Hansard Transcript 1986-Jun-02 | Legislative Assembly of Ontario

The Deputy Speaker: I ask all members of the Legislative Assembly to join me in recognizing and welcoming in the Speaker's gallery the Honourable Evan Walker, Minister of Agriculture and Rural Affairs, Victoria, Australia.

MEMBERS' STATEMENTS

HEALTH SERVICES

Mrs. Marland: It is with grave concern I rise today to report the death of someone in 1986, a death which could have been avoided. On May 28, John Mee, a 53-year-old former Canadian Football League referee, died unnecessarily in his home in Mississauga while waiting for a bypass operation that would have saved his life. John's operation had been postponed for five weeks because of a bed shortage at the Toronto General Hospital. The hospital currently does not have any chronic care beds, and 50 of its acute care beds are occupied by chronic care patients.

The Ontario Hospital Association has told this government that $250 million is needed to resolve the bed shortage in Ontario hospitals; yet the Liberal government refuses to provide the necessary funds that would have saved John Mee's life and the lives of countless others who have died unnecessarily. Instead, it continues to obscure the real issues in health care for the sake of the political life of the Liberal Party and has engaged our medical community in an unnecessary confrontation that will not provide one additional dollar for health care in this province.

The tragedy of John Mee's death should prompt all Ontarians to look behind the rhetoric of the Liberal Party and give their full support to those who are truly committed to saving lives.

OCCUPATIONAL HEALTH AND SAFETY

Mr. Martel: Last week the Minister of Labour (Mr. Wrye) announced a review, to be made by Mr. McKenzie from Coopers and Lybrand, to look at the Occupational Health and Safety Act and determine its efficiency. As well, it will determine the priorities.

The minister sent with the task force I conducted a senior policy analyst, who followed us around for the full five weeks and saw all the problems involved in this bill. I invited the minister to meet with Mr. Gulbinas of his own staff and with me to determine what was wrong with the act. We do not need a further delay. Mr. Gulbinas from the ministry is fully aware of what is going on. To this time, the minister has not accepted our invitation. He has just adopted a smokescreen, which will delay any improvement in the Occupational Health and Safety Act to protect the workers.

At the same time, I might indicate that what happens at the Ministry of Labour, according to his own staff, is that issues which are fed in go through five or six layers of bureaucracy. By the time what is laid on the deputy's desk reaches him, it has been altered so badly that the deputy is making recommendations on issues which are totally irrelevant. These are based on the facts put before him, which do not recognize the facts which started into the swamp. I hope we will get some clearance so that we will get the swamp cleared up once and for all.

RECYCLING

Mr. Offer: It is a pleasure to rise today to inform the Legislature that today, June 2, 1986, marks the official launching of the city of Mississauga's city-wide curbside recycling program, the largest undertaking of its kind in North America. Householders throughout the city have been given a special recycling box, known as the blue box, as shown in this poster, in which to store their recyclable material in their home and to set it out at the curb. Old newspapers, glass and metal cans will be collected once a week from the curb on the regular garbage day. It is estimated that approximately 10,000 tons of recyclable material will be collected during the first year of operation.

The council of the city of Mississauga is to be congratulated for this endeavour, together with Laidlaw Waste Systems. They have acted in a most responsible manner. They understand that recycling helps to conserve our raw material and energy resources and that recycling 7,800 tons of newspaper represents the equivalent of more than 132,000 trees. This action, not only by the council of the city of Mississauga but also by the participation of all the householders within the city, serves to remind us that rather than inheriting the environment from our parents, we borrow it from our children.

HOMEMAKER SERVICES

Mr. Sheppard: The future of the Canadian Red Cross homemaker service in Ontario depends on government funding. In view of large deficits for 1986, the Red Cross must reluctantly consider the closure of some or all of its homemaker service operations. Homemakers are an integral part of our health care system. They deal not only with problem families but child abuse, palliative care and the handicapped. In Northumberland, our two services, namely, the East Northumberland homemaker services and the West Northumberland homemaker services, employ 98 homemakers, who earn an average of $4.60 per hour. In addition, they have to provide their own transportation with no mileage allowance available. Their projected loss for this year is $3,000.

In the past, the service in Ontario has had to meet its costs by restricting the wages of homemakers. This is no longer possible. It is about time the Liberals faced up to their commitments to the voluntary sector. Homemaker services, including those in my riding, would like to be assured that initially they will receive an increase in the hourly rates paid for service, with a catch-up arrangement in 1986, and later have the ability to negotiate annual increases.

HAZARDOUS SPILL

Ms. Gigantes: I want to make a complaint about an event which has happened in Ottawa. It has to do with the discovery, once again this spring, of a slick. It was called an oil slick when it was first reported in the Ottawa press several weeks ago, but upon investigation it turned out to be coal tar. Pumping began of the coal-tar site, which was an old Ottawa Gas company site on Lees Avenue and is the site of a transit station in the Ottawa area. So far the region has pumped 1.1 million gallons of coal tar out of that site at a cost of $1.8 million. The pumping, which was supposed to be done in a couple of days when it first started, turns out to be a pumping job of some magnitude.

The workers involved in the work were sent in without uniforms and without protection. Though regional officials were given information on May 15 that there was a danger in exposing the workers, it was not until May 27 that they themselves were told. The coal tar has been shipped to a plant in Gloucester, which is operating on a site that does not have the proper zoning, and the processing plant was supposed to have closed down by now. It has not. Children in the next-door school, the Notre Dame des Champs school, 130 of them, have been kept out of school by their parents. I would like some explanation of how this mess has occurred.

CHILDREN'S MIRACLE NETWORK TELETHON

Mr. Reycraft: I want to report to the Legislature the splendid response by the people of western Ontario to the Children's Miracle Network Telethon last weekend. The telethon, which was broadcast by CFPL-TV in London and CKNX-TV in Wingham, was part of an international effort. Last weekend marked the first time western Ontario has participated in the telethon, a fund-raising effort that has become an annual event in a number of locations.

In total, the telethon resulted in more than $30 million being pledged to 132 children's hospitals in Canada, the United States and Australia. In western Ontario, the telethon, which started at 9 p.m. on Saturday and ended at 6 p.m. yesterday, concluded with more than $330,000 being pledged. All of these funds will be directed to the Children's Hospital of Western Ontario in London. The money will be used to support much needed research, new equipment and expanded programs.

More than 2,000 volunteers participated in the telethon, manning telephones and performing other duties in a makeshift television studio at Victoria Hospital's Westminster campus in London. I want to salute those volunteers this afternoon for their very generous donation of their time and talents and to congratulate them on the success of the Children's Miracle Network Telethon.

ROYAL CANADIAN LEGION

Mr. Haggerty: Today marks the 120th anniversary of the Battle of Lime Ridge or the Battle of Ridgeway, turning back the Fenians. This year, 1986, marks the diamond jubilee of the founding of one of Canada's largest veterans' associations, the Royal Canadian Legion. Branches of the Royal Canadian Legion in Fort Erie, Port Colborne and Bertie have established a tradition over many years of carrying out the mandate of honouring Canada's fallen soldiers from the battlefields of the Niagara region, Western Europe, England, France, Italy, Belgium, the Pacific Rim, Hong Kong and Korea.

Visits by legion members to many cemeteries, marking the veterans' gravesides with a Canadian flag, flowers and a poppy, awaken memories of the past, of the perils and triumphs that mark our nation's history. Decoration Day honours the veterans of the First World War and the Second World War. It is a special tribute to the many thousands of young soldiers who never returned to their beloved homeland.

2:12 p.m.

STATEMENTS BY THE MINISTRY AND RESPONSES

SENIOR CITIZENS' SERVICES

Hon. Mr. Van Horne: Mr. Speaker, as you can see from the lapel button I am wearing and from various posters around the building, June is Senior Citizens Month in Ontario. It is fitting, therefore, that today I am tabling our white paper entitled A New Agenda: Health and Social Services Strategies for Ontario's Seniors.

The agenda is indeed new. It is also unprecedented. For the first time in the history of this province, a government has set out a broad strategic plan that will serve our senior citizens now and in the future.

Before I elaborate on this blueprint for the future, let me point out that our work on this white paper, which has been carried out on a co-operative basis with several ministries, has not kept us from acting. In January, we provided $11 million to improve community services for seniors. We are also in the midst of implementing our new homemaker program. This represents an additional $8 million this year. Further, under our new housing strategy, more than 1,500 housing units for senior citizens will be started this year.

This brings me to our white paper. Its central purpose is to develop a comprehensive system of services to help seniors live active and independent lives in their own communities and to reduce significantly preventable and unnecessary institutionalization. To accomplish this, the white paper sets out a broad plan based on five strategies.

Our first strategy is to improve the health and functional status of our senior citizens. We will do this through an increased emphasis on health promotion and illness prevention, education in geriatrics, education of more geriatric and psychogeriatric specialists and research related to ageing and the aged.

Our second strategy is to help keep the frail elderly in the community. To achieve this, we intend to expand significantly community support services, particularly in northern, remote and underserviced areas, and to improve accessibility and delivery of these programs through a single access or a one-stop shopping approach.

Third, hospitals play a key role in maintaining the health of the elderly and thereby enabling many to continue living at home. Our third strategy then is to enhance geriatric hospital care. We will accomplish this primarily by setting up regional geriatric centres, expanding specialized outreach and inpatient services and placing a greater emphasis on rehabilitation and convalescent programs.

Our fourth strategy is to ensure high quality, long-term care for those who cannot continue to live independently in the community. Pivotal to this is the development of new legislation to rationalize and improve significantly the existing extended care program. We also intend to regulate the quality of care in rest homes.

Finally, it is clear that a comprehensive system of services for seniors cannot be achieved through a fragmented series of initiatives as in the past. Accordingly, our fifth strategy is to introduce comprehensive planning and management of health and social services for the elderly at both the provincial and local level.

The strategies I have just described outline a broad plan to meet the challenges of Ontario's ageing population. Planning is not enough. We have to act and act now. Obviously, everything we want to do for our elderly cannot be done at once, nor can it be done in an ad hoc fashion. The system can be created only through planned co-operative action. Today the Minister of Health (Mr. Elston), the Minister of Colleges and Universities (Mr. Sorbara) and the Minister of Community and Social Services (Mr. Sweeney) will announce our first round of initiatives in direct support of this white paper.

Before my colleagues provide the details of their specific initiatives, I want to point out that these programs represent an additional expenditure of $13.5 million in this fiscal year and an annualized cost of more than $30 million in 1987-88 in new dollars.

In addition, I will continue my role in policy development in health and social services. I will address three major areas: new extended care legislation, the regulation of rest homes and one-stop shopping for community services.

Considerable consultation will be required to develop and implement these initiatives. However, I want to stress again that it is our intention to move as swiftly as possible. For example, we intend to have the first pilot one-stop shopping project in operation in approximately 15 months. Our new agenda is full and our timetable busy. We are planning; we are acting; we are moving in vital new directions for Ontario's senior citizens.

The white paper I released today concentrates on health and social services for the elderly. In the future, I will be releasing further reports on other issues affecting senior citizens such as housing, income security and transportation.

Before I take my seat, let me simply say thank you to the many hundreds of Ontarians who assisted me with their input in this consultation process and also thank my staff, who have worked so diligently on the preparation of this paper.

Hon. Mr. Sweeney: The government of Ontario has made a strong commitment to improving the quality of life of the seniors of this province. I am very pleased to be working with all of my cabinet colleagues towards that important goal. In that regard, I would like to inform this House about three new initiatives to improve community services for the elderly. Let me quickly outline the details.

On January 28, 1986, I announced that the new integrated homemaker program would be introduced in six communities across the province. Five of the six projects are now providing homemaker services to clients and the sixth project will be on board shortly.

I am pleased to announce today that we will be extending that program to include an additional six to eight communities during this fiscal year. The cost of this expansion will amount to more than $12 million a year. I will be announcing very shortly the names of the specific communities involved.

Second, there will be a substantial improvement to home support services. We will be allotting an additional $2 million this fiscal year to enhance these vital services for seniors. This funding is in addition to the $11 million in new spending for home support services announced on January 28. These additional dollars will go towards an expansion of services and an enrichment of the funding base.

As of April 1, the provincial share of the cost of home support services was increased from 50 to 60 per cent. I am pleased to tell the House today that, beginning next fiscal year, we will be increasing our share to a maximum of 70 per cent. This change will amount to an additional cost of $2.4 million.

Third, we will be contributing an additional $3 million annually to enhance community services for victims of Alzheimer's disease and their families. We will be experimenting with innovative approaches to providing residential services in small, home-like settings for Alzheimer's victims who can no longer be cared for by their own families.

The white paper on health and social services for the elderly released today by the Minister without Portfolio responsible for senior citizens' affairs (Mr. Van Horne) provides an important blueprint for the future. I can assure members that my colleagues and I will continue to work together to take the steps necessary to translate that blueprint into reality.

Hon. Mr. Sorbara: I should like to reinforce my colleague's statements concerning this government's commitment to enhance the quality of care of Ontario's senior citizens.

J'aimerais souligner l'importance des observations de mes collègues en ce qui a trait à l'intention du présent gouvernement d'élever la qualité des soins dispensés aux personnes âgées de l'Ontario.

Pour parvenir à cette fin, nous devons nous assurer d'avoir à notre disposition les services de professionnels qualifiés qui soient en mesure de répondre aux besoins particuliers des personnes âgées.

The continuing growth in the proportion of elderly in our society has been recognized by Ontario's colleges of applied arts and technology and by our universities. Many have developed new courses and have improved gerontological and geriatric content in health sciences, social services, family studies and other program areas. Faculty members in our universities and teaching hospitals are engaged in basic and applied research related to the aged and to the ageing process itself.

However, given the rate of demographic change in our society, these efforts will need to be further enhanced. We need to continue to improve undergraduate and graduate training for all those who will work with the elderly in the future. We need to continue to assist in the development of continuing education programs for our existing practitioners. We also need to ensure an adequate supply of geriatric specialists, for example, geriatricians, psychogeriatricians, audiologists, nurses, physiotherapists, occupational therapists, social workers and others.

To support these activities and to promote excellence in education, this government has committed itself to establishing a multidisciplinary department of geriatrics at an Ontario university health sciences centre. This department will provide a focus for the development of exemplary clinical services in conjunction with regional geriatric units and with related institutional, home care and community services. It will also provide teaching resources for undergraduate and graduate medical, nursing and other professional education programs and will be involved in research related to the elderly.

The department is expected to be developed on a phased-in basis, beginning with geriatric medicine in 1987-88. Other professional programs will be added in subsequent years. Up to $1.5 million has been designated for this initiative in 1987-88.

Mr. Rae: Is this another university or the same university?

L'hon. M. Sorbara: Ce n'est pas une autre. Je compte écrire, au cours des prochaines semaines, aux universités dotées d'un centre des sciences de la santé pour leur faire part de cette initiative et leur demander de nous communiquer leurs suggestions. Nous avons également l'intention de consulter auprès du Conseil des universités de l'Ontario à ce sujet.

I am sure members of the Legislative Assembly will join me and all Ontario citizens in welcoming the opportunities being presented to us this afternoon for improving services for our Ontario senior citizens.

Hon. Mr. Elston: The provision of care and supportive services to the elderly of this province is one of the major priorities of my ministry. When we consider the demographic changes now occurring within the Ontario population, it becomes apparent that a great deal of careful study, planning and deliberation must take place if the programs we will soon require are to be properly financed, implemented and organized for effective delivery.

Therefore, the Ministry of Health has strongly supported the special responsibility and mandate given to my colleague the Minister without Portfolio responsible for senior citizens' affairs.

We have worked co-operatively with the United Senior Citizens of Ontario to see that the white paper being presented today marks a new beginning in the development of services for the elderly in this province. We will fully support the consultation process soon to be under way.

Our common goal is to see a comprehensive, co-ordinated network of services in which elderly people are able to move smoothly from one level of care to another as their health status and support needs change and evolve.

We want to see a better and more effective balance develop between institutional care, on the one hand, and community-based programs, on the other. We want to expand the support structures that will enable more elderly people to live independently in their own communities just as long as that is a feasible and realistic option for them.

Shortly, I will ask the 12 community health centres operating in Ontario to review their programs and services and to consider how they might be adapted to meet more of the needs of elderly people. Specifically, we will be looking to the development of programs such as nutritional counselling, occupational therapy, physiotherapy and dental hygiene, as well as educational programs on drug monitoring and substance abuse.

I have also asked the district health councils throughout the province to give special consideration to proposals for community health centres with a particular orientation to caring for the frail elderly. Similarly, any new proposal for a CHC that is to be located near senior citizens' housing and with programs especially designed for elderly people will be considered favourably. The ministry has allocated $500,000 in funding, which will be made available for community health centres that are ready to move ahead with these initiatives.

The Ministry of Health will also provide $5 million towards the development of five regional geriatric units in the five health sciences centres in Ontario. The units will be located at university teaching hospitals and will become resource centres for geriatric care in their respective areas.

Our five health sciences centres in the province are Toronto, Hamilton, London, Kingston and Ottawa. Among these, two geriatric units were established earlier on a developmental basis at Ottawa Civic Hospital and Hamilton's Chedoke-McMaster hospitals but have never been fully funded. These initiatives will provide additional funding to allow these units to reach full regional status, as well as funding for three new regional units. Local district health councils will consult with medical faculties and their affiliated teaching hospitals to recommend where the new units will be located.

All regional geriatric units will have multidisciplinary health care teams for assessment and treatment and will operate on both an outpatient and inpatient basis. The teams will be able to work with elderly people with complex health problems, bringing a variety of skills to the assessment process. Specialist geriatricians, nurses, social workers, physiotherapists, dieticians, pharmacists and other care providers will also be involved.

In addition to directly providing assessment and treatment programs for the elderly patients, each unit will be a resource centre for other institutions and community programs. They will promote improvements in the quality of care in hospitals, other institutions and community programs involved in providing care to elderly people. The units will be training centres for undergraduates, post-graduate physicians and other health care professionals and will undertake research on issues of ageing. They will help to develop guidelines to assist district health councils and hospitals in developing a comprehensive plan for geriatric services.

Once this initial program is fully staffed and operational, it will be subject to a thorough review and evaluation. When this evaluation has been completed, we will then consider the expansion of regional geriatric units to other hospitals in the province.

I wish to stress that, for the Ministry of Health, this is only the beginning of what will be a series of major new program developments for elderly people. This is one health care challenge we accept enthusiastically. As minister, I am pledged to see the services of my ministry developed and strengthened in such a way that we will be able to meet the future health care needs of all the people of this province.

Mr. Dean: On behalf of my colleagues in this party, I welcome the final emergence, from wherever it has been hiding, of the statement and report by the Minister without Portfolio responsible for senior citizens' affairs. I congratulate the minister in apparently being able finally to convince his colleagues that some action was needed here.

I also note we are still going to have to wait a long time, as we have already had to wait -- namely, about 11 months and a further 15 months, which makes a total of two years and two additional months -- before we actually get any positive action on some of these absolutely essential things.

In the meantime, I am sure members are aware that the Progressive Conservative Party released in April a discussion paper called Care for the Elderly: Developing a More Co-ordinated and Community-Based Approach. I suggest one reason for the long delay was that the government was incorporating those very good comments in this paper because there are some very similar wordings.

Here is one example: On page 4 of the minister's statement, it states that he is going to introduce "comprehensive planning and management of health and social services for the elderly." In our paper, we advocate "rationalized, co-ordinated and linked services for a community-based...complete continuum of care for the elderly." This is something we can all agree with, but we have some reservations about some of the details which we will be addressing later.

Mr. Cousens: We on this side are pleased to see a continuum of care for senior citizens. It is rather surprising. Our belief is that every month should be Senior Citizens Month. Ongoing support for seniors is not something on which there should be a surge at the beginning of Senior Citizens Month.

I share in the comments of our critic for senior citizens' affairs that this is a most important subject and that we in our party, in the preparation of this report and in the continued dialogue we are having with people across the province on Care for the Elderly, are anxious to make sure that the needs of our seniors are being met, are being addressed fully and honestly, and that our society is giving its share back to them for what they have done.

From what they are saying, I am sure the ministries are still arguing to try to come up with a solution. The integrated homemaker program is one program we began ourselves. We are pleased to see it being expanded. To put $2 million into home support services does not begin to solve the problem. At least we are seeing some action in the right direction. We are pleased to see the initiatives being taken today. We just hope they are not empty words.

Mr. Andrewes: I want to indicate at the outset that I am not nearly as combative as I look. I congratulate the minister and the government on the presentation of this document. It seems rather strange that I have yet to locate my button in the package. I see other members have buttons, and I am sure they will want to share those buttons with members of the opposition.

The pages have brought me two buttons. Now I am going to have quite a collection.

As did my colleagues the member for Wentworth (Mr. Dean) and the member for York Centre (Mr. Cousens), I welcome the presentation of this paper. It is a very complicated and detailed document, so I am sure I will be excused if I do not comment in detail on some 24 pages, including two pages for notes.

On page 1 of his statement the Minister of Health says, "Therefore, the Ministry of Health has strongly supported the special responsibility and mandate given to my colleague the minister responsible for senior citizens' affairs." I suggest the minister had his tongue a long way in his cheek, given that we have waited so long for this document and that the minister's budget had to be quadrupled to accommodate the repeated reprintings of the document as it was savaged by his cabinet colleagues.

Finally, on page 3, the Minister of Health --

Mr. Mancini: Send the buttons back.

Mr. Andrewes: Does the member want the buttons back?

The minister discusses the regional geriatric assessment centres. That is a commendable idea. I only say there are many communities in rural Ontario which need the same kind of co-ordination and we would encourage that kind of thought.

Mr. D. S. Cooke: My colleagues from the Conservative Party and from the Liberal Party who talk about a continuum of care point out very clearly the problem today in regard to care of the elderly of this province. The fact that we assume there is a continuum of care where all senior citizens, as they grow older, have to go into institutions is the bottom-line problem with our health care system in Ontario.

Ontario's rate of institutionalization of its elderly people is absolutely disgusting. It is something of which every one of us in this Legislature should be ashamed. Statements were also made by other ministers today, but the statement of the Minister of Health specifically seems to repeat the assumption that our older people must eventually end up in institutions. I quote from the minister's statement:

"Our common goal is to see a comprehensive, co-ordinated network of services in which elderly people are able to move smoothly from one level of care to another as their health status and their support needs change and evolve."

That points very clearly to the fact that this government assumes elderly people in this province must eventually end up in institutions. They use a good line today in all the statements; they use all the right words. The reality is that there is virtually no new money in all the statements the ministers have made today.

The $11 million referred to was announced in January. Housing has already been announced. The fact is that the amount of money here today is about five per cent of the amount of money we spend annually on nursing homes alone in this province. The amount of money totally, even the re-announced money, works out to perhaps one chronic care hospital. It appears there has been very little shift in policy announced here today by the government.

There is talk by the Minister of Health and by the Minister of Community and Social Services about emphasizing the 12 community health centres and re-evaluating their priorities, but where is the statement about expanding our community health service program? Why are we not putting in a significant amount of money and initiating community health centres in this province so seniors and other communities have access to community-based services? There is no mention of that.

One aspect I am very pleased with is the minister's announcement that rest homes in this province are going to be regulated. Our party has been asking for regulation of private rest homes for years. I dare say many senior citizens and many residents of rest homes have been involved in incidents that have resulted in death. The lack of regulation of rest homes is something about which the former government should hang its head in shame, because it neglected that group of people in our province.

All the right words and all the right phrases are used today, but I hope the government will look at a real change in philosophy and put that change in philosophy into practice. I would have been much happier had the government put forward some money today and had it looked at a shift in responsibility. In my view, as long as we continue to leave the majority of responsibilities for senior citizens' care in Ontario with the Ministry of Health, we are going to have a continued emphasis on illness treatment and on institutions.

If we are to look at community-based services, we can do that. There are services that have been tried. All one needs to do is to look at day hospitals, home care programs, day care programs and group homes. These programs are already in place. We do not need to continue to consult. We need a government with the guts and the will to put these programs in place. I hope today is the beginning of that reality.

Mr. Warner: It is fairly obvious from the paper that was read out today that there are some glaring omissions. I do not know how the minister can leave out dental care for seniors, transportation services for seniors and temporary short-term or long-term care to provide respite for family members who are caring for seniors, or how he can consider reforming the system of care for seniors without launching a complete and full investigation into the deplorable state of this province's nursing homes.

Whoever wrote the line in this book that there were reservations regarding quality of care and inspection services in nursing homes must be living in another ozone layer.

ITALIAN NATIONAL REPUBLIC DAY

Hon. Mr. Ruprecht: On behalf of the Premier (Mr. Peterson) and the government of Ontario, I rise for the purpose of recognizing an important event that took place on this day 40 years ago, June 2, 1946, the establishment of the Democratic Republic of Italy.

To celebrate this day, I am honoured to recognize in the gallery representatives of the Italian government and leaders of the Italian-Canadian community: Dr. Massimo Machia, consul general of Italy; Aldo Violi, the president of the National Congress of Italian Canadians, Toronto district; Manlio d'Ambrosio, president of the Ontario region of the national congress; and Angelo Delfino, national secretary of the congress.

June 2, 1946, is of great historic significance and sentimental value to our citizens of Italian heritage and to the people living in Italy, a country not only of monumental buildings, famous explorers and noted scientists, but also a trusted friend and ally, a loyal trading partner and a committed supporter of democratic and civil rights around the world.

We recognize the valuable contribution Italo-Canadians have made to the cultural and economic development of Ontario and Canada. Our province has become enriched because our Italian friends, on coming here, have brought with them their love of art, music, architecture and education. More than that, they have strengthened the pillars of our multicultural society by adding their traditional respect for hard work and family life. We have benefited greatly from their participation in sports, business, professions and, more recently, government and law.

The Deputy Speaker: The time for ministerial statements has expired.

Mr. McClellan: Mr. Speaker, perhaps you could waive the time requirements for ministerial statements and permit each of the opposition parties to welcome the delegation, outside the provision of the standing orders.

The Deputy Speaker: Is there unanimous consent to extend the 20 minutes?

Agreed to.

The Deputy Speaker: The responses are not going to be part of the 10-minute responses, is that correct?

Some hon. members: Yes.

The Deputy Speaker: Is there unanimous consent?

Agreed to.

Hon. Mr. Ruprecht: Thank you, Mr. Speaker. I appreciate the suggestion.

In appreciation of this contribution, our welcome to visitors from Italy is always warm and sincere. Therefore, in recognition of this special bond of friendship that exists between the people of Ontario and Canada and the people of Italy, the government of Ontario proclaims June 2 as Italian National Republic Day.

Ms. Fish: I am pleased and proud to rise and join in the sentiments expressed by the minister on behalf of the government and extend to our Italian brothers and sisters our sincerest congratulations on this 40th anniversary of the arrival of true democracy to their country. For those many who have chosen to come to this land we are pleased to call Canada, put down their roots and contribute to our society, we are ever grateful. Congratulations, and welcome again.

Mr. Rae: [Remarks in Italian]

2:46 p.m.

ORAL QUESTIONS

HOSPITAL FUNDING

Mr. Rowe: I have a question for the Minister of Health. His government has made a lot of noise lately regarding the some $850 million for capital projects in the health field in the last budget. Can he tell me why there is a further delay of nine months to a year before the new hospital in Barrie will to get a starting date?

Hon. Mr. Elston: The honourable gentleman who at one time, before he was even elected to this assembly, took it upon himself to announce the hospital would be built, will want to know that we have moved ahead with the planning procedures. We have given approvals to do planning with respect to joint function stage reviews at Orillia and Barrie. We have gone a long way to addressing the needs that have been suggested in questions brought to our attention by the district health council in the member's area. We are progressing at the rate that is the usual pace at which planning is done. We are not going to move ahead quickly in the sense of cutting off time. We want to make sure we have the best functional plans for the people of his area. He will appreciate that the planning process must follow those routes.

Mr. Rowe: I suggest to the minister that planning does not take a lady dying in the hall without her family. That does not move them ahead or help them a bit.

Is the minister aware of a letter of transmittal dated April 18, 1986, from the Simcoe District Health Council to him giving its final advice on six recommendations establishing the breakdown of beds and recommending that the new hospital in Barrie start as quickly as possible? Why does he continue to delay a decision on this matter and play a game of health roulette with the residents of Simcoe county?

Hon. Mr. Elston: The member is absolutely wrong. We are not playing a game of health roulette with anybody, least likely with anybody in his riding. His comment in his preamble that suggested the lady had been pulled from a room without the presence of her family is absolutely wrong. In addition, she was placed in an area where her family members could have access. These people will understand that the staff at the hospital provided that lady with an area where she could be visited by her family.

We are not playing medical roulette or health care roulette with any of the people there. We have received recommendations from the district health council, and in addition, the district health council has done a lot of work to provide us with an overall planning document with respect to bed needs in the entire Simcoe area. The member will understand and appreciate we must have that advice and we must act upon that overall co-ordinated planning advice. We are proceeding to review the submission put by the hospitals. Those hospitals have done a lot more work together since I met with them last fall than they had before. They are making good progress. Progress is being made, and I am pleased to see it being made.

Mr. Rowe: Both the district health council and the hospital agree that the council's final report, which will take between nine months and a year, will not affect the planning process. The minister has available right now all the information he needs; so why will he not stop playing politics, stop giving the residents of Simcoe county a second-class health care system and give us a starting date for the hospital? He has it all. He could do it now if he wanted to.

Hon. Mr. Elston: I have never seen anybody stand up and play more politics with this issue than the people in the honourable member's party. It was introduced in about 1979 by a former Minister of Health. We are moving along in the planning process at the rate the planning process is supposed to move. We have not delayed it. We have asked the questions that must be asked to make sure the planning is co-ordinated not only between the hospitals in Barrie and Orillia but also to meet the needs of the long-term guidelines of the district health council.

I have spent a lot of time making sure those plans have been formulated in a manner in which there will be delivery of good and quality health care and co-ordinated health care services in the member's area. We have moved a lot farther than it had moved in previous months. I am very intent on making sure that we come up with a good facility there and that we end up having first-quality health care in the area. I pledge that to the member, and I undertake to report to him as soon as we have been able to review the latest of the reports that have come forward to us.

URBAN TRANSPORTATION DEVELOPMENT CORP.

Mr. Gillies: My question is for the Minister of Transportation and Communications. I wonder whether the minister will inform this House how the negotiations are proceeding on the unfortunate fire sale of the Urban Transportation Development Corp.

Hon. Mr. Fulton: I was not aware that there was a fire sale on in terms of UTDC. As the member knows, the negotiations are very complex and are moving very slowly.

Mr. Gillies: As a supplementary to that rather facetious answer, I want to quote something the minister told this House on March 7. He said, "No layoffs are contemplated at the Thunder Bay facility from the present level of 700 before current orders are contemplated in 1988." Whether the minister knows it or not, it will be announced at four o'clock this afternoon that 126 employees are being laid off at that facility. How can that be justified in the light of his recent statement?

Hon. Mr. Fulton: Had the member taken the time to read the entire statement released by the president of RailTrans and Can-Car, he would realize the levels of employment are ahead of those projections made in October 1985, the time the rationalization was announced.

Mr. Gillies: It is not that complicated. The minister said there would be no layoffs. Now there are going to be layoffs, and there are rumours of more layoffs in Thunder Bay and in Kingston. The minister's mishandling of this sale is costing that company orders and jobs. Will he commit to this House now that he will live up to his commitment of March, rescind the order for these layoffs in Thunder Bay and ensure that no more layoffs occur at the company until he has made some final decision as to what is going to become of this company?

Hon. Mr. Fulton: The layoffs currently taking effect are those that fall through from the rationalization that was indicated clearly to this House last fall and restated in March. The current level of employment following that layoff will be higher than was projected last fall.

SOUTH AFRICAN INVESTMENTS

Mr. Rae: I have a question for the Treasurer, who I am sure will agree that the entire province was electrified and moved by the visit of Bishop Tutu, not only to this Legislature on Friday but also to all the public meetings that took place over the weekend.

Since Bishop Tutu made it very clear that the way to eat an elephant is to do it bite by bite, can the Treasurer tell us now what the next bite is as far as the Ontario government is concerned in its own dealings with companies and institutions that continue to be involved with South Africa?

Hon. Mr. Nixon: I think the honourable member is aware of the statement made by the Premier (Mr. Peterson) in the House and publicly on a number of occasions, indicating it was his wish and the wish of the government that all companies and agencies divest themselves of holdings that might be associated with any kind of support, financial or otherwise, of the apartheid administration in South Africa. We have reported to the House the information that was available to us. He will also know the Ontario municipal employees retirement system board has met and confirmed its views that it would invest in nothing associated with South Africa and would divest itself of anything it holds at present.

Mr. Rae: It is my understanding from our discussions with OMERS this morning that the whole issue is still under review, that no formal policy statement has been made and that not even a press release has been issued. As far as we are aware, no formal decision of any kind has been made by OMERS. If it has been, it has not been communicated publicly; and if it were to be communicated, I would have expected it to be made to the Legislature.

Can the Treasurer explain why no public statement has been made, why no clear public declaration of policy has been made, and why he will not invoke the powers granted to him by section 14 of the legislation that sets up OMERS?

Hon. Mr. Nixon: As I indicated to the honourable member, my understanding is that the OMERS board met recently and that by resolution it affirmed what I have said. If a statement is to be made, OMERS will make it, and the honourable member can comment on that. Its policy, as passed by resolution of OMERS, is that it will not undertake any additional investment and that it will divest in a timetable that is appropriate and as rapid as possible.

Mr. Rae: We also have the question of the hospitals which I have raised in the House. We have the question of what will be done with respect to the liquor that is still being sold by the Liquor Control Board of Ontario. We have the question of government contracts with corporations such as, to mention only one, the Moore Corp., the business forms corporation, which does quite significant business in South Africa.

In relation to those, does the Treasurer not think it appropriate for the government of Ontario to establish and publicly announce today a boycott policy that makes it crystal clear to those companies doing business in South Africa that they are going to have to deal differently with the government of Ontario? Does that not make sense?

Hon. Mr. Nixon: The honourable member is aware that the government of Canada has a code of what it considers to be ethical conduct in this regard. The Secretary of State for External Affairs has put this before Parliament, and it should be the guideline that controls all governments and businesses in this connection. I believe the Deputy Minister of Finance is going to be tabling a report in the House of Commons in the near future about the application of the code.

The honourable member would know that all members of this House would agree with the views expressed by the Premier, the Leader of the Opposition (Mr. Grossman) and himself, as well as by many other members, associated with the visit of Bishop Tutu and even before that, that the government of Ontario and businesses in Ontario should not being doing business with the government of South Africa or businesses associated there and should be withdrawing with all reasonable haste.

EQUAL PAY FOR WORK OF EQUAL VALUE

Mr. Rae: I have a question for the Attorney General as the minister responsible for women's issues. He will be aware that a report by the alternate panellist appointed by the Ontario Federation of Labour has been made public with respect to the issue of equal pay. Since the information contained in that report points out on a purely factual basis that 92 per cent of those presenting briefs called for legislation that covers all workers, including part-time and casual workers, and that 89 per cent of the presenters felt the legislation should apply to all employers in the same way regardless of size, has the Attorney General made up his mind with respect to those crucial issues: the inclusion of part-time workers and the inclusion of all businesses regardless of size? Is he prepared to announce that today?

3 p.m.

Hon. Mr. Scott: I have received the report my friend refers to, which I think was issued this morning. I have had occasion to look through it fairly carefully. It is a series of questions defined by the writer of the report and a catalogue listing the presenters in favour and the presenters against. I do not mean to say it necessarily matters, but there is no catalogue to tell us how many people are represented by the presenters in favour or the presenters against. I do not hold that against it; I simply make the observation. I want to tell my honourable friend that I find this very helpful for the purposes it serves, but we have not as yet made up our minds. The matter has not yet been decided by cabinet.

Mr. Rae: The report also does not mention the net worth of the presenters, which seems to be currently preoccupying the government. That is its big problem; we all know that. We know that is the issue that troubles the government.

I would like to ask the minister responsible for women's issues, what is the specific timetable? if he is not prepared to say that today, can he at least give us the assurance that his three reporters will also issue a public report and that all their recommendations and advice to him will be made as public as the report of Janis Sarra has been today?

Hon. Mr. Scott: I have indicated the timetable for the release of the presenters' report. I will give consideration to determine the other request the honourable member has made and in due course I will decide and let him know what the government's decision is.

Mr. Rae: Perhaps we will have to get it under the Freedom of Information and Protection of Privacy Act, whenever that is presented by the government; I do not know.

Does the minister not realize that as a consequence of the delay, for which he himself is responsible and to which he is catering, it is extremely difficult for those groups that are not covered by Bill 105 to know what the alternative is to a significant review of Bill 105? Does the minister not realize that, and also the consequences that is going to have for the consideration of Bill 105?

Hon. Mr. Scott: I understand the consequences it may have and I am very conscious of them. However, we have made it plain from the very beginning that the private sector and expanded public sector bill is going to be subject to this consultation process. It has now terminated in the sense that the hearings have taken place, and we will announce the terms of the bill as quickly as we can. I am very conscious of the observation the honourable member has made. I recognize its importance to him and to others. We will try to introduce the bill as quickly as we reasonably can.

Mr. Gillies: My question is also to the minister responsible for women's issues. We sincerely hope he will make this consultation public and not restrict it to just his ears and those of the Premier (Mr. Peterson). Will the minister tell the House whether he will be bringing his public sector Bill 105 into this House before the end of this month for an expedient second reading, so that the bill can go out to committee consultation during the summer months?

Hon. Mr. Scott: That is a question for the Minister of Labour (Mr. Wrye,) who has carriage of the public sector bill. He is absent today. I will have to draw the question to his attention.

The Deputy Speaker: Is there a supplementary on that?

Mr. Gillies: The minister felt unconstrained to comment on the progress of that bill last week as far as the consultation process was concerned. I want to make it very clear to him that we are very interested in the passage of that bill and in amending it at the committee stage. That can only be done in the near future if the bill is brought to the House and can go out to committee at the end of the session. While I know the minister cannot answer for the Minister of Labour, would his advice to the Minister of Labour be that that kind of timetable be met?

Hon. Mr. Scott: I will bring the matter to the attention of the Minister of Labour.

PENSION FUNDS

Mr. McClellan: We are waiting for the Minister of the Environment (Mr. Bradley), but I have a question for the Treasurer concerning a report by Pension Finance Associates. It is a report of pension fund earnings categorized on a one-, two- and three-year rate of return basis, ranked on the basis of earnings. Given that the first quartile has four-year annualized rates of return of 19.6 per cent earnings and that the earnings last year for the first quartile were 25.4 per cent, can the Treasurer explain why his government still continues to prefer the policy of allowing companies to steal surplus pension funds rather than to use so-called actuarial surpluses in the funds in order to provide inflation protection for pensioners?

Hon. Mr. Nixon: Am I to understand the report the honourable member has is for the next four years?

Mr. McClellan: No, the last four years.

Hon. Mr. Nixon: So the average for this last one for 19 per cent may explain why the teachers are somewhat dissatisfied by the investment of all of their payments into Ontario at about 12 per cent. It may be why they have brought that to my attention repeatedly.

As I have said in the House before, we are aware under the present statute and regulation of Ontario of the requirement put forward by the Pension Commission of Ontario for the presence of 125 per cent of the requirements to be on deposit. Anything over that is considered to be surplus. Under the present regulations and statutes, it is distributed by the agreement to the employers.

That is correct. The employers can, as the member says -- I am not going to use the verb he uses -- remove the surplus with the agreement of the Pension Commission of Ontario. I am sure the member is aware that the legislation in draft form is before the community. The people are responding to my colleague the Minister of Financial Institutions (Mr. Kwinter) and we expect to proceed with legislation either exactly as in the draft or as amended some time in the fall.

Mr. Rae: I do not think he answered the member's question.

Mr. McClellan: No, he did not.

The rate of return for the third quartile, that is to say the pension funds that are ranked in terms of earnings between the bottom 25 and the bottom 50 -- these are not the top earners; it is the group between 25 per cent and 50 per cent in terms of earnings -- averaged 21.3 per cent last year. These are the losers. Their four-year annualized rate of return is 17 per cent.

Given those humungous rates of return for the pension funds in this province, can the Treasurer explain to me what he meant when he said to me a few weeks ago in response to a question about indexation, "If we impose indexation on pension funds of the type that are currently established, they will simply disappear"? Surely the Treasurer must realize that with those rates of return, it is simply the course of rationality to use these funds for indexation of benefits.

Hon. Mr. Nixon: There are two things to be said. I indicated I thought that many of those pension plans would disappear because there is no law that says a company or corporation of any kind must have such a program.

Mr. McClellan: That is the Treasurer's second amendment.

Hon. Mr. Nixon: It may be the member's amendment. The way the law is now, there is no requirement that a pension fund be set up. There are many of them, and I think the member would be aware that in less buoyant economic times the same statute of which he is so critical required the employers to ante up the needed extra when the figures for the quartiles were somewhat less impressive than the ones he is putting before the House today.

RAPE CRISIS CENTRES

Ms. Fish: I have a question for the minister responsible for women's issues. May I ask the minister why his government has slashed funding to the Ontario Coalition of Rape Crisis Centres?

Hon. Mr. Scott: It is really a question for the Solicitor General (Mr. Keyes) under whose ministry this funding comes. I should ask the member if she would like the question referred or if she would like my observations about the question.

Ms. Fish: I am addressing the question to the minister responsible for women's issues because I understand a representative of the Ontario women's directorate --

The Deputy Speaker: Order.

3:10 p.m.

Hon. Mr. Scott: I am prepared to say the Solicitor General, with the support of his colleagues, took the determination that was made. It is funding for a period of one year. It is funding that is provided under an agreement under which we hope there will be a co-operative review of the processes of the crisis centres and the way they admit members to their organization. It will lead, we hope, to a rejuvenated response on the part of those centres and to the ability of government to fund them in the future. That is why we have done it.

Ms. Fish: The government's offer was $200,000, down $50,000 from the three-year commitment it had had, $250,000 in each of three years, from the previous government. The funding will place in peril the opening of two new centres this year. It will place in peril the translation of their materials into native tongues and into the French language. I say again to the minister responsible for women's issues, with $24 million to go to racehorses, why can his government not find an additional $50,000 for the victims of rape in this province?

Hon. Mr. Scott: The reality is, of course, that those assumptions are wrong. It will not place in peril the opening of any rape crisis centres in the province at all. One of the difficulties with the rape crisis centre funding arrangement is that no new centre is eligible for the funding until a year has gone by. One of the concerns of the government is that, as all funding for rape crisis centres goes through the coalition, it should make a proposal to the government that will permit the funding of its member rape crisis centres as soon as they are founded and not compel them to wait a year before funding is made available to them.

INCINERATORS

Mrs. Grier: I had hoped the Minister of the Environment might celebrate World Environment Week by laying before the House today a very clear statement of action he intended to take, but in the absence of that I will ask him a question.

The Toronto Board of Health's report pointed out the urgency of reducing dioxins and furans in our environment. The ministry's own reports have pointed out that the major contributing factor to those contaminants is incinerators. In view of that, can the minister tell us why he is allowing the addition of 15 new garbage and sewage sludge incinerators in this province at this time?

Hon. Mr. Bradley: The member is aware that on Friday last week representatives of Pollution Probe met with me to outline what they felt was a good response, Toxic Fallout into the Food Basket: Dioxins and Incineration. They presented this report to me on Friday. They identified as an area of concern incinerators that might operate in the province -- and some might be oncoming -- and made certain recommendations. I indicated I would give very serious consideration to them, as I always do to Pollution Probe's presentations.

The member knows that one of the difficulties we face all the time -- Mr. Speaker, you would be particularly aware of this because of circumstances that affected your riding -- is that every time there is a proposal for a landfill site, people say landfill is not the route to go, incineration is. When there is a proposal for incineration, the suggestion is that landfill is preferable.

We have to find the best and safest way of dealing with our problems, including a very strong recycling component. I will certainly take into consideration the representations made by Pollution Probe. I have indicated to them that, as they requested, I will get back to them in two weeks with a reply that the House will be aware of.

Mrs. Grier: If the minister has read the Pollution Probe document, he will know it states that only one per cent of this province's garbage is now recycled. I hope he will take that alternative strongly into account when he is reviewing their document.

The minister has continually told this House that the way to solve environmental problems is to get at the sources of the problems. Does he not agree the 15 incinerators that are mentioned are merely new sources that would contribute to the degradation of the environment?

Hon. Mr. Bradley: A list of incinerators was provided. This is the one the member is making reference to, table 3. Some of them, for instance, are going virtually nowhere. I notice, for instance, that St. Catharines is mentioned as one site. I do not think there has been much serious consideration given recently to the regional municipality of Niagara, for instance, dealing with energy from waste. That seems to have been put on the back burner. The member will recall that the impetus for this largely came from the high oil prices at the time and it seemed to be attractive. While there have been some suggestions that many of those I am looking at will want to proceed, they are well down the line.

I indicated to Pollution Probe that I am giving serious consideration to not allowing them to proceed, as they have done in Sweden. We have to get all the facts before us, because the same people who advocate the elimination of the incinerator as a potential solution also do not want us to allow further landfill sites in the province.

INSURANCE AGENTS

Mr. Runciman: In the absence of the Minister of Financial Institutions (Mr. Kwinter), I will direct my question to the minister responsible for women's issues. The minister may know that more than 40 per cent of part-time insurance agents are women; yet his government plans to ban part-time agents. Has the minister looked at this? If he has, what are his views on this serious matter?

Hon. Mr. Scott: I thank the honourable member for bringing the matter to my attention. l will have to consult with my colleague the Minister of Financial Institutions about it when he returns.

Mr. Runciman: We have been having this song all afternoon on very important issues dealing with the women of this province. The minister does not seem to be aware of many of them. I am looking for a commitment that he will not only meet with the minister, but will also attempt to drag himself and the minister into 1986 and scrap this anticompetitive, discriminatory proposal that will serve only to worsen job prospects for women.

Hon. Mr. Scott: As there was no question in that elaborate remark, I do not think there is anything to answer. There was a bit of a speech, and it was entertaining too.

ELECTRIC SHOCK THERAPY

Mr. R. F. Johnston: My question is for the Minister of Community and Social Services and concerns the use of cattle prods in our institutions for the mentally retarded. The minister must be aware that this is not, as he indicated, a short-term process, that it deals only with the behavioural symptoms of the people involved, and that even political dissenters of strong will in other lands who have had this kind of adverse behaviour therapy given to them are known to change their behaviour for short periods of time. Is the minister aware of the high rate of recidivism involved for people who have had this therapy?

A Windsor Star article on the weekend that gives the Cedar Springs point of view on all this, and one would presume uses its best examples, tells the story of a man named David, who, after being in for many months of behaviour modification with the use of electric shock, was back after only one month in the community in 1984. They are hoping to be able to release him again some time this year. Does the minister have any evidence at all that this does anything more than change behaviour for a brief period of time? Does he have any evidence that it gets to the causes of the difficulty and is therefore real therapy?

Hon. Mr. Sweeney: As was indicated earlier, the whole purpose of the review is to respond to the very questions the honourable member is raising. I will go back to the specific instance the member referred to. He will recall from the article that this young man came to the centre after having been in a straitjacket for four years and that he had passed from facility to facility, each trying to help him with his self-abusive problems. He is now out of that straitjacket.

I repeat that I am not in favour of the shocking technique. I have said that clearly. I have also said we are conducting a review to find out whether it produces the results that have been claimed and whether there are more appropriate ways. When that review result is in, I will take the necessary action. However, the evidence seems to indicate, and the one the member mentioned seems to be one of them, that in some cases a suitable and workable alternative has not been found up to this time.

3:20 p.m.

Mr. R. F. Johnston: I will not read into the record the incredible excesses that are involved in that case, but I will ask a very particular question about Durham Centre's closing, a place where, as I understand it from the Oshawa papers today, at least four people in that institution are receiving shock therapy at this point. What happens when it closes? It is supposed to close this weekend, but there are still some 30 patients left. Where are those patients going to go? Are they going to go back to D'Arcy Place, which prohibits this type of treatment? Is the minister going to force D'Arcy Place to give this treatment or is he going to ship these people to Cedar Springs where they can continue shock treatment?

Hon. Mr. Sweeney: The entire purpose of the program is to assist people to the point of independence and autonomy where they are able to go out and live in the community. In the examples the honourable member mentioned earlier, that is precisely what has happened and what will continue to happen. The member knows the people who are in Durham right now are being prepared to move out into the community. Only when there is a suitable place for those people to go out into the community will they be released from Durham.

The member indicated that some people in Durham are going to D' Arcy, which does not use this procedure. If it were required to be continued, they would not go to D'Arcy. They will be assisted until they are ready to go into the community.

EXTRA BILLING

Hon. Mr. Elston: I want to advise the House today in relation to a question that was asked last week by the Leader of the Opposition (Mr. Grossman) with respect to a report on the circumstances of the two-day job action by Ontario physicians. I apologize to the Leader of the Opposition, who is not here, but I think this is an important enough issue for me to provide this information for members now.

First, no serious problem regarding patient care was reported and inpatient services were maintained in all Ontario hospitals. In general, there was no significant increase in --

Mr. Harris: On a point of order, Mr. Speaker: I have no objection to reverting to statements if that is what the minister wants us to do. He is giving out information after the questions have been asked. How can this possibly be an answer to a question?

The Deputy Speaker: I understand there was an undertaking by the Minister of Health to the Leader of the Opposition to answer the question today. I am assuming it is a relatively short answer; otherwise it should have been put in under statements. It is an answer to a question.

Hon. Mr. Elston: I tried to save some time by handling it through my statement. There were fewer than 30 telephone calls regarding the job action received by my ministry's public information centre over the two-day period. Only one had to be referred to the College of Physicians and Surgeons of Ontario. Finally, the college reported to the ministry that it had not identified any serious problems in the provision of medical services over those two days.

Mr. Rae: Supplementary.

The Deputy Speaker: I believe the question was put by the --

Mr. Rae: No. It was not. With great respect to the minister, I put the question to the minister on Thursday relating specifically to the reporting mechanisms in place and how many surgeries were cancelled. If you look at Hansard for Thursday, you will see I asked that question specifically.

The Deputy Speaker: The minister did indicate to the chair in a note that he believed it was the Leader of the Opposition. There was some doubt.

Mr. Rae: In that question on Thursday, I specifically asked the minister whether he could tell us how many cancer-related surgeries were cancelled on Thursday and Friday on a hospital-by-hospital basis. The minister has not provided us with that information. From published press reports, we know there was at least one, which I read about in the Toronto Star, and others were reported in other local newspapers.

Can the minister give us that information? In his view, is it appropriate professional conduct in the case of patients who have had cancer surgery scheduled to have that surgery cancelled because of action being taken by doctors in this regard?

Hon. Mr. Elston: In relation to the two questions, first, I do not have the information assembled at this point with respect to hospital-by-hospital data. I do have some information which the member has seen reported, but my information from contacting the hospitals has been that most of the procedures that were cancelled on Thursday and Friday were rescheduled very quickly thereafter; at least a date was provided. I do not have more information than that.

I do know efforts were made on the part of those who were suggesting cancellation or postponement of surgery to give alternative dates and that patient consideration was involved in decisions wherein cancellation was made.

[Later]

Mr. Harris: Mr. Speaker, there may be several points of order arising, but I have one. I refer to the Hansard of Thursday, May 29, 1986. The member for York South (Mr. Rae) asked a question of the Minister of Health. There were several allegations that it was asked by our leader, and I was accused of not knowing what was going on. In spite of the fact that it was not our leader, I do know what was going on.

This is the response from the Minister of Health: "We will be getting that information. In fact, some initial contacts were made around noon hour today; the information was not available for me to bring to the House. On Monday, I will provide the information by way of a statement."

I suggested to you, Mr. Speaker, that it was a statement and that it should be part of statements. I said I would revert to statements but the time should not come out of question period. I ask you to add two minutes to question period so we can finish the business of the day.

The Deputy Speaker: I do thank the member for his point of order. I will look into it. I was advised by the minister that it was in response to a question. I will look at Hansard to establish whether it is a statement, a response to a statement or a response to a question.

DRUG BENEFIT FORMULARY

Mr. Leluk: My question is for the Minister of Health. The minister told this House last November, some seven months ago, that he could not publish a new Drug Benefit Formulary because of pending litigation. Since the Divisional Court gave the green light to his ministry some seven weeks ago, why does the minister continue to delay? Does the minister realize that this delay is substantially costing the Treasury, is threatening the survival of small independent community pharmacies and is costing Ontario consumers? Does the minister realize that he is restricting the advent of new beneficial drugs because of his delay? Does he enjoy playing with the health and lives of our seniors?

Hon. Mr. Elston: First, we are not playing with the health and lives of seniors in this province. The member will know we have been able to make arrangements, if medications are required, to proceed by special authorization. I think the gentleman would want to check the basis on which he makes the final remark.

Interjections.

The Deputy Speaker: Order. The member for York Mills (Miss Stephenson) and the member for Essex South (Mr. Mancini) are making enough noise that I cannot hear the reply.

Miss Stephenson: It was the member for Niagara Falls (Mr. Kerrio).

The Deputy Speaker: Will you please be quiet while the minister gives his reply?

Hon. Mr. Elston: In relation to that litigation, the gentleman will also know there was a request for leave to appeal and other things have intervened since the court decision was given. In relation to looking at printing a new formulary, we have requested some more information with respect to marketing. I have spoken, actually this morning and on other occasions, to pharmacists with respect to some of the areas in which they can provide me with information as to where they have suffered losses.

Mr. Wildman: Let us proceed with the legislation.

Hon. Mr. Elston: If they want to pass it through in a hurry --

Mr. Harris: Last December it had to go through before Christmas.

Hon. Mr. Elston: Let us put it this way. These gentlemen do not really quite understand the legislation they are asking to be passed in a hurry, because they have not done an analysis of it. The information is being assembled to do some work on the formulary, even though the bills are not yet in place and have not yet been proclaimed.

Mr. Leluk: The minister told us in November of last year that the additional cost to the Treasury for having paid inflated drug prices was some $4 million a month. How long is the minister prepared to pay these inflated prices for drugs purchased by the government under the Ontario drug benefit plan? Will the minister assure this House that the new formulary will be published immediately, with realistic drug prices and a fair dispensing fee for pharmacists, who have gone for about two and a half years without any increase?

Hon. Mr. Elston: I cannot quite understand where this gentleman comes from because he was one of the people who spoke, not only at length but also excessively long, in reading out the series of pieces of mail which he received last fall. Now he is urging that there should be no delay and he is blaming me for the delay. That is not the case.

We have tried to shepherd this piece of legislation through our committee stages fairly quickly. Members know as well as I do that there was considerable debate on second reading. Just recently, there were extensive amendments to this legislation. We must now analyse the impact of those amendments.

It seems to me there are a number of housekeeping matters which might bear taking a look at. I will share those with all the people here before we come back to the House and provide them with an assessment of the effect of the errors and omissions of two or three words. I will share that with those people. I will also undertake that we will move as quickly as we can to deal with the problems the gentleman has outlined here this afternoon.

3:30 p.m.

HAZARDOUS SPILL

Ms. Gigantes: My question is to the Minister of the Environment. Can he tell us how the Lees Avenue coal-tar environmental mess in Ottawa-Carleton managed to develop without ministry intervention that would have prevented the exposure of workers to carcinogens, the exposure of the public at the Lees Avenue transit station to carcinogens, the use of a chemical processing plant that was ordered closed in September 1985 and the exposure of children at Notre Dame des Champs school?

Hon. Mr. Bradley: I have personally been in contact with the chairman of the regional municipality of Ottawa-Carleton, and our officials have been in contact with officials of the regional municipality on an ongoing basis to discuss all matters related to this.

As the member knows, concern was expressed about the placement of the material and the manner in which it would be dealt with, that is, the separation of the contaminated oil and the water and the site to which it would be taken. She will also be aware that Gloucester township had undertaken action designed to close that site in Gloucester. That action was supposed to be in effect as of this weekend.

Navro is not dealing with it at this time, but the Tricil company is now dealing with it. The separation of the material is taking place right on site. The consulting firm M. M. Dillon is supervising that. Then the material is being taken to a site in Quebec. Those problems have been overcome, and I appreciate that people in the area have had that concern, including the member.

Ms. Gigantes: My question was not answered. How is it that a site that has been listed on the ministry's site inventory study since 1980 is a site where workers and the public are exposed, the material is shipped to a processing plant that should not be operating and schoolchildren are showing symptoms of illness?

Hon. Mr. Bradley: In relation to the site where the spill took place, for instance, the regional municipality purchased that site for its purposes, for the transitway. As I recall, the Lees Avenue site was an old industrial site, not a waste disposal site. At that time, the region could have looked into the history of that site. However, they had determined it was an appropriate site for their uses and decided to make use of it. This spring, it was found that the site was not without some problem. They discovered the leakage that was taking place. As a result, remedial action was taken to overcome that problem.

FIRE VIOLATIONS

Mr. Sterling: My question is to the Solicitor General. Why has the fire marshal's office not acted upon repeated complaints, deficiencies and fire violations in both the Woodstock and Ingersoll courthouses?

Hon. Mr. Keyes: I cannot give the honourable member an answer on that today. I had some comments on that issue before with regard to the public institutions inspection panel, which inspects these facilities. I have not had a chance to see the two reports that have been prepared by that panel. I will do so and report back to the member immediately.

Mr. Sterling: I understand this same question was asked of the Solicitor General on May 27 by some members of the press. In view of the fact that the courthouse in Woodstock does not have fire alarms, smoke detectors, fire escapes or sprinklers --

Hon. Mr. Scott: We do not own the courthouse.

Mr. Sterling: That makes it even better. If there were a fire in the basement, people on the third floor would not know about it and would have trouble getting out. Why does the Solicitor General not prosecute the landlord?

Hon. Mr. Keyes: As I said in my earlier statement, I will doublecheck that and be sure to get back to the member this week with an answer to those issues in those two centres.

COUNSELLING PROGRAM FOR WIFE ABUSERS

Ms. Bryden: I too have a question of the Solicitor General. As he knows, we face a huge problem of wife battering in this province, with estimates of up to 10 per cent. I am sure he also knows that treatment and counselling for men convicted of wife assault is a very important way of reducing its incidence.

Why has the minister not even replied to requests for funding from one of the few male counselling services operating in this province, namely, New Directions in the Ottawa-Carleton region? They wrote him on April 1 and May 1 and sent a telegram on April 14. They have had to cut their program in half, and they may even fold by the end of this month without help from his ministry. When will he meet with them?

Hon. Mr. Keyes: The issue is being reviewed by staff and myself to look at the service provided by that organization. We will be responding to them.

The matter of providing programming for those who perpetrate the assaults is something we have been studying in general in the ministry, because it does provide an opportunity to alleviate some of that great hazard of abuse that has been brought upon a segment of our society.

Ms. Bryden: All they are asking for is $16,000, which is one fifth of their total budget; it would cover the 20 per cent of their clients who are mandated by the courts to attend counselling services. I understand the minister is now paying $40,000 a year to the Changing Ways male counselling program in the London area, which has been very effective in rehabilitating men convicted of wife assault.

Does he not think his ministry has a responsibility to see that similar programs are provided not only in London and Ottawa but also in all other parts of the province so that judges will be encouraged to require attendance at such programs as part of probation orders?

Hon. Mr. Keyes: The merit of the program is being addressed, as I said earlier. I can be corrected by the Minister of Community and Social Services (Mr. Sweeney), but I also understand it is a Ministry of Community and Social Services facility, at the moment operating under contract to the ministry. Incidentally, it is also a fairly expensive treatment in that area, costing somewhere in the vicinity of $800 a person.

However, as I said, we are reviewing that program to see what are the most effective means of providing this type of counselling for the male population.

CALIFORNIA WINES

Mr. Andrewes: My question is of the Minister of Agriculture and Food. Does he think it is appropriate that the Trillium restaurant, which is in Ontario's showcase at Expo 86, should be promoting and selling the wines of the state of California?

Hon. Mr. Riddell: I certainly do not think it would be appropriate. It is something I will check into to see whether we cannot change that.

Hon. Mr. Bradley: I think it was a request of the local wineries.

Hon. Mr. Riddell: Oh, I see. My good colleague tells me it was done at the request of the local wineries.

Mr. Partington: Would the minister do a little more than check into it? It is vital to the Ontario economy and to the pride of the Ontario wine industry. Will he see immediately that the government takes steps to prohibit further sales of California wines in the Trillium restaurant and immediately withdraw, or cause to be withdrawn, California wines from the wine list?

3:40 p.m.

Hon. Mr. Riddell: I would like to direct the member's question to the Minister of the Environment (Mr. Bradley).

The Deputy Speaker: This is not a question within the purview of the Minister of the Environment.

Interjections.

The Deputy Speaker: Order.

Hon. Mr. Bradley: If I may, Mr. Speaker, I have special responsibility for the field of wine policy in the government of Ontario.

The Deputy Speaker: Carry on.

Hon. Mr. Bradley: The question is --

The Deputy Speaker: Order. There is a point of order from the member for Nipissing.

Hon. Mr. Bradley: If the member does not want an answer, that is fine.

Mr. Harris: On a point of order, Mr. Speaker: The question was asked of the Minister of Agriculture and Food. It is an agricultural question. We get 30 different responses from over there: "That is not mine." "I will take it." "Let me run with the ball." "I am the Minister of Health today." Either they do it one way or they do it the other.

Interjections.

The Deputy Speaker: Order. Since all honourable members are honourable members and the Minister of the Environment did say he was in charge of the policy, then it is appropriate for the Minister of Agriculture and Food to refer the question to him.

Hon. Mr. Bradley: If the members are interested in the answer, and I know the member for Lincoln (Mr. Andrewes) and the member for Brock (Mr. Partington) are, I recall having this brought to my attention as well. I did some investigation of it because on the surface it appears to be inconsistent with what we consider to be Ontario policy.

I investigated and found out that, at the request of the wineries in this specific case, they wanted the opportunity to have California wines compared with Ontario wines to demonstrate the high quality of our wines.

Mr. Andrewes: Did the minister ever think to ask the growers? Is he the minister of wineries?

The Deputy Speaker: Order.

Hon. Mr. Bradley: It is my understanding that this request was made. The people who work there are asked to compare the two wines. if a person orders a California wine, they will then suggest he tries an Ontario wine to show its high quality. That is the purpose of this policy, made at the request of the wineries.

The Deputy Speaker: That is a satisfactory answer.

Hon. Mr. Bradley: They have shown a preference for Ontario wines.

Mr. Gillies: On a point of order, Mr. Speaker: With respect, I am sure the minister's answer was out of order. Could he provide to you, Mr. Speaker, documentation which says he is in charge of wine policy so you can fulfil the letter of the standing orders?

The Deputy Speaker: The minister made the statement that this was within his policy as minister. We must accept his statement as such.

Interjections.

The Deputy Speaker: Order.

[Later]

Mr. Gillies: On a point of order, Mr. Speaker: Going back to the earlier point regarding the answer given the House by the Minister of the Environment, this is not a life-or-death matter, but it is the precedent that concerns us. Standing order 29(f) states, "A minister to whom any oral question is directed may refer the question to another member who is a member of a board or commission to which the question applies."

If the Minister of the Environment has any responsibility for wine policy, it is complete news to the members of the opposition. We are worried about the precedent that any member of the government may be able to hop up and answer questions about any matter he wishes to. That troubles us because we direct questions within a minister's responsibility and do not get answers.

The Deputy Speaker: As I said before, I cannot allow that as a point of order. All members of the House are honourable members. When any minister states it is part of his policy as minister, we must accept that. That is not a proper point of order.

UNIVERSITY EXCELLENCE FUND

Mr. Allen: I have a question of the Minister of Colleges and Universities with respect to the faculty renewal program he announced last week. Will the minister explain to us how his $84 million to cover 500 faculty during the period of his plan will do the job that the Bovey commission estimated, with all the contingencies required, would cost $152 million?

Hon. Mr. Sorbara: If the member for Hamilton West wants a detailed analysis of how the faculty renewal plan will work, I will be more than happy to provide him with that. We anticipate under the plan that during the course of the next five years, 500 faculty members will be hired. With some attrition rates, we have estimated -- and I think our estimates are good ones -- that in constant 1986 dollars the program during the period will cost $84 million.

If the member wants to challenge the figure or wants to assess it against Bovey's, he is perfectly free to do that. I will send him the analysis that shows how we are going to do it.

Mr. Allen: I will be happy to receive the analysis, but there are institutional adjustment elements, charter rights and so on built into the original plan, and the question is whether they are involved in that. Since Bovey also indicated that 900 new faculty members would be needed in the universities between 1988 and 1992 simply to maintain the faculty-student ratio in the light of the double cohort that is coming through as a result of the Ontario Schools, Intermediate and Senior Divisions guidelines in the secondary schools, how is the minister going to cope with that crisis with his underpaid 500 new faculty members?

Hon. Mr. Sorbara: My friend suggests they are going to be underpaid. The statement I made in the House suggests that salary scales for the 500 who will be affected by the program will be set in conjunction with the Council of Ontario Universities. Obviously, it will take into consideration the pay scales of existing faculty. We are talking of 500 new faculty members who would not normally have been hired were it not for the faculty renewal program. An additional allocation of $84 million to a program will make a significant dent in the needs identified by Bovey; in fact, it will match those needs.

My friend raised the question of the double cohort and I should take an opportunity to respond. We are tracing the double cohort and because it is now 1986, not 1984, we have far better information about how many students will come together in one year for first-year registration in our institutions. There are far fewer than was contemplated by Bovey. The analysis Bovey did was based on 1984 statistics. Our statistics indicate we will be able to cope with the double cohort with the faculty renewal program and the increments we have provided.

3:50 p.m.

PETITION

NATUROPATHY

Mr. Polsinelli: I have a petition signed by 90 Ontarians which reads as follows:

"To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

"We, the undersigned, beg leave to petition the parliament of Ontario as follows:

"Whereas it is our constitutional right to have available and to choose the health care system of our preference;

"And whereas naturopathy has had self-governing status in Ontario for more than 42 years;

"We petition the Ontario Legislature to call on the government to introduce legislation that would guarantee naturopaths the right to practise their art and science to the fullest without prejudice or harassment."

INTRODUCTION OF BILLS

YOUNG MEN'S CHRISTIAN ASSOCIATION OF CAMBRIDGE ACT

Mr. Barlow moved first reading of Bill Pr35, An Act respecting the Young Men's Christian Association of Cambridge.

Motion agreed to.

CITY OF WINDSOR ACT

Mr. D. S. Cooke moved first reading of Bill Pr6, An Act respecting the City of Windsor.

Motion agreed to.

Mr. D. S. Cooke: It gives me a great deal of pleasure to introduce a historic piece of legislation. This is the first municipal right-to-know legislation in the history of Ontario.

The Deputy Speaker: It is difficult to know if some of the people who are standing are wishing to introduce bills.

MUNICIPALITY OF METROPOLITAN TORONTO AMENDMENT ACT

Hon. Mr. Grandmaître moved first reading of Bill 48, An Act to amend the Municipality of Metropolitan Toronto Act.

Motion agreed to.

Hon. Mr. Grandmaître: Today I am pleased to introduce for first reading legislation that will authorize the Metropolitan Toronto council and the councils of the six area municipalities in Metropolitan Toronto to establish pension plans for the members of council and their surviving spouses and children.

I want to emphasize that these plans will be supplemental to pension plans already established under the Ontario municipal employees retirement system, which provides council members in Metropolitan Toronto with the same benefits as municipal and provincial employees.

Legislation has been requested by the Metropolitan Toronto council to make pension benefits for its council members similar to those for members of this assembly. This bill will give the metropolitan council and its six area municipalities discretion to determine what, if any, additional pension benefits should be provided for their council members.

ORDERS OF THE DAY

BUSINESS OF THE HOUSE

Hon. Mr. Nixon: Although the business paper indicates we will begin with second reading of Bill 98, it has been agreed by all three parties that we will not proceed at this time with Bill 98. Therefore, I will call the second order.

House in committee of the whole.

HEALTH CARE ACCESSIBILITY ACT

Consideration of Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act.

Hon. Mr. Elston: I have provided some amendments for the other parties with respect to section 1. I believe we will be moving progressively from section 1 through to the end of the bill. There are a number of items under the definition section that I would like to see amended. I am prepared to wait for those amendments to be made until we consider amendments to sections 3a and 3b, where those definitions will be needed. That is the way we have handled the clause-by-clause stage in other committees. Do you want to handle these suggestions in that way, Mr. Chairman, or do you want to move the amendments now before we have the substantive sections?

Mr. Chairman: I am trying to go through this and line up the various sections you want to amend and speak to. I see new sections 3a and 3b that are being put in.

Hon. Mr. Elston: That is correct. I can give you the list of all the sections we are looking at amending: section 1 with amendments to definitions; adding new sections 3a, 3b, 3c and 3d; changing subsection 4(1); voting against subsections 4(2), 4(4), 4(5), 4(6) and 4(7), which will not be needed if the other amendments are accepted; and adding sections 4a and 4b. That is the entire package of amendments we have provided.

Hon. Mr. Nixon: On a point of order, Mr. Chairman: I am sorry to interrupt. The minister has indicated it will assist him and the discussion in this important matter if his staff are permitted to be present at the table to advise him. If there is no objection, we will have them take their places.

Mr. Chairman: Is it the pleasure of the committee that the minister's assistants sit at the table?

Agreed to.

4 p.m.

Mr. Chairman: Minister, I note your proposed amendment to subsection 4(2) is that it be struck out. The appropriate procedure would be to vote against it. The same would apply to subsections 4(4), 4(5), 4(6) and 4(7). We will leave that for now. A new section 4a is to be added, and a new section 4b.

Are there other amendments?

Mr. Henderson: I wish to propose amendments to sections 2 and 4.

Mr. Chairman: You are striking the entire section 4 and moving a new one. That is fine.

Are there any other amendments, comments or questions? Let us hear the member for Windsor-Riverside (Mr. D. S. Cooke). I see some amendments in front of me here. Am I correct that in these proposed amendments you wish to have an amendment to add a subsection 2(2)? You might confirm this for Hansard as I go along here.

You have a lengthy amendment to section 3 with 20 subsections. The entire section is to be struck out and a long one is to be put in its place. You also have an amendment to section 6.

Are there any other sections that members wish to discuss? If members wish to make any comments, tell us on which sections you wish to make amendments, comments or questions.

Mr. Andrewes: We have some amendments. We have some comments on virtually all the sections.

Hon. Mr. Elston: On a point of order, Mr. Chairman: If there are amendments that we have not seen, are we going to see them today? Is it the situation that he is going to speak all day and will not have to give them to us until tomorrow? I would like to know.

Mr. Chairman: I am sure all members will co-operate and get written amendments to the chair and to others as soon as possible. The member for Lincoln (Mr. Andrewes) wants to put in amendments, comments, discussion or questions with regard to which specific sections? We will just list them now so we know where we are going.

Mr. Andrewes: I will want to reserve an opportunity to comment on all sections of the bill, but on section 2 specifically we wish to move an amendment.

Mr. Chairman: It is an amendment, not a comment, on section 2.

Mr. Andrewes: Right.

Mr. Chairman: I am taking some care with this, members. I hope you will bear with me, because we are on a long road and we want to know where we are going.

Mr. Andrewes: The other section on which we wish to move some amendments is section 4. At the moment I have only two copies, which I will offer to --

Mr. Chairman: Can the chair have one of those, please?

Mr. Andrewes: I will be delighted.

Interjections.

Mr. Chairman: The member for Lincoln.

Mr. Rae: He has disappeared.

Mr. Breaugh: He has disappeared and waived his right to speak. Let us proceed.

Mr. Chairman: I am a little bit confused. I have received from the member for Lincoln a photocopy of the original act with notes. Behind that are fully typed amendments. Am I to assume that one is simply an expansion of the other and that they are not additional amendments?

Mr. Harris: I will endeavour to find out for you forthwith.

Mr. Chairman: Thank you.

Do we have all the comments on sections 2 and 4, on all the sections everyone wishes to speak to?

Mr. Lupusella: I would like to raise a question with the minister on section 3 of Bill 94.

Mr. Chairman: We cannot carry anything because we are dealing with section 1. I take it everything is in and we are not going to have surprises as we go along, with somebody wishing to revert.

Mr. Rae: On a point of something, Mr. Chairman: Could we have some sense from the Conservative Party as to whether there will be amendments moved other than the ones we have not yet seen but which we understand were tabled today? We have had eight or nine months, a long period of time in which this has been debated. It would be helpful to everybody if we could have those amendments. I do not think it is any secret that we are all having caucus meetings tomorrow morning. To have practical discussions on those amendments, it would be useful for us to have them and to have some assurance that will be it.

Mr. Harris: We will endeavour to have the answer for the member, if not all the amendments. My colleague and our critic, the member for Lincoln, will be back in about two minutes and I think he can give that information.

Some of our amendments or amendments to amendments arise from amendments we did not get until very late in the process, for example, on Thursday. I guess we were supposed to caucus instead of listening to Bishop Tutu, but regrettably, that is not the way our party works. I apologize that there may be some that members have not had an opportunity to --

Mr. Chairman: I point out to the House leader it is not necessary to apologize.

Mr. Harris: I do not mind apologizing. With great respect, we will always attempt to have our amendments out as early as we can and as soon as we can. I offer our apologies. However, I am quite certain the member for Lincoln will be in these very chambers within the next minute or two, and he could respond more fully.

Mr. Chairman: We may have a long road here. It would simply be more convenient for all concerned if people would get proposed amendments in front of the chair and the other parties as soon as possible. It means things will go in a little more orderly fashion.

4:10 p.m.

On section 1:

Hon. Mr. Elston: I indicated earlier that I am prepared to move the amendment now or, if it were the wish of the committee, we might review the clause as it stands now, see whether the substantive section is passed and then come back to section 1 to move the amendment of definitions which would be needed under sections 3a and 3b.

Mr. Chairman: What is the substantive section?

Hon. Mr. Elston: Sections 3a and 3b, which would need these definitions.

Mr. Chairman: Is it the pleasure of the committee that we go to sections 3a and 3b, see how those are dealt with by the committee and then revert to section 1, if necessary? Agreed?

Mr. Breaugh: Agreed.

Mr. Andrewes: Hold on.

Mr. McClellan: Do you want to run that past us again?

Mr. Chairman: The minister's amendment to section 1, which is the definitions section, is contingent upon the success or failure of his amendments to add new sections 3a and 3b. If one does carry, he wishes to revert and amend definitions. if it does not, it is unnecessary to revert to section 1, the definitions section.

The minister is asking whether we can deal with his sections 3a and 3b before we come back to section 1. However, there are others who wish to amend section 2, and section 2 should be taken first. Therefore, all we are asking is, can we revert to section 1, the definitions section, after dealing with new sections 3a and 3b?

Mr. McClellan: Why do we not just stand down section 1 and start with section 2?

Mr. Chairman: Is that agreed?

Section 1 stood down.

Mr. Chairman: Shall we carry on to section 2? We have amendments not only from the member for Humber (Mr. Henderson) but also from the member for Lincoln. Without having looked at the two, the member for Humber's should come first.

Mr. Henderson: I am more or less organized to propose my amendments to section 2 and section 4 at the same time, Mr. Chairman. Would you prefer that I not do that? I do not know that it will matter too much to me. Would you prefer that I do section 2 now and then section 4 later?

Mr. Chairman: Yes. We will do them in order.

On section 2:

Mr. Chairman: Mr. Henderson moves that section 2 of Bill 94 be struck out and the following substituted in lieu thereof:

"2(1) A physician or an optometrist who does not submit accounts directly to the plan under section 21 or 22 of the Health Insurance Act or a dentist shall not charge any patient,

"(a) over the age of 65 years;

"(b) receiving general welfare assistance or family benefit allowance;

"(c) receiving benefits under the Workers' Compensation Act and who has no other source of earned income;

"(d) who is a member of a group prescribed by regulation or who meets conditions prescribed by regulation; or

"(e) for a service rendered in a hospital emergency department or for such other service as is prescribed by regulation,

"more or accept payment for more than the amount payable under the plan for rendering an insured service to an insured person."

"(2) Except as prohibited in subsection (1), a physician or an optometrist who does not submit accounts directly to the plan under section 21 or 22 of the Health Insurance Act or a dentist may charge an amount not to exceed the amount provided for in his or her professional association's schedule of fees provided that,

"(a) the practitioner is billing for services rendered while practising in an area, hospital or clinic designated by regulations where more than 50 per cent of the practitioners in the same field of practice or specialty do not bill or accept payment for more than the amount payable under the plan for rendering an insured service to an insured person; or

"(b) the practitioner, in each of the previous three consecutive months, billed more than 50 per cent of his or her monthly billings on the basis of the amounts payable under the plan for rendering insured services to insured persons; or

"(c) the practitioner has been granted dispensation from the application of the subsection by the Minister of Health.

"(3) The Lieutenant Governor in Council may make regulations,

"(a) prescribing groups for the purpose of clause (1)(d);

"(b) prescribing conditions for the purpose of clause (1)(d);

"(c) prescribing services for the purpose of clause (1)(e);

"(d) designating areas, hospitals and clinics for the purpose of clause (2)(a); and

"(e) prescribing methods of determining whether any charge or billing is in respect of services rendered in a particular area, hospital or clinic.

"(4) The minister may designate, on the recommendation of the appropriate regional health council, practitioners for the purpose of clause (2)(c) and may exempt a practitioner from the fee limit of the amount provided for in his or her professional association's schedule of fees as specified in subsection (2)."

Mr. Henderson: Mr. Chairman, do I speak now?

Mr. Chairman: Yes, you may discuss your amendments and the reasons for them and make any comments. I remind the members that there is no restriction on speaking more than once in the committee of the whole House.

Mr. Henderson: I rise to offer views and propose amendments to Bill 94, particularly to section 2, so as to place before my legislative colleagues an option I am convinced they do not hold at this moment, preceding my amendments. It is an option to vote for measures that will ensure accessibility to health care services and end the problems of extra billing, yet hold out a reasonable prospect of finding enough acceptance with my physician colleagues to end the increasingly bitter standoff between physicians and the government.

I speak as a private member and not for the government. Many have asked how I will vote when Bill 94 comes before the Legislature for third reading. I have found that to be a very vexing decision to try to make, for it involves selecting between two very negative options.

On the one hand, I do not wish to vote against a bill put forward by a minister of the government of which I am a part, a colleague within the party under whose banner I ran for elected office a little more than one year ago.

On the other hand, I cannot vote for a bill which I believe to be a bad one in its present form. It is a bill whose measures, in my view, will not solve the problems they purport to address and a bill conceived, in my view, out of an insufficient exploration and understanding of those problems. Simplistic solutions rarely solve complex problems. In the long term, simplistic solutions fail, sometimes tragically and sometimes horrendously. Physicians who deal day by day in life-or-death matters know that only too well.

4:20 p.m.

Happily, the decision to return Bill 94 to the committee of the whole House for clause-by-clause examination eases my dilemma. I propose first to invite other members of this Legislature to ask themselves whether they would not wish to join with me in seeking a reasoned solution to the problems of extra billing and a reasoned approach to the assurance of accessibility to health care services and to the avoidance of a two-tiered approach to delivery of health care services.

I therefore put forward amendments that will, in my view, achieve those objectives and meet the campaign promise of my party a little more than a year ago. With goodwill in the eye of the beholder, these amendments will also, in my view, satisfy the requirements of the Liberal-New Democratic Party accord in the sense that I shall describe. Perhaps not every member will agree with me about this, but I will put forward my view.

The amendments, if adopted by this Legislature, would also do much to attenuate or eliminate the bitter dispute that has developed in Ontario between government and physicians, the chief providers of health care services, upon whose goodwill we depend to make the health care system work.

I am no newcomer to this matter of health care accessibility. I have clinical experience in public hospitals, government hospitals, academic and university hospitals, private practice and even medical missionary work. I have been opted out, opted in and salaried. I am trained in general practice, public health administration, preventive medicine, psychiatry, psychoanalysis and medical economics. I have strong points of view based on training, experience and perhaps a little wisdom. Those points of view have made it extraordinarily difficult for me to remain silent in the face of what I consider to be, in its present form, an unwise bill.

It is not so much the aims or the principles of Bill 94 that fail as certain of its specific provisions. One can admire the intent of prohibition, knowing what human suffering follows on alcohol addiction, yet not favour prohibition as the solution. I agree, as do most physicians and, incidentally, as does the Ontario Medical Association, that problems in the practice of extra billing need to be addressed. I agree that accessibility to medical treatment must be assured and that a two-tiered system of service delivery should be avoided. Those principles are not in dispute, yet there is a dispute of growing rancour and danger occasioned by this bill.

I wish to be critical of no one. I wish and I seek to embarrass no one. The Premier (Mr. Peterson) and the Minister of Health (Mr. Elston), my Liberal caucus colleagues and my friends in the NDP caucus are to be commended for their courage in tackling the question of health care accessibility and the problems of extra billing , with vigour and determination.

Health care services are too important for partisan rhetoric. I have often wished we could find some way to set aside our partisan affiliations in our approach to Bill 94 and simply proceed as a collective of concerned legislators. I wish we could vote, if votes be required, on the basis of conscience, and I dare to challenge House leaders and party leaders to allow a free vote on the amendments I have placed and shall place.

I hope we legislators and the physicians, who are in one sense our colleagues and even our partners in the delivery of health care services, will continue to meet, dialogue, reason and, if possible, negotiate a solution together.

Mr. McClellan: On a point of order, Mr. Chairman: Just so there is no confusion in the member's mind, my colleagues in the New Democratic Party intend to vote on this bill according to their consciences.

Mr. Chairman: That is not a point of order.

Mr. Henderson: All of us agree we should avoid a two-tiered system of health care, yet the Minister of Health and even the Premier have suggested that physicians who extra bill are not generally better at what they do than physicians who charge the Ontario health insurance plan rate.

Accordingly, I am not convinced the wish of some patients to be free to select physicians who work at arm's length from the state and who may charge a little more for their services and the wish of some physicians to contract the amount of their fee on an individual basis with their patients necessarily lead to a two-tiered system of health care. Indeed, in my view, that minority of patients and that minority of physicians comprise a nonvisible minority group whose rights and democratic freedoms must be assured by a government that hopes to preserve its credibility in a free state like Canada.

It is necessary to ensure that patients really do have a choice in this matter of choosing what kind of physician they wish to consult. I believe that can be done easily enough without risking a serious breakdown of the health care system and without major, long-lasting rancour between physicians and government.

I believe my proposed amendment to section 2, along with my proposed amendment to section 4, which will be presented later, will go a long way to achieving those objectives. These amendments will establish that no senior citizen and no low-income Ontarian can pay more than the OHIP rate for an insured service. In addition --

Mr. Chairman: Order. I point out that the staff who are on the floor should remain in their seats except for ingress to and egress from the chamber.

Mr. Henderson: No patient, regardless of age and regardless of income, will have to pay more than the OHIP rate for emergency treatment, emergency surgery or any treatment in a hospital emergency department.

Furthermore, by these amendments, a physician cannot charge more than the OHIP rate for a service performed in any office, clinic or hospital unless at least half the physicians in that office, clinic or hospital are opted in, or unless at least half the billings of the physician performing the treatment have been submitted at the OHIP rate for the previous three consecutive months. To preserve flexibility, occasional exceptions to that guideline may be granted under unusual circumstances by special dispensation from the Minister of Health.

Whenever a practitioner bills more than the OHIP rate, his fee cannot exceed the rate provided for in his or her professional association's schedule of fees except again by special dispensation from the Minister of Health.

Currently, with physicians fully at liberty to opt in or out of the plan as they please, 88 per cent of physicians in Ontario are fully opted in and 97 per cent are at least partly opted in. Yet there is a distribution problem because, in a few areas of the province and in a few fields of medicine, too many physicians may be opted out and bill more than the OHIP rate. My amendments would serve to correct that distribution problem and might well raise the overall figures, province-wide, to 95 per cent of physicians fully opted in and 98 or 99 per cent of physicians at least partly opted in.

These amendments ensure accessibility, yet respect the insistence of my medical colleagues on the preservation of their professional freedom on their own and their patients' behalf. To me and to most physicians, professional freedom on our own and our patients' behalf is as deeply valued as are ethical and moral values on such matters as right to life, freedom of choice and issues of capital punishment to many citizens and many legislators.

No government should underestimate the vigour with which that professional freedom will be defended. The amendments follow a principle that I set forth in my remarks in the Legislature on January 28, that we should go as far we can towards solving problems of accessibility by negotiation and agreement and then see how much of a problem still remains and decide later whether coercive legislation is required and at what price in health care excellence.

4:30 p.m.

Much has been made of the $50 million or so in transfer payments for health care that the federal government now withholds from Ontario each year. The constitutionality of the legislation enabling that withholding has yet to be established. I hope that by the amendments I propose the federal government can be persuaded to free up the withheld funding, for surely it rightfully belongs to the taxpayers of Ontario for their health care.

However, should Ottawa persist in withholding health care funding from Ontarians, I doubt very much whether most Ontarians care whether health care is funded by Ottawa or by Queen's Park. What they do care about is fair taxation. If health care must be funded entirely from Queen's Park, without the federal transfer payments, the people of Ontario will rightly demand that a corresponding downward adjustment be made in the level of federal income tax they have to pay.

Some will foresee or pretend to foresee enforcement problems with the amendments I propose. Surely, if goodwill can prevail, both sides will find ways to work together to solve new problems. I believe good compliance with agreed-upon guidelines can be achieved by a combination of the honour system, peer pressure and complaint reporting to the College of Physicians and Surgeons of Ontario.

I will state in order what I feel to be some further advantages of the amendments and the model I have proposed.

1. These amendments accord with the liberal and democratic principles of negotiation, flexibility, compromise, respect for individuals and respect for minorities. The current measures of Bill 94, in my view, do not. These amendments also respect personal and professional freedom. They propose a democratic solution, not an imposed solution. They accord with our broader notion of a mixed economy, blending state concern with personal freedom.

2. These amendments solve the problems of extra billing and stop there. They offer a pragmatic approach that preserves goodwill, or is likely to do so, and involves minimal or even virtually no use of power to achieve a desired goal .

3. These amendments ensure that extra billing will function in a way that is comparable to a progressive tax, with an advantage on the side of the consumer. Those who can afford to pay more and, in the case of this model and these amendments, who choose to pay more may do so. Those of limited means pay less or not at all. In either case, excellence of care is facilitated.

4. These amendments will defuse the tension and rancour of future negotiations between government and physicians on the matter of the OHIP tariff at a time when the provincial Treasury is already strained by high deficits and heavy demands for social expenditure. A safety-valve advantage of extra billing is preserved, but so are guaranteed accessibility to service and the avoidance of a two-tiered system of health care.

5. These amendments respect the honour and dignity of senior citizens, who are assured of access to all services at OHIP rates. That is as it should be. To our senior citizens, we owe the legacy that is ours through the fruits of their industry and their commitment to personal freedom and democratic government. To them, surely, we owe comfort and excellence in care during their senior years.

6. Persons of limited financial means are protected from financial hardship or compromised service and are spared the personal humiliation of a means assessment. Rhetoric about examining the pocketbook before examining the patient can be allowed to subside.

7. The amendments I propose provide for measures that should be relatively easy to administer, especially if they are perceived by both sides as fair and equitable. Self-regulation through the honour system can be backed up by complaint-based enforcement by the college of physicians and the penalty I shall propose later in amending section 4, the penalty of enforced opting in, is fair, appropriate and straightforward.

8. These amendments substitute a negotiable middle ground for non-negotiable polarities.

9. These amendments construct a win-win rather than a win-lose scenario for both parties in a highly polarized and even bitter standoff between physicians and government.

They allow the government to fulfil its promise to end the problem of extra billing. When politicians speak of eradicating something, they mean eradicating it in so far as it hurts people. When we declare war on poverty, for example, we are not talking about the vows of poverty taken by a monastic order or a religious group. We mean the kind of poverty from which people cannot escape, the kind of poverty that hurts people, families and children.

Similarly, when my colleagues and I campaigned a year ago last April on the basis that we would negotiate to try to end extra billing, I believe we meant extra billing in so far as extra billing hurts people. I hope we did not have in mind infringing on the democratic right of some citizens to contract services from some practitioners on an individual basis in a way that would cause injury to no one.

By the guidelines I propose, the Premier will have fulfilled his promise to ensure accessibility to health care, to avoid a two-tiered system of health care and to negotiate with physicians to end the problems of extra billing. He will also have fulfilled his commitments under the Liberal-NDP accord.

The physicians of Ontario will have preserved their professional freedom and their professional autonomy. They will have preserved the arm's-length relationship from politicians and government that they and I believe crucial to the continued provision of excellence in health care services.

10. The amendments I propose avoid the difficult and potentially divisive idea of setting up a mechanism to allow extra billing by special categories of practitioners, such as those with special training, special experience, special needs or special seniority.

11. These amendments similarly avoid the equally divisive and potentially contentious idea of a two-tiered OHIP tariff whereby special categories of practitioners would receive a higher fee through OHIP. To avoid such a measure surely seems appropriate at a time when the already strained provincial Treasury can ill afford such largess. The more recent government proposal of an excellence fund suffers from the same disadvantages and is therefore equally ill advised, in my view.

12. To preserve at least in some measure the physician's right to opt out and to negotiate directly a fee with a patient provides a safety valve that may well defuse future OHIP fee negotiations. Conversely, physician conscription into the provincial plan will charge up OHIP fee negotiations and render them fractious and confrontational as physicians realize they are negotiating, under the thumb, their only possible means of income. Their demands on the provincial Treasury will be greater and their mood more bullish.

13. If these amendments can help lay the groundwork for successful physician-government negotiations on accessibility and extra billing, they shall have ended withdrawals of physicians' services, including a possible province-wide withdrawal for an indefinite period of nonemergency physicians' services.

4:40 p.m.

Another Liberal, well known to all of us, once said the state has no place in the bedrooms of the nation. I would like to add that the state must carefully limit its place in the clinical consulting rooms of patients and their physicians. About 88 per cent of physicians in Ontario are entirely opted in. About 96 per cent of services to patients are billed to OHIP on an opted-in basis, and only about three per cent of physicians are entirely opted out for all of their practice.

There is, to be sure, a distribution problem of opted-out physicians. They are concentrated in certain cities, in certain fields, in certain offices and in certain hospitals. My amendments would correct those distribution problems, because every area of Ontario would have at a minimum more than half its clinical services on an opted-in basis in every field of practice.

Furthermore, adoption of these proposals would reduce overall rates of opting out. If these measures were adopted, perhaps 95 per cent of physicians would be entirely opted in, perhaps 98 per cent of services would be billed on an opted-in basis and perhaps one and a half per cent of physicians would be entirely opted out. If those kinds of figures could be achieved in Ontario, would there be an accessibility problem to health care, and would extra billing be a problem?

Men and women who feel secure in their administrative mandates are able to be flexible. Men and women who feel insecure often find flexibility more difficult. Solutions negotiated in an atmosphere of relative goodwill are always better than imposed arrangements. I urge flexibility towards a negotiated outcome, and I urge my colleagues to feel secure enough to do that.

In the Legislature on January 28, I expressed confidence that wisdom would prevail in the end. I believe I have outlined, through this amendment to section 2, a mechanism whereby a negotiated solution can succeed. I will propose an amendment to section 4 in due course, and I will have a few words to say about that.

The Deputy Chairman: Does the minister have a response?

Hon. Mr. Elston: The government will not be supporting the amendments put by the member for Humber for the various reasons we have suggested in previous public statements with respect to limited response to the need to end extra billing. Although the member seems to think this will deal with the problem of extra billing, it will not deal with that problem at all. In its general sense, it does not comply with the intent of the Canada Health Act and does not address the problems addressed by the legislation I have introduced. As a result, we will not be supporting these suggested amendments.

The Deputy Chairman: Does the member for Humber wish to comment?

Mr. Henderson: I do not think I need to say much more. The minister and I have different views. I have spoken to my amendments, and I believe they will solve the problems in the ways I have indicated.

Mr. Andrewes: We will be supporting the amendments of the member for Humber. We do so because they very much embody the spirit of the amendments we have proposed. I, like some of my other colleagues in this House, can count; so it is quite clear the member for Humber's amendments will not carry.

We will be putting subsequent amendments, for which we will solicit the members' support and argue in favour, particularly because in our view they address in a legislative framework much of the work that has been done and much of the progress that has been made -- if the minister will allow me that word. I am not sure he would.

If I might use the word "progress," I would say the progress that has been made during the past five to six months on negotiations between the government and the Ontario Medical Association has come about because the OMA has brought to the negotiating table a series of proposals that goes a long way to addressing the principles embodied in Bill 94.

The minister has said to us that the final proposal of the OMA, that of providing a service anywhere in the province at any time at the prescribed OHIP fee, would not be sufficient to meet the principles embodied in Bill 94. He said this because he has given us an indication that this kind of proposal would leave the health care system in Ontario with a two-tiered aspect.

I say to the minister only that it is our feeling and our argument that the amendments proposed by the member for Humber, which embody the spirit of the amendments we will be proposing, are clearly an indication in this legislative framework that one side at the negotiating table has moved progressively towards a solution.

The minister has offered us some amendments on the part of the government. Those amendments, of course, embody the proposed penalty that the original Bill 94 established. We can only assume that those are the legislative framework for the progress the government has brought to the negotiating table.

It seems to me and to members of our caucus, and I am sure to the member for Humber, the negotiations that were undertaken were made in an attempt to resolve this issue before the issue itself jeopardized an effective health care system in Ontario. Yet although the OMA has progressively moved towards a solution to that problem, we cannot say the same for the government.

The member for Humber used the expression, "Simplistic solutions are not sufficient." Clearly, although the legislative content of Bill 94 is full of the usual phrases that are required of a legal document, it offers a simplistic solution to a very complicated issue. It says to a group of medical practitioners in this province that the government has taken the position that it is opposed in principle to a long-standing agreement that was reached with medical practitioners many years ago and now proposes to terminate that agreement to come into line with a federal statute, while at the same time it has offered to negotiate an end to the practice to satisfy that same federal statute.

4:50 p.m.

Clearly, I come back to my point that the simplistic solution offered to this complicated problem is the legislation itself; that a real and effective solution to this complicated problem would be for both sides to sit down quietly at a table and come to some reconciliation.

If, in the good judgement of those much wiser than I and learned in the law, that reconciliation does not appear to be in line with the federal statute, perhaps then it is obligatory on the part of the government, which has reached a reasonable conclusion to the discussion, or on both sides, if they feel they have reached a reasonable conclusion to the discussion, to go to that same federal government and say, "This is what we propose to do."

There have been indications in various documents that have been floated out by the government of Canada recently, and more specifically in the Nielsen report, that the federal government has some concerns about the position the Canada Health Act has taken. One of those concerns is that it inflicts upon the province a level of inflexibility in determining its relationship with medical practitioners. The federal government has given an opening to the Minister of Health and his colleagues to come to it with a position they might argue that would embody a reasonable compromise in the dispute currently raging between the government and the doctors in Ontario.

The member for Humber has indicated the health care system is too important to be lost in political rhetoric. I could not agree more. What we have in this bill is a legislative mandate undertaken by the Liberal Party in its campaign of last March and April, a campaign that also saw the New Democratic Party consistently -- I must give it credit -- as it has in the past, arguing an end to the practice of extra billing. In the following days, the accord, the pact between the two parties, was undertaken, committing the Liberal government to follow through not only on its election promise but also on its commitment to the NDP.

There has been a cloud of political rhetoric around this legislation, a cloud that has hidden the real issue. If we were to stand in this House for months on end debating this legislation, which is not our intention in our presentation here, we would not compromise the partisanship of the positions taken to this time. We would probably only harden those positions.

Yet this is a piece of legislation that in our view deserves the time and the consideration of every member in this Legislature. We join in this debate and look forward to the participation of as many members as can make a substantive contribution, not in the name of partisan rhetoric but in the name of trying to convince those who might wish to be convinced, those whose minds might be open enough to be convinced and those who might agree with the member for Humber when he suggests that a vote in this chamber on this important issue should be taken as a matter of conscience and that we do so after hearing the very important view of all its members.

We talk about dialogue, reasoned discussion and negotiation. It is not in our self-interest as a political party that we seek dialogue, reasoned discussion or negotiation. It is in the interest of the nearly nine million people in this province who are dependent upon the medical practitioners to deliver health care services to them effectively, efficiently and compassionately at a level of excellence that has been a tradition to those who have practised that profession in Ontario.

I mentioned at the outset that we will be supporting the amendments of the member for Humber. If these amendments fail, then we will be proposing our own amendments to section 2. I hope the member for Humber will have some success between now and the time this vote is held on this important issue to convince his colleagues to join with us in supporting his amendments.

Mr. Henderson: It is gratifying to know these amendments will have some support. I only learned of this just now when the honourable member advised the House that he and his colleagues would support these amendments. I truly believe these amendments would solve the problems and could find a measure of acceptance with physicians. I truly believe the acceptance of physicians of whatever approach we wish to take to the problems of extra billing will be very important to the future of the health care system and to good relations and harmony between physicians and government.

I do not know that I can hold out too much prospect of convincing many of my colleagues on this side of the House to support them too, but it is a nice idea. I wish they would.

Mr. D. S. Cooke: It will come as no surprise that our party will not be supporting this amendment. The member's amendment is just the Ontario Medical Association's position. He has accepted the OMA's position hook, line and sinker, as have the Tories.

I feel very strongly that on a matter of principle such as this, if the member cannot agree with his own party, he should accept the consequences of disagreeing with his party on a major matter of principle. The consequences are clear. He should either sit as an independent in this Legislature or cross the floor and join the Conservatives.

Interjections.

The Deputy Chairman: Order.

5 p.m.

Mr. D. S. Cooke: I can understand the reluctance of some of the Tories. One doctor in a caucus is enough. I can agree with that.

After several weeks of public hearings, after listening to debate on this for many years, I find it amazing that anyone could possibly support the OMA position or that of the Leader of the Opposition (Mr. Grossman). I know this is similar to the position the Leader of the Opposition put forward on the first day of public hearings, but this puts medicare back into the prospect of charity medicine.

All this simply says is that if a patient wants to have Ontario health insurance plan coverage or have payment of doctors at OHIP rates, he or she must go to the doctor and say, "Dr. So-and-so, I am on unemployment insurance," or say "I am on welfare" or "I am a senior citizen," and beg for OHIP rates. That is what this kind of an amendment puts forward. The member for Humber said here today that his amendment is going to solve the problem. The reality is it would set back medicare in Ontario to the 1950s. It would bring back the concept of charity medicine built in as a principle of the Ontario health insurance plan.

I find it amazing that kind of amendment would be even presented in the Legislature. However, after hearing the many doctors who made presentations in front of the committee, I think there is something to what Stanley Knowles used to say in the federal House, which was that anyone who has a huge income begins at times to lose touch with ordinary people in this province or in this country. The reality is that many of the doctors who appeared before the committee, and the member for Humber is obviously in the same category, have not understood what the principle of medicare is all about in this province and this country. We in this party, and the vast majority of the people in this province, are not prepared to put medicare back into the context of a charity program. He should understand that. If he understood that principle and how dearly that principle is held by the people of this province, he would never have moved such an amendment.

This proposal that he has put forward today is not unlike the proposal put forward by the Ontario Medical Association in 1978, I believe it was, when an agreement was worked out between the then minister, the member for Don Mills (Mr. Timbrell), and the Ontario Medical Association whereby all services in hospitals were supposed to be provided at opted-in rates. Even if one accepted the principle of charity medicine, why would we think that any kind of an agreement such as this would work, since we know the agreement the Ontario Medical Association committed itself to with the member for Don Mills was never lived up to. It was never lived up to by a large number of practitioners in this province.

The Conservative Party puts all the blame on the government for negotiation. How can one possibly negotiate a principle? The principle is a black-and-white matter. Either one supports the idea of universal accessibility with no indication and no discussion about finances when one goes to see a practitioner or a doctor in this province or one does not accept that principle. One cannot negotiate that principle. One can negotiate the implementation of that principle and how a fee schedule is to be worked out. We have put forward what I think is a very positive proposal for a negotiating process, but the principle of either supporting or opposing extra billing is something that cannot be negotiated. That is what this party said when this process began several weeks and months ago. That is why we felt very strongly that we could have proceeded with this bill many weeks ago and avoided many millions of dollars of extra billing.

There has been no progress in negotiation, not because the Ontario Medical Association is a bunch of evil people and the government is an evil body, but because we cannot negotiate a principle. The principle is there. The majority of the people of this province support the principle of universal and equal accessibility, and the word "equal" is very important. The member for Humber's principle or amendment does not accept equal accessibility for all people in this province.

I hope we will have a quick vote on this amendment. I hope we can set this aside and deal with the other types of matters in this legislation, such as the negotiating process, so we can finalize Bill 94 very quickly. Every minute and every hour we speak costs thousands of dollars. In fact, for every week that this bill goes on, there is $1.1 million worth of extra billing. It is incumbent upon us all to say that the people of this province have passed judgement. They want Bill 94 passed. As responsible legislators, we should pass it very quickly.

Mr. Henderson: I have to reply to that one. I was tempted on a couple of occasions to reach for a point of order or a point of privilege, but I was able to restrain myself. I would submit that what I put forward was not at all the position of the Ontario Medical Association.

I believe and know that many physicians and many of my colleagues in the OMA not only would object, but would object rather vigorously to some of the proposals I have put forward. The member must know this. I think he is mounting rhetoric in the way the member for Lincoln and I both have talked about, mounting rhetoric for the sake of rhetoric.

I cannot believe the member for Windsor-Riverside honestly has the view that what I put forward in my amendment to section 2 is the view of the OMA. He is factually wrong on that. The amendment I put forward differs from the OMA position in that I proposed a limitation should be provided by the professional association of the physician, the optometrist or the dentist.

It may be true that the professional association can, in turn, raise the fees if it so chooses, but it is fair to say that it would be under tremendous pressure from the government and the Minister of Health not to do so. That pressure could have some effect. Therefore, I believe I introduced a very real safeguard in the process of proposing an amendment to that section.

My proposal of a 50 per cent limit on opting out in a particular area before any physician can opt out, given that there is already an 88 per cent opted-in ratio, provides a real safeguard to the regional maldistribution of opted-out physicians. It would ensure that well over half, but for the most part 80, 85, 90, 95 or 100 per cent, of physicians in a particular area would be opted in and billing at the rate of the Ontario health insurance plan. That is not tokenism; that is a significant gesture in the direction of ensuring that patients will have a choice in the matter, and as far as I am concerned, choice is what democracy is all about.

The provision that 50 per cent of the billings of a particular physician have to be opted in before, under some circumstances, that physician can opt out and extra bill is similarly a very real safeguard. It is not something that I have ever heard the OMA talk about. That would provide the certainty that not only in a particular area, but also in the practice of a particular physician, there could well be the option to have service at the OHIP rate. Similarly, that is not tokenism and it is not the position of the OMA. It is the position of my amendment and it is substantially different from either the government or the OMA position.

That has been my objective. I have endeavoured to steer a course that would be a meaningful compromise between two highly polarized positions in the service, I hope, of eventual harmony and resolution of a problem.

There are some other matters in my amendments that differ from what the OMA has proposed and from what it might accept. My proposal that the minister can regulate groups not to be extra billed without the requirement of further legislation, my proposal that he can regulate what groups can be exempted under the emergency-treatment guideline without further legislation and my proposed involvement of the regional health council are all steps in the direction of ensuring the minister's prerogative to guarantee services at OHIP rates, opted in within the program, and to involve the regional health council in a way that hitherto has not occurred.

I do not know whether the member was proposing that I have a huge income in his reference to people with huge incomes. However, I assure him that is not the case. It never was huge and it is now even less so than it was a year and a half ago, since I became a member of this Legislature.

5:10 p.m.

Believe me; I know physicians pretty well. I know a lot of them. I think I am making a point that is not fully understood by the members on this side of the House and perhaps by those on the other side as well. I do not believe money is the heart of the issue. I am not saying there are no individual physicians for whom financial considerations are not the prime motivating factor, but I do not believe the issue in the dispute is money; I believe the issue in the dispute is freedom. Any legislator who fails to appreciate that this is the case fails to understand what this dispute is all about.

If 88 per cent of physicians are fully opted in and 95 per cent of services are rendered on an opted-in basis, I have a very difficult time believing that the inequities and the injustices my friend on the other side of the House spoke of or alluded to are problems much beyond problems of distribution.

Mr. Philip: How do you have an operation without an anaesthetist?

Mr. Chairman: Order. The member for Etobicoke (Mr. Philip) will have lots of time to make his comments.

Mr. Henderson: If 30 per cent, 20 per cent or even 10 per cent of citizens in Ontario want to have a physician who is at arm's length from the state, and if only five per cent of services and only 10 per cent or so of physicians are opted out, that too is a problem of accessibility. There are accessibility problems on both sides of this issue. The accessibility problem is not simply a problem of people who are financially disadvantaged having access to service. There are also the rights of nonvisible minorities that have to be considered. The approach proposed by my friend on the other side, the Health critic of the New Democratic Party, rides roughshod over the rights of that minority of Ontarians that feels very strongly about having its physicians at arm's length from the state.

That is as much as I need to say now. The member for Windsor-Riverside ought to re-evaluate some of his views about democracy. The kind of socialism he stands for is supposed to be democratic socialism. I would like him to make an effort to put the D back in NDP because he is losing sight of it.

Mr. Philip: How about democratic liberalism?

Mr. Henderson: There is no other kind.

Mr. Stevenson: It is with some regret that I find it necessary to join in this discussion, but with the bill coming forward in this format, I have no choice but to make some comments. As our Health critic stated, we will support the amendments of the member for Humber. We feel the amendments we will put forward are somewhat more definitive and better than those of the member for Humber; however, we will support the member.

I agree wholeheartedly with the member's comment that the health care system is too important to get wrapped up in a lot of political rhetoric. Unfortunately, exactly the opposite is happening. He went on to say that he hoped the members of this Legislature would vote on conscience in determining their personal decisions on the amendments to this bill and that there would be no embarrassment to the minister or his party with him taking the position that he has taken. Quite clearly, there has to be some embarrassment.

I would suggest the member has very little to gain politically by taking the stand he has taken. He is a person with a somewhat unique insight into the medicare system in Ontario. He also has the insight of how this bill was put together, and what went on inside the party that is putting this bill forward.

I am sure the position he has taken is not going to gain him a great deal of support in his own riding. There is some question, I suspect, about what this will mean to his own political future within the party. One has to look at the gut-wrenching decisions he had to make in bringing forward these decisions.

One has to look and say that the member for Humber is not getting involved in a great deal of political rhetoric. He has come forward with decisions that I am sure he has considered for not just hours but for days and weeks. He has come forward with amendments that are not in line with those of the Ontario Medical Association. They are amendments that he feels will address the concerns of many of the citizens of Ontario, that will form a compromise between the position taken by the government and that of the OMA. His positions are similar enough to the compromise positions of this party that they warrant some considerable attention.

I want to repeat that the member has little to gain from being heavily involved in the politics of this issue and he is therefore coming forward in a very thoughtful and sincere manner which cannot help but be an embarrassment to the Minister of Health who, for the same reason, is involved in a great deal of political rhetoric.

I would like to suggest that we possibly should have amended the title of the bill to call it an act for regulating the amount of political pop that the government may gain from rendering wrongheaded tampering with the Health Insurance Act.

As the member for Humber has stated, it is a very simplistic way of dealing with a very complicated issue, an issue that strikes at the heart of the health insurance system in this province. I very strongly believe we shall see the results of this bill showing up over the next many years in the health care system of the province. I regret considerably that all too many of the results of this bill are not going to be positive and are not going to be for the benefit of the general public of Ontario.

5:20 p.m.

The amendments that the member for Humber has put forward can address the accessibility issue. In the area I represent, we have the Uxbridge hospital, the Port Perry hospital and the Newmarket hospital serving most of the people in the riding of Durham-York. No one extra bills, at least of the doctors who live within the general area in the Uxbridge and Port Perry hospitals and who work out of those hospitals. A number of the doctors who are associated with the hospital in Newmarket do so.

In the five years that I have been a member representing that area, I have had one phone call of a somewhat unfortunate situation where a person was extra billed for medical service and found it somewhat difficult to deal with the situation. Very clearly, the health care professionals, the doctors in that hospital, have dealt with the situation in a very professional way over the past many years and have carried on their practices in a similar manner to that suggested by the amendments of the member for Humber and in a very similar fashion to that of the amendments we will make.

Anyone who expressed a problem in meeting any costs associated with a particular procedure to be done in that hospital was given the service at the Ontario health insurance plan rates. Clearly, the people and the system can adjust to the needs of individuals. It has been done very successfully in the past. The amendments we will be putting forward -- and to that extent the amendments the member for Humber has put forward -- clearly address the situation and could resolve the relatively few problems that exist in the present delivery of health care in Ontario.

The amendments address not only the situation of whatever problems exist out there on an individual basis but also the distribution problem that exists. They cover it quite well and still leave the system in a form that will give doctors individual initiative and the necessary degree of freedom to practise medicine in this province with a professionalism and a degree of excellence that is necessary for top health care.

I am quite sure that Bill 94, as proposed, will not allow for that same degree of professionalism or the same degree of excellence in the future health care of Ontario. It is just a matter of years before we start seeing that effect showing up in our system.

This bill does not bring an end to what limited two-class medicine might exist anywhere in Ontario. Certainly if there was any intention of trying to address the problem in a real way rather than in just a political way, they would look at the other health care providers not named in the act who extra bill on a regular basis.

I suppose they would eliminate semi-private and private care in the hospitals. Why should people be allowed any special service in a hospital simply because they happen to be able to afford it? It is not really clear to me why the government has isolated the doctors for its attention. It could have addressed a great many other areas if it were really sincere, or if it believed for a moment its actions would have any real effect, or if it were addressing a major issue in the delivery of or accessibility to health care in the province.

Why should people have private nursing attendants in a hospital just because they can afford them or because they have an insurance plan that supplies them? Why not cut off those sorts of services? That may not be part of a two-tiered system of health care, or the government may have felt there would not be much political gain by going into that sort of thing.

Why can some people afford to have colour televisions or telephones by their beds and others cannot afford them? Is the government going to give those sorts of services to everybody?

Mr. Breaugh: This is right on the amendment, is it, Mr. Chairman?

Mr. Stevenson: Yes, I am talking about the amendment. Certainly it is.

I do not pretend to understand every issue involved in the delivery of the whole of the health care system, but I see how it affects the people in my constituency and the members of my family. I quite frankly do not see how this act is going to address many of the issues that involve the accessibility of uniform health care across Ontario.

As far as costs are concerned, it is safe to say that costs will go up, and the member for Humber has addressed this issue. He clearly feels that his amendments will reduce the costs to the Treasury and to the taxpayers of Ontario, and I am sure he is correct.

If one has a problem in one's own household that is costing $500 a year and that is going to cost $2,000 a year to solve, does one live to some degree with the problem and try to resolve it as best one can? Or does one pay through the nose for something that is quite questionable, that is not going to be any better and that many of us believe may well be worse?

Hence, from an accessibility point of view there is very much a question of whether this act is any step forwards at all. I suggest that the member for Humber has thought about this situation for a great many hours, and he clearly thinks it is a definite step backwards, not forwards. Certainly, the cost does not favour the passage of the bill.

5:30 p.m.

I firmly believe this bill will not bring an end to what very limited, if any, two-tiered delivery of health services there is in Ontario.

Many other instances are much more obvious. There are instances of the delivery of extra billing practices right from the ministry. I am sure they will come out in the next few days if they have not already been mentioned in previous debates. To suggest that this is going to solve the problem is nonsense. As far as payments to doctors are concerned, I do not think there is any question but that they will continue to go on in some underground form. I suspect the net result may well be even more troublesome in the future.

Mr. McClellan: Tell us about under-the-table payments.

Mr. Stevenson: There are tips for services in all sorts of areas of our society. To suggest that they will not occur in Ontario as they are already occurring in other provinces of Canada, we only have to --

Mr. McClellan: What a high opinion of doctors the member has.

Mr. Stevenson: It is not an opinion of doctors at all; it is an opinion of people who go to them. If they decide to give a donation for excellence of service to somebody who has worked for them, whether it is their local carpenter or doctor --

Mr. Breaugh: What about a member? Do people give the member for Durham-York (Mr. Stevenson) tips?

Mr. Stevenson: No, they do not. It will happen. If members think the bill is going to solve that problem, we have only to talk to our friends in Quebec. Clearly, it is going on on a daily basis on a very wide basis.

Mr. McClellan: It is a bribe.

Mr. Stevenson: It is not a bribe at all, for heaven's sake.

If the minister suggests for a minute that this will resolve the problems, it most certainly will not. I ask him to reconsider the carefully thought out position of his own caucus colleague, the member for Humber, or preferably the amendments that will be put forward by this party, and to have another look at trying to solve this situation by negotiation or some sort of compromise here in the Legislature.

The Deputy Chairman: Does the member for Humber wish to comment?

Mr. Henderson: I do not, other than to commend the member who just spoke for his sensitivity and wisdom. I do not think I need to speak further.

Mr. McClellan: I do not want to take a long time, but I want to respond to the suggestion made by the member for Humber and by the member for Durham-York that instead of passing Bill 94, we should be negotiating an end to extra billing with the Ontario Medical Association.

I will not ask the member for Durham-York before he leaves, but I am sure the member for Humber does not share the view of the member for Durham-York that the passage of Bill 94 will result in what can only be described as one of the silliest slanders ever made against the medical profession in this province, that they will take payments under the table to provide medical care. This is the second time the member for Durham-York has made that suggestion.

Miss Stephenson: That is not what he said.

Mr. D. S. Cooke: That is exactly what he said.

Mr. McClellan: It is exactly what he said, that people will have to pay extra money to get medical service. It is an outrageous and intolerable slander of the medical profession, no matter what side of the debate one is on. I doubt very much that the member for Humber shares that view, which has been expressed on more than one occasion by Conservatives. It should cause the member for Humber to reflect for a moment about who his allies are in this discussion.

On the question of negotiating an agreement, the member for York Mills took some sotto voce umbrage at my colleague's reference to the agreement that was negotiated with the Ontario Medical Association by the member for Don Mills when he was Minister of Health. I want to review it for the benefit of those who suggest we can negotiate a settlement with the Ontario Medical Association. I have the announcement of the agreement in my hand. It is dated March 29, 1979. The then Minister of Health came to the Legislature on Thursday, March 29, 1979, and announced an agreement between the Ministry of Health and the Ontario Medical Association. He described it as an agreement and presented it to the House as an agreement.

He said in his statement, and I am reading from his actual statement that was in my file, "both the Ontario Medical Association and the Ontario Hospital Association have agreed to begin joint discussions immediately to devise a mechanism to ensure" access to medical services at the assured rates in every hospital. Second, there was an agreement that the OMA would undertake to help citizens obtain the services of an opted-in physician. Third, the OMA would be the sole negotiating agency for physicians. Fourth, the OMA agreed to support the principle that the physician should inform the patient in advance of any charges above the OHIP schedule of benefits.

That was described as an agreement between the government of Ontario --

Mr. Ashe: Which of those things did not happen?

Mr. McClellan: My friend the member for Durham West should wait for it. It was described as an agreement of the Ministry of Health, the government of Ontario and the Ontario Medical Association. It was presented to us as the result of a process of negotiation and that this was the agreement. What did we learn subsequently? Through an investigation by the Ombudsman of Ontario, the Honourable Donald Morand, we learned that there was no agreement at all.

I quote from the report of the Ombudsman's investigation of May 1982, from the Ombudsman's report of May 27, 1982. "Further information was sought concerning this `agreement.' My investigator determined that the `agreement' referred to was the minister's March 29, 1979, statement to the Legislature. There is no other document concerning this `agreement' other than the statement to the Legislature.

"According to Dr. Surplis" -- who was an assistant to the minister of the day - "representatives from the Ontario Medical Association met with ministry representatives on the evening of March 28, 1979, and agreed upon the statements that were to be made by the minister to the Legislature the following day. Dr. Surplis advised that there is no legal basis for the present `agreement.'"

Later in the same year, the Health Disciplines Board ruled in a decision of June 1982 that this agreement was legally meaningless and that the Ministry of Health had no power to enforce anything.

That is the record of the previous government with respect to dealing with extra billing. When they stand in the Legislature in 1986 and talk about sitting down with the Ontario Medical Association to negotiate an end to extra billing, the record speaks for itself.

5:40 p.m.

When they had the opportunity to try to do something about extra billing, they engaged in a cheap public relations exercise that was as phoney as the paper that it was not written on. They have a nerve coming forward now, after the hoax they perpetrated in the 1970s and 1980s, to tell us that the course of wisdom is to sit down and negotiate an agreement.

My friend the member for Humber is allying himself with people who do not deserve his alliance. The course of wisdom for him is to support the members of his own party and the members of the New Democratic Party and have speedy passage of Bill 94.

Mr. Henderson: I will make one or two comments on those remarks. I confess that I do not fully understand what the member for Bellwoods (Mr. McClellan) is getting at when he proposes that I should reflect on who my allies are. I am not a Tory but I respect all members of this House. I respect the Tories. They will support or not support my amendments for their reasons, the same as members of the third party will support or not support them for their reasons and the same as members on this side of the House will support or not support them for their reasons. I am happy to have the support of whoever thinks my amendments are a good idea.

I think they are a good idea and that they would solve the problem we are addressing. They would do it in a way that would preserve reasonable harmony with physicians. Reasonable harmony with physicians will be very necessary in the years to come. I think my amendments are a good idea and I am happy some other members of this House are willing to support them.

My second point is that there has been an awful lot of rhetoric about this business of negotiating and about who is and who is not willing to negotiate. I do not wish to prolong that discussion by more than a minute or two. When that rhetoric was flowing pretty thick and fast a few months ago, I did what I hope a few other members did. I looked up in a dictionary what "negotiate" means. This is from Merriam-Webster: "Negotiate" is "to confer with another so as to arrive at the settlement of some matter."

I know many members of this House do not agree and I try to respect their perception of the situation, but there is no doubt at all in my mind that the Ontario Medical Association has been willing since this past summer, has become increasingly willing as the months have evolved and is currently willing to negotiate by the definition I just quoted. There is no doubt in my mind that it has gone a long way in negotiations. It has moved a long way from the position it started with on this matter.

Incidentally, it has moved a long way from its membership. If anything, the OMA as an official body is getting into difficulty because the membership is saying: "Look you guys, look OMA, you are going too far in this negotiation. We, the members, are not so sure we want to go quite that far, at least not yet." The OMA has done a very honourable job of negotiating.

I am sorry I find myself having to reiterate what I said in January. I believe that we on the government side have to give a little on what we call "principle." What we as a government call "principle" is a little more than a principle; in fact, it is a lot more than a principle. It is a particular type of solution to a particular problem. A principle is a general statement of how one wants to go about something, what style one wants to adopt, what ideas one has and what one's end point might be.

What we have insisted on from the outset is not a principle. It is an imposed solution, with some variation in how we dot the i's and cross the t's. I have an idea of what negotiation comprises that is a little different. To me, when one negotiates something, one negotiates a problem. One examines the problem, tries to formulate it, tries to agree on how one might formulate it and examines a range of possible solutions. There is some give and take. There may be a provisional agreement, and one may try out the provisional agreement or one may evaluate the results and decide what further steps are needed. To me, that is what flexible, democratic problem-solving in government is all about.

If one is worried about the paper, tie it down in legislation, in writing and in regulations -- that is what my amendments propose to do -- and it will be worth the paper it is written on.

Miss Stephenson: I am pleased to participate in this debate on the first amendments introduced under Bill 94 to ensure that the very rational point of view put forward by my colleague the member for Humber is considered seriously by all members of this Legislature.

As my colleague has suggested, his amendments are based on the need, as he perceives it and as many of the rest of us perceive it, to find a solution to the current impasse. If this is solved by the legislation introduced by the government, it will ensure that there will be a significant deterioration in the quality of the health care system in Ontario. In the perception of almost all the physicians in this province -- I would say 98 per cent of them -- the bill as it is currently written has the effect of conscripting the medical profession into a no-choice position, which is not the kind of position they have enjoyed since the national health program was introduced in 1967.

If the members of the New Democratic Party believe the only way to achieve principle is by bludgeoning the opposition to death, then obviously that is the direction they will pursue. The member for Humber is suggesting there is another route to find solutions to these problems and impasses. We should be thoughtful, perspicacious and sensitive enough to pursue those alternative courses to finding solutions.

The issue in this current impasse for the physicians of Ontario, and I believe for the optometrists and dentists as well -- I have difficulty understanding why podiatrists, chiropractors and all the others for whom bills are paid by the Ontario health insurance plan are not included in this legislation. I do not understand why they continue to have the legislated right to extra bill when it is being taken away from others. I ask the deputy minister to provide us with a fuller explanation than one that suggests that because not all their services are covered, they therefore are not included. I remind him that not all dental services are covered, nor are all optometrists' services covered, yet those two professions are being subjected to the same potentially extremely oppressive action that Bill 94 in its current form would introduce.

For the practitioners for whom this bill is important at present, because they are included, the issue is freedom. It is the freedom of the members of that profession to determine the way in which they will function in relation to and in support of the health care system in Ontario. In this province, all the physicians, and I believe all the affected dentists, have functioned effectively in support of the principles of the health care system of this province and this country, the principle of as much universal access to health care as possible.

5:50 p.m.

Mr. D. S. Cooke: How would the member know?

Miss Stephenson: The member for Windsor-Riverside asks how I would know. I have a little more experience in direct involvement in the health care system of this province than he will ever have. That continues on a daily basis now, since my husband currently practises full-time. If I am out of touch, the member is on a different planet. That planet, I suggest to the members of this Legislature, is Venus, because that guy is in some kind of super-rarified atmosphere that affects his brain on a daily basis.

I come back to the issue before us, which is the legislation that is at hand.

I am sorry the member for Windsor-Riverside is going to disappear, because he raised an issue in conjunction with his discussion of the amendments proposed by my colleague the member for Humber that suggested we are reverting to what he called charity medicine. The member for Windsor-Riverside does not know the meaning of the word "charity." He does not know that charity is not part of the philosophy of physicians, not in his terms.

The responsibility of professional practitioners of medicine in Ontario and in Canada for lo these many decades has been to deliver first-class health care in all circumstances, no matter what is going to happen after that delivery occurs. It has never been part of the philosophy of physicians that they were do-gooders or people who dispensed charity. They simply provided the best service they could to every single patient in all circumstances, no matter whether that patient was ever going to pay them.

It has nothing to do with that member's concept of charity; it has nothing to do with second-class citizens, because there are none. There are no second-class citizens as far as physicians in this province are concerned. No second-class service is provided and there is no two-tiered delivery of health care in this province. There never has been and there never will be, no matter how much the member tries to denigrate whatever system we have at the present time.

It is unfortunate there has been an insistence on payment by the government for every single service that is provided. That has negated some of the quality of the understanding of full responsibility that physicians have traditionally had in this province. It has not destroyed it all, thank goodness, and I hope it never will destroy it all. We will do our best to make sure it does not. A physician's responsibilities encompass the need to ensure that no matter who the individual is, in whatever circumstance or in whatever part of his province, the quality of the health care that will be provided to him will be the best the physician can provide.

He also talked about equality of accessibility. This bill does nothing to ensure equality of accessibility. The individual patient in Ear Falls who has an optic neuritis usually cannot see an ophthalmologist within a 12-hour period. We do not have equality of accessibility to the full range of health care services provided in this province for all the people of this province, because it is not possible to do it. The distances and the sparseness of population ensure that the full range of specialties is not available in every hamlet of Ontario.

Therefore, the person who lives in downtown Toronto in actual fact enjoys a great deal more accessibility to the full range of health care than does the person who lives in Ear Falls, Wawa, Hudson, Geraldton or any of the northern communities. Until the government ensures that the full range of services is available within a very short period of time equally to the people who live in downtown Toronto and to the people who live in those remote communities, we cannot talk about full equality of accessibility. Let us not talk about things we have not been able to achieve.

Hon. Mr. Bradley: The Conservatives had 42 years to do that.

Miss Stephenson: This province has done a better job of ensuring that kind of accessibility than any other jurisdiction in Canada. The member for St. Catharines (Mr. Bradley) would do well to stuff his mouth with some of his pollution material and not talk about things he does not know anything about.

In addition, we must ensure the other aspects of equality of accessibility as well as we can. However, the solution provided by the government is not one that will provide equal accessibility throughout the province, and it is foolish, misleading and somewhat dishonest to suggest to the people of Ontario that it will.

It is important that the members of this House recognize, as has the member for Humber, that the Ontario health insurance plan is an insurance program. It is a voluntary program for individual citizens in this province.

There are some rules. In some circumstances, if one is an employee in certain situations one must contribute because one's contract says so. There are employers who, because of the size of their employment establishment, must ensure that they have formed groups to provide the insurance program for their employees. However, there are significant numbers of individual citizens of this province who are not necessarily financially embarrassed in any way who have made the decision that they will not participate in OHIP. It is not mandatory in all circumstances to sign a contract as an individual Ontarian with the Ontario government to ensure health care services. It is not mandatory for all citizens, nor is it mandatory for all physicians. That balanced freedom is the Canadian approach to problems and to the types of solutions we have for them.

If we make it mandatory for all patients, then we must make it mandatory for those who will provide the services. However, the patient in this province has the freedom to choose whether he or she will participate, unless he or she is in an employment situation that requires it.

He or she has the right to choose the individual initial provider of health care services in all circumstances. However, OHIP does not provide freedom for the individual patient to determine that in the first circumstance; for example, an obstetrical patient will go to a specialist obstetrician. That is not a freedom provided under OHIP. OHIP ensures that the patient must require the services of an obstetrician and must be referred for those services by the family physician or the initial examiner, the initial provider of health care, in order that the services of the obstetrician will be covered by the insurance program.

To suggest, as the minister did the other day in this House, that it was going to be the right or was the right of every citizen in Ontario to decide which consultant he or she was going to see and when, and to have those services provided at no cost to the pocket of that patient, is not entirely the truthful emanation one would have hoped would have come from the minister. The patient does not have that freedom under the current health insurance program.

This is the type of thing my friend the member for Humber is acutely aware of when he attempts to find a reasonable, middle-path solution to the problems that have arisen as a result of the intellectual and emotional impasse that has come into existence since the introduction of this bill. It is part of his suggestion that the freedom or choice permitted to the patient is balanced by a modicum of choice granted to the physician.

That choice is tempered very severely and critically in a number of areas. It will be modified dramatically if, in the area in which he or she practises, there are not sufficient physicians who deal directly with the insurance plan on the basis of the OHIP level of payment. The right and freedom will not be there for that physician in that circumstance, as I read his amendments. What he has done is to suggest that there are freedoms allowed to the individual who has the contract with the government.

I remind the members that in this circumstance, only the patient has the contract with the insurance program. The physicians voluntarily agree under the present circumstance to accept payment as full and final in their opted-in positions. They simply signify that they are opted in. I suppose that could be construed as some type of contract, but it is not the type of insurance contract one signs with an insurance company if one is going to be a beneficiary of that insurance company's activities.

6 p.m.

The freedom that is being suggested here, as I said, is not expansive; it is not unlimited. It is not granted without licence. It is not to be exercised in a profligate way. It is a very limited and very responsible kind of freedom. Although it is very similar in scope to the limited freedoms that were suggested in the negotiations by the Ontario Medical Association, it does not stop there but goes on to provide for a process of limitation of the exercise of those freedoms, which is a very interesting new introduction and an introduction that I doubt would have the total support of all the members of the medical profession.

However, in this circumstance, if there is an agreement that the current provisions of Bill 94 as written by the minister could be displaced totally and replaced by the interesting suggestions and useful alternatives provided by the minister or, rather, the member for Humber -- I guess I say "minister" with a Freudian kind of overtone, because it would be so helpful if we had a Minister of Health on that side of the House with the knowledge and understanding of, and the sensitivity to, the health care system that this member for Humber has demonstrated.

Mr. Martel: We saw a certain Minister of Education, a former Minister of Labour, who was a real dinosaur.

Miss Stephenson: The member for Sudbury East (Mr. Martel), of course, is the individual who would suggest that only a teacher or the principal of a school should be involved in all of the ministries; nobody else can do anything. I have a little more charitable view of the capacities of my fellow human beings. I believe that each individual has talents and capabilities and that they should all be exercised, even if the member for Sudbury East disagrees wholeheartedly with me about that, as he usually does about everything.

Mr. Martel: That is right, because you are always wrong. It is not my fault.

Miss Stephenson: I must admit the only person who is ever always right is the person who never says or thinks anything, and I guess that describes the member for Sudbury East. The only person who is wrong from time to time is the person who tries to do something.

Mr. Martel: You are driving your own Health critic out of the House. Why are you being such a pussycat? Get tough.

Miss Stephenson: Just wait; I shall.

It was unfortunate the member for Windsor-Riverside decided the member for Humber had less knowledge, less capability and less understanding of the direction this bill should take. The people of Ontario want the health care system they currently enjoy to continue in its good, healthy and progressive form; they do not want it to be burdened with a potentially fatal illness. That is one of the understandings the member for Windsor-Riverside does not possess at present, because he does not seem to understand that the capacity, the motivation and the commitment of professionals who are conscripted or legislated into a role they do not wish to fulfil will not provide the leadership to encourage the development of a health care system similar to that which we currently enjoy.

We were talking about negotiation, which is a very significant part of the amendment suggested by my honourable friend. We were talking about negotiations and discussions and about finding solutions to problems. It is a measure --

Mr. Martel: The Ontario Public Service Employees Union thought that on the colleges bill. They thought it was real negotiations too.

Mr. Chairman: Order. The member for Sudbury East is being entirely too noisy. The chair cannot hear and other members cannot hear.

The member for Hamilton East (Mr. Mackenzie) is also not in his seat and therefore would not interject, would he?

Mr. Martel: I know what the member for York Mills did to the community college teachers.

Miss Stephenson: He does not.

Mr. Martel: She savaged them.

Mr. Chairman: Order. Carry on.

Miss Stephenson: On a point of personal privilege, Mr. Chairman --

Mr. Chairman: No. I am sure it is not a point of personal privilege.

Miss Stephenson: As a matter of fact, it is point of order, because the remark from the member for Sudbury East is again erroneous. Who established the Skolnik commission to look at the problems of the teachers in the community college system to try to find a solution to the problem? It was not the member for Sudbury East; it was someone else. I am too humble to tell who it was; so I will not.

However, I am delighted to know that it turned out to be such a good report and that it has been useful in solving the problem of the master teachers in the community college system. We needed to ensure that there was a balance in that situation as well and that the needs of the students were met, as were the needs of the teachers; we achieved that. We are doing the same thing with the amendments of the member for Humber to this legislation: achieving the needs of the patients and the needs of the providers of the service to ensure the maintenance of the quality of the program we all enjoy.

I believe discussion and negotiation are possible. I was a little nonplussed when I read in the newspaper the other day that one of my colleagues who specializes in a form of geriatrics suggested that the OMA trade the matter of professional freedom for an absolute guarantee by this Liberal government that it would never intrude into any other aspect of health care delivery. I must admit I thought it was an intriguing suggestion.

I then started to laugh a little, because I remembered very well that in 1983 and 1984, the present Premier stood up and made impassioned speeches in this Legislature and in other parts of the province suggesting that legislating an end to extra billing in the way suggested by the New Democratic Party would be totally destructive of the health care system in Ontario. I have a little difficulty understanding how any knowledgeable physician could believe we could get an iron-clad guarantee from this government that it would never intrude.

That, of course, is the concern of the physicians. The concern of the physicians is based on history, on personal and association observation of the events that have occurred in all the jurisdictions where this kind of legislation has been introduced. This is always the first step, just a gentle first step that ensures no one will ever have to put his hand in his pocket to pay for any insured service under the Ontario health insurance plan, except of course for the services of chiropractors, podiatrists and a few other people who are excluded from this bill.

The principle is that they will not have to put their hands in their pockets. That is fair for everybody. That is egalitarian and levels everyone. There cannot be any discrepancy. There cannot be any kind of variation. There cannot be a concern expressed by anyone.

What happens next? The physicians are virtual employees of the government; they would be in that circumstance because when one negotiates remuneration with the person who is supplying the remuneration, and one has to come to an agreement about it, one must be, even in their parlance, in an employer-employee relationship. That circumstance holds true here as well.

As soon as that is introduced, the next thing that happens is that there is a little leaning in a direction that will ensure the health care professionals who are needed in North Overshoe, who are interning at the time at North York General Hospital, will go to North Overshoe for a period of four years. We have tried it with a period of one year but that is not good enough because the people of the north deserve more than peripatetics.

That is the kind of activity that ensues. It not only happens in other jurisdictions outside of Canada; it is happening in Canada right now. If the members do not believe that, they can look slightly to the east, to Quebec, which is introducing the same kind of procedure that currently is in British Columbia.

6:10 p.m.

The next step, of course, is to determine just how much can be expended for health care and to limit the range of services made available. Can everybody get all the range of services? No, of course they cannot, because what we must deliver is what is necessary for the vast majority of people.

Then we move ahead to the next procedure, which is the rationing of those services. That is currently being done in Britain, where the individual patient who may need a kidney transplant or even dialysis will get that a good deal more readily if he or she happens to be under the age of 60 than if he or she is over the age of 60.

Mr. Breaugh: Slandering Margaret Thatcher; this is awful.

Mr. D. S. Cooke: It is the Tory party, is it not?

Miss Stephenson: It is not just in Britain. This is also happening in such delightfully socialist countries as Romania, Yugoslavia, Albania, Hungary and Czechoslovakia. It is the inevitable follow-through of the initial first step, which Bill 94 in its current form is introducing. We have heard the minister say he is never going to intrude upon anything. That is hogwash. He is not going to intrude on anything any more than he did in Bills 54 and 55 or is proposing to do beyond that.

Mr. Chairman: Order. The member should get back closer to the amendment of the member for Humber.

Miss Stephenson: I shall be delighted to. Thank you, Mr. Chairman, for reminding me.

Mr. Breaugh: It only took the member an hour to get there.

Mr. McClellan: Leaving the concentration camps.

Miss Stephenson: The only concentration camps I have ever visited are those which I think are an abomination of humanity, and I am not suggesting anything of that sort. I would be happy if the rhetoric of the member for Bellwoods were a little less vivid in directions that are totally inappropriate in this debate.

Mr. Breaugh: Just Romania and Czechoslovakia.

Mr. Martel: Is the member trying to be inflammatory?

Mr. D. S. Cooke: Double standard.

Mr. Chairman: Just ignore the interjections.

Miss Stephenson: To the master of double standards in this Legislature --

Mr. Chairman: No.

Miss Stephenson: All right. Fine.

Mr. Breaugh: It sounds impossible, but she is being provocative.

Mr. D. S. Cooke: And totally inaccurate and untrue.

Miss Stephenson: No. It is of grave concern that there be reasonable discussions and reasonable negotiations between the government and those responsible for negotiating. To my knowledge, there has been precious little negotiation with the College of Optometrist of Ontario. I am not at all sure there has been very significant negotiation with the Royal College of Dental Surgeons of Ontario regarding the effects of this legislation. It will provide for fairly significant limitations in very narrow areas for those two professions.

The member for Bellwoods suggested there had been an agreement in the past which had been breached. It is my understanding there had been an agreement regarding a statement that was to be made and an agreement that there would be discussions between the Ontario Medical Association and the Ontario Hospital Association to try to find directions that would provide solutions to the problems of the provision of care within hospitals at a rate for which the payment would be the OHIP level of benefit.

I am aware there was initial discussion about that subject. I am not aware of the reasons for the demise of those discussions; however, I am aware there was firm commitment on the part of the OMA to the other three items that were agreed upon that evening. That kind of agreement is something that could be improved upon. It is those kinds of negotiation and improvement we need in Bill 94.

We must have a negotiated settlement and reach some reasonable compromise, such as suggested by the member for Humber in his amendments to this section of Bill 94, which would ensure that there would be careful examination of the unhappy impact for a considerable number of people of the maintenance of that pejorative term "extra billing," or billing beyond the OHIP level of payment.

There could be a careful examination by both parties of the ways in which this could be measured and identified appropriately without doing disservice to the people who are affected by it. No one is suggesting, and particularly not the member for Humber, that every individual within the list he is putting forward for our consideration be stamped with a scarlet letter of some sort on the forehead, the wrist or the back, so that would have to be examined to determine whether the individual was one of those for whom extra billing should not take place.

What is being proposed is simply that there be discussions to ensure this can be done effectively and unobtrusively, without causing embarrassment, distress, disturbance or any discombobulation to those people who would be affected by the exceptions he is prescribing in the first part of his amendment. That is a very reasonable direction for a member of this Legislature to suggest, and a very reasonable direction for the members of this Legislature in toto to pursue in this whole area.

The member goes on in the next part of his amendment to section 2 to suggest there are certain exceptions and exemptions to the limited freedom that is being provided in his amendment to subsection 2(1). Those exemptions are very specific and they are good. They are firm. There are probably members of the OMA who would find them difficult to accept, and I remind the members of the House that the OMA is not a trade union and does not enjoy the kind of capability for singular direction.

However, through moral suasion and through active educational programs, the OMA can ensure that the members of the association follow the directions that are being pursued. If, as the member has suggested, these directions are a part of the legislation, then there is no doubt in my mind that all the members of the medical profession within this province would pursue that practise, which would ensure they would not be in breach of the legislation put forward here.

That is not the attitude that Bill 94, as it is currently written and as supported by the New Democratic Party, is going to engender within the hearts of the practitioners in Ontario. It has been suggested that it is a denigration of the profession to suggest there would be other means that might be found by patients to provide the appreciation they feel for their physicians and that it would be entirely the fault of the practitioners if this were to happen.

I feel very strongly, and have felt this way for almost the 11 years I have been here, that the government, in any jurisdiction, should not busy itself with the development and passage of legislation which encourages activities that are not entirely ethical or moral, or which encourages some breach of what we know as the legal framework within which we operate. I fear that some of the activities in which we have been involved -- and I confess I have been part of some of this as well -- have not been entirely lily-white in that type of description. They have not --

Mr. Haggerty: Now the member is being honest.

Miss Stephenson: I am always honest.

I believe this legislation, as currently proposed by the government, is one of those examples of legislation which will stimulate the idea that perhaps one can circumvent the legislation without causing any problem, that one can do something that is slightly dishonest without disrupting the system. That should bother each and every member of this Legislature.

6:20 p.m.

I do not believe that any one of us wants to be involved with the development, passage or promulgation of legislation that encourages people to think dishonestly, even to imagine or to act dishonestly. If we are guilty of behaving in that inappropriate fashion, it behooves each and every one of us to rethink our position. I honestly believe the present structure of Bill 94 is very much an action that will push people in that direction, not necessarily just the deliverers of the health care services but those who receive them as well.

It seems to me we cannot afford a society in which large numbers of people, including some of the leaders of our society, are prodded, pushed, encouraged, cajoled or even stimulated to think about behaving in ways that are not to the benefit of society as a whole. In terms of our understanding of the necessity for the support for the rule of law, I believe that with all my heart, and I believe the amendments --

Mr. Chairman: The rule of law is quite a piece off the member for Humber's amendment.

Mr. Stephenson: I disagree with you, Mr. Chairman, if I may do so. I firmly believe the amendments being proposed by the member for Humber are the alternative direction that will help this Legislature to move towards the passage of legislation that will encourage and stimulate the deliverers of health care to function not only in an ethical and professional way in the delivery of care but in an ethical and professional way in all other circumstances as well, because they will not have been denied the total freedom that has traditionally been a part of their relationship to the health insurance program, the health support program in this province and in this country.

If the bill is passed as currently written and the legislation at the federal level is found not to be constitutional and not to be supportable, the amendments proposed by the member for Humber ensure that we have legislation that is in support of the principle of accessibility and universality but is not based primarily on the thesis that we have to recover an amount, incorrectly computed though it is in Ontario. It is probably slightly less than half that suggested by the members of the New Democratic Party. The legislation would be reasonable and would not need to be amended dramatically. It would be in place and would continue to provide the framework for the delivery of health care in this province that it currently does.

I believe the member for Humber has exercised all the skills and talents he innately has, which have been honed by the education and training program provided for those who decide to become involved in the delivery of medicine for the benefit of patients in Ontario. He has exercised a good deal of his own perspicacity in pursuing other courses of educational program to make himself more knowledgeable.

As a result, he is probably the most knowledgeable individual in this Legislature at present in relation to the effects of Bill 94 as it is written, in relation to the need for reasonable compromise and in relation to the health economic directions he is suggesting with his amendments. We have all the advantages of the mind, experience, training and background of the member for Humber in the development of these amendments.

Surely this Legislature is not going to be so blind as to ignore that, even though there is no strong commitment at present on the part of his colleagues across the floor to support the very reasonable direction he has developed. It is a direction that I implore each member opposite to consider seriously, particularly the member for Huron-something. What is it?

An hon. member: Huron-Bruce.

Hon. Ms. Caplan: I thought you were talking about the member for Huron-Middlesex (Mr. Riddell).

Miss Stephenson: Jack? I would not ask Jack to consider anything, but I thought perhaps the member for Huron-Bruce (Mr. Elston) --

Mr. Breaugh: Is this a breakup?

Miss Stephenson: Jack's mind works in a different direction.

Mr. Chairman: Order. I remind the member to use the name of the riding and not the surname or first name.

Miss Stephenson: The member for Huron --

Mr. Chairman: The member for Huron-Middlesex.

Miss Stephenson: Is Huron-Middlesex the riding of the Minister of Agriculture and Food?

Mr. Chairman: Yes.

Miss Stephenson: Thank you. I always thought it was just Huron. I apologize, Mr. Chairman.

I ask all the members opposite, including the Minister of Agriculture and Food, to consider very seriously the amendments that have been proposed by their colleague the member for Humber, who has provided them with a direction that solves one of the major problems of negotiation, and that is the requirement to ensure that major face is not lost when a solution is developed. He is giving the government that. He has provided it with the kind of solution that will ensure it is not going to lose face, that it is pursuing the direction it said it was going to pursue and that it is going about it in a sensitive, thoughtful and knowledgeable way.

I ask that there be very serious consideration of this kind of activity on the part of all the colleagues of the member for Humber, because he has put his mind to this with vigour since December. He has done yeoman work on behalf of that caucus. He has ensured that some of the members of the caucus neither were drawn and quartered nor suffered at the hands of slightly overenthusiastic surgeons, a fate that might have been slightly less than beneficial for two or three of them. I still have my rusty scalpel for the member for Brant-Oxford-Norfolk (Mr. Nixon) -- at Earl's Shell; we are going to use the desk.

At any rate, it is imperative that the impasse, which is now not just an intellectual exercise but an emotional impasse, be dealt with appropriately by the acceptance of these very rational amendments proposed by a member of the Liberal caucus. He has worked diligently to come up with a solution to the problem which would ensure that all the necessities embodied within the government's support for this kind of direction were achieved and that we could move in the direction of ensuring that good health care would be delivered by reasonably satisfied health professionals who had not been denied under any kind of legislation the same kind of freedom that is offered to all others in Ontario -- within reasonable limits, within the kind of limits that would ensure the people who might in any way be damaged or disturbed by unusual action or by broadly based action would be protected. That is precisely what he has done.

Let us seriously consider this. Let us ensure that members consider it seriously for the next 24 hours and then think seriously about the way they are going to vote on this amendment to section 2 of Bill 94. I do not think members are ready yet, because I do not believe they have thought about it as seriously as they should.

Hon. Mr. Nixon: Is that a threat?

Miss Stephenson: No, it is not a threat. I am simply being absolutely reasonable in asking members to think about it very seriously so they will be prepared to vote on it when we begin the debate on this section tomorrow.

On motion by Hon. Mr. Nixon, the committee of the whole House reported progress.

ROYAL ASSENT

The Acting Speaker (Mr. Morin): I beg to inform the House that in the name of Her Majesty the Queen, the Honourable the Lieutenant Governor has been pleased to assent to a certain bill in his chambers.

Assistant Clerk: The following is the title of the bill to which His Honour has assented:

Bill 40, An Act to authorize the Raising of Money on the Credit of the Consolidated Revenue Fund.

The House adjourned at 6:30 p.m.