REVIEW OF OFFICE OF THE OMBUDSMAN
CONTENTS
Wednesday 4 November 1992
Review of Office of the Ombudsman
Ontario Public Service Employees Union
Fred Upshaw, president
Tim Little, legislative liaison
Ontario Hospital Association
Dennis Timbrell, president
STANDING COMMITTEE ON THE OMBUDSMAN
*Chair / Président: Morrow, Mark (Wentworth East/-Est ND)
*Vice-Chair / Vice-Présidente: Haeck, Christel (St Catharines-Brock ND)
Akande, Zanana L. (St Andrew-St Patrick ND)
Drainville, Dennis (Victoria-Haliburton ND)
Duignan, Noel (Halton North/-Nord ND)
Henderson, D. James (Etobicoke-Humber L)
Johnson, Paul R. (Prince Edward-Lennox-South Hastings/Prince Edward-Lennox-Hastings-Sud ND)
*Miclash, Frank (Kenora L)
Murdoch, Bill (Grey PC)
Perruzza, Anthony (Downsview ND)
*Ramsay, David (Timiskaming L)
Witmer, Elizabeth (Waterloo North/-Nord PC)
Substitutions / Membres remplaçants:
*Abel, Donald (Wentworth North/-Nord ND) for Mr Duignan
*Carr, Gary (Oakville South/-Sud PC) for Mr Murdoch
*Harrington, Margaret H. (Niagara Falls ND) for Mr Perruzza
*Mammoliti, George (Yorkview ND) for Mr Johnson
*In attendance / présents
Clerk / Greffier: Carrozza, Franco
Staff / Personnel: McNaught, Andrew, legislative counsel and research officer, Legislative Research Service
The committee met at 1013 in room 151.
REVIEW OF OFFICE OF THE OMBUDSMAN
The Chair (Mr Mark Morrow): I see a quorum. If I may, I'd like to call the standing committee on the Ombudsman to order. I'm Mark Morrow, chairman of the standing committee.
ONTARIO PUBLIC SERVICE EMPLOYEES UNION
The Chair: This morning, we're continuing our review of the Office of the Ombudsman and I'm pleased to have before us the Ontario Public Service Employees Union. I want to welcome you gentlemen. Begin when you're ready. You do have a half-hour and I'm sure the members present would like to ask you some questions and/or have some comments when you're done. Although I haven't done it, would you please state your names for the record when you're ready to begin.
Mr Fred Upshaw: My name is Fred Upshaw and I'm president of the Ontario Public Service Employees Union. Tim Little is our legislative liaison on staff at OPSEU.
I want to start off by simply saying I'm pleased to be here to make this presentation. The Ontario Public Service Employees Union appreciates this opportunity to submit its views on the Office of the Ombudsman. OPSEU brings to bear, on many of the questions developed for this review, a wealth of experience in delivering Ontario's public services. Our 105,000 members play a pivotal role and a very large proportion of the government activity covered by the Ombudsman Act.
OPSEU made a submission to your committee in 1988 in response to the Ombudsman's proposal for extended jurisdiction; that submission is attached for your information. Responding to the committee's recent invitation, we will augment that submission with comments reflecting OPSEU's more recent public policy concerns.
Protection for complainants: OPSEU members are on the front lines of public services in Ontario. Public-minded OPSEU members have exposed many government wrongdoings such as jail overcrowding, coverup of pollution levels, illegal forestry permits. Too often the courage of those who risk their livelihood and health has not been recognized by the statutory protection from retaliation by embarrassed governments.
The Ombudsman currently lacks enforcement powers to protect a public service whistle-blower from any negative actions taken against him or her as a result of a complaint.
The Ombudsman Act must be amended to provide full protection for all workers whose dedication to the public's welfare compels them to bring forward complaints. An effective way to ensure such protection would be to include coverage in the act for complainants under promised whistle-blowing legislation.
As committee members will be aware, in the days of the 1985-87 accord, the Ontario Law Reform Commission embraced much of OPSEU's argument regarding whistle-blowing protection and political rights for public employees. Implementation of the OLRC recommendations has been a stated priority of two governments over the past six years. We understand that such provincial whistle-blowing legislation for Ontario is imminent. We commend the government in advance for such an investment in the public good.
We believe that members of the standing committee want to improve both the effectiveness of the Ombudsman's work and future complainants' trust in the whole investigation process. These objectives will more likely be realized if you urge the Legislature to infuse the Ombudsman Act with solid whistle-blowing protections.
In our comments of 1988, we did suggest that OPSEU's membership would appear to have less need of this kind of protection when involved with complaints to the Ombudsman than workers who lack union protection. At that time, though, it was necessary for us to point out the chilling effect of the Crown Employees Collective Bargaining Act.
Until now, CECBA has inappropriately denied collective bargaining rights to an extraordinarily large number of public employees. This has meant many thousands of workers without a collective agreement or effective grievance procedure and thus less willingness to expose problems to the Ombudsman.
However, we are optimistic that recent progress in the recognition of bargaining rights for 9,000 excluded public employees will diminish the hesitancy many would feel in coming forward with concerns to the Ombudsman.
For the 65,000 members of the OPSEU Ontario Public Service bargaining unit, CECBA has meant denial of the right to bargain such critically important issues as pensions and the introduction of new technologies. These are the kinds of government decision-making which have caused OPSEU to approach the Ombudsman for assistance. Here too there is reason to be hopeful. Announced reforms to CECBA will widen the scope of collective bargaining and, in so doing, decrease the need for our membership to seek out the Ombudsman's advocacy services.
Despite the improved rights that we hope will soon become law for unionized and unorganized public employees, OPSEU remains convinced that all employees should be entitled to full protection under the Ombudsman Act from any form of employer sanction.
We have been asked specifically for our thoughts on the possibility of the inclusion of children's aid societies within the Ombudsman's jurisdiction.
In our 1988 submission, we framed our support for the extension of the Ombudsman's jurisdiction by outlining our commitment to the principles of social unionism.
For OPSEU, encouraging a wider mandate for the Office of the Ombudsman, including children's aid societies, is consistent with our proud history of advocacy on behalf of all our client groups. To support equity, fairness and consistency in the treatment of Ontario's vulnerable communities, OPSEU will continue to oppose compromises or wrongdoing in the delivery of any public services.
To repeat the commitment to our clients we outlined in 1988, OPSEU supports a broader scope for investigations under the Ombudsman Act, fully aware that the redress people may seek could be directed at activities of our members, as well as those of managers or others. Our commitment to protect the rights of our membership calls for us to also repeat our determination to secure fair treatment for members whose work is the subject of any investigation under the act.
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Across Ontario OPSEU represents over 1,000 members working in children's aid societies. These workers are charged with an immense responsibility: ensuring the safety and wellbeing of vulnerable children. Like some 32,000 other OPSEU members in Ontario's broader public sector, children's aid society employees carry out critical and mandatory functions under provincial statutes.
We trust that when CASs are brought under the mandate of the Ombudsman, the attention of the province and the public will be more sharply drawn to critical issues of accountability and consistency of service. When unelected boards of directors operate community-based public services, we can only hope the Ombudsman is able to help expose compromising gaps in those services.
In the case of jurisdiction for the Ombudsman over public hospitals, we refer you to Care and Quality, OPSEU's submission to recent hearings on the Public Hospitals Act. In that brief we expressed our belief that hospitals must be more accountable and more responsive to the public.
"Hospitals must be regarded as being as much a part of the community as our other health agencies. Mechanisms must be established to ensure accountability of all health agencies to their communities.... OPSEU believes that hospital boards should be elected.
"There must be an active, accountable relationship between the board members and the community being represented. Boards should be hands-on working bodies that could and should develop internal committees to liaise with the hospitals' communities."
Election of hospital boards, especially with membership split equitably between staff and the community, would provide an expert range of ombudsmen for hospital clients.
The health care system is being dramatically transformed by serious changes in the direction of policy and continuing cutbacks in federal and provincial funding. There are over 5,700 OPSEU members in 90 public hospitals, who know first hand that the public needs vigilant representation to ensure that health care decision-making leads to improved care. In the absence of direct democratic elections for hospital boards and seats on each board for hospital staff, the participation of the Ombudsman will be particularly welcomed.
OPSEU's view of the Ombudsman's jurisdiction is based in part on our conviction that essential services for Ontario's people are best delivered by a one-tier delivery system. Similarly, a single level of service is best delivered by the government that funds it. There is considerable and understandable confusion in the public over general welfare assistance, delivered by municipalities in most areas, and family benefits, administered by provincial employees. Vulnerable people often move from one type of assistance to the other, struggling to know who their case worker is or why they may have been denied benefits.
As this muddle of services continues and as hard-pressed municipalities perpetuate a patchwork quilt of welfare services across the province, it is hardly surprising that the Ombudsman seeks to have the jurisdiction to investigate general welfare assistance. It is our view that the most effective means of ensuring fair and equitable delivery of such an important statutory service is to unify the administration at the provincial level, where the Ombudsman will have jurisdiction under the current act.
OPSEU has a great deal of experience in attempting to provide professional, quality services and care in the midst of underfunding and understaffing. This is certainly true, for example, of our members who work in children's aid societies and public hospitals, two of the public services that are subject to your committee's review.
Nothing could more swiftly undermine the Ontario public's confidence and trust in the Ombudsman than failure to provide financial resources commensurate with any expansion of jurisdiction. OPSEU members include support staff, case aides, investigators and administrators. We can relate directly to fellow workers within the Office of the Ombudsman, whose case loads have tripled since 1982. We would urge the members of the standing committee, therefore, to strongly advocate on behalf of the Ombudsman. She will require a much enhanced budget to match a broader mandate.
The standing committee has invited comment on the issue of authority or requirement for the Ombudsman to conduct educational programs. A valuable service like that of the Ombudsman must not be the exclusive preserve of those with the skills, education and other resources to seek out her office. The work of the staff of the Ombudsman should help to empower marginalized people.
The Ombudsman's survey in 1991 regrettably found a level of awareness of her services significantly lower than that of the Ontario Human Rights Commission or the Workers' Compensation Board. A high proportion of complaints came from vulnerable people. These facts suggest that the present Ombudsman is to be applauded for her outreach efforts, and that educational and outreach programs ought to be formalized at the regulatory level.
The committee has asked, should the title of Ombudsman be changed so that it is gender-neutral both in meaning and in connotation? Simply put, yes. No public office should continue to be labelled in a way that suggests males are the natural or preferred incumbent. OPSEU believes an appropriate name would be Office of the Public Protector.
Finally, OPSEU feels it is important to clearly express our support for an Ombudsman's office that continues to be at arm's length from partisan political interests. We are especially concerned that legislators have recently attempted to circumvent the confidentiality provisions of the act in requesting file details from the Ombudsman.
OPSEU endorses the advice given by the Ombudsman to the members of the standing committee to maintain a graceful balance of independence and accountability.
The financial and administrative reviews provided through the Board of Internal Economy and the Provincial Auditor seem well crafted to ensure the public's confidence in the Ombudsman. If directly overseen or challenged in her decision-making by a government-dominated Legislative committee, we believe the Ombudsman's neutrality will be immediately and completely compromised.
The Chair: Thank you very much, gentlemen. Any questions and/or comments?
Mr Frank Miclash (Kenora): Mr Upshaw, thank you for your presentation. I certainly enjoyed it.
I'd like to go back to page 3 where you talk about public hospitals and election of the boards, especially "with membership split equally between staff and the community." As a former member of a hospital board, I take a look at that makeup and try to think of where you would fit in the executive director and the management staff of that particular institution, knowing that they are ultimately responsible for the decisions made. If half of your board is made up of staff and half representation from the community, where would they fit in?
Mr Upshaw: I would suggest that the way we do business today is through what we call partnership, and to me there's no problem in having a proper blend from the administrative side and from the staff side on a community board.
Mr Miclash: So you're suggesting that the split in terms of staff would be a split between administration and general staff?
Mr Upshaw: Yes.
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Mr Gary Carr (Oakville South): I'm sorry I missed some of your presentation. Mr Murdoch, who usually sits in this committee, called in and is sick today, so I'm just filling in. But I did get the chance to read a little as we were going along.
My question is with regard to the ultimate authority over the Ombudsman's office. As you know, the big problem we've got is the delicate balance: How do you have an arm's length relationship with some form of accountability? How do you see that happening? As you know, the accountability with governments is that at the end of the day they have to be re-elected and the people can judge.
When you're giving, as I read this, more power to the Ombudsman, how do you see the checks and balances? Let me just throw this up to you: If we have somebody in there, a hypothetical case, who isn't doing a good job and has overstepped powers or whatever, what would the procedures be for correcting that situation?
Mr Upshaw: Let me respond by using an example we've been reading about recently in the newspapers with respect to the sexual harassment cases around the province. As these cases start to be exposed, more and more women who have been exposed to sexual harassment are coming out and speaking up. When asked why they hadn't come out in the past, it was because they feared the system. They need to have that feeling that they can make a legitimate complaint in strict confidence.
What we're saying is that arm's length will give people who have complaints the confidence to go to the Ombudsman's office and make those complaints without fear of retaliation, given the Legislative process that rules the Ombudsman. That should never be the case.
I can give you another example. I can recall in a hospital where I worked that we had a staff nurse who was responsible for the staff, and the administrator insisted that that health nurse turn over confidential records to the administrator. The nurse refused and was terminated. The confidence of the staff in confiding in that employee nurse meant a lot. Staff will not confide if they have any concerns in terms of any repercussions that might come from it. So arm's length is the only way, in our opinion, to ensure people's confidence in going and exposing things.
Mr George Mammoliti (Yorkview): It's nice seeing you again, sir. It's nice seeing you, Tim, as well. Tim and I go back a long way; we both came out of the Ministry of Housing.
I agree in terms of the change of name. I'm not too happy with "Ombudsman" either, and I think we've got to do something about that; I agree with you on that point.
Where I disagree is the expansion. I don't agree that at this point we should be looking at including children's aid societies, for instance. I'll tell you why before I ask you the question. I don't agree, because there are a lot of problems that come out of the office, there are a lot of internal problems within the office, there are a lot of communication problems within that office. That has been made very clear to this committee.
Shouldn't we address those concerns first and try to fix any of the problems that exist within the office as it is now before we expand the role of the Ombudsman? I don't believe we can do it at the same time. Shouldn't we fix what's there first before we expand it?
Mr Upshaw: Maybe if you had expanded the Ombudsman's role years ago you wouldn't have the problem you have now. It's not a case of going in there now and trying to do a patchwork job. What you have to consider is, why weren't the problems brought forward much sooner? By expanding the role of the Ombudsman's office, then maybe those problems would have come forward and by now they would have been fixed.
Mr Mammoliti: The point is that there's a problem there now. This is the first time I've been a politician, this term of office anyway, and I think that for the most part the people who sit on this committee have sat on this committee for the first time. So to answer questions in terms of why it hasn't happened in the past I think at this point is irrelevant. I think we've got to look to the future. I think this committee's done a pretty good job in terms of looking at the problem and seeing what we should be doing in terms of recommendations to the Legislature. I don't believe one of those recommendations should be expansion -- yet; I think it might come later on. The reason is that there are just too many problems within that office right now.
Mr Upshaw: Because I probably deal with a lot of those problems a lot more than other people, I say to you that if you extend the Ombudsman's role, people would come forward, and that coming forward would assist us in solving those problems.
I don't think it's relevant to say that what happened in the past happened in the past. That's not the point. The point is that the people who provide that service, which is an extremely essential service, should have the same opportunity as anybody else to come forward with complaints about areas that they feel jeopardize their responsibility in looking after these children. They should have that opportunity like anybody else.
Mr Tim Little: I was just going to add briefly to Mr Upshaw's comment. In reviewing the history of the committee, it seems that there have been very few opportunities for a review of the act or the standing orders. In 1990, an act to make some amendments died. It seems as though there are very few opportunities to make changes, with the realities of the legislative procedure, and to make a piecemeal change now would put many other important reforms, perhaps, on a back burner. It looks like your review is quite comprehensive, and if there are progressive changes to be made, grasp the opportunity to do so.
Mr Mammoliti: It could be a nightmare.
Mr Little: I would imagine that your recommendations would want to be as comprehensive as possible in the sense that, as we've suggested, don't make the expansion without ensuring and advocating that the appropriate financial resources are there. So if there's going to be expanded jurisdiction, then staff and budget and provisions to make sure it's effective would also be critical. Again, the reason for our caution there is that we've seen too often services undermined by a lack of resources. Your own experience might suggest that too.
Mr David Ramsay (Timiskaming): Mr Upshaw, in defence of all the members of this committee, I just wanted to refute something you said in your second paragraph under accountability, "An Accountable Office, Free From Political Expediency," when you said that we have circumvented the confidentiality provisions of the act in requesting file details from the Ombudsman.
We have not done anything in this committee that committees before us have not done in trying to address concerns that the public bring before this committee about how effectively a complainant's case has been investigated. In some cases, cases are outstanding to resolution two to three years, and what we ask for is details as to the process that the case has moved along, to ensure for us and for the people of Ontario that the Office of the Ombudsman is working effectively on behalf of the people of Ontario.
I guess the question here is, who watches the watchdog? The ombudsperson has a budget of $9.5 million and is accountable to the taxpayers of Ontario. This committee believes it's our mandate to make sure that office is accountable to the taxpayers of Ontario.
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Mr Upshaw: Once again, the people who must use the services of the Ombudsman's office must have a sense when they come forth that it's confidential. If they feel there's a possibility -- especially the people I represent. You might say people in the Legislature are their bosses, yet they're coming forward with information that they could be punished for if it got out. If by going to the Ombudsman and making a declaration to the Ombudsman, then the file was going to end up in the hands of a legislative committee, which could be considered their boss, that could be detrimental.
Mr Ramsay: I agree totally with that. I think every member of this committee agrees with that. The only time we get involved is when the complainant comes to us as a committee and writes the committee through the Chair or the clerk to say: "I would like you to look at my file. I would like you to investigate the file that the Ombudsman has in regard to my complaint, because I am unhappy that it's taken 18 months" -- or two years, three years -- "to investigate my complaint, without resolution." We don't go on some sort of witchhunt and say, "Gee, let's take a look at some file." As a matter of fact, we don't even know what complaints are there until a complainant comes to us and says, "I am not happy with the way the Office of the Ombudsman has concluded my case," or, "There is the lack of progress on my case." That's the only time we get involved, and only if the complainant wants us to get involved in some of the details do we do that. But I agree with you that there has to be total respect for the privacy of the workings of all the cases of the Office of the Ombudsman.
The Chair: Just to further what Mr Ramsay said for a point of clarification, even when a file comes before us, the name does not come before us. It's usually given a letter connotation, like Mr M or whatever, so we don't know the identity of the person.
Are there any further questions and/or comments?
Ms Margaret H. Harrington (Niagara Falls): Just a clarification on your statement here about public hospitals: You say, I think quite clearly, that if there's election of hospital boards, these would provide a range of ombudsmen for hospital clients -- that is, an elected board -- whereas you say then, in the absence of direct elections for hospital boards, the participation of the Ombudsman would be particularly welcomed. I just wonder if you could clarify that. You're saying that if changes are made so that there is an elected board, you would not see the Ombudsman involved?
Mr Little: No. I think a clarification is appropriate there. We are saying that where a service is a provincial service, where it's funded by the province and is a mandatory service, and with health care taking up the portion of the provincial budget that it does, the Ombudsman's jurisdiction is appropriate, and that it's especially so in the absence of those other ombudsmen who would be there if there were elected boards. But in the absence of that kind of democratic representation for the public at hospitals, then the Ombudsman's jurisdiction is particularly welcome.
Mr Mammoliti: It may be off the wall, but that's just the type of guy I am. You're an expert, of course, in the field of grievance procedures and employee relations. You realize that the Ombudsman's office is not unionized. Do you think they should be? Do you think it would pose a problem within that office if the employees were able to unionize? Do you think that would pose some sort of problem in the relationship between the Ombudsman and the employees, or perhaps the office and ministries?
Mr Upshaw: I don't see that as a problem if they were unionized. I can draw your attention to a program called employee assistance program, where everything in that program is confidential, yet it's members going to members in confidence to talk about a problem they have. It's probably the most progressive joint venture that this government and our union have working together, and that's the employee assistance program. The people involved are management and bargaining unit people. I see no problem if the employees in the Ombudsman's department were organized. I don't see any conflict.
Mr Mammoliti: I've told you that in my opinion anyway there's a problem with communication within the office. Do you think that would improve communication between employees and the Ombudsman?
Mr Upshaw: It depends on the type of problem. When you say "problem with communication," that could mean almost anything. It could be a problem, but if they were unionized, maybe I could go in and straighten it out. For now, I can't. Or maybe one one of our experts in labour-management relations could go in and straighten it out if they were organized.
The Chair: Mr Upshaw, Mr Little, I want to thank you for taking the time out of what I know is your busy schedule to appear before us this morning.
ONTARIO HOSPITAL ASSOCIATION
The Chair: The next group presenting is the Ontario Hospital Association. Good morning and welcome. Thank you for coming. You have as much time as I think you need to read your brief this morning, and I hope you'll leave some time for questions and/or comments from the members of the committee. When you're comfortable, can you please begin. There's water there. As you begin, can you both please state your name for the record, as I have not done so yet. Begin when you're ready.
Mr Dennis Timbrell: Thank you, Mr Chairman and members of the committee. My name is Dennis Timbrell. I'm the president of the Ontario Hospital Association. Joining me today for this presentation is Carolyn Shushelski. Carolyn is senior legal counsel for the Ontario Hospital Association.
I will, with your indulgence, read into the record a statement that summarizes our brief which is, notwithstanding your generous offer of unlimited time, far too long to read in its entirety, which will then leave, one hopes, more than ample time for discussion. We appreciate this opportunity to speak to the committee today as part of the process of the review of the Ombudsman Act.
The Ontario Hospital Association is the collective voice of Ontario's 223 public hospitals. The association represents their needs and views to government, to outside organizations and to the public at large.
It is for this reason that we focus today particularly on one question, namely, whether the jurisdiction of the Ombudsman should be expanded to include public hospitals. We appreciate that this is only one of the issues brought forward in the recommendations of the committee's 1991 report, calling for a comprehensive review of both the act and the Office of the Ombudsman.
The current role of the Office of the Ombudsman is to investigate recommendations, decisions and actions or omissions in the administration of governmental organizations that affect individuals or groups.
Ontario's public hospitals are not governmental organizations, and it is the considered opinion of the OHA that they should remain outside the jurisdiction of the Ombudsman.
As I've said, there are 223 public hospitals in Ontario. The majority of these hospitals are independent corporations, incorporated as not-for-profit organizations under part III of the Corporations Act.
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Each and every public hospital in Ontario is governed and managed by a board of directors elected primarily from the corporate membership, in accordance with the hospital's bylaws. The board is responsible for setting policies, while day-to-day operational management is delegated to a salaried administrator or chief executive officer. Directors serve on a voluntary basis and are directly or indirectly accountable to the Minister of Health, the corporation and the community.
Ownership is a function of the hospital corporation, which is comprised of members of the community, who usually pay a small membership fee or annual dues.
The issue of overview and jurisdiction, which is central to the present comprehensive review of the Ombudsman Act, is an important one for hospitals. There are in fact numerous statutes which provide for the investigation and review of a public hospital, including 22 listed in our full brief. Most notable, of course, among these statutes is the Public Hospitals Act.
The concurrent review of the Public Hospitals Act this year has been an effort to balance the ownership of public hospitals with enhanced openness and accountability of hospital boards. Under the Public Hospitals Act, the Lieutenant Governor in Council may appoint one or more persons to investigate and to report on the quality of management and administration of a hospital and the quality of the care and treatment that patients receive in a hospital.
If the results of such an investigation are disturbing, a hospital supervisor may be appointed to act in the best interests of the public, providing advice and guidance to the hospital's board and administration. This could focus on improving the quality of the management and administration of the hospital and/or the care and treatment of patients.
I would like to mention briefly the considerable review, complaint and approval procedures to which hospitals are already subject as part of existing governance and management arrangements. Our written submission covers this in detail, and I commend it to you for your attention.
First and foremost, health professionals are committed to the provision of safe and effective care, in recognition and respect of individual needs and rights. Most hospitals have mechanisms for dealing with patient complaints. Some hospitals have gone so far as to implement a patient representative program, designating a person to act as intermediary between the patient and the hospital when needed as a quality assurance measure.
Beyond investigations under the authority of legislation, hospitals participate in a voluntary accreditation process through the Canadian Council on Health Facilities Accreditation. This program involves completing an extensive questionnaire and an onsite inspection by a team of independent surveyors. The resulting accreditation certificate is posted in public view, and the findings which accompany it provide the board of directors and staff with an assessment of the hospital's performance, including strengths and weaknesses.
In addition to statutes which provide various mechanisms for inspection of a hospital, there are also eight different methods by which members of the public can bring complaints against a hospital. Our written submission includes a brief description of these eight methods, but I would like to highlight two of the most common types.
First, perhaps the most frequent method of bringing a complaint against an institution and/or a health professional is through the legal system. Any person who believes that he or she has suffered injury or loss as a result of negligence can seek redress through the court system.
There are psychiatric facilities within 70 of the 223 public hospitals and there are also 10 psychiatric hospitals in the province. Both fall under the Mental Health Act, which contains extensive safeguards for patients and their rights. However, only the psychiatric hospitals are owned and operated by the crown, making them governmental institutions that do fall under the jurisdiction of the Ombudsman Act. The question, then, is whether that jurisdiction should be expanded.
Other channels for complaints about professional conduct include the Health Disciplines Act and the regulated health professions legislation. These provide avenues for complaints either to existing professional regulatory bodies or to those that will be established under the Regulated Health Professions Act, which is expected to become law shortly.
While this complaint mechanism will apply to specific actions of health professionals, the complaint could certainly apply to an incident that took place in a hospital setting.
Patients are not the only ones who can bring complaints against a hospital. Employees have a variety of mechanisms for taking action, ranging from grievances to legal actions or complaints under the Human Rights Code. The Occupational Health and Safety Act requires hospitals to have joint health and safety committees and provides unrestricted access to hospital premises for Ministry of Labour inspectors. Other legislative initiatives include proposed amendments to the Pay Equity Act and the proposed Employment Equity Act, which will provide additional avenues for employees to pursue recourse for perceived wrongdoings in certain circumstances. Members of the medical staff, health professionals to whom the hospital board has granted certain privileges for their practice, also have opportunities to bring complaints against the hospital through means identified more fully in our written brief.
As you will know, the standing committee on administration of justice has just completed a clause-by-clause review of the package of legislation concerning advocacy, consent to treatment and substitute decision-making, and the purpose of this legislation is to provide enhanced protection for the rights of patients.
As you can see from this brief outline, hospitals are already subject to a great deal of review and scrutiny, which brings us back to the question of whether or not hospitals should be subject to the authority of the Ombudsman Act. While acknowledging the rationale of the act, namely, public concerns about government administration, we believe that hospitals are outside that mandate. Furthermore, it is the view of the OHA that the many existing avenues for complaints from the public, patients, employees and medical staff make it redundant for hospitals to be considered to be subject to the Ombudsman Act.
The Chair: Thank you very much for that fine presentation. Questions and or comments?
Ms Harrington: I have a couple of questions. First of all, welcome back to this building.
Mr Timbrell: Thank you. It looks familiar.
Ms Harrington: On page 7, you mention that the accreditation process is voluntary. Are there hospitals that do not take part in this accreditation process?
Mr Timbrell: None that I'm aware of at this time. There have been some concerns expressed in recent years about the costs involved in preparing for and going through the process, because it's a very, very exhaustive process, but at this stage, I'm not aware of any that have pulled out of that.
Ms Harrington: So it is pretty well a blanket --
Mr Timbrell: I might add, by the way, that the Canadian Council on Health Facilities Accreditation made a decision within the last year or two to consider granting a four-year accreditation. Until now, if you were accredited, you got a three-, two- or one-year accreditation; most hospitals have three-year certificates. For the first time anywhere in Canada, a hospital in Ontario was granted a four-year accreditation about a month ago, and that's the Mount Sinai Hospital, only minutes away from where we're sitting.
Ms Harrington: That would certainly cut down some of the costs of administering that program.
Mr Timbrell: If you'd had a chance to sit in on some of the sessions at our recent convention, I can tell you that everybody in the system has refocused all their efforts on quality issues, particularly in light of the fiscal environment in which we're operating. Whether it's the board or the medical advisory committees or other standing committees of the board, everyone has focused almost single-mindedly on the issue of the maintenance of quality, and how to maintain or enhance quality in the light of diminished fiscal resources.
Ms Harrington: It certainly is an important consideration.
Mr Timbrell: Yes, it is.
Ms Harrington: You also mentioned that directors who serve on a voluntary basis on a hospital board are directly or indirectly accountable to the Minister of Health. From that, you go into some detail about the different interactions between the ministry and the actual care provided. In that direct or indirect accountability to the minister, is there any way in which the minister could remove a board member or a board and say "This was not appropriate"?
Mr Timbrell: Under amendments I introduced in 1981, the minister does have the authority to send inspectors in -- I alluded to that in the presentation -- and, depending on the results of the inspectors' report, to put in a supervisor. That arose out of a situation at the Toronto East General Hospital in 1981. So the minister does have the authority to move directly into a hospital.
What the minister does regularly is that each year a number of hospitals are subjected to what are called operational reviews, which involve independent consultants, or they might involve teams of people drawn from other hospitals. In that regard, more and more turn to our association to assist them.
The purpose of those reviews is to either zero in on a particular program where there are problems -- it might be to do with overruns in spending or it might be concerns about the relationship of one hospital's dialysis program, for example, to the regional issues, and that may have got to the point where they want some outside advice -- or it may be an overall review. Those reports then form the basis of the measures which the government then pursues with the hospital.
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The most recent example I would cite would be at Huntsville. There was an operational review carried out. The government is working through, with the board, the development of corrective measures and actions in response to the issues highlighted by the person who conducted that review for them.
Ms Harrington: Just in closing, I'd like to mention that in certain regions, obviously, we're going through that process of trying to work together with other hospitals in the area to consolidate services. That's a very important process. I represent the city of Niagara Falls, and we have an excellent hospital operation there.
Mr Timbrell: In fact, are you not a former member of the board?
Ms Harrington: Yes. How did you know?
Mr Timbrell: You'd be amazed what I know.
That's a good example. The district health council is meeting today, as a matter of fact, with the hospitals in Niagara. They've developed their own package of proposals, which we're going to review later today and, hopefully, later this week with the ministry, on how to deal with the operational planning process so it doesn't become overbureaucratized and cumbersome for the health councils and the hospitals.
Ms Harrington: Also, a week ago the district health council met with all the local area MPPs to explain hospital workings.
Mr Timbrell: Yes, I was aware of that.
Ms Harrington: We appreciate the contact.
Mr Miclash: Just a statement. Dennis, I thank you for your presentation. You're speaking to a good number of former board members on this committee, actually, and I don't think we have to be convinced of the number of avenues that are open to both employees and people making use of services in the hospital. I think you've just put it very precisely and directly as to the number of services available, and I thank you for that.
Mr Timbrell: Thank you.
Mr Ramsay: Welcome, Mr Timbrell; nice to see you again. You're around a lot, keeping all of us from all the parties informed on the doings of the Ontario Hospital Association, and we certainly appreciate that information.
From the presentation you gave today, to me it's very obvious that hospitals in Ontario are very well regulated; one may say overregulated. But certainly hospitals have to be consistent to the various acts and regulations that are applied to them. It's very rigid in Ontario, and I think from that we derive very good service .
I'm not one to suggest that we should be expanding the Ombudsman's jurisdiction in Ontario. If there were a need for some sort of overseer for the hospitals, I would suggest that it should not come from the Ombudsman of Ontario, but someday, if the Ontario Hospital Association felt it necessary, maybe it would establish its own Ombudsman or something like that, sort of like what newspapers do etc. But I certainly would not propose that we expand the mandate of the Ombudsman of Ontario, who I feel really has the jurisdiction to look at direct government goings-on, and that's the person the people of Ontario go to.
I was wondering if it would be possible for you to put on a past hat of yours to maybe give us some insight. As we all know, you were in government, and my recollection is that you were in government specifically at the time when the act we're reviewing today was brought into being. I would really appreciate getting any insights you have about the birth of this act and any recommendations you might have for us as a private citizen, but one who has some knowledge of how this all came into being in the first place.
Mr Timbrell: You're quite correct: I was at the cabinet table when this was discussed in the mid-1970s and when we put it through the House. This followed a complete review of the overall government organization known as the the COGP, committee on government productivity, which Jim Fleck headed up on behalf of the government. Having reorganized the government in the late 1960s, early 1970s, the period I'm referring to, as you appreciate, the size of the government and the scope of the government was growing quite remarkably every year.
My first year in cabinet, for example, in 1974, the provincial budget included a 25% increase in government spending, which embraced the introduction of a whole host of new programs including the drug benefit program, for example, which was introduced in that budget.
We were conscious, talking with people like Alan Borovoy and others from not just the civil libertarian groups but other consumer groups, that as the government presence in the province and its impact on the lives and livelihoods of individual citizens was growing, there needed to be some independent buffer, if you will, arbiter, to call us up short where that was appropriate.
In the design of the legislation of the program, it was never intended that the Ombudsman would become a one-person legislature, so independent of the elected representatives that that person could ignore the wishes of the Legislature or act in a way or manner which in itself might be offensive to due process, natural justice, whatever. That's why this committee was struck. That's why it was envisaged in the beginning that ministers would have to come to the committee on occasion to justify why they had not accepted the recommendations and what they had done instead of or in spite of the Ombudsman's recommendations. But equally, it was intended all along that the Ombudsman would be accountable to the Assembly, because the Ombudsman is appointed by the Assembly, under the terms of that legislation, through this committee.
Mr Ramsay: I think what we're really trying to grapple with here too is the appearance of the two conflicting principles of independence and accountability, and how we marry the two. I think that's what we're grappling with, and how I would see sorting those principles out is that we obviously must have respect for the independence of decision-making in regard to the Office of the Ombudsman. At the same time, I think there has to be accountability of financial management and also of process, to make sure that for all that money -- the $9.5 million that's spent every year by that office -- the people of Ontario are receiving good value. I just wonder if you'd have any comments on balancing those two principles.
Mr Timbrell: Well, there is one more important principle and it's why the legislation was structured the way it was; that is, that Parliament is all powerful. It was never even envisaged, never even considered, that the Ombudsman would be appointed by order in council or some other administrative fiat of the executive council. The legislation is very clear that the Ombudsman is a servant of the Assembly and therefore a servant of every member of the Assembly and therefore a servant of every citizen of the province, and therefore must be accountable to the Assembly. That one principle, the supremacy of Parliament, must never be lost sight of.
Mr Mammoliti: If you don't mind, I just want to mention the acts, once more for the record, that pertain to hospitals and that hospitals are regulated under. The Corporations Act you've mentioned, the Public Hospitals Act, the Mental Health Act, the Human Rights Code, the Health Disciplines Act, the Occupational Health and Safety Act, the Pay Equity Act, the Employment Equity Act. Which would supersede which, and, if we brought in the Ombudsman Act, would that supersede all of them?
I agree with Mr Ramsay. I think the employees and the people who work in hospitals have got to at present account for everything they do and every decision they make. There's got to be forms filled out and there's got to be questions asked. At present, when I talk to nurses and when I talk to some doctors and when I talk to even the clerks in lobbies, they're always having to worry about these things.
I just wanted to put on the record that I agree, that I don't think we should be expanding, that you're already accountable for so many things and decisions that you make every day and that I agree with you. That's the comment I wanted to make, Mr Chair.
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Mr Timbrell: I appreciate that. I might say that in the course of this day, the hospitals of Ontario will probably see and serve over 100,000 people. There are perhaps 35,000 to 40,000 who are in hospital beds today and that many more again who will come through outpatient clinics, emergency departments, visits to physicians whose offices are located in the building. Everybody involved in the hospitals understands very well just the sheer magnitude of the responsibilities which they carry for dealing with that many people on a daily basis.
Mr Carr: Thank you very much for your presentation, Dennis. I want to say right off the bat that the question I've got may sound political but I don't mean it to be, particularly for the other side.
Mr Timbrell: I'm apolitical myself.
Mr Carr: The funding issues we face would be there whether the Conservatives were in, or the Liberals or so on. In part of my riding, Burlington, Joseph Brant Hospital is facing some major problems, and I think from the average person's standpoint, there is more chance that he or she won't have the services there when they're needed in our hospitals because of funding issues than it is because the hospitals aren't being run properly or the quality of care isn't there.
As we sit here today, would you say that to be a fair statement, that the real pressures don't relate to the quality of our hospital management, or the nurses or the doctors or the workers, but that it really more than anything else is a funding issue that could threaten our hospital system?
Mr Timbrell: Well, the big concern of any hospital is ensuring that the services the people of the community need are available when they need them. Now having said that, hospitals more and more recognize that the patterns established 25 or 30 years ago, where hospitals attempted to be all things to all people -- those days are over. It more and more means that hospitals are having to look to ways to sort out their programs in relationship to the other hospitals in their area and, wherever possible, to acknowledge that they maybe have to give up doing certain things, so that another hospital in the region will do it, but that they may be able to take on a broader responsibility for other services; in other words, that there be movement of programs and responsibility for them back and forth.
That's a little bit easier in a community like yours, where you have three hospitals within half an hour of one another. Not quite so easy in Kenora, where it's a two- or two-and-a-half-hour drive to the next hospital, in Fort Frances or in Dryden or whatever.
We have, I think, acquitted ourselves within the hospital system extremely well in this last year in that, with a relatively small increase in funding, the hospitals of Ontario, the boards and the administration, working with their unions, working with staff, working with the professions, have mounted a monumental effort to maintain the quality in the face of reduced funding.
But there's no question that we're looking to next year with some apprehension. We have a promise of a 2% increase in funding and, I have to tell you, we're banking on that promise. We are banking on that promise and we've given the government our commitment that we will live with that, whatever happens with arbitration awards and other cost increases. If that were to be taken away, then yes, it will throw 223 boards, 223 management groups, 223 communities back to the drawing board, and the concern about access to needed services will be heightened.
Mr Carr: Some people would lead us to believe that if you just had the Ombudsman identifying the problems, everything would go away. I don't believe that's the case. I think the boards, the Ministry of Health, know what the problems are, and that it really comes down to a case of the whole funding and the economic issues.
But specifically on something you mentioned, you said there are some stats on operational reviews. Maybe you could give us some idea of the numbers that were recorded last year and what the reasons were. In other words -- and I know it's probably difficult to do in a short space of time -- were the problems related to bad management on the boards' parts, as they may be in some of them? Is it staffing issues, not having enough people? Of those stats on the operational reviews, maybe you could just tell us, ballpark, how many there were and what specifically they were about.
Mr Timbrell: My recollection is a little vague, but my recollection is that in the last year there were perhaps 10 or 12 ORs, as we call them, operational reviews, done. They did highlight, in some instances, issues pertaining to communication within facilities among the board and management and staff. In some instances they highlighted some concerns about the way certain programs or departments are organized, and some of that had to do with just straight management issues and in other instances had to do with the relationship of a program to similar programs within the region, the kinds of things I was alluding to when I answered your question about Joe Brant. But in none of those operational reviews did -- well, sorry, I shouldn't say none. There was one.
Mr Carr: Big one.
Mr Timbrell: One beaut at St Michael's Hospital --
Mr Carr: Yes, which everybody refers to.
Mr Timbrell: -- which I guess I put in a different category from the other operational reviews. That one certainly did highlight some major concerns that everybody in the industry has certainly taken to heart, about the role of the boards, the communication with management, the role of the ministry. That review, in fact, found fault with everybody, from the ministry to the board, to the administration, to the owners of the hospital, and it was one of those cases that will, I think, go down in the history of the evolution of our system in Ontario as a very significant development, one from which everybody has learned to improve.
Mr Carr: I agree, and what happens with the cases like that, of the 223 operating, one has a major problem and we turn around and try to change things based on that.
Some would say, "Well, if we just had the Ombudsman, we could have prevented that one earlier." I don't believe that is the case. I honestly believe that the procedures in place right now -- and this is giving credit to the ministry. The Ministry of Health does a good job in its function of monitoring hospitals. Would you agree that the ministry does do a reasonably good job in terms of its responsibility of overseeing what happens at our hospitals?
Mr Timbrell: I do. I think it could be better, and in that regard the ministry and we at the OHA have now launched a joint initiative called the joint policy and planning committee, or JPPC, which is a body through which we are collaborating in the development of policies and directives to hospitals. That should, if anything, make hospitals and the ministry much stronger partners than they've been in the past.
Mr Carr: The problem you've got with this is you've got an Ombudsman's office that is dealing with different problems. As I get approached by whether it's hospitals or individuals or doctors or nurses, they're talking about some of the problems in the health care. It is very technical and very difficult when they come up and tell you what some of the problems are. What I see is, one of the major concerns with the Ombudsman's office is that it's taking such a broad issue that the people who really can take a look at what the problems are are the people who do it in the Ministry of Health, because it is very specialized in looking at it.
I guess one of the big concerns, the way some people see the Ombudsman, is, this is the person who is the court of last resort, who can oversee everything if the ministries, whatever they are, aren't performing, if the legislatures aren't performing. What would you like to see as the final decision? Would it be the Ministry of Health over hospitals, or is there some role that the Ombudsman could play?
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Mr Timbrell: I don't see any role for the Ombudsman. It's clear in the legislation that the ultimate responsibility rests with the minister for the direction of the health care system of the province.
You must understand too that, as I pointed out in my statement, hospitals are not crown-owned assets. That only happens in New Brunswick now. They are owned by the community, perhaps by a religious order, perhaps by a civic body such as in Ottawa, North Bay, Sarnia, elsewhere, or, if not, then by a not-for-profit body incorporated under the Corporations Act for the purposes of, initially, the development and then the operation of a hospital.
It is, if you will, a form of a purchase and sale of services. The government said years ago, "We're going to fund these services, and we're going to buy them from you in these 223 hospitals." Over the years that has evolved into, sometimes, concerns about the way the services were provided. You know, "That isn't what we meant to buy," or "That isn't the way we meant to have it delivered." That's become a very complicated science in itself: How to review the operations of hospitals and make sure that you're getting value for money and that what's being done in one hospital is appropriate relative to the other hospitals in the whole system.
In fact, I meant to point out, partly in answer to a question Mr Ramsay asked when he suggested maybe the OHA would eventually set up some kind of a monitoring body, when the government of Ontario, 35 years ago, decided to establish a hospital insurance plan, the OHA set it up for them. We seconded over 200 staff to the provincial government, sold them land and a building in which to establish the Hospital Services Commission, and the first head of the Hospital Services Commission had previously been -- no, that's not true; the second head -- a president of the OHA. We've been deeply involved as an association and as individuals members in the evolution of the system, but clearly, on the understanding that we are providing a service on a not-for-profit basis that the government is buying from us.
Mr Carr: One last question. This one might not be fair because it sort of goes outside your responsibilities with the Ontario Hospital Association, but everybody knows that you do have a background. I agree with you that the ultimate authority should be with the elected officials. As you know, we've been in a bit of a battle over that and trying to get the delicate balance. You may have followed it, because it has been in the newspapers. If you were in our position as legislator, knowing the circumstances, what would you recommend we do with regard to the Ombudsman and this whole situation that we're facing now. I don't mean to put you on the spot --
Mr Mammoliti: Put him on the spot.
Mr Carr: -- but as a former politician, I guess you're used to it.
Mr Timbrell: I was trying also to reference that point in my remarks earlier about how the legislation was originally crafted and why it was crafted the way it was; that is, I would say to the Ombudsman, I would say to any other official: "Parliament is supreme. If Parliament, through one of its committees, wants to meet with you, wants to ask you questions, then you come and you answer."
Ms Christel Haeck (St Catharines-Brock): I've had a chance, as the discussions have gone on, to review your larger document. While it is longer, it is quite cogent, and I think would make it clear to all of us the range of restraints and constrictions and whatever that you function under. The legislation you've listed at the back which controls the professions as well as the hospitals I think is quite illuminating, the depth and breadth of it.
Having said that, however, I have in my role as MPP run into a constituent who was seriously distressed; in fact, was seriously considering suing two medical institutions within the peninsula regarding care.
Mr Timbrell: Is that medical institutions or hospitals?
Ms Haeck: Both of them are hospitals. In fact, the constituent after some thought decided not to.
On page 14 of your larger document you refer to the possibility of legal action, which I think we are all clear would be fairly expensive for most individuals. Then on page 18 you talk about the public relations and patient representative programs and some of the guidelines under which these particular programs may be set up.
They mirror some of the kinds of issues which the Ombudsman does investigate, things like: "to facilitate the complaint resolution process;" "to interpret hospital policies and procedures and to direct patients to appropriate services and resources." In my time on this committee, we've had a chance to listen to Justice Morand, who was a former Ombudsman. One of the comments he made is that members of the public who tend to come to the Ombudsman are not looking for justice, they're looking for mercy. I thought that was also rather instructive, how he, as a former Ombudsman, definitely viewed this as a court of last resort.
The Ombudsman looks at timeliness, looks at whether there are policies and procedures to deal with complaints. Given the fact that even though you have these public relations programs available in hospitals, but that patients, patients who are not necessarily in good financial circumstances, may feel at times that in some respects their particular complaints aren't being seen to in a timely fashion or that there may not be adequate procedures to deal with their particular complaints, would you see that this might be an area for the Ombudsman to play a role?
Mr Timbrell: No, because the Ombudsman, with all due respect to the present incumbent, her predecessors and her successors, knows nothing about the practice of nursing, medicine, physiotherapy and on and on. The people within the hospital boards and the administration are either trained to deal with those issues or have taken the time and made the commitment to become involved as members of, first, the hospital corporations and the committees and, ultimately, the board, to educate themselves.
I wish I could say that every hospital were doing this; they aren't. In most cases, virtually every case, it wouldn't be because they're not conscious of this. In many cases, it's the administrator who ends up doing this, it isn't a staff person, because for budget reasons they simply can't afford to have a person designated to do this and only this, so the CEO does it.
I was reminded this morning of a CEO of a small-to-medium-sized hospital east of Toronto whose policy it is to take all correspondence from patients, good or bad, to the board. The board meets in an open session, although I suppose they're careful to protect the anonymity of both the practitioners and the staff and the patients.
As we're reviewing with the government the provisions for the Public Hospitals Act, I think this is probably going to be one area, as quality assurance has been highlighted by both sides in the discussion as something that merits consideration as we look at the development of new legislation, where we may want to consider certain guidelines that would be issued for all hospitals to follow. Again, you've got 4,000 hospital trustees who for the most part see themselves as ombudspeople, if you will, and that's even more pronounced in smaller communities; I'm sure in Mrs Harrington's case people knew she was on the board, and she probably heard about it from people at various times in her daily activities. I certainly hear that from people all the time, that they're well known in the community as members of the board and therefore they get called on to advise and assist in redressing issues. But it's an area that we properly should look at, with respect to the Public Hospitals Act, for guidelines.
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Ms Haeck: By virtue of the fact that I've been involved in my community, I guess I'm a little more aware of who sits on my hospital boards. But as a private citizen, prior to about 12 years ago, for the most part I had no idea who was sitting on my public hospital boards. Realistically, in my riding I have four hospitals, and by virtue of my job these days I do encounter these folks on a more regular basis, but I would say the average citizen, John and Joan Q. Public, do not know who's on their hospital board and, in fact, in most instances would probably just be dealing with the administrator in terms of dealing with whatever concern they may have.
I have sat on a few boards myself, and I understand that we do end up trying to arbitrate or mediate various concerns, but I would suggest to you that the kind of review the Public Hospitals Act is undergoing, making the boards a bit more visible maybe in the community, to provide access for the larger community to those boards and possibly expanding their role as far as arbitration and mediation are concerned, I think is highly appropriate and important.
My question about the role of the Ombudsman is one that this one constituent really made quite clear to me. The description of various administrators basically coming to him, as a senior citizen, begging him not to institute a legal suit was one that really was quite -- well, it was a very negative image. I guess the other thing is that he does have enough money to do this, but he decided in the end that it wouldn't serve any useful purpose. He had his health back and he was prepared to enjoy that.
Mr Timbrell: I'm sure you realize that there are always at least two sides to every story, sometimes three.
Ms Haeck: I understand that. But realizing that Niagara-on-the-Lake is made up of people who may not be as well heeled, what are the options if there aren't the appropriate mechanisms to deal with some of those complaints out there?
Mr Timbrell: I'm sure you must have asked yourself the question that if you were to entertain the notion that you will expand the role of the Ombudsman to cover anything and everything funded by the provincial government, then it is also going to be looking at the Shaw Festival at some point. They're also going to be looking at other cultural programs. Where do you draw the line?
Ms Haeck: I understand your point. I guess it's a general perception of the kind of gut-wrenching issues out there. Health is one that really hits everyone -- not to suggest that the Shaw Festival isn't an important cultural industry: As the representative from that area, I would say it keeps a lot of my constituents employed and definitely provides a great economic boon to the town of Niagara-on-the-Lake and the Niagara region. But health care really cuts across every community, and it is the thing that not only you heard about when you were an elected official but all of us hear about on a regular basis, and they're usually very heart-rending situations.
Mr Timbrell: We're very conscious of that. You may know that, for example, at convention last week, the members present unanimously passed a resolution calling on our association to develop guidelines to help all hospitals to institute open board meetings, to remove any barriers, if they exist or where they exist, to membership in the hospital corporations, and to build on the existing base of accountability and links of hospitals to the community, to strengthen that and to open the process.
At the end of the day, though, if somebody has what they feel is a legitimate complaint and if they've exhausted all the processes through administrators and others, and if they still decide that they want to pursue it either to the appropriate college -- the college of nurses, the college of physicians, the college of midwifery, whatever it might be -- or to the courts, then that of course is their right, and then other mechanisms kick in, including legal aid and other means of assisting those who are not in a position to personally afford to pursue their rights.
Ms Haeck: I appreciate your comments, and while I understand some of the complaints out there, I personally wouldn't support putting hospitals under the umbrella of the Ombudsman at this point. But I also feel I have to ask the question, because there is a concern out there among some constituents we've heard from, and I have a very tangible case from my office.
Mr Timbrell: I suppose the two committees that most trustees rely on most heavily and for which there are lots of volunteers are the quality assurance committees of boards and the finance committees, because they recognize that they do go together.
The Chair: Any further questions and/or comments? Seeing none, I want to thank you both for appearing before us this morning. I can only start to imagine how strenuous your schedule is, so I really do want to thank you for taking the time out.
Mr Timbrell: A pleasure. Thank you.
The Chair: Next week, November 11, this committee will not be meeting, as it is Remembrance Day. But the following Wednesday morning, November 18, at 10 am, we have appearing before us the Law Society of Upper Canada; at 10:30 the Ontario Public School Boards Association, and at 11 am the Ontario Home Warranty Program.
This committee now stands adjourned until November 18.
The committee adjourned at 1137.