CONTENTS
Tuesday 23 June 1992
Ministry of Health
Margaret Mottershead, assistant deputy minister, health systems management
Bob Pharand, manager, financial management services
STANDING COMMITTEE ON ESTIMATES
*Chair / Président: Jackson, Cameron (Burlington South/-Sud PC)
*Vice-Chair / Vice-Présidente: Marland, Margaret (Mississauga South/-Sud PC)
*Bisson, Giles (Cochrane South/-Sud ND)
Carr, Gary (Oakville South/-Sud PC)
*Eddy, Ron (Brant-Haldimand L)
Ferguson, Will, (Kitchener ND)
*Frankford, Robert (Scarborough East/-Est ND)
*Lessard, Wayne (Windsor-Walkerville ND)
O'Connor, Larry (Durham-York ND)
*Perruzza, Anthony (Downsview ND)
Ramsay, David (Timiskaming L)
Sorbara, Gregory S. (York Centre L)
Substitutions / Membres remplaçants:
*Henderson, D. James (Etobicoke-Humber L) for Mr Sorbara
*Sullivan, Barbara (Halton Centre L) for Mr Ramsay
*Wessenger, Paul (Simcoe Centre ND) for Mr O'Connor
*Wilson, Jim (Simcoe West/-Ouest PC) for Mr Carr
*Winninger, David (London South/-Sud ND) for Mr Ferguson
*In attendance / présents
Also taking part / Autres participants et participantes: O'Connor, Larry (Durham-York ND)
Clerk: Greffier: Carrozza, Franco
The committee met at 1530 in committee room 2.
MINISTRY OF HEALTH
The Chair (Mr Cameron Jackson): The Chair recognizes a quorum. I'd like to call to order the standing committee on estimates to resume the estimates of the Ministry of Health, with approximately four hours and six minutes remaining.
Mr Paul Wessenger (Simcoe Centre): Mr Chair, I don't think there's a quorum.
The Chair: The Chair has recognized a quorum. I see representatives from every political party here. If the parliamentary assistant would please take his seat, it would be helpful.
Mrs Barbara Sullivan (Halton Centre): Mr Chair, due to the fact that neither the minister nor the deputy is, again, available to appear before the estimates committee to deal with the estimates of the Ministry of Health, I move adjournment of the committee for today's session.
Mr Wessenger: I'd ask for a 20-minute bell, a 20-minute vote on this.
The Chair: Very good. The request is for 20 minutes to caucus your members.
Mrs Sullivan: Mr Chairman, the committee is to start its proceedings at 3:30. This is the second day in a row the minister has not been available. The members of the committee who are assigned to the committee have an obligation to be here to participate in the activities, and the minister has a responsibility to appear and defend the estimates.
The Chair: Mrs Sullivan, excuse me, but we have a motion to adjourn. It's not debatable. There's been a request for 20 minutes. This meeting is adjourned for 20 minutes.
The committee recessed at 1533.
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The Chair: I call to order the standing committee on estimates.
Mr Gilles Bisson (Cochrane South): A point of order.
The Chair: No. We're in the middle of a vote; there's no point of order in the middle of a vote. Mr Wessenger called for a 20-minutes recess. We must call the vote immediately.
The motion before us is moved by Mrs Sullivan, that the committee adjourn for the day.
Mrs Margaret Marland (Mississauga South): This is a recorded vote.
The committee divided on Mrs Sullivan's motion, which was negatived on the following vote:
Ayes -- 5
Eddy, Henderson, Marland, Sullivan, Wilson (Simcoe West).
Nays -- 6
Bisson, Frankford, Lessard, Perruzza, Wessenger, Winninger
Mr Bisson: On a point of order, Mr Chair: According to the resolutions when this committee was first formed, the committee is not to commence until we're into orders of the day within the House. I'd like to have some clarification why this committee actually started before the orders of the day.
The Chair: It was my understanding from the TV screen in front of us that routine proceedings had been completed. I recognized a representative from each political party. The words used by the Chair were not that a quorum existed but that the Chair sees a quorum, and we proceeded on that assumption. Frankly, we've gone three weeks and it's my hope that we can get these estimates done some time this year, if not Health alone.
Mr Bisson: I would just like to indicate for the record itself that this committee of estimates today started before the actual orders of the day. The resolution in the House is quite clear: The committee is not to start until orders of the day in order to allow members to get here to participate in the dealings of this committee. I can't so much reprimand the Chair but to say that the Chair should have at least checked with the Clerk of the House to make sure that we were still in a position of being able to sit as a committee. At that we will let it go at this point, but I certainly hope that will not happen again.
Mrs Sullivan: Mr Chairman, I would like to know from you or from the clerk if you had advance notification from the minister that the minister would not be present today and when that notification came.
The Chair: I checked with the clerk when I entered the room and found out at that point. Neither the clerk nor I were advised that either the minister or the deputy would not be present for their estimates.
Mrs Marland: I think everyone understands what the process of estimates is all about. It's about the minister defending the estimates of his or her ministry. I don't have any personal problem with the parliamentary secretary or the assistant deputy minister -- we haven't met so I apologize for not --
The Chair: There will be an opportunity to introduce these new faces.
Mrs Marland: I just want to refer to you by name.
Ms Margaret Mottershead: My name is Margaret Mottershead. I'm the assistant deputy minister of health systems management in the Ministry of Health.
Mrs Marland: Margaret, I know your name well; I just didn't recognize you.
The fact is that for us to go into an estimates committee hearing and have the kinds of questions and issues that we wish to discuss -- Certainly speaking I think for both opposition parties, the whole process of estimates and why these committee hearings are held would not be worthwhile. Nor is it fair to the assistant deputy minister Ms Mottershead to expect that we can have the kind of political and policy answers, both of which are part of the process in getting answers from the minister on estimates. We have a new deputy minister, we have a new minister, and I think with a new government we are entitled to have an in-depth look at the estimates for the biggest ministry in Ontario.
For us to be here looking at a $17-billion expenditure or whatever the final figure is, I think it's an insult to the process to suggest that we should go ahead in the absence of the minister.
Last week the minister was ill and we were given notice at some point, I think during the afternoon, that she couldn't be here because of her illness. Mr Chairman, you and I have been in this House -- I'm trying to see who else has been here seven years. I've always been on estimates. I have never yet been through an estimates process without the minister and the deputy being present. I would think that if this government wants to be fair to the intent of the estimates committee hearings, it would suggest that we defer these hearings until such time as the minister is able to be here.
Mr Bisson: On a point of order, Mr Chair: The standing orders are fairly clear that the minister or the designate through the parliamentary assistant is allowed to come to the estimates committee in order to present the estimates on behalf of the minister.
The second point is that the last time this committee met there was an agreement just prior to our committee adjourning that we would not adjourn the committee last week until such time as I got back, at which point I wanted to put on the record that the minister would not be here today. Unfortunately that agreement was not lived up to. The committee was adjourned before I, the whip of the government side, was allowed to come back here and report to the committee what was going to happen.
Mrs Marland: Allowed to come back?
Mr Bisson: I have the floor.
The Chair: I'm not sure this is a point of order, but I will recognize you in the speaking rotation.
Mr Bisson: The last point is that it was clear the last time the minister was here that it was indicated to the clerk of the committee that she would not be able to attend during this week because, as you know, I think the conference is happening right now and most people are aware of what's happening around that.
Clerk of the Committee (Mr Franco Carrozza): The minister did not inform me of that date because I was not here for her to inform me. It's not my duty to inform anyone if I'm not told anything, so I wish to correct the record on this.
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Mrs Marland: Could somebody tell us where the minister is?
The Chair: It would be helpful. Where we are at this moment is that it would appear neither the clerk or the Chair were advised, either routinely or out of courtesy, of their lack of attendance. We were not advised that the deputy would not be here. Perhaps if we could have someone speak to that issue that might relieve some of the tension the Chair is experiencing at the moment over this diversion of the committee's activities.
Mr D. James Henderson (Etobicoke-Humber): On a point of order, Mr Chairman: Is it in order for my good friend the parliamentary assistant to be here in the capacity of representing the minister and also be deemed to be a voting member of the committee?
The Chair: Yes. The member has been substituted in through a regular member of the committee, and the government total complement of eligible voting members has not increased. I'm sorry, Mr Wessenger wanted to comment.
Mr Wessenger: Yes. The question was asked, first of all, where the minister is. The minister is in Ottawa at the national physicians' conference. On the question of the point of order, I don't know whether it's appropriate. I'd ask the Chair this question. We had a motion for adjournment. We now seem to be discussing the question and I don't think that's in order. I don't even know whether it's in order to discuss a motion for adjournment.
I might just add that the minister was available last Tuesday but the opposition did not show up. The minister was also available last Wednesday and again the opposition didn't show up. On one other occasion the minister was sick. So she scheduled three previous days for estimates.
Mr Jim Wilson (Simcoe West): On a point of order, Mr Chair.
The Chair: First of all, I would like to rule that we're not debating a motion to adjourn. This committee is discussing a concern in procedure and precedent and it has every right to do so. Mr Wilson had a point of order. If it's not a point of order, Mrs Sullivan is next in the speaking order.
Mr Jim Wilson: I think the --
The Chair: Is it a point of order? I need you to say it's a point of order and then I'll recognize you.
Mr Jim Wilson: On a point of order, Mr Chair: I think the parliamentary assistant is totally incorrect and is making a mockery really of what happened last week, which was that the House never did reach orders of the day on the days referred to by the parliamentary assistant. He may want to correct his record in light of that information.
Mr Anthony Perruzza (Downsview): On the same point of order, Mr Chair. Actually, on Mr Wilson's point of order: I don't understand. I've sat here for the last 10 minutes and I can't figure out what it is we're doing and what it is we're speaking to. We took a vote --
The Chair: Lack of understanding is not a point of order, Mr Perruzza.
Mr Perruzza: We took a vote --
Mr Bisson: I have a motion. I would like to place a motion. The motion is that we can proceed with the estimates from Health on the part of the parliamentary assistant.
The Chair: A motion to proceed. We are in estimates for the Ministry of Health, but you have a motion to proceed with the estimates; in other words, move directly to it. The motion is in order.
Mrs Sullivan: Mr Chairman, I'd like to speak to that motion. I think perhaps what the members from the government party do not understand in relationship to the discussion that is now occurring around the table and the concerns that are being expressed by opposition members is that the estimates process is one of long standing in the Legislature, where ministers are responsible to Parliament and to the public for defending their estimates and defending the policies and processes and implementation of those policies that are being affected by the ministry for the current fiscal year and, where future fiscal years are involved, for the period of time of a longer-term process.
We are frankly outraged that the minister did not have the courtesy to advise the Chairman of the committee or the clerk officially that she would not be available nor would her deputy be available to appear before us.
Mr Perruzza: On a point of order, Mr Chairman --
The Chair: I hope it is a point of order. What's your point of order?
Mr Perruzza: She's just beating a dead horse all over again. Come on, we're in estimates. Let's move on.
The Chair: Mr Perruzza, it's customary and courteous to refer to the member by her riding name, not "she." You'd be well advised to elevate your conduct in that regard.
Mr Perruzza: Maybe we can get riding maps and names on the thing. I don't know where the member is from.
The Chair: It's not a point of order. Mrs Sullivan, please complete your comment.
Mrs Sullivan: As we concluded the last section of estimates, the minister had begun to discuss particular areas of interest, not only to the opposition but, I would assume, to government members as well. She was talking about in-home care programs and the delivery of community-based services where there are substantial policy decisions being made, not only substantial delivery decisions that are being implemented through the bureaucracy.
It is vitally important that we be able to follow up in that area of questioning. The minister, frankly, despite all of the good intentions of Mr Wessenger, is the person who bears cabinet responsibility for the policy decisions that are being taken and in fact knows precisely what is going to be put before cabinet and where she is willing to admit changes, discuss problems and respond to the concerns of citizen and other groups who are affected by those decisions. There were comments the minister had put before the committee that indeed have raised questions in the community that we want to pursue. Without the minister being here, frankly, it is impossible to do so.
If the government members do not understand the importance of those issues, then I say it just follows the normal pattern.
The Chair: Mr Wilson and then Mrs Marland, briefly, because the motion is very clear and each caucus should be given an opportunity to comment.
Mr Jim Wilson: I would like to address the motion, which I gather is to proceed with the estimates. I would echo the sentiments made by Mrs Sullivan and by my colleague Margaret Marland. First of all, the minister did not give us any notice. I think that to proceed is to make a mockery of Parliament. I, for one, will not be part of an estimates process that flies in the face of tradition of this Parliament, and it makes a sham of the estimates process.
We have gone around consulting with groups and individuals and we have promised them that we will raise these issues specifically with the minister who heads up the ministry, who is one of the most powerful ministers in this government, and we demand the right to do that. For this government to railroad this committee because it happens to have more members than we do I think makes a sham of the political process, and it should be ashamed of this motion that is on the table.
Mrs Marland: I'm sitting here finding this whole afternoon very depressing. I think it's unfortunate that all six of the government members who are here this afternoon do not have the historical perspective of what it is we're dealing with. It's fine for governments to change and then for governments to decide they're going to change all the parliamentary procedures to suit themselves, but I think everybody would do well to be warned about the fact that we should all tread carefully, because eventually things that go around come around. When you throw the parliamentary tradition of this House out the window and make the kinds of statements that are being made this afternoon by the government members, it is a very sad day for the people in this province.
I think in fairness I would ask Mr Wessenger, the parliamentary assistant, to withdraw his comments that his minister was here last Tuesday and Wednesday and was willing to sit but there were no members here. For the record, it's terribly important for your own personal credibility, Mr Wessenger, to identify why the members were not here. They were not here because committees were not sitting. That's the reason.
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Mr Jim Wilson: They were in the Legislature.
Mrs Marland: They were in the Legislature because we were not out of routine proceedings. It's up to you whether you want to stand with your own personal integrity on that kind of information or not, but I would advise you that I think you would be very wise to correct the record.
I cannot see how dealing with the minister's -- I'm glad you think it's amusing, I say to the member for London -- what is your riding?
The Chair: Mrs Marland, through the Chairperson.
Mrs Marland: The member for London South, Mr Winninger, who doesn't understand when I look at him and speak to him that I'm speaking to him -- I say to you, Mr Chairman, if this is the kind of exercise this socialist government wants to take the people of this province through, so be it. It will be on their heads. When the public asks why we were not able to identify what the minister's programs and policies were in the estimates for this year -- that we were not given the opportunity to raise questions and concerns and in some areas identify programs that we're happy to see there because we've been asking for them and we support them. If there's no two-way exchange of information over a $17-billion budget, as I said earlier, of the largest ministry in this province, then I think the people of this province will know and fully understand what a game this Parliament has become under this government. I would like to know from the clerk, through you, Mr Chair, whether a quorum requires all parties to be present.
The Chair: The request is of the clerk to clarify. Proceed.
Clerk of the Committee: Mrs Marland, the standing orders specifically say it should be seven "members." It does not say "parties." However, the tradition and convention have always been that one from each party be present to see a quorum.
Mrs Marland: All right. Thank you for that answer. I think that since we have waited a number of months already to review these estimates and since there are some estimates of the government that because of a time factor, if the House isn't sitting -- actually the House is sitting next Monday and Tuesday, so we could sit next Tuesday at least with the minister present. Perhaps we could know now. Is the minister going to be available next Tuesday?
Mr Wessenger: I don't know the minister's schedule, unfortunately.
Mrs Marland: Today is Tuesday. Is the minister available tomorrow?
Ms Mottershead: I guess we will have to check with her schedule.
Mr Wessenger: We'd have to check with her.
Mrs Marland: Isn't that interesting, Mr Chairman. We're supposed to be able to ask the parliamentary assistant and the assistant deputy minister questions on the estimates and they can't even confirm to us whether the minister is going to be here tomorrow, knowing that tomorrow Health estimates have been scheduled for this committee. I think it's significant because there are four hours and six minutes left in these Health estimates. If they can't even speak for her schedule, how can they speak for her estimates and her policies?
I think the best thing this committee can do is adjourn for lack of a quorum, or agree, politely, that we can adjourn until tomorrow, hoping the minister can be here, or adjourn, if we are sitting next Tuesday, until next Tuesday and we can deal with these important estimates.
The Chair: Fair enough, but I have Mr Bisson, Mr Mammoliti and then the parliamentary assistant.
Mr Wessenger: I wonder if I could reply to the question of the member first, with respect to the minister.
The Chair: Mr Bisson agrees that you can proceed.
Mr Wessenger: Perhaps what I think would be the most advisable procedure is that the members proceed with estimates today and we will try to ensure that the minister is available tomorrow for estimates to continue. I think that would be the wisest move in these circumstances.
Mrs Marland: In that case, Mr Chair, maybe we could agree, if there are four hours and six minutes left, that the government members use their hour and 20 minutes today and we can ask our questions when the minister is here. I think that's a fair request.
Mr Bisson: Okay, just to go through --
The Chair: I will remind all members we have a motion on the floor which says we proceed into Health estimates.
Mr Bisson: With the estimates with the parliamentary assistant and representative.
A couple of things: there was some fairly strong language utilized here on the part of the opposition in regard to this whole process being a sham and somehow the rules of this House being hijacked. I would ask the members of the opposition to take a long, hard look in the mirror when making those kinds of allegations. This committee tried to sit on two occasions last week on which the minister was prepared to sit, and the committee could not sit because of the games that were being played in the Legislature.
Mr Jim Wilson: Talk to your House leader.
Mr Bisson: I would also say that I sat and listened very attentively to the remarks made by the three opposition members. We did not heckle. We allowed you to make your positions. You will allow us to make ours.
The other question, and I mentioned it just briefly before, is that one of the last times we met I had asked the Chair at the time -- and I think the whip on the part of the opposition was here; I don't quite remember who was here from the official opposition -- that the committee not adjourn until such time as I got back because I wanted to put on the record that the minister would not be available for today. The committee adjourned outside that agreement. It was the prerogative of the committee to do so, but there was a sort of gentlemen's agreement on that.
The other question, as I had mentioned in the beginning, is that again the opposition utilizes strong language and talkes about a sham. I would say that the standing orders and the resolution in the House on how this committee operates clearly set out that this committee is not to proceed with the business of the day until we are into orders of the day. For whatever reason, today the opposition saw it fit and in order to move an adjournment to this committee prior to orders of the day. If that is not hijacking the rules of this House and the privileges of myself as a member, I don't know what is. I'll put that very clearly on the record.
The Chair: Mr Bisson, I'm sorry, if I may --
Mr Bisson: I'm allowed to make that very clear, because it is fairly obvious what is happening here.
The Chair: If I may, Mr Bisson --
Mr Jim Wilson: Would you like to start over?
The Chair: No, Mr Wilson, please; this is not easy. Let's proceed through this. I would just indicate that the Chair made the decision to start the meeting. It's fair to assume that once I had ruled that estimates were to begin it was a safe assumption. If the Chair erred, he has indicated that.
Mr Bisson: That's fair.
The Chair: Frankly, I did call the meeting when it appeared to me, from my position here in the chair, that routine proceedings had been completed.
Mr Bisson: I accept that. But if, as I am called, an inexperienced member, I know the difference between orders of the day and when we deal with routine proceedings, I would hope that civilized members who had been around here for a while, who supposedly understand the rules, would know the difference and would be able to correct the Chair in the event that a mistake is made on the part of the Chair. That did not happen, so I have to assume that there was something going on.
The other question, in regard to a sham and games being played -- it was just said by the previous member, the Vice-Chair from the Conservative Party -- is that if we did not proceed with the minister there were two ways we could proceed: We could have a sort of gentleman's agreement of what we were going to do in getting the minister here, or we could adjourn this for lack of a quorum. I take it that's what is going to happen here, that the opposition -- I see the Vice-Chair from the Conservative Party getting ready to leave --
The Chair: Mr Bisson, excuse me.
Mr Bisson: That's the way we would go. I just want to put this all on the record. I have a motion on the floor --
The Chair: Mr Bisson, it is completely out of order to deal with the issues of absences of current members, nor is it helpful to imply motive. I would ask you to please speak to the issue.
Mr Bisson: Can you clarify a point, though, Mr Chair?
The Chair: I'm going to clarify for you that your fears are for naught, that every opposition member could up and leave, save and except the Chair, and you could still proceed. Now that this has been clarified, I'd appreciate if you'd stick to your motion and not speculate about any motive on the part of another committee member.
Mr Bisson: But just to clarify --
Interjection.
The Chair: No. Mrs Marland, you are not in your place and you're not on Hansard.
Mr Bisson, speak to your motion. I would like to proceed with these estimates.
Mr Bisson: But just a last point --
Mrs Marland: I'd like to raise a point of privilege, Mr Chairman.
The Chair: Now that you are before your microphone, you may.
Mrs Marland: I would like the record to show that the critic for Health for our party is present, attending this committee. Yes, I would explain to Mr Bisson that I am leaving and I am not leaving for any other reason than that I knew from the beginning I could only attend this meeting until 4 o'clock today. I have a speaking commitment in Mississauga at 5:30 with the board of trade, if you'd like to know exactly where I'm going to be.
Mr Bisson: I appreciate that. We have a motion on the floor, Mr Chair.
The Chair: I have other speakers. Mr Perruzza, thank you for being so patient.
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Mr Perruzza: All I want to say, really, is that I came here today prepared to roll up my sleeves, hunker down and get to work and do some estimates. For the first 20 minutes I've seen us debate two separate motions that do essentially the same thing. One was to just simply disband the committee today and come back another day. The other one now is a positive motion on the floor that says we should be doing the estimates. I think that when the first motion failed, we should just have moved and gone into the estimates until 6 o'clock, as we normally do, and that's what the agreement seems to be.
In closing, I just want to say that with respect to Mr Wessenger, I have full confidence in his ability and his knowledge of the Ministry of Health and I know the assistant deputy minister is sitting right next to him and there's a wealth of information, if we want to get to work and do the business of this committee and do what this committee is mandated to do. I also know that Mr Wessenger is an exemplary parliamentarian and in no way would I undermine his ability and credibility by suggesting for one minute that anyone else need be in that chair for today for us to be able to adequately do what this committee is mandated and entitled to do. So I just say we should get on with it and let's do the business. That's it, Mr Chairman.
The Chair: Thank you.
Mr Perruzza: I'm prepared to vote.
The Chair: Since you were the last speaker, then we will proceed with the vote. All those in favour of proceeding directly in to the estimates? All those opposed, if any? The motion is carried. The time allocation will commence now.
Mrs Sullivan: Given the fact that the government is very anxious to proceed, I believe it's their turn in the rotation. Is that correct?
The Chair: That is correct.
Mrs Sullivan: I would like to suggest that we, in my party, stand down our questions until the minister is able to be here and that the government party proceed with the 82 minutes of time available to it during today's proceedings and present its questions to the parliamentary assistant and the assistant deputies who are here. I would like to frame that in the form of a motion.
The Chair: A motion has been received. Discussion on the motion? I caution members, though, that we are now using the time of --
Mr Bisson: On a point of clarification.
The Chair: Let me finish, Mr Bisson. We are now in the time when the committee has ordered up the business of the review of estimates. We now have a motion which the Chair has accepted, which deals with the order and the time allocations we will proceed under. I would hope the debate on this motion, if any, is very brief.
Mr Perruzza: Mr Chairman, just in speaking to that motion, I would hope that motion not pass and that in fact it fail because I think a proper motion that should be placed on the floor and one I would support is that for me these estimates commence on or around 4 o'clock, and I, as a member of the governing party, would give up my time for today if we could roll back the clock to 4 o'clock, start the estimates time then and give both opposition members their time for today and simply knock the 20 minutes off our questions. I think that would be more appropriate.
The Chair: I would ask you to speak directly to the motion.
Mr Perruzza: That's it. In speaking to that motion, I'm not going to support it because I don't think it makes a whole lot of sense. We've been working for 20 minutes and that 20 minutes should be put on the clock.
The Chair: Just for the record, immediately following the motion to adjourn, I was called upon on a point of order raised by Mr Bisson. Mr Bisson called the Chair for a point of order to raise the issue of the preceding activities of the committee that precipitated the motion for adjournment. What ensued was 20 minutes of discussion dealing with committee business. I might not have ruled accordingly but clearly Mr Bisson, by his motion to then proceed and begin Health estimates, acknowledged the manner in which the Chair was conducting the clock.
I would ask that we speak to the motion, which is simply that the government be asked to be given the first 80-some minutes, according to Mrs Sullivan's motion. Mr Bisson?
Mr Bisson: Just a point of clarification with the clerk, and I also want to clarify that the motion I gave was that we go into estimates utilizing the parliamentary assistant. That is the motion I put forward. The thing I would like to clarify with the clerk is that it is my understanding of the standing orders that after the vote was taken in regard to the adjournment of the committee, we were into the time of estimates. I would like that clarified because the time started on the estimates as of the time we had the vote in regard to the --
Mr Perruzza: Then we can move a motion to --
Mr Bisson: I've got the floor, thank you. We were into running off the clock in regard to the estimates as of the time after we had the movement to adjourn the vote.
Clerk of the Committee: Can I?
The Chair: Please proceed, Mr Clerk.
Clerk of the Committee: To answer your question, Mr Bisson, the Chair controls the time when to begin.
Mr Bisson: You are saying the standing orders are not clear on that point?
Clerk of the Committee: That is correct.
Mr Perruzza: Can we do it through a motion?
The Chair: You can challenge the ruling of the Chair, but the Chair recognized the point of order of Mr Bisson. I thought I was responding to a point that the government member wanted raised in committee time. I didn't feel it was fair to in any way detract from the time allocated to the minister or the ministry to complete their estimates, as well as the committee's time to complete the estimates. My understanding is we were discussing committee business around a certain standing order that dealt with who should represent the ministry, and the Chair ruled on that early. But the committee members proceeded into a lengthy discussion and at any time could have moved a motion, which ultimately Mr Bisson did move. Not seeing a challenge, Mr Bisson -- have you not finished?
Mr Perruzza: Just a minor point of order, Mr Chair.
The Chair: Points of order are neither minor nor major; they are points of order or they're not. If you have a point of order, please proceed.
Mr Perruzza: I'm going to give the floor to my friend here.
Mr Bisson: If we can have an understanding on this, that if what we end up doing is finishing estimates by tomorrow -- is that what you're proposing?
Mrs Sullivan: Through you, Mr Chair, what I am suggesting and what is in the motion is that the time be divided equally between the three caucuses and that the New Democratic Party use its allocated time today so that the opposition parties can proceed with their remaining share of questions directly to the minister. The government party clearly feels that it's appropriate to proceed with the parliamentary assistant. We're suggesting that they proceed, given that the time left on the clock today is approximately the 82 minutes, as I understand it, which is the remaining time available to the New Democratic Party.
The Chair: I should, for the benefit of the entire committee -- the clock is running on the NDP's allocated time, since the Chair was asked to clarify that the first group to speak would be the NDP, even though it was Mrs Sullivan's motion. I would ask members to resolve to complete their comments and we can get to this motion.
Mr Jim Wilson: Just very briefly, Mr Chairman.
Mrs Sullivan: I say it's reasonable. Say yes.
Mr Jim Wilson: Thank you for the time. I've sat here patiently for the past few minutes. It makes perfect common sense to me, and I don't understand why the government is not agreeing with the motion that's on the floor. Here the government wants to proceed with the parliamentary assistant, and the two opposition parties do not want to proceed with the parliamentary assistant because we believe it is traditional and our right to have our questions answered by the minister herself. So I think it makes perfect common sense, and I don't understand the government's reluctance to support this motion. You can go ahead today with your time allocation, and we can stand down our questions until such time as the minister is available. Perfect sense.
The Chair: Thank you. I would like to call the question. Okay, I'm not seeing unanimity in calling the question.
Mr Robert Frankford (Scarborough East): On a point of clarification, Mr Chair: Assuming the minister comes here, would there be the opportunity for the minister and/or the deputy responding to questions that are raised by us this afternoon?
The Chair: Yes, once this vote is over with, I would like --
Mr Jim Wilson: I can't believe we've been arguing for an hour.
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The Chair: Excuse me, Mr Wilson, please. A point of clarification has been raised. First of all, the Chair cannot prejudge the vote, which allocates all of your time today. The Chair has the responsibility of ensuring that a certain fairness in access is provided. You've raised the question of having fairer access to a minister and possibly a deputy, who may be here tomorrow, and the Chair's not in a position to rule until those circumstances are presented to the Chair. But it is the Chair's past rulings to be very flexible in these matters to ensure that members, especially those who've persistently expressed an interest in certain matters, be given a certain access. That's the best I can do to guide you.
Mr Frankford: I think it is customary, is it not, that parties may submit questions in advance that would be answered by the minister after investigation by staff the following day?
The Chair: That was going to be my question before Mrs Sullivan placed a motion, whether the ministry has come today prepared to respond to questions that were tabled three weeks ago with the ministry, and that is a matter for all the committee members to deal with. I will speak to that as soon as this motion is covered, if I can suggest to you to save that question; it can be raised immediately following this vote because the Chair wishes to have that clarified for the benefit of the committee to understand certain matters.
Mr Bisson: In regard to the motion that was put by the Liberal caucus, we'd be amenable to that. I just want to clarify something, that if we do it in that way, that would mean to say that if the minister is here tomorrow, whatever time is left would be considered the end of estimates as of 6 o'clock tomorrow night, rather than trying --
Mrs Sullivan: What about the standing orders?
Mr Bisson: We can do that if we all agree. I'm just asking, is that what the agreement is?
The Chair: No, it isn't.
Mrs Sullivan: No.
Mr Bisson: If that's the proposal, we'd be prepared to go along with it.
The Chair: It is a matter for this committee in its entirety to determine when its estimates are completed.
Mr Bisson: That's right.
The Chair: Although you were posing your question to a specific member of the committee, had you gone through the Chair as a question, I would have clarified that any arrangement that you think may or may not be made is not binding on this committee. Only through the Chair and through a motion of this committee is it binding on when we complete, or when the time has elapsed according to the standing rules and the time allocated by the House.
Mr Perruzza: Can we move an amendment to her motion?
The Chair: Yes, an amendment would be in order. I'm sorry. I apologize. Yes, an amendment to a motion is in order. That is correct.
Mr Perruzza: Then I would move that tomorrow night at 6 o'clock Health estimates be finished.
The Chair: I do not believe that would be in order. I don't believe the wording of your amendment would be in order. That's the Chair's ruling.
Mr Perruzza: Can we have her motion back, please? I don't remember it.
The Chair: Would the clerk please assist the Chair?
Clerk of the Committee: Mrs Sullivan moved that the Liberals place aside their time to question the minister and have the NDP proceed with its time allotment today, which is 80 minutes.
Mr Bisson: Can I suggest, to make this very clear, that if the subcommittee agrees -- who here is on the subcommittee? The Conservative member is not here. If we can come to an agreement of the subcommittee in regard to how this will work out, we'd be very agreeable, if there's any consensus on the part of the opposition. I'm looking for some signal from the opposition here.
The Chair: Again, I will rule that the subcommittee cannot be called unless the Chair calls it or members of the subcommittee request a meeting outside the committee time. But we are currently in estimates hearings and I would ask that people stay with the motion, which simply sets out the order of the questioning and the time, which, as I read it, indicates that you would consume the balance of your time allocated directly now with the parliamentary assistant. That is all that motion says and I would ask the members to now vote on this motion.
Mr Jim Wilson: On a point of order, Mr Chair: I wonder if it would be amenable to the mover that the motion be amended, so that rather than "Liberals" as the first word, it would be "the opposition parties stand down their questions." Otherwise that leaves my party --
The Chair: That would be in order. Is that agreeable to the mover? I hope there's no discussion on the amended motion. Could we please call the question? Would someone ask the Chair to call the question?
Mr Perruzza: On a point of order, Mr Chairman. What's the amended motion?
The Chair: The motion now reads that the opposition parties would stand down their time this afternoon to allow the government party to ask its questions of the parliamentary assistant, up to a total of its allotted time of 80 minutes, of which 15 are already gone.
Mr Perruzza: Okay, and I moved an amendment to that that we would agree to do that.
The Chair: I ruled that amendment was out of order. You had the right to challenge that and you did not, so your right to challenge it now has passed.
Mrs Sullivan: Question.
The Chair: All those in favour?
Mr Perruzza: Mr Chairman --
The Chair: No, I'm sorry, Mr Perruzza.
Mr Perruzza: Why it is out of order?
The Chair: I ruled it out of order. I gave an explanation, even though I wasn't called upon to, and I have called the question. A member of the committee has asked that the question be called.
All those in favour of the motion? Opposed, if any? The motion is defeated.
Mr Bisson: Let's try this another way. We'll do this very simply. I would put a motion before this committee --
The Chair: I would like to advise you that you have been recognized by the Chair to proceed with your estimates.
Mr Bisson: You will not entertain a motion?
The Chair: I would be more than pleased to entertain a motion.
Mr Bisson: The motion is, and I will just simply put it, that the government side of the committee will proceed with questions in regard to the estimates with the parliamentary assistant today, allow the opposition to ask questions of the minister tomorrow, but that we agree unanimously that we would be finished estimates by 6 o'clock tomorrow night.
The Chair: That is the motion. The Chair accepts the motion.
Mr Jim Wilson: Could I speak to the motion, Mr Chairman?
The Chair: Yes, you may. I just want to make sure the clerk has it down sufficiently. He indicates he does. Please proceed.
Mr Jim Wilson: I'd ask for a clarification from the clerk on the motion. How much time would that mean the opposition parties would have tomorrow, and how much less time would that be than our total allocation if this motion were not to pass?
Clerk of the Committee: We began at 4:22 this afternoon. If we proceed until 6 o'clock, you will use one hour and 38 minutes, and if you are to meet tomorrow, you could use two hours and 30 minutes if we begin at 3:30. The total will give us close to four hours and six minutes and practically finish all the time you have now. If you give me a minute, I'll give you the correct figure.
Mrs Sullivan: If I could just speak to that, frankly we in my party believe these issues are enormously important issues relating to the Ministry of Health that have to be discussed in estimates committee. We want our full allocation of time, and if it's possible that the proceedings can be completed at 6 pm tomorrow night, we would be happy to guarantee that our time is used. We do not want to give up one minute of our time in terms of minister's responses and availability to us, and all of this is dependent, frankly, on the length of time in the House before routine proceedings start. We want to have full access and our full right acknowledged and in fact adhered to in terms of questions to the minister, and we feel the issues are that important that we should have that full time allocation.
The Chair: Mr Wilson, the second time you're speaking to this motion.
Mr Jim Wilson: And it may require more, Mr Chairman. Perhaps the mover would be friendly to an amendment or two changing the wording of his motion, that we proceed with the committee tomorrow, with the opposition parties using their full allocation, which may mean, from the sound of it, we may have to go to 6:15 or 6:30 if we don't get started right at 3:30, because there's no guarantee in the House that the orders of the day will be called at 3:30. That way we could go and we wouldn't be short any time. You would have your estimates over tomorrow evening.
Also, I would like to ask as a supplementary, do we have the assurance that the minister will be here tomorrow?
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The Chair: First of all, I would like to offer up some rulings the Chair would rule at this time.
First, no motion would be entertained that ties directly the attendance of the minister, because clearly the standing order says the minister.
Second, it is custom, and since all members have discussed the issue of what's custom -- it would be customary for want of 15 or 20 minutes or half an hour of time remaining in estimates in most cases -- arrangements are made through the subcommittee and discussions with the Chair not to drag out the minister and all the staff for want of 15 minutes or 20 minutes.
The third point is that we cannot prejudge tomorrow's estimates. I accepted the motion and perhaps I should not have, but I accepted the motion because it's clear that it is important that we complete the estimates of the Ministry of Health at some point. The Chair is of a mind to start early, as I attempted today. I will attempt again tomorrow to start early because I have an obligation as Chair of this committee to ensure that we proceed through our estimates which, I might remind committee members, are badly behind schedule. Without impugning motive, it is badly behind schedule and the Chair will be moving more vigorously to ensure this committee starts on time. I've been advised it was a little too vigorous today, but it will continue to be vigorous none the less.
Mr Jim Wilson: Mr Chairman, are you ruling the motion in order?
The Chair: No. I'm guiding the committee with some advice here in the hope that it will move quickly to the vote and proceed. We are using up the government's time.
Mr Jim Wilson: Mr Chairman, a response to my request for a friendly amendment from Mr Bisson through you, if I may.
The Chair: Mr Bisson, you've had a request to consider amending your motion.
Mr Bisson: If you work the math out on this thing, doesn't it work out that they will get the full time with the minister if we're here to start tomorrow at 3:30? It would be two and a half hours, which would be more than what their allotted time would be. Perhaps I can have the clerk just clarify that.
Clerk of the Committee: Within two minutes, that is correct.
Mr Bisson: Yes. The other point is with regard to the staff of the Ministry of Health who would have to be here and the staff of the committee. It would mean they'd have to be here past 6 which, I imagine, would put those people at a bit of a disadvantage in regard to their own time.
The Chair: Mr Bisson, we cannot sit past the hour of 6. We cannot. The standing orders -- only on a Monday evening and since we don't sit on a Monday evening it is impossible for this committee to extend its hours.
Mr Bisson: You're saying the friendly amendment is out of order. That's what you're saying.
The Chair: That's what I thought I said to Mr Wilson.
Mr Jim Wilson: It can be no more out of order than the original motion, Mr Chairman, and you've ruled that the original motion is in order. My friendly amendment is consistent with that. First of all, you said you can't prejudge tomorrow, which is a ruling against my prejudging that the orders of the day may not start at 3:30 tomorrow. If they start at 4:30, I'd like the committee to go to 6:30 or 7 so that we get our full 82 minutes each. Now, you can't have it both ways, Mr Chairman.
The Chair: That's part of the luxury of being the Chair. I've made my ruling and I've had a motion to call the question. Could the clerk please remind all of us what the motion is?
Clerk of the Committee: Mr Bisson moved that the government party proceed to ask questions of the PA today and on Wednesday the opposition party ask questions of the minister and complete the estimates of the Ministry of Health at 6 pm.
The Chair: It's understood.
Mr Jim Wilson: If we get to orders of the day at quarter to 6 tomorrow, we get 15 minutes, Mr Chair. Well, that's just fine, fine cooperation on behalf of the government there.
Mr Bisson: Just a point of clarification: I'm sure the government will not hold up the procedures of the House.
Mrs Sullivan: Question.
The Chair: The question has been called. Thank you, Mrs Sullivan. You are correct. All those in favour? Opposed? The motion is carried.
Mr Bisson: I think we have questions from Mr Frankford and questions --
The Chair: I did indicate that there was a committee matter I needed resolved. It is a custom and the Chair's responsibility to ensure that questions are tabled and that the responses are received in a timely manner. I believe a substantive number of questions have been tabled with the ministry and part of our mandate is to have those during the course of estimates. Would the ministry please table those answers so those members who have asked them can continue with their questions?
Mr Wessenger: I would comment that the questions tabled on June 9, which were very detailed, should be tabled before the House rises.
Mrs Sullivan: I have tabled with the clerk additional questions from the Liberal caucus relating to the Health estimates that I had intended to put to the minister. I'm sure they will get back to her.
The Chair: The parliamentary assistant's responses put the Chair at somewhat of a disadvantage since the minister and the deputy undertook to get responses to assist the process of estimates. It is completely in order and within the understanding of the operations of this committee that there would be some effort in order to obtain answers to those questions, since they flow directly from the estimates process. If what the parliamentary assistant is saying is that we'll have answers to these questions before the House rises, this is not quite helpful to the work of the committee.
Mr Wessenger: The only answer I can give is that they are very detailed questions and there is difficulty getting answers to all of them within that time frame, the time frame to date. But certainly they will be tabled as soon as they are available.
The Chair: There have been a series of four sets of questions tabled during the course of these estimates. Custom and procedure is that an effort is made, and the ministry did respond to several immediately. The Chair and the clerk's responsibility is to get those responses to the members as quickly as possible since they flow from estimates questions.
Mr Jim Wilson: May I ask a quick question with your indulgence, Mr Chairman?
The Chair: If it's a point of clarification, fine.
Mr Jim Wilson: It is.
The Chair: But I really am trying to recognize the government party for purposes of asking questions.
Mr Bisson: We'll be amenable; we're very kind souls.
Mr Jim Wilson: Thank you very much, Mr Bisson, Mr Chairman. Just a very quick question. If the ministry is unable to come back with the answers before time expires for estimates tomorrow, are we still entitled to the answers of any questions that may be tabled?
Mrs Sullivan: Yes, we are.
The Chair: The minister undertook to get responses to all of these questions. Once they're distributed to the clerk, he'll in turn send them to all members of the committee and the critics.
Mr Frankford: I'd like to get into an area which I find very interesting. I think it is a very important one right now and certainly will be in the future. This is around genetics or genetic-related conditions. I have looked through the estimates book and I can't see that there is any specific area that looks at genetics per se. I believe there are genetics clinics in hospitals, and I believe the figure that is spent on those is something like $20 million. I have this from a press release, which I'm afraid I don't have with me here.
This, I think, is only one aspect of it. This is what it would be as delivered in genetics clinics in a certain number of hospitals. For a start, can you make some comments as to whether I'm in the right area and where this spending does take place?
Mr Wessenger: I gather what you'd like is an outline of what programs are funded by the ministry with respect to the whole question of clinics and genetic research.
Mr Frankford: If I can interrupt, I think that it actually covers a great many things. There are things that are formally called genetics clinics or genetics programs. I think it actually gets into much broader areas: Diabetes has a genetic component, there are blood diseases with a strong genetic linkage and there are many other things which I think would not necessarily be covered by genetic clinics. But perhaps I can just start by asking for some response to it.
Mr Wessenger: I will ask the assistant deputy minister to respond to that question.
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Ms Mottershead: We currently have nine regional genetics programs running in the major teaching institutions across the province. We are in the process of actually surveying each one of those centres to determine the extent to which research and programming is going on because, as the member might be aware, the budget for the hospitals is funded on a billable basis. We are, through my division, trying to determine the extent of those programs using the global budget, because the budgeting isn't normally done on a line-by-line basis. We have conducted surveys of the genetic centres and we are compiling that information right now. We'd be pleased to table the information with the member.
Mr Frankford: Am I correct that one couldn't identify it in the estimates?
Ms Mottershead: That's correct. It is in each hospital's global budget. The genetics programs cover a range of specific areas. You've mentioned diabetes. There's oncology, there's reproductive technology. It covers the waterfront; therefore it's very difficult to point to a particular program in the estimates, given that it's global budgeting of hospitals.
Mr Frankford: Identifying the clinics and also knowing what they provide I think is quite difficult. If I can give a specific example, in my riding, Scarborough Centenary Hospital has, within recent months, opened up a genetic clinic. There has been some publicity about this. I'm not clear what range of things are to be referred there. I'm not clear how much information is provided to family practice in the whole community. I suppose that basically I'm saying, what assurance is there that the resources of this, which I think do affect many people in Scarborough -- what resource allocation planning is there?
Ms Mottershead: We are, as I mentioned, in the process of evaluating the survey results to determine exactly what the funding has been used for -- whether it's clearly for research activity, whether it's research and a combination of service delivery, for example, in a number of women's programs -- and then to determine whether the funds are actually expended on the priority areas of the ministry. That process is going on right now. The member might be aware that a number of these programs get started as a result of physicians having an interest in being in a particular hospital and attracting the kind of activity and programming as a result of their particular expertise.
We would like to evaluate the situation to determine how that program should be managed to meet the needs of the population, rather than be established as a result of a particular expertise in a particular area.
Mr Frankford: My understanding is that in this clinic -- and I don't know if this is general -- the physicians work on a fee-for-service basis. This may be different in the teaching centres, I imagine.
Ms Mottershead: I really can't comment on that situation. I'll have to investigate that.
Mr Frankford: In some correspondence I had there was a question about how appropriate this was, because obviously there must be a considerable amount of counselling, administration and other things which are not well covered on the traditional fee-for-service approach.
Ms Mottershead: That's right.
Mr Frankford: On the question of resource allocation, I notice on page 10, on the list of ministry agencies, boards and commissions, that there is the Advisory Committee on Genetics Services. I noticed that in the past year it actually only spent $200 and that its estimate for 1992-93 is $12,000. Could I have some clarification? Is this an active committee? Is work being done on resource allocation? Is advice being given on genetics? What can one deduce from these figures?
Ms Mottershead: I really don't have the details to give you that response at the moment unless -- manager of fiscal?
The Chair: Please identify yourself for the record.
Mr Bob Pharand: Bob Pharand from the fiscal resources branch of the ministry. That committee is one that's related to the public health area. It has not been very active over the past couple of years. As you can see, only about $200,000 was spent in 1991-92 --
Mr Frankford: In fact, $200, isn't it?
Mr Pharand: Yes, $200, and only approximately $12,000 is expected to be spent, but that's the committee that deals with inborn metabolism changes and things like that which are related to the public health area, not related to hospitals.
Mr Frankford: With respect, I think there's going to be some confusion, because if you go down two lines, one has the screening for inherited diseases in infants, which I think is --
Mr Pharand: The two of them are related. They're both in the public health area, which also runs, as you know, the family planning program. So it's not a committee related to the specific genetic services that you find in the hospital sector.
Mr Frankford: With respect, I would like some clarification on that, because this is not my understanding. I have had some research done on the Advisory Committee on Genetic Services, which has been around for a great many years. I think you'll find that it has given considerable advice on genetic services in hospitals. I was unable to find any recent reports of what it's done, but I believe it has a number of academic geneticists on it. To me, it seems to be potentially a very important committee that should be giving advice on the priorities, as the assistant deputy minister pointed out.
There is considerable pressure to develop these services. As I say, I'm sure there is considerable need in the local areas -- in Scarborough, which I know, and the other areas -- that we have decided to allocate resources to. I believe the mandate is to advise the minister on genetic services. It would seem to me there is really very good reason to give this considerable priority, as I say; the ones I mentioned and the ones that were added, such as oncology. These are very important areas that can affect all of us.
I'd mention also blood-related conditions. I touched on it briefly. To my mind, this is a very important area. As you are aware, the black population overall may well have 5% who are carriers of the sickle-cell gene, so I think this is not a trivial problem, and considerable resources are there. I would hope that this committee will be spending at least its $12,000. I would like to hear any comments on how one is going to set priorities here.
Ms Mottershead: I could respond to that by saying that obviously the ministry does feel that the committee has a lot to contribute, and therefore you see the increase in the estimate of spending for 1992-93. The committee has been active. It has been consulted on a number of programs. One of them is the maternal serum alpha protein-plus testing issue and also in terms of more counselling and education of both physician and the public through the public health system. To answer your question, yes, there are some increased activities that the committee will be requested to undertake in the coming year.
Mr Frankford: I think you mentioned some very important areas, the foetal testing. I won't go into the details, but I think the members of the committee might well want to look into it. There are certainly a number of ways in which prevention through testing could be of great benefit, but we have to look into the cost-benefit, of course, and the ways in which this is going to be implemented.
I'm really surprised that one can do it with this amount of money. Would these testing programs be implemented through the clinics that exist at the present time, or is it something that should be done through public health or through individual physicians? Just the things I can think of in this context are real major policy decisions which I think are of pure clinical interest but are also of considerable fiscal interest for the long term.
We are dealing with the possibility of reducing serious lifetime disabilities. There are some very interesting estimates that may not come into this sort of estimates process, but if one is looking at the health system in the long run, I think these are very important areas.
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Ms Mottershead: If I may add to that, the ministry does agree. There is testing going on right now, there is research going on right now. There's a lot of activity. We do hope our survey results will be very useful. We certainly have had a number of recommendations including those from the committee, from the genetics section of the Ontario Medical Association, that we need to introduce a better-managed system in terms of genetics. We are taking those recommendations very seriously. I will be looking at them and making recommendations to the minister shortly.
Mr Frankford: I'd be happy to defer.
Mr Wayne Lessard (Windsor-Walkerville): I have a few questions and I hope the parliamentary assistant will have some knowledge of this area. My first has to do with commercial lab testing. I would like to refer the parliamentary assistant to this excellent brochure called Managing Health Care Resources, which was prepared as a supplementary paper to the Ontario budget. It referred to a dramatic increase in expenditures that have taken place yearly with respect to commercial lab services. In order to control these increases, it's pretty evident that a new payment policy is being enacted. That will include the increase of existing discount factors for large volumes of tests.
Also, it proposes that a new utilization sharing formula will come into effect on April 1, 1993. What this will do is reduce payments to commercial laboratories by 50% when the numbers of tests grow by more than 2% per year.
I've been advised by representatives from a lab in my riding that a task force on the use and provision of medical services was established and it prepared a report. In a section of this report on thyroid function guidelines, it was suggested that currently there are inappropriate thyroid testing practices that are being permitted because of a limitation of lab licences for certain types of tests.
There's a recommendation in that report that what is known as sensitive thyrotropin testing, sensitive TSH, be listed as the only thyroid test, as this would reinforce the concept of the single-test entry point for suspected cases of thyroid dysfunction, while removal of outdated tests would discourage their use. It's suggested as well that cost savings would result because that would decrease the number of tests performed per patient.
As I said, I ask that question because located in my riding there is a business called Medical Laboratories of Windsor. They've applied for a sensitive TSH licence but they haven't been able to receive it yet. They're concerned that if the recommendations of the thyroid function guidelines are followed and sensitive TSH tests are listed as the only test, then labs that already have such a licence would clearly benefit more than labs that don't. That would be notwithstanding the proposed utilization sharing formula. They state that if Medical Laboratories of Windsor were granted this licence some time in 1993, for example, this formula would unfairly limit its revenue after April 1, 1993.
I should point out that Medical Laboratories of Windsor is a small, Windsor-based business. There seems to be a trend that contributes to large labs, mostly located in the Toronto area, becoming larger, and they perceive this to be at the expense of smaller community-based labs.
My question is whether the ministry is considering the impact on smaller labs when taking steps to develop a more efficient approach to lab services.
The Acting Chair (Mr Ron Eddy): And your question is to Mr Wessenger?
Mr Lessard: Yes.
Mr Wessenger: The ministry is conducting a review of the whole role with respect to laboratory tests and the role of commercial laboratories, and that's all the information I can give you with respect to the matter. However, the assistant deputy minister might be able to give some more specific information. Your question probably requires a written reply, but I'll just confirm that with the ADM.
Mr Lessard: I know it's a technical question dealing with certain types of lab testing, but I understand it is an area of lab testing where the costs are increasing substantially year over year.
Ms Mottershead: I'd like to answer the question by putting a few facts on the table. I'll start off with the fact that the Ontario Association of Medical Laboratories does represent all commercial laboratories, including the one you mention in Windsor, and there have been discussions with the association with respect to how best to introduce these measures to ensure that there isn't a disproportionate impact on a number of laboratories, for whatever circumstances. Therefore, as we continue to have our discussions on implementing either a cost utilization sharing formula or an increase in discount factor, those issues will be raised and we have agreed with the association that if there are other alternatives that can be explored, we will do so during those discussion. In other words, we will not be limited by the narrow framework of some of the directions that have been enunciated.
In fact, you may be aware that the association itself, when issues of efficiency and trying to reduce the rate of growth have been discussed with it, proposed looking at a number of tests and had proposed that rather than dealing with across-the-board issues of discounting or rollbacks we look at some of the areas of testing where there has been a medical benefit question raised with respect to those specific tests. So we are engaged in that kind of dialogue.
Yes, the report of the task force is out there. We have also, as a ministry and as a joint management committee with the OMA, agreed to look at some of the recommendations of the -- I believe you are referring to the Scott task force and looking at issues of implementation. The Institute for Clinical Evaluative Sciences, which is the clinical and evaluative research group that has been established through the joint management committee, will be looking at some of those issues. We are aware of them and we're going to try and deal with them in a broader context than just strictly the fiscal reality.
Mr Lessard: I take it from your answer that there's still some flexibility with respect to developing the formulas or the approach the ministry is going to be taking with respect to lab testing.
Ms Mottershead: The framework has been enunciated in the document you referred to, the supplementary budget paper. However, within that framework there will be opportunities for all the stakeholders to recommend alternative strategies, and if they are ones that are desirable and perhaps more beneficial, we will put those recommendations forward to the minister.
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Mr Lessard: My next question has to do as well with something that was stated in Managing Health Care Funding, the budget supplement, which also referred to double-digit growth in the Ontario drug benefit expenditures.
In my riding there's a pharmaceutical manufacturer known as Wyeth Ltd. They developed a liquid adult nutritional product called Enercal. They applied for listing of this product as a non-formulary benefit. They've told me that their main competition is a product called Ensure, manufactured by a corporation based in Quebec; they tell me as well that it sells for a higher price and is now listed as a non-formulary benefit. They suggest to me that if they were to be listed as a non-formulary benefit, some substantial cost savings could be achieved because their product can be sold at a lower price.
I understand there has been a review process going on for some time now and that the government's reluctant to add products to the non-formulary benefit list, but I am advised there was a Mead Johnson nutritional product called Criticare HN and that was listed in the April 9, 1992, formulary.
I've written to the minister as well with respect to this in the past, and also Wyeth has, and they had asked the minister whether she would consider granting Enercal listing as a non-formulary benefit or, in the alternative, consider deleting the other product so that this business that is located in my riding can compete on a level playing field. I wonder whether you can respond to that.
Mr Wessenger: Yes. We have in the ministry the nutritional products review panel, drug programs branch, which did contact all known manufacturers of nutritional products using a list of manufacturers whose nutritional products were already covered by the Ontario drug benefit program as a basis for the communication. At that time, Wyeth had no products on the list and therefore was not on the mailing list.
Yes, you're quite correct. Wyeth made a submission for the new product you mentioned in April 1991, but no new products will be added to the Ontario drug benefit listing of nutritional products until after the recommendations of the nutritional products review panel have been evaluated and a nutrition support program is developed and implemented.
Mr Lessard: Do you know when that might be?
Ms Mottershead: I don't have that answer.
Mr Wessenger: I will see if we can give you some information about that at a later date. We don't have that available today.
Mr Lessard: The other area of concern I have deals with the Swimmer report. I know most people here are aware of that, and the fact that it deals with ambulance services in general. You'll also recall a couple of weeks ago there were a lot of people involved in the ambulance business who attended here at Queen's Park to visit us. They were interested in the implementation of the recommendations that are contained in the Swimmer report.
One of the areas I am kind of concerned with is with respect to non-emergency transfers. One of the recommendations in the report was that the patient transfer system be tiered into three categories according to the severity of the patient's condition so that services outside the regular ambulance system, such as taxis, personal vehicles or Wheel-Trans or something of that nature could be used for non- emergency transfers. That would free up the regular ambulance service to be available whenever there may be an emergency condition.
Another business that's located in my riding is known as Sports Medic. They've been performing non-emergency transfers between hospitals and places like nursing homes. They've also been doing non-emergency transfers between hospitals in Canada and the United States, because it seems as though there aren't many other people who really wish to provide the service in Detroit, and I can understand that. It seems to me as well that their customers are happy with this service.
I suggest this recommendation -- that is, the tiered categories to provide patient transfer service -- would ensure that ambulance services are available to those clearly in need, when they need it. It would also enable some private sector participation. I wonder whether the ministry is prepared to consider that recommendation.
Mr Wessenger: I can certainly understand your concern about this matter because my own local area had a similar situation with respect to the question of a role for private transportation facilities as supplemental to ambulance services.
First of all, with respect to the whole question of the consumer report -- as you may know, after the initial report I believe there are consultations being done again by Dr Swimmer with respect to the response to his report. Do you know the date we are expecting recommendations from Dr Swimmer?
Ms Mottershead: End of June.
Mr Wessenger: Yes, by the end of June I believe we're expecting to have his report in. At that time the report will be evaluated and the ministry will be looking at his recommendations. I am going to ask the assistant deputy minister to indicate whether the scope of his report would also include the role you indicated with respect to companies such as Sports Medic.
Ms Mottershead: I think we are aware of the issue of non-emergency transport of patients and the need to free up the emergency services dedicated for emergency purposes. There has been contact already established with the Ontario Hospital Association to look at developing some guidelines on the transport for elective purposes, and those discussions have started and will continue. Also, there has been a working group formed to review the customer satisfaction with other modes of transportation for non-emergency services.
All of this will be fed into the discussions when the minister is also presented with the recommendations from the Swimmer report. We appreciate the nature of the issues out there; they are real and we wish to consider them in the context of the whole emergency service area, both the critical emergency service as well as the lack of elective.
Mr Lessard: Just to follow up on that, I understand that if I were to call for the services of an ambulance, basically for whatever reason I might choose, and the ambulance attendants show up at my house and I tell them I want to go to the hospital they are really kind of obligated to deliver me to the hospital. It's really the physician's role to determine whether I'm an emergency or a non-emergency type of patient to determine whether I should have to pay one amount for that service, or another amount if it were an emergency.
I've been told -- and I stand to be corrected -- that doctors really don't like that role very much, and because of that, don't want to expose themselves to any liability and are reluctant to indicate that a patient transfer to a hospital, for example, is a non-emergency.
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I know the reason for having the two levels of fees. That's to try and discourage people from using the ambulance service in cases where they really may have some other forms of transportation available to them. I'm just not so sure that it's working the way it has been set up to work. I wonder if that's something that's being reviewed or whether there are some changes that are contemplated in that area.
Ms Mottershead: We are aware that there are some doctors who really don't like to be put in that position. We're also aware that there are some cases where it's pretty cut and dried in terms of whether it was an emergency situation or whether it was just a facility that was being used because it happened to be convenient. In those cases the receiving hospital is obliged to have a report filled out by a doctor that indicates whether or not it was an emergency situation. I suspect the number of cases where the issue is a little bit grey is not as great as people make it out to be.
We are, however, aware of it and have been looking at it as part of our overall management of costs, not just to the taxpayer but also to individuals with respect to those kinds of services. I know that my colleagues in the ambulance services area have undertaken a review of that. I just cannot speak with any degree of confidence or certainty as to what the results of the particular review are or where the ministry is at, at the moment, in terms of a change in policy.
Mr Lessard: Can you indicate what the fees are for transfers at the present time, what a patient would have to pay if it were an emergency or if it weren't an emergency?
Ms Mottershead: I'll get the figures for you. My recollection at the moment -- I'm not the responsible ADM for this area -- is that it's $45, or $185 if the service was not an emergency or of medical necessity.
Mr Lessard: Okay. Thank you.
The Chair: Is there no other staff here from that department who could answer that question?
Mr Lessard: It doesn't look like it.
The Chair: No? Okay, Mr Bisson.
Mr Bisson: Like many government members, I guess some time last February, March or April, depending on when we did it, there were public consultations with regard to the whole question of the budgeting process the government undertakes prior to a budget being tabled in the Legislature.
In the process we went through, basically a presentation of the numbers, as Health is the largest chunk of the pie when it comes to one ministry in regard to the overall cost of operating government here in Ontario, many questions came up in regard to whether there are ways we can manage our health care system better. I think a lot of people recognize that in these times of financial constraint, low revenue on the part of governments, fewer and fewer people working, unfortunately, because of other ravages that we've seen within the economy, people ask questions about the types of things that could be saved. I just want to go through some of them with you to find out if there's been any movement and direction on some of them.
One of the things that came up quite often was the question of some of the procedures used within the medical health system, such as ultrasound, for example. There used to be a time when ultrasound tests were done basically on a need basis, based on the judgement of the doctor at the time. It has now become a very common thing. Women, because other doctors and other patients have said it's a good idea to get an ultrasound, go to the doctor and say, "I want an ultrasound," and doctors have gone out and bought ultrasound machines and obstetricians have put ultrasound machines in their offices. It's almost become a little business unto itself.
I know the ministry is looking at and contemplating dealing with that question. I wonder if you could elaborate a little more and we can take it from there.
Mr Wessenger: Yes, you're quite right that part of the health care reform aspect is looking at the whole question of inappropriate care. They're trying to lessen the amount of inappropriate care in the health system as a means certainly of achieving savings within the health system, but the process the ministry follows in this whole question of determining appropriate care is not on a unilateral basis in any way. We basically work through the joint management committee with OMA and the Ministry of Health, and when any decisions are going to be made by the Ministry of Health with respect to changing the standards, with respect to the question of what is appropriate or inappropriate, we would be looking at the recommendations of the joint management committee before any such action was taken.
Mr Bisson: Could I follow up on that point? I'm well aware, as most members in the Legislature are, of the work happening between the OMA and the Ministry of Health, that joint committee. Because I understand what is trying to be done here -- maybe I won't word it that way.
We're trying to get the medical profession itself to come to grips with the question of how we deliver services in the health care sector in order to keep an eye on costs. I know there was some discussion going on in the OMA, because I've had that discussion with some of the doctors within my own community up in Timmins and Iroquois Falls, about the whole question of what happens on, for example, the ultrasound. Just how far has that gone? Does it look as if it can be dealt with within the doctors, or are we going to more or less have to lead the way by the ministry? I'm just wondering.
Mr Wessenger: We are, first of all, in the initial stages of this whole question of working in cooperation with the OMA and the joint management committee. I think it's working very well. If we're going to bring our health care costs under control by one of the means, that of controlling inappropriate care, we have to recognize that health care costs are basically physician-driven in the sense that it is physicians who order the tests and who order the particular type of treatment. If we want to be successful and at the same time have a health care system that is efficient and delivers the services people need, we have to have cooperation with the medical association. It's not something that any government would want to do or ought to do: to try to unilaterally make decisions.
When I say "with the cooperation of the medical association," I think we also have to look at the whole question of consumer interests and consumer points of view. I'm sure there will be occasions when the OMA and the present government or a future government might think a particular type of care was inappropriate, but I think we have to take account of not only the views of the medical association but also the views of the recipients of the care.
Mr Bisson: The parliamentary assistant is saying that the cooperation is starting to happen between the OMA and the Ministry of Health, but that the Ministry of Health doesn't want to send signals that it would move a little bit more quickly than the OMA. We're sort of urging the OMA to come to grips with some of these questions and looking for some leadership within the OMA.
Mr Wessenger: Certainly we are looking for leadership from the Ontario Medical Association in this area.
Mr Bisson: Again on the same line, those particular budget consultation meetings lasted for two or two and a half hours per meeting, of which health care could have taken up the better part. One of the things that came up in many examples was that the average consumer of health care would give examples of how you'd go to the emergency department at 3 o'clock in the morning because of whatever might ail you and by 10 o'clock in the morning you're back in your doctor's office with the same tests or blood tests being ordered that you might have gotten in emergency. One of the things they talked about is the possibility of trying to coordinate some of the testing that's done; for example, maybe blood being taken at the hospital for a particular test at 3 in the morning and the same test again being ordered through maybe a private lab or a provincial lab at 4 or 5 o'clock in the afternoon.
Is there an attempt being made on the part of the ministry -- I don't know how you would do this -- to look at a central registry, utilizing automation, computers or whatever, to take a look at ways of bringing down the costs in regard to some of the testing that is being done? Is there any movement there?
Mr Wessenger: Certainly there is a recognition that there is a problem with respect to the question of testing. There are many inappropriate tests rendered. We have examples. I've heard many stories of the duplication. I've heard even patients saying, "I don't want another set of tests; I just had them," and in fact refusing -- the patient himself trying to impose some rationality on the health care.
Mr Bisson: Those are the stories we got, yes.
The Chair: We've heard that about meals in hospitals.
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Mr Wessenger: I have to say again that this is a part under the joint management committee. That's the first area we try to work with with the medical profession to try to work out methods to avoid these unnecessary duplications. However, I think I'll turn it over to the assistant deputy minister with respect to the question of what technical aspects you might be looking at.
Mr Bisson: I recognize, as those people did, there would be an initial outlay of capital if you were going to do these kinds of things.
Mr Wessenger: There are also some great ideas of how to control costs, but the technology itself is very expensive and cumbersome in doing that. For instance, the smart card aspect, the pharmaceutical things -- that's one of the technological ideas. I'll turn it over to the assistant deputy minister.
Ms Mottershead: In terms of the joint management committee, the Institute for Clinical Evaluative Sciences, which is ICES, which has been jointly formed, is in the process of putting together an agenda that will attempt to prioritize some of the issues that have to be looked at immediately to effect an early return and can be implemented to achieve both effectiveness in terms of health service as well as a cost saving.
They will be looking at things like small-area rate variation. They'll be looking at practice patterns of physicians. They'll be looking at testing. They'll be looking at efficiency of certain procedures and actually developing a program for not just making sure that whatever decisions have a clinical basis but also that some guidelines can be developed that can be easily transferred and implemented.
Mr Bisson: That's interesting. If I understand what you're saying, you would be looking at the practices of particular doctors, looking at the kinds of tests and the number of tests for the number of patients being looked at and looking for anomalies. Is that the idea?
Ms Mottershead: Correct.
Mr Bisson: That's not a bad idea.
Before I pass it on to Dr Frankford -- I know he has a number of other questions and I would hope he would leave me some time as well to get back -- something came up that was of interest, not to take too much time on it. A particular administrator of one of our hospitals -- I think it was the Timmins hospital -- talked about a program that was put together I think in California. Every time somebody came into the emergency department of that particular hospital they would give the patient sort of a what-to-do list.
For example, your young daughter or son has a temperature. "Did you do all of the following things: A, B, C, D, E, F"? At the very end, the last thing you do is call the doctor or go to the emergency department. Apparently, from what I was told, the savings were actually quite substantial -- the number of visits to those emergency departments.
Quickly, is there anything like that being looked at? I know within emergency departments that tends to be one of the operations that are fairly expensive for most hospitals and it's a question of trying to educate the consumer.
Mr Wessenger: I certainly think that is a very interesting concept, but I will turn it over again to the assistant deputy minister to what she is aware of what is being done in the area of consumer education with respect to consuming health service. I know we do publish certain materials certainly from the preventive aspect. There's certainly a major role in the Ministry of Health in the preventive area with respect to consumer --
Mr Bisson: Yes, that's the flip side.
Ms Mottershead: I think it's very useful to look at other jurisdictions in terms of what kind of innovations they have brought on stream to effect some savings in the health care system. I also think it appropriate that we look inside our own province for some very good examples of those measures being taken to date, except that we don't give ourselves a lot of credit for what is happening.
Not to evade the answer to your question directly, I'd like to point out some efforts in some emergency departments to deal with the issue of screening inappropriate use of emergency departments. One hospital I will mention is the Greater Niagara General Hospital, which does have a quick response team that actually does an analysis and uses a multidisciplinary team approach to have a look at the patient coming in to see whether or not he belongs in the hospital in the first place.
That's one example. I think we have to do a lot more as a ministry, together with the OMA and the Ontario Hospital Association, in getting those examples out there so that others can learn to use some of those techniques that have proven to be beneficial in certain areas.
Mr Bisson: I would pass the floor over to my colleague Dr Frankford, but remind him I have other questions.
Mr Frankford: Perhaps I could start by responding and speaking for the medical profession.
Mr Lessard: You're out of order.
Mr Frankford: I'm sorry my Liberal colleague has left for the day.
There are many pressures in the doing of tests and I suppose one cannot deny that financial incentives that may be somewhat unconscious exist, but I think predominantly what one is trying to do, what is good standard practice -- and certainly there are distortions to what is good standard practice. I think if one is doing things just on the very slight chance that something may be abnormal, but you would be criticized if you hadn't done it, this is a pressure that puts the standards practice somewhere which is perhaps too expensive, perhaps demands too many resources; certainly the points that my two colleagues here raised around thyroid testing and ultrasound testing.
I think there are some important considerations in the yield of testing or the appropriate use of resources. One should not obviously just do a whole battery of tests because you would lose points if you didn't, although unfortunately I think this is the way things tend to go in teaching hospitals. This is where physicians learn their practices and without much consideration of the economic costs. I think one can get into a much more scientific approach and look at the yield of tests, and this is where I would say one could really start doing very constructive things with the data that are produced on the question of thyroid testing. One could be looking at protocols based on the experience, how many tests are abnormal, what are the hazards of missing ones where you know there's only a less than 1% yield or what do you do about ones where you get a 99% positive yield. Obviously there are real questions about whether it's worth doing in either of those cases.
Perhaps to get a bit more specific, to pick up on Mr Bisson's point, I have no doubt that as we move into an information society there is huge potential for sharing all those data electronically. One could get feedback. The test you had done in emergency at 3 in the morning is sent by e-mail or whatever to the physician's office the same day and can be acted on. I would certainly be very encouraged to hear that we're moving right ahead there. The most recent Lancet that I got yesterday spoke very well of what they're doing in Australia. I know people have concerns about confidentiality and where the files are kept, but I think that, properly planned, you can have it all. I think you can have just as much, if not more, confidentiality and excellent access to the real information that works.
To get slightly specific, on page 58 we have information systems expenditures, and what strikes me is the amount of reduction that is here. Maybe this is well worth it, but it seems to me that investment in information technology, if it's properly done, can have a huge payoff. I could see the possibility of savings in the areas that my colleagues have mentioned here, but if you look at 1990-91 the actual expenditure was $80 million, in 1991-92 the actual was $54 million, and for 1992-93 the estimate is $44 million.
It's great to save money, but I wonder if you'd like to elaborate on why it's going down so much, particularly at a time when I would have thought one could really be investing a great deal if physicians -- let's not be doctor-centric -- and other health teams had computer linkages. I practise with a computer on my desk myself and I printed out all my prescriptions on a printer, which I think has very great advantages but it was not linked to anything. I think there's a model there. I know other of my colleagues do the same sort of thing. I'm surprised we're not maintaining the expenditure there, unless this is an indication of how steeply the price of microcomputers has dropped.
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Mr Wessenger: I'm not going to give you a detailed answer on this, Dr Frankford, and I will be turning it over to the assistant deputy minister, but one thing that strikes me initially is the fact that we had quite a major expenditure on information systems when the institution of the health card came in. I would assume that was the basic reason for the cost being so high in 1990-91. I assume the structure of the level of services has gone down because consulting services have been reduced.
The Chair: The bugs are out of the system now.
Mr Wessenger: I know there's been an attempt within the ministry to try to do more work in-house and less with consultants. Maybe the assistant deputy minister can add something.
Ms Mottershead: No, that's fine. The explanation is --
Mr Frankford: That these computer consultants would be counterbalanced by Mr Layton's fees.
Ms Mottershead: I think that's the point.
The Chair: Perhaps to be helpful, was your question not in what other areas is the pursuit of information systems being considered by your ministry? I thought that was the other part of the question.
Mr Frankford: Yes. You mentioned health cards. I think we've all had problems in our constituency offices with people getting registered. I believe potentially there is considerable merit in having a unique identifier. Maybe you could comment on what payoff there is right now and what is foreseen in the future.
Mr Wessenger: What future directions are foreseen as well as how well the system has worked with the health card. Okay, I'll ask the assistant deputy minister.
Ms Mottershead: In terms of pursuing some further technological innovations in the ministry, we are continuing to work on the smart card pilot. We do have one started now in Fort Frances, so development activity is going on there.
There are a number of other issues we are looking at that hopefully will have a significant payback: improvement in terms of the drug payment program, continued improvements in the health insurance area, and claims payment in terms of automating, either through a diskette or whatever, the payment of physicians. We continue in that particular effort. We will definitely be exploring the uses of technology with respect to other claims payment activities -- for example, assistive devices -- to make sure we have the technology that is able to expedite payment for customer service but also decrease administrative costs for the ministry. So there are a number of areas which we are pursuing at the moment through that particular allocation.
Mr Lessard: I just wanted to follow up on the points Mr Bisson and Dr Frankford made with respect to the utility of doing different types of testing, because that reminded me of a letter I received this week from a constituent, Mrs Morrison, who has another theory as to why doctors may do testing. Dr Frankford referred to doctors who may lose points if they don't do certain numbers of tests.
Mr Frankford: Academic.
Mr Lessard: Okay, academic points. This constituent's theory is that doctors are really only trying to protect themselves from malpractice suits and really places some of the blame on lawyers. Of course you can understand my reluctance in even bringing this issue up, but I thought it may be an interesting theory.
She says there should be some encouragement for patients not to sue for malpractice, and that would result in a real reduction of malpractice insurance. A deterrent for patients to sue would also encourage doctors to resume their former practice of diagnosing and treating patients without unnecessary lab tests. She talks about an incident that happened to her where she went in because she had a cough and was sent to a hospital to visit a specialist. That would involve her being checked in and getting a blood check and an electrocardiogram and things that she thought were completely unnecessary, so she didn't go.
She suggests that maybe there should be some in-depth study made of the number of malpractice suits and the settlements that may have been made over a certain period of years. She seems to think maybe that would go some way in developing some guidelines to place limits on the liability of doctors or whether there was something we could do in that area.
I know that's not something that's referred to in the budget supplement or the estimates, but I bring that up because I thought it was timely that I had received this letter this week. I just wondered whether the parliamentary assistant, also being a lawyer, might have some response to that, and whether this is something the ministry has ever looked at as a means of reducing medical costs.
Mr Wessenger: I think it's a good point that you've made, Mr Lessard. Certainly the liability question is, I'm sure, one of the influences with respect to the matter of testing. I know in my discussion with many members of the medical profession, they indicate that this is the case. They also indicate some criticism of some of their colleagues for overtesting on the basis of being overly sensitive to the liability question.
I think part of the problem has to do with the fact that California is looked at by many physicians; they look at the situation in California rather than the reality in Ontario. The fact is that there are very few malpractice suits in Ontario. If we look to the Prichard report, which looked into this whole question of liability, I think it indicated that first of all there were very few suits in Ontario, and there is very little compensation paid with respect to the whole question of injuries suffered by individuals as a result of medical acts, some of which may or may not have been negligent.
Of course, as you may know, the Prichard report recommended a sort of mixed no-fault system with respect to the question of compensating for injuries. I don't know whether our ministry has any position with respect to the Prichard report. The implementation of any legislation based on it would be under the purview of the Attorney General rather than the Minister of Health. I certainly think it's something that is worth looking at. I'll be careful what I say here because I don't want to speak for the minister, but I'll speak on my personal opinion that I think it would be --
The Chair: I would remind the member that in your present capacity, you are speaking for the minister, and I'd ask you to speak on behalf of the minister. You do have the option to go back and sit over there if you'd like to meander with your personal opinions.
Mr Wessenger: In that case I would just say I think it's something that should be looked at. I think the Ministry of Health should take a look at the question and should make an appropriate recommendation to the Attorney General in this regard.
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The Chair: Three other speakers; 10 minutes left. Mr O'Connor.
Mr Larry O'Connor (Durham-York): Actually, I think that Mr Bisson --
Mr Bisson: Oh, take a few minutes.
Mr O'Connor: There's one question that I guess has struck me. On an occasion recently I met with a constituent who has had some severe back problems, and she showed me the cards she had from all the hospitals. She had cards from about five or six different hospitals. These are these little plastic cards that they run through a machine something like they do a Chargex or a Visa or a Mastercard. These cards all seem to contain the very same information.
You mentioned the smart card. I wonder if you could elaborate a little bit on that, because it seems to me that the time spent for the clerk or whoever in the hospital makes up these cards has got to be enormous when you multiply that times the number of patients.
Mr Wessenger: I'm probably going to have to defer to the assistant deputy minister with respect to the question of how the smart card works --
Mr O'Connor: That would be fine.
Mr Wessenger: -- in the sense that I know it's to contain medical information but I don't know what type of medical information and to what extent it is contained on the pilot project. I assume it contains the medical history of the individual, though I don't know how it relates to drugs and that sort of thing.
Ms Mottershead: With respect to the hospital card, it is given to establish a medical record for that particular hospital the first time an individual receives a hospital service. There is a record and it has very general information. It doesn't have detailed clinical information or anything else at that point in time. It establishes the home address, the immediate person to call, the relative or next of kin, and those kinds of records.
Therefore, if one individual has a number of community hospitals that they visit, I think it would be important as part of our look at the smart card technology and some of the fields of information contained to see how many services this individual is seeking and what the issue is there.
Is it because the doctor who is treating this person has privileges in a number of hospitals and the person therefore is using the hospital setting as a convenient place for receiving treatment? Is it because they make inordinate use of emergency departments? There are some issues you raise there that go beyond the smart technology aspect of the card, which is intended to carry with it very critical information in terms of types of drugs, medication, attending physician, family physician at home and in the hospital and those kinds of things: medical history as necessary. It's really not intended to supplement or replace the hospital records, although we will be looking at integrating hospital information so that you get a complete picture.
Mr O'Connor: Thank you.
The Chair: From personal experience, I can tell you that my wife appreciated, while she was under active labour, that she was able to get through the admissions department very quickly on April 4, and that was the purpose of the card as we have it. Mind you, we only have the one hospital in Burlington, but the presumption is that you will go to your community hospital. So we only have one card.
Mr Bisson: Thank you very much, Mr Chair.
The Chair: Mr Bisson.
Mr Bisson: That was a very interesting story.
The Chair: Well, there is more to it if you'd like to hear it.
Mr Bisson: No, no. This is my time. I want 40 seconds back. Let's banter around.
I have a question to the parliamentary assistant. I believe there are some 36 hospitals across the -- we are seeing the pictures of the newborn daughter of the Chair.
The Chair: Michelle Deanne.
Mr Bisson: Very nice.
The Chair: She's beautiful.
Mr Bisson: For the record that should have taken -- no, I won't even say it.
Okay. There are some 36 hospitals, I believe, across the province that are going through the process of submitting deficit recovery plans. Is that right? Just say yes or no. I think about 36; yes or no?
Ms Mottershead: We are requiring all hospitals to report to the ministry, whether or not they have a deficit, to determine how they were able to balance their budget.
Mr Bisson: It was my understanding there were 36. You are saying all.
Obviously, one of the things going through all that is that I'm very much aware, being involved with one of the hospital boards up in my riding, that the process we are asking from the Ministry of Health would include not only people on the board, but also the people who work within the hospital, the district health councils and others, in order to set some of the priorities and look at some of the spending within the hospitals.
I think it's been a fairly difficult process for some of the boards because, quite frankly, they've not been used to doing things that way. They've been used to the fact that when they have problems in a hospital, they get money. But with transfer payments from the federal government being cut, and provincial governments consequently having to watch their expenditures, the one, two and two increase that we gave them over the next three years doesn't meet the total need. I think most people recognize that.
Some of the boards have been fairly reluctant to include some of the workers at the hospital, some of the nursing staff. In some cases even the DHCs have had a hard time getting input into the hospital boards. I understand with the changes to the Public Hospitals Act -- there are going to be some revisions. I think the last time it was revised was in 1933, and there hasn't been very much change since. Is the change to the hospitals act going to contemplate formalizing how some of this operates with regard to maybe the constitution of the board so that you have a broader representation within a community or a process by which various stakeholders can be involved in a process such as this? In some cases it's worked very well. I understand from other members that in some cases it hasn't worked well at all.
Mr Wessenger: Thank you very much for giving me an opportunity to talk about the consultations I'm doing on the Public Hospitals Act.
The Chair: In under three minutes.
Mr Wessenger: Okay.
Mr Bisson: We get 40 seconds because of the picture.
Mr Wessenger: I'll be conducting hearings across Ontario at nine different centres, including Thunder Bay and Sudbury for the north. Unfortunately, we can't go everywhere in the province. What we are looking at is trying to ensure that the new Public Hospitals Act will ensure that the governance of the hospitals reflects the communities they serve.
Mr Bisson: Very good.
Mr Wessenger: That means it reflects the consumer interest and also the viewpoints of the health professionals and the employees within the hospital. That doesn't mean there's any set pattern. For instance, there's no set pattern of whether a board would consist of all community representatives, which is the recommendation of the steering committee, or whether it would have maybe some employee representation. That's what we're consulting about, to ask people how they think that should be done.
Mr Bisson: When is the consultation going to be over? Is it just about to start? I know some preliminary work has been done.
Mr Wessenger: We've had one already. Starting the week of July 4, we'll have four consultations. Then again the week of August 16, another four consultations, plus one on August 12.
Mr Bisson: When do you expect the consultation to be over?
Mr Wessenger: That official part will be over, but the consultations will continue right up until the time we have draft legislation or legislation introduced. The consultations will of course continue even after the draft legislation.
Mr Bisson: Any guesstimates with regard to when legislation amending the Public Hospitals Act will be introduced?
Mr Wessenger: We would hope to have some form of draft legislation or first reading hopefully by the end of this year. Mr Bisson: Very good. I see we're coming close to the end of the clock. I would just like to thank the parliamentary assistant for the Ministry of Health for coming down here today in the place of the minister and carrying on extremely well in the absence of the minister in answering questions of the members of this committee.
At this point I would ask, I would imagine, to have the committee adjourned.
The Chair: I wanted to thank the assistant deputy minister for filling in for the deputy and several other members of staff who were unable to be here today. In the interest of being helpful to the committee, I recognize that you have responses to Mr Lessard's questions. To be fair, perhaps you'd circulate those to the clerk and then they can be distributed to all members of the committee.
There being no other business, motion to adjourn?
Mr Bisson: Motion to adjourn.
The committee adjourned at 1759.