcohol is a major problem. We think it will become a more serious problem. I believe there is a conference at the Royal York, right now, discussing advertising. I believe the parliamentary assistant to the Provincial Secretary for Social Development is there and has expressed an opinion. I believe our cabinet will be considering advertising and other incentives.

You touched on ARF, and Ontario is the leader in Canada; it is virtually the only source of major research on addiction problems in Canada, I would say.

Mr. Godfrey: Why compare yourself with other jurisdictions. Why not lead?

Hon. F. S. Miller: We are leading. We are leading by so far that there is nobody else in the race.

Regarding TB incidence I am told the morbidity is declining overall, although the new immigrants contribute a major share. I question whether the morbidity in TB is always from legal immigrants, which is a point we should look at sometimes.

Mr. Godfrey: Oh, there are not that many illegal immigrants.

Hon. F. S. Miller: On the COCO group, as we call chiropody, osteopathy, chiropractic and optometry, three of those do have the right to co-charge, and once the scopes of practices are brought into line, I think we will see a tightening up on those fee schedules.

[6:15]

Mr. Kerrio: I would address myself to one specific area in this vote, and that is to do with the public health nurses. I’m very concerned, and I would ask the minister a question in regard to his suggestion that he’s going to leave the local boards to deal with this particular matter -- in all probability all across the province. I would suggest to you that the public health nurse groups that protested here in such an orderly fashion, and their well presented document to the Minister of Labour and yourself, and the dedication they have to their job impressed me for one.

The fact that all the ingredients do not really exist for what you might consider real collective bargaining in that particular sector, and due to the fact that they themselves are asking for compulsory arbitration, I understood from your earlier remarks that you were content to leave them settle with each individual board. I wish that you would reconsider and somehow get a consensus of all those boards across Ontario so that they will have a settlement much sooner than we could expect if they’re dealing on an individual basis all across the province.

Now, you yourself suggested that you felt quite bad that they were being subjected to lockouts, and after their protest to let their feelings be known here, your reaction in regard to their request is a bit of a surprise. I would like you to seriously urge all the boards across the province taking into consideration all the facts, negotiating in good faith and handing down a decision as soon as possible. Otherwise I can’t see any end to the lockouts and the strike as it exists.

Hon. F. S. Miller: Mr. Chairman, that’s a very interesting problem, because earlier today your leader gave me something of a lecture on the return of responsibility to local people. And he was questioning me on district health councils. He claimed that they would not work until district health councils right away made local decisions on their own basis. Here we have one of our oldest local health agencies, the boards of health and the health units of Ontario. Each is spending money in an executive sense. Each is raising a share of that money on the local mill rate. Each is negotiating with its employees itself.

Now, I think one has to very carefully decide whether the suggestion you’re making fits in with the thoughts your leader is making, that in fact local decision-making should be left at the local level. You’re saying, centralize it.

That’s a rather interesting dispute in that the locals of the ONA cannot ratify an agreement. Do you know that? It can only be ratified by their central office. Yet each of the boards of health may.

Mr. Makarchuk: Are you prepared to give them more than eight per cent?

Mr. Hall: Take the elastic band off.

Hon. F. S. Miller: I think it is a very interesting point, first of all, that there’s a differential in the salaries between the public health nurses and the nurses in hospitals. It was not based upon any decision of this ministry.

If one goes back to 1974, we gave the local boards of health all of the rights to match the salaries paid in the hospitals. They chose not to do so. It was their decision, not ours. I think one should keep that in mind.

It pointed out one interesting fact -- that if a local board operating in the health field had to raise part of its health levy locally, it wasn’t as quick to grant demands as the hospital boards who did not. The hospital boards almost unanimously paid the maximum in our guidelines. The boards of health almost unanimously did not.

Some of them bought trouble at that time because by keeping the 1974 wage levels relatively low they are really hit by the constraints the hon. member just referred to -- the eight per cent and 10 per cent constraint.

So I say, I am anxious to see a resolution but I think we shouldn’t give away a couple of basic principles: 1. the right to negotiate, which has always been cherished by the union movement; and 2. decentralized authority which now exists.

Mr. Kerrio: Just one comment, please.

Mr. Makarchuk: Give them moral support and they will --

Mr. Kerrio: I concur with your thinking. I think that in this case the exception would be in order. I think that is our responsibility, when we have people as dedicated as the public health nurses willing to go to compulsory arbitration, I think there is more onus on us to participate to a greater degree. What are their alternatives, in fact, if we do not?

Mr. Deans: Fund them.

Hon. F. S. Miller: Mr. Chairman, I heard the Minister of Labour at the meeting on Thursday with the Association of Boards of Health ask them to go to voluntary arbitration this year. They refused this year; that was one of their rights. They are considering it for next year.

Mr. Deans: What have you said about the funding?

Mr. Kennedy: Thank you, Mr. Chairman. It was getting dull. I’m sorry you are going to be let down, Mr. Minister.

I just wanted to speak very briefly on the Allergy Information Association, a volunteer group that has been going for some 10 years now. It provides information to allergy sufferers and their families, providing such things as dietary sheets and cookbooks and this type of thing.

This organization, as you know, is a volunteer organization and it provides information to those afflicted. It is not only an Ontario-based volunteer group but, as I understand it from one of their newsletters, it serves people across Canada and even beyond Canada. It started as a volunteer group but there has been so much interest that they get up to 300 inquiries a week. There was an interesting article in the Star of the June 5, 1976, setting out some information and also --

Mr. Conway: It’s a great paper, the Star.

Mr. Kennedy: -- that the federal government -- which I think should provide some assistance to this excellent work they are doing, but they are caught between being a consumer group and a health group. The federal Department of Consumer -- whatever it is called -- Consumer and Corporate Affairs, say it is a health problem. The Health department says it is a consumer problem. The long and short of it is that there has been no assistance from them.

I realize the budgetary constraints under which we operate but I know of their budgetary requirements. For example, they have some 3,000 members now. They have a budget that’s doubled in expenditures in printing. They have a membership which costs $5 and a renewal of $3. This has escalated from something like $5,000 to $10,000 and they are operating within this figure.

But their inquiries run to as many as 300 per week. I think that it is a very vital and valuable service that is being provided by them. I don’t know whether we, as a province, and your ministry, might be of assistance.

I received a pamphlet which your ministry puts out on allergies in which you make reference to the Allergy Information Association and that information such as recipes and other material might be received from them. This, of course, is a good thing but it adds to their budget. I don’t know whether any grant might be approved for them or whether some services might be provided which would alleviate the constraints under which they are operating. Perhaps I could have some comments on that.

Hon. F. S. Miller: Mr. Chairman, we have had requests from quite a few groups, either in the information disseminating field or some specialized group like your own. The answer in almost every case is “no” to more money this year. I would recommend though, since this is one of those groups that have been in contact with our ministry, I believe, that we pursue this with our own ministry’s communications staff. They may be able to find ways of helping defray some of the printing costs as part of our overall programme.

Mr. Deans: Why is it that all these Tory back-benchers are --

Interjections.

Mr. Chairman: Order, please. There are 18 minutes left for supply.

Mr. Martel: The minister indicated that there was a lack of responsibility over on this side of the House with respect to dealing with the occupational health problem. Let me tell you the most recent statement -- no, you suggested we should get together and do it in a more --

Hon. F. S. Miller: That’s called brotherhood.

Mr. Martel: Right, brotherhood -- you know, the all-embracing arm of the Tories.

Let me read you the most recent statement by your colleague, the Minister of Natural Resources (Mr. Bernier), on April 26 in Quebec, and tell me if he really means to combat industrial disease. Listen to what he says:

“Thirdly, and perhaps most important, our policies on occupational and environmental health in the mining industry must he improved. The policy of the Ontario government is clearly and distinctly safety first. [And he goes on] It has always been that, but lately we are realizing that we have to anticipate both present and potential hazards to health in a positive and effective way.

“Our standards are being set so that insofar as medical science can determine there will be no appreciable risk to human health in the mines of Ontario. We recognize that this will put us at a disadvantage relative to other jurisdictions who perhaps accept less stringent standards or enforce them less rigidly, but we believe that if we are right this disparity will be short-lived. [Now, get the next sentence) If we are proven wrong, then we can adjust our policies.”

You know what he’s saying, Mr. Minister? Do you know what your colleague is saying, and the new entente that you have over there among the four of you? He’s saying that if it’s too costly and it doesn’t work properly and it puts us at a disadvantage, we should say to hell with all the care and the wellbeing of the miners -- we can go back to the old system. I am quoting directly from the minister’s statement. If that’s what you are talking about, obviously you haven’t yet convinced your colleague, the Minister of Natural Resources.

My colleague, the member for Nickel Belt, is obviously right -- it’s still class and it’s still money. If it’s money that is going to count, then we say to heck with health and we go to money. That’s what Leo said in Quebec on April 26. You squirm out of that one. That was a great statement.

I heard that the Treasurer (Mr. McKeough) ranted and raved yesterday about my taking statements out of this with respect to mining revenue. That was Leo making the same statements then as well, because I quoted directly, as well, for the Treasurer’s edification yesterday.

Mr. Chairman: You mean the hon. Minister of Natural Resources?

Mr. Martel: Yeah, Leo -- the Minister of Natural Resources --

Mr. Chairman: The hon. member --

Mr. Martel: -- I wonder why he was ever allowed to be a minister.

Let me tell you, though, the occupational health branch, like the Minister of Natural Resources, really has something to answer for. In the case of Elliot Lake, they have known of each and every incident of fatalities. That information was supplied by the Workmen’s Compensation Board to them. If they sat on their proverbial hands it is not the Minister of Natural Resources alone who must bear the responsibility, but the Minister of Health, through the occupational health branch.

Dealing with that ministry is something to behold. I have been trying for two years, as the minister knows -- since I discovered that there were 791 industrial deaf cases in the Sudbury area -- to get the government to move in two areas. One was some type of programme to prevent industrial deafness to any other man -- and the other some type of programme for those men who are already afflicted -- in terms of speech therapy, in terms of lip reading, in terms of adjustment for hearing aids, in terms of not having to come to Toronto. And after two years -- nothing.

[6:30]

My last letter to the minister was a major letter I wrote just before his illness on Feb. 2. It was a very lengthy letter in which I asked the minister to be specific in what they were doing in respect of dealing with those men who had industrial deafness. Secondly, I asked the minister what policies we’ve launched in order to guaranty that no other men become afflicted by industrial deafness.

I have not received a reply to that letter, and as recently as May 7, I wrote the acting minister at that time asking if she would kindly submit a response to my letter of Feb. 2 to indicate what the occupational health branch was going to do to assist those who were already afflicted.

I also want to know what type of programme you have launched in terms of testing in the mines and testing in the pulp and paper industry. We are not the highest in very many things, but northern Ontario has the highest percentage of industrial deafness in the province -- 50 per cent -- and the most severe cases of industrial deafness are in northern Ontario in the pulp and paper industry and in the mining industry.

What are we doing to ensure that the men who are there who are not presently suffering from it, don’t become industrially deaf? What programmes have you and your colleagues, the Minister of Labour (B. Stephenson), the Minister of the Environment (Mr. Kerr) and the Minister of Natural Resources (Mr. Bernier) embarked upon?

We thought we had something going for us recently. We met with Michael Starr from the Workmen’s Compensation Board and he agreed that Dr. McCracken would go to Sudbury. When Dr. McCracken came back, we were to meet with their representatives from the Ministry of Labour and their representatives from the Ministry of the Environment -- high-ranking officials according to Mike Starr -- so that we could then set about devising a policy; and it was the minister who invited us to help develop a policy.

I got a letter from Mike Starr on June 11, and it was very brief. Let me quote it for you.

“Thank you for your letter of June 7 concerning Dr. W. McCracken’s recent visit to Sudbury related to industrial deafness and requesting a meeting during the week of June 14 to 18, or thereafter. Dr. McCracken as very encouraged by his visit with all concerned agencies in Sudbury, since it would appear that the facilities there for dealing effectively with industrial deafness have greater potential than had been thought.

“Dr. McCracken is currently reviewing his findings and discussing various factors which flow from his many meetings and conversations, but will be returning to Sudbury for further discussions and explorations which he believes will be of significant assistance.

“In view of the changing situation and the prospect for further development, I think it would be more appropriate for Dr. McCracken to visit with Mr. Germa, Mr. Laughren and yourself to bring you up to date.”

Well, that’s a copout -- because we had an agreement. We had an agreement that when Dr. McCracken came back from Sudbury we would sit down with very high-ranking representatives and all the ministries involved to try and determine a policy to cover both areas -- those who are already afflicted to protect others from becoming afflicted.

My two colleagues, the member for Sudbury and the member for Nickel Belt were at the meeting with Michael Starr. But in his letter to me he says, “No, that meeting is off. You can talk to Dr. McCracken in Sudbury.”

That isn’t what we agreed to. We agreed to meet here with high-ranking officials from Health, Labour, Environment and Natural Resources to work out a policy to prevent men from becoming industrially deaf and to cope with those men who already are having problems.

And that is the type of co-operation, Mr. Minister, that you talk about. Well, I don’t happen to believe this government has ever concerned itself with the workers in the workplace. I want to tell you that I have been around here a few years, and when it came to the cancer in the sintering plant in Copper Cliff it wasn’t this ministry that helped. It wasn’t this ministry that helped, it was Dr. Cecil Ionni from Hamilton.

When it came to the Elliot Lake thing, we flew by the seat of our pants. But then there was no help from any of these ministries and I want to tell you, it is about time that we stopped flying that way.

If you’re sincere about what you say today, and that certainly contradicts what the Minister of Natural Resources said in his most recent statement in Quebec, then you will involve the workers immediately. In the Sudbury area, you will do about four things with the deaf. At Cambrian College my colleagues were with me when we spoke to Mr. Koski, the president, who is willing to do something in the line of speech therapy. He is willing to do something with the introduction of some type of course so that the men would have some training. Those men in Sudbury don’t get any type of training -- speech therapy, lip reading or anything. You do in Toronto. There is a course at George Brown but not up there. We’ve got to stop bringing the men down to Toronto and treat them there.

I just say to the minister that he can tell me that he wants a spirit of co-operation but the statement by the Minister of Natural Resources decries that. The position taken by Michael Starr, where he reneges on an agreement made at a meeting in his office recently, decries that there is any effort to he cooperative. The only thing we can do, then, is to come out swinging.

Just before I sit down and allow the minister to respond, I would ask the minister if he is prepared -- and it is on a totally different subject -- to give to the health boards more than eight per cent in order to resolve the impasse. How can he talk about local autonomy when, in fact, he controls the purse strings? What is it? About 75 per cent of the moneys for local health units are out of the Treasury of the Province of Ontario.

Mr. Deans: No, no, he wants an answer.

Mr. Martel: No, just go ahead. I just want some answers.

Hon. F. S. Miller: Sorry, I temporarily was writing a note on some information you asked. Would you please repeat that last question?

Mr. Deans: You mean you missed the only question?

Hon. F. S. Miller: Listen, when there is so much sound and fury, one has to listen for a change in emphasis to --

Mr. Martel: Well, that comes as a result, of course, of dealing with this government.

Hon. F. S. Miller: I have, right now, some occupational deafness.

Mr. Chairman: Quick now, please. There are only six minutes left.

Mr. Martel: I asked the minister, since you prepare --

Hon. F. S. Miller: My answer is with the boards of health. My staff have clarified it. I told the boards of health last week that I was not prepared to adjust the guideline letter.

Mr. Mancini: Mr. Chairman, I would like to address myself to the district health councils where I see there are expenditures of $1,400,000.

Mr. Martel: On a point of order, Mr. Chairman.

Mr. Chairman: Do you have a response to the member for Sudbury East on industrial deafness?

Hon. F. S. Miller: Mr. Chairman, he had asked me a specific question on boards of health funding. That’s what I was told. That’s what I was replying to. I wasn’t trying to reply to his entire speech because I didn’t think he was through and quite honestly --

Mr. Martel: No, I am just waiting because we only have six minutes.

Hon. F. S. Miller: Are you all through?

Mr. Martel: Well, I am trying to.

Hon. F. S. Miller: Mr. Chairman, I have to get more information on the present state. When I was in Sudbury last Friday I understood that facilities had been set up at both the Laurentian and General Hospitals for audiometric testing.

Mr. Martel: That’s all.

Hon. F. S. Miller: As far as the programme is concerned, I can’t answer the question today. I, in fact, sent out for information while you were asking me about it in the hope that you would still be talking when it came back. It’s not here yet. I’ll be glad to even see you in my office to discuss it more.

Mr. Mancini: Mr. Chairman, I would like to start all over again and I would like to address myself to the district health councils where I see there are expenditures of $1,400,000. I’m sure the Minister of Health is aware that just recently, in the last few months, they have established a Windsor and Essex county district health council. The point I would like to make here is to say to the minister that if we are going to establish these district health councils and if we are going to have this kind of expenditure, then I assume we are going to take their recommendations also.

Some time ago the district health council made a recommendation to the Ministry of Health that the volunteer ambulance service of the Amherstburg, Anderdon and Malden communities be left the way it is. Unfortunately, your ambulance branch saw fit not to accept the recommendations and made it known publicly that there was a possibility the communities would lose their volunteer service because they could not operate without a dispatch in their own area. After having several meetings, one with the volunteer ambulance people and another one with Mr. Brubacher of your department, it was finally decided that the ambulance service would be left alone.

However, we have still not received that letter from Mr. Brubacher which he promised me and the people in the volunteer service. I would ask you please to check into that to see if we can get a final and written report.

I’ll end my comments there.

Mr. Chairman: That was on the previous vote but you can reply briefly, if you wish.

Hon. F. S. Miller: I am almost sure I signed a letter to the Amherstburg ambulance group within the last four or five days. It dealt with some of the issues you’re talking about and it probably is in their hands but I would be glad to double-check it and see if it was --

Mr. Mancini: Was it favourable? Was it a favourable decision which you rendered?

Hon. F. S. Miller: I can’t quote the contents of the letter by memory. It was a fairly long one, as I recall.

Mr. Mancini: We just want to state to you how very important it is to keep that service intact.

Mr. Chairman: The hon. member for Kitchener-Wilmot. You’ve got about one minute and 30 seconds.

Mr. Sweeney: Can I just ask one question?

Mr. Deans: Quickly.

Mr. Sweeney: There is considerable evidence that malnutrition in a developing child within the pregnant mother and malnutrition in a baby in the first and second years of life can do serious damage to brain development. What is your ministry doing to offset this?

An hon. member: There’s a good question.

Mr. Makarchuk: The nurses go out on strike.

Hon. F. S. Miller: When we get into nutrition, it’s an educational programme more than anything else, I would say. As I said earlier in the last estimates debate --

Mr. Laughren: It has to do with income too.

Hon. F. S. Miller: -- good food is not necessarily costly food. It’s a question of people being aware of the food they should provide their children. We eat a lot of junk food in Canada which is very costly and not nutritious. Through the health units we do our best in the various clinics to educate prospective mothers -- and mothers, in fact -- on the best nutritional means possible. As you know, the school programmes have some content on that too.

Mr. Makarchuk: Put the public health nurses back to work.

Mr. Chairman: The time for supply has expired.

Vote 3003 agreed to.

Mr. Chairman: This concludes the estimates of the Ministry of Health.

Hon. Mr. Welch moved that 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 certain resolutions.

Clerk of the House: Mr. Stokes from the committee of supply reports the following resolution:

Resolved: That supply in the following amounts and to defray the expenses of the government departments named be granted to Her Majesty for the fiscal year ending March 31, 1977.

Mr. Breithaupt: Mr. Speaker, I suggest that, as it has been distributed and will appear in Hansard as well as the particular votes having been recorded heretofore, we dispense with the reading of this resolution.

Agreed.

Resolution concurred in.

ANSWERS TO WRITTEN QUESTIONS

Hon. Mr. Welch: Mr. Speaker, I wish to table answers to questions 102 and 116 standing on the notice paper.

Mr. Speaker, Her Honour awaits and if members would bear with us for just a few moments, we will be back with the Lieutenant Governor.

The Honourable the Lieutenant Governor entered the chamber of the legislative assembly and took her seat upon the throne.

ROYAL ASSENT

Hon. P. M. McGibbon (Lieutenant Governor): Pray be seated.

Mr. Speaker: May it please Your Honour, the legislative assembly of the province has, at its present sittings thereof, passed certain bills to which, in the name of and on behalf of the said legislative assembly, I respectfully request Your Honour’s assent.

Clerk of the House: The following are the titles of the bills to which Your Honour’s assent is prayed:

Bill 81, An Act to amend the Environmental Protection Act, 1971.

Bill 87, An Act to amend the Education Act, 1974.

Bill 89, An Act to amend the Municipal Act.

Bill 94, An Act to provide certain Protections for Purchasers of New Homes.

Bill 98, An Act to amend the Travel Industry Act, 1974.

Bill 100, An Act to amend the Municipal Conflict of Interest Act, 1972.

Bill 101, An Act to amend the District Municipality of Muskoka Act.

Bill 104, An Act to amend the Provincial Parks Act.

Bill 106, An Act to amend the City of Thunder Bay Act, 1968-69.

Bill 108, An Act to provide for the Continuance of Certain Payments between Municipalities under the Child Welfare Act, 1965.

Bill 122, An Act respecting the Lake Superior Board of Education.

Bill 123, An Act to amend the Legislative Assembly Act.

Clerk of the House: In Her Majesty’s name, the Honourable the Lieutenant Governor doth assent to these bills.

The Honourable the Lieutenant Governor was pleased to retire from the chamber.

Hon. Mr. Davis: Before the House leader moves the adjournment I would just like to take this opportunity to thank the members opposite for their very constructive cooperation during the past few weeks and to suggest to them they have a very pleasant summer recess which, hopefully, will be of some duration, but that I cannot predict with total accuracy. I also say to them that I hope they spend the summer explaining to their constituents the many positive pieces of legislation that we all collectively passed and, of course --

Mr. Singer: Some of the negative ones.

Hon. Mr. Davis: -- who enthusiastically support all of the policies of this government in the very broad sense of the word.

I would also extend an invitation to each and every one of you to come and see a prelude of major league baseball as it will be seen here a year from now. It is not at the main stadium of the CNE, it is a little to the west. It will start in exactly six minutes --

Mr. Singer: We understand you are not the favourites.

Hon. Mr. Davis: -- when that team known as the “sources close to the Premier” have extended a challenge to those men and women who report so accurately the activities of members of this Legislature. The reserved seats are going at very minimal prices. The proceeds from the sale go to the coffers of the Progressive Conservative Fund Ontario to assist us in our worthwhile activities and all of you are more than welcome.

Mr. Breithaupt: Bill Kelly is monitoring it.

Mr. Peterson: Not quite a sellout.

Hon. Mr. Davis: In fact, if some of you do appear and we need the odd designated hitter or pinch-hitter or what have you, I know just those members opposite that I would presume to ask to fill in.

Mr. S. Smith: You probably will be very good at stealing bases.

Mr. Singer: The bases will be pretty loaded against you.

Hon. Mr. Davis: Mr. Speaker, I do say the odds are not only heavy against us, they are almost insurmountable, but we have faced insurmountable odds before and prevailed. But I do say most sincerely that in spite of some of the pressures and what has gone on in the past few months, I would like to extend my appreciation to the members opposite to wish them a pleasant summer vacation and we will look forward to seeing you sometime before Oct. 31, 1976.

Mr. Singer: Maybe even before the end of June.

Hon. Mr. Welch moved the adjournment of the House.

Motion agreed to.

Mr. Speaker: This House stands adjourned until, as announced earlier today, a date to be named by the Lieutenant Governor by her proclamation.

The House adjourned at 6:55 p.m.

June 22, 1976

ESTIMATES, MINISTRY OF HEALTH

MERCURY POISONING IN IRAQ AND JAPAN

COW-CALF PROGRAMME

CLOSURE OF ARENAS

ASSISTANCE FOR ARENA REPAIRS

CLOSURE OF ARENAS

CLAIMS FOR LUNG CANCER

ELLIOT LAKE RETRAINING PROGRAMME

FREEDOM OF INFORMATION LEGISLATION

HOSPITAL CLOSINGS APPEAL

ALCOHOL CONSUMPTION

MILK PRODUCTION

VINYL CHLORIDE LEVELS

AIR TRAFFIC CONTROL DISPUTE

AIB RULING ON TEACHERS’ CONTRACT

TELEPHONE SOLICITATIONS

TAXI INSURANCE PREMIUMS

LEGISLATIVE PAGES

ANSWERS TO WRITTEN QUESTIONS

CONCURRENCE IN SUPPLY

ENVIRONMENTAL PROTECTION AMENDMENT ACT

EDUCATION AMENDMENT ACT (CONCLUDED)

MUNICIPAL AMENDMENT ACT (CONCLUDED)

ONTARIO NEW HOME WARRANTIES PLAN ACT (CONCLUDED)

THIRD READINGS

Ayes

Nays

NOTICE OF MOTION NO. 6

ANSWERS TO WRITTEN QUESTIONS

ESTIMATES, MINISTRY OF HEALTH (CONCLUDED)

ANSWERS TO WRITTEN QUESTIONS

ROYAL ASSENT