CASE OF MR S

CONTENTS

Wednesday 1 October 1997

Case of Mr S

Ms Roberta Jamieson, Ombudsman

Ministry of Health

Ms Mary Catherine Lindberg, assistant deputy minister, health insurance

Mr Gordon Kumagai, acting director, assistive devices program

Ms Carol Jones, manager, professional services, assistive devices branch

STANDING COMMITTEE ON THE OMBUDSMAN

Chair / Président

Mr John O'Toole (Durham East / -Est PC)

Vice-Chair / Vice-Président

Mr Trevor Pettit (Hamilton Mountain PC)

Mr Dominic Agostino (Hamilton East / -Est L)

Mr Douglas B. Ford (Etobicoke-Humber PC)

Mr Allan K. McLean (Simcoe East / -Est PC)

Mr John O'Toole (Durham East / -Est PC)

Mr John L. Parker (York East / -Est PC)

Mr Trevor Pettit (Hamilton Mountain PC)

Mrs Sandra Pupatello (Windsor-Sandwich L)

Mr Bill Vankoughnet (Frontenac-Addington PC)

Mr Len Wood (Cochrane North / -Nord ND)

Substitutions / Membres remplaçants

Mr John Gerretsen (Kingston and The Islands / Kingston et Les Îles L)

Mr Peter L. Preston (Brant-Haldimand PC)

Clerk / Greffière

Ms Tonia Grannum

Staff / Personnel

Mr Philip Kaye, research officer, Legislative Research Service

The committee met at 1006 in room 151.

CASE OF MR S

Consideration of the Ombudsman's case report in the matter of Mr S and the Ministry of Health.

The Chair (Mr John O'Toole): Let's call the meeting of the Ombudsman's committee to order. We have before us the agenda, which is dealing with a case in the matter of Mr S and the Ministry of Health. I would hope that every member has a copy of the report. This is the Ombudsman's report on that. Does everybody have that document? We're pleased to be joined by the Ombudsman this morning. Good morning, Roberta.

Ms Roberta Jamieson: Good morning. Before I begin, let me say bonjour, sago in my language, and welcome to the new members of the committee. I know there has been a change in committee makeup and I see some new faces, though not to me, certainly to the committee and I look forward to working with all of you.

I am very pleased this morning to have the opportunity to present the findings that I've made following an investigation into a complaint concerning the assistive devices program. It's commonly called the ADP, and that's the term I'll be using, and it's administered by the Ministry of Health. For this presentation, as with the case report that I made available to the Legislature, there is a practice of anonymizing the individuals involved and that continues.

As you know, tabling a case report with the Legislature is the last step open to the Ombudsman in the procedures set out in the Ombudsman Act. At this stage, I will have raised the issues and discussed the case with the head of the governmental organization. I will have advised the minister responsible. I will have notified the Premier of my conclusion and recommendations. At this stage, I am coming to this committee, through tabling a report in the Legislature, to seek your scrutiny on the case, to seek your intervention and support of my recommendation so that the ministry will itself feel obliged to put this matter of unfairness right. So this is the final step.

I want to turn to the case of Mr S and the Ministry of Health's assistive devices program, the specifics of it. This program provides funding to assist in the purchase of certain high-technology aids required by persons with disabilities. In the case of high-tech visual aids, an assessment is required by an ADP-approved assessment centre to determine which devices may be most suitable to meet an individual's needs. At the time of his complaint, the nearest of these centres to Mr S's Ottawa residence was in Toronto. S complained to my office that in denying him financial assistance to cover the cost of travel to Toronto, the ministry was effectively denying him access to the program. In the absence of an assessment by the ADP-approved centre, he was then not eligible to receive program funding for a high-tech vision enhancement device.

The situation of S is a classic case of catch-22. He was seeking financial assistance to purchase the device he needed through the ADP but could not get this assistance because the program would not assist him with the travel funds to complete the eligibility requirement. His predicament -- he is not alone -- is representative of other people with disabilities who, because of their geographic location or lack of financial resources, are effectively denied access to a program that is supposed to be equally available to all eligible applicants in Ontario. This is not the first instance where this type of case has been brought to committee, where a program or policy which appears to be fair and neutral in fact in practice has a negative impact on a group of people who share certain characteristics or circumstances.

The number of potential applicants to the ADP who are financially disadvantaged is disproportionately high, and that's as a result of the regrettable statistical fact that Ontario residents with disabilities have an average income which is 28% less than that of Ontarians without disabilities. It's also true that travel is often a more difficult undertaking in general for a person with a disability. Consequently, financial considerations and geographic location are particularly acute concerns for those individuals whom the ADP was designed to benefit.

Successive governments in Ontario have long promoted the importance of accessibility for basic health care services to all Ontarians. My principal concern in this case is that the financial assistance that ADP provides for devices which are essential to individuals with disabilities is not universally available if any of those individuals are prevented, because of their economic or geographic location, from obtaining that financial assistance.

The discriminatory effect I have described here is not intentional in the design of the program. Indeed, this ministry recognizes that disparities exist as a result of remote geographic location and compensates for this, at least in part, through its administration of the northern health travel grant, which helps residents of northern Ontario travel to designated health care facilities.

The ministry, I acknowledge, has also been working to approve additional ADP assessment centres, which would reduce the distance that some applicants would have to travel to determine eligibility. As more centres are approved, this will reduce the extra costs for some applicants, but it will not adequately address the situation of S and others like him. There would have to be an extremely large number of approved assessment centres before all the province's residents are brought within a reasonable proximity to one. That is why I formulated a recommendation to provide financial assistance for travel needs as an accommodation for those individuals who otherwise would not have access to the program.

At one stage of the investigation process in this case, the Deputy Minister of Health observed that if applicants' travel costs were to be reimbursed or subsidized, it would substantially increase the cost of administering the program and therefore reduce the funds available for the assistive devices themselves. While the ministry did not indicate any estimates of such costs, this position goes to the crux of the problem: the cost implication of addressing the inequity that exists. In my discussion of this issue in the case report, I've raised two options for the ministry to consider that would enable it to implement my recommendation.

First, the ministry could provide additional funding for the operation of the assistive devices program; in other words, increase the envelope. This, of course, would be my preference, as my findings in the case of S are critical of the inequitable access to the ADP and not of the program itself. Any solution to the access problem that would be detrimental to the overall program would not be a positive outcome. Additional funding to cover the necessary travel needs of applicants would provide true universality of access rather than access for only those who can afford to travel.

Second, I have acknowledged that the introduction of a sliding scale for reimbursement based on a means test would ameliorate the financial aspect of the access problem; in other words, the same envelope, different rules within it. Individuals who receive funding through the program already incur a copayment charge on the devices and the assessment fee. Such costs alone may represent a prohibitive financial barrier, apart from any travel costs. A sliding scale for reimbursement would mean that those with no capacity to pay any travel or device-related costs would be fully subsidized, while those who have sufficient resources to contribute to the cost of travel and acquiring devices are assessed on the basis of their ability to pay. Right now, if you earn $200,000 or $5,000, the rules are the same.

To summarize, I believe it is neither fair nor reasonable to expect those applicants who are economically disadvantaged -- and many people with disabilities are -- to incur travel expenses, while those who are fortunate enough to live near an approved centre have no such burden. Ignoring the diversity of circumstances in our population and treating everyone the same, regardless of obvious and significant difference, does nothing to promote fairness in the delivery of government programs. Accordingly, the Ministry of Health should take steps to remove the discriminatory effect of its policy in the administration of this program.

I therefore urge you to support my recommendation that the Ministry of Health should ensure that appropriate financial assistance is available to applicants of the assistive devices program to offset the cost of their travel to and from program-approved assessment centres where such assessments are necessary for the purpose of determining their eligibility under the program for high-technology visual aids.

I'd be very pleased to answer any questions that members may have.

The Chair: Thank you very much. At that point, I'll open up to members of the committee, if there are any questions. Mr Gerretsen, did you have a question?

Mr John Gerretsen (Kingston and The Islands): Yes. I assume we'll be hearing from the ministry later on.

The Chair: Yes.

Mr Gerretsen: Do I understand that currently there are three other centres that have been opened up to do these kinds of assessments?

Ms Jamieson: Additional centres have been opened up, yes, Mr Gerretsen.

Mr Gerretsen: It includes the one in Ottawa where Mr S is from, but that was not the case at the time this matter came before you?

Ms Jamieson: That's correct.

Mr Gerretsen: Okay.

Ms Jamieson: This case, the reason I continued with it is that S is not alone. He is representative of a much larger group of people who may be still too far away from the centres in their current locations. I applaud the opening of additional centres. It doesn't help those people who are still located far away and it certainly doesn't help those people who can't afford to get there.

Mr Gerretsen: The people in northern Ontario already have a special grant available to them in order to access one of the centres.

Ms Jamieson: In the far north, there is something called the northern health travel grant program.

Mr Gerretsen: Did you review at all the government document that is put out by the ministry about the assistive devices program? On page 3 it says:

"What happens next?

"Usually, your doctor will refer you to an 'authorizer.' This is a health care professional registered with ADP."

To my way of thinking, and just a plain reading of it, it doesn't seem to indicate that these people can only be found in effect in four centres in Ontario. It almost makes it sound as if they're available much more readily --

Ms Jamieson: Kind of everywhere.

Mr Gerretsen: -- than is the case.

Ms Jamieson: I believe we have examined most of the material available publicly on the program. I don't have in front of me the document you're reading from, but my understanding is that when people are assessed by their doctor and they're sent to someone for an assessment -- it may be their optometrist; they may have started there -- they end up having to pay to get themselves to the assessment centre, and then there is an assessment fee, but that is partially subsidized, as is the equipment. The only piece of the process for which there is no financial assistance available is getting there in the first place.

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Mr Gerretsen: Just one final question, and I'm just trying to get the sequence of events here. I'm new on the committee and I'm not quite familiar with the processes. You indicated, and in the material that you filed as well, that you wrote a letter to the Premier some time near the end of May. Do I take it that in the past something would have been negotiated through the ministry as a result of letters you would write to the various ministries involved, but in this particular case you didn't get any response at all and that's why you went public with the information?

Ms Jamieson: Just to briefly recap the process that the member asks about, by far the vast majority of complaints that come to my office are resolved. Many are resolved early without an investigation. Quite a number are resolved through the process of an investigation. Some I go to the end and do a report that I put in front of the ministry saying: "Here's what I found wrong. Here's what I recommend to fix it." Hopefully they listen. If they do not, I will finalize that report. That report goes to the minister. There's an opportunity then for the minister to solve the problem, and this has happened in the past. Then I'm obliged to notify the Premier. It has also happened in the past where a Premier has stepped in and solved the problem. Then, if all that fails and I still feel the case is one that ought to be brought to the public's attention, I will table a special report in the Legislature. Then it comes before this committee, and I have an opportunity to present and the ministry to explain why it won't follow the recommendations, and hopefully the committee to have its say on the findings.

Mr Gerretsen: This is only the eighth case where this has happened during your tenure, since 1989, according to the media reports.

Ms Jamieson: I think it's the ninth, in fact, since I've been the Ombudsman. I actually tabled around five in 1993. Two of those were solved a few days after I tabled them. The others went to hearings. Then there was a gap. In the last 12 months, I've had four that I've brought in this way.

Mr Dominic Agostino (Hamilton East): I guess the fact that there is a program to assist residents in certain parts of northern Ontario would acknowledge the program restrictions within the fact that those centres are not readily available, and would mean that there is already a basis there to discriminate against people based on where they live. That has been acknowledged by the fact that the program says we will help people from northern Ontario, as an example, access centres and pay for travel to access centres. I think that principle has been established that the program itself is discriminatory based on travel and ability to get there through friends or relatives and so on.

Do you agree with that understanding of it, that in a sense acknowledgement has been made already and it's just a question of which locations get approved for travel reimbursements, not necessarily that the principle on its own already is there by the northern Ontario grant?

Ms Jamieson: The ministry has acknowledged in the past the difficulty of people in the north to access services and there is a northern health travel grant provided, so there's an acknowledgement there that assistance is required to get there. They have also opened up additional assessment centres, and so they have acknowledged that there's a problem.

I'm saying that despite those two things, they still have not addressed the situation that many people will find themselves in. If you're in Windsor, you still have to travel, even in the south, quite a distance to be assessed. If you're in Parry Sound, if you're in -- Ottawa is okay now but there are many other parts of Ontario where you will. We all know how big Ontario is and what it costs to move around and so to get there is a significant expense.

Some people, I fear, aren't even going to try. They don't have the wherewithal to even attempt it, to ask relatives. Should we be putting people in this position when we say the service is universally available? I don't think so. People have talked about means testing. There's a means test if I ever heard it. If you don't have the means, you don't get the test, in this case.

Mr Agostino: Just briefly on this. The way the program is now structured, if you lived in Windsor, as an example, and you needed the assessment, you may qualify fully for the assessment. Obviously there is a financial means test that is applied for eligibility for ADP. Generally, the income level of a person living in Toronto who is eligible for assistance for the ADP and the income level of a person living in Windsor would be relatively the same?

Ms Jamieson: They don't take into account, as I understand it, income level. This assistance is a benefit that you get if you are approved at an assessment centre, whether you earn a quarter of a million dollars a year or $20. That's not taken into account. The differential is the means with which I get myself to the centre. If you're in Owen Sound, if you're in Windsor, other parts of Ontario -- we can all kind of visually see a map -- you still have to get yourself to the centre.

Mr Agostino: The ministry is suggesting you use family or relatives or friends, and if you don't have them, have they suggested an alternative? If there are no friends or family or support systems around you to get you there, is there any other alternative for an individual to get to this assessment centre?

Ms Jamieson: That's certainly a good question to put to the ministry. I feel myself that to ask people who are poor to access friends to get there for a benefit that they are to be entitled to is discriminatory when you don't ask that of people who have the means to get there. That's not a universally available or a universally accessible program or benefit.

The Chair: I have a number of questioners. I'm going to continue in the sequence I've recognized them. The next one is Mr Pettit, then Mr Preston and then Mr Wood.

Mr Trevor Pettit (Hamilton Mountain): Ms Jamieson, during your investigation, did you determine what, if any, travel costs are covered for this type of program in other provinces?

Ms Jamieson: I didn't investigate this matter in other provinces but I can tell you that the ministry certainly let me know they feel Ontario is not alone.

Mr Pettit: Would you care to elaborate on what you mean by "not alone"?

Ms Jamieson: They feel Ontario is the leader in having the assistance that we do have for this type of program.

Mr Pettit: Since the Mr S case, have you had any other complaints regarding the question of travel to ADP assessment centres?

Ms Jamieson: I'm not sure if I can give you numbers, but I wouldn't require another case to put this forward, because by virtue of the very nature of the circumstances here, there are probably many people out there who can't get to the centre and who wouldn't have the wherewithal or wouldn't be brave enough to speak out and complain. S was, and that's why I picked this case up and looked at it, because S is representative of a group of people.

There is an injustice here, and even if it were only S, I would say there is an injustice here. But there are more Ss behind him. There are more people in this circumstance, and that's why I brought the case forward, because it's fundamentally unfair. Numbers to me are not persuasive or particularly relevant when I find an unfairness in the system.

Mr Peter L. Preston (Brant-Haldimand): I understand you have no problem with the ADP itself; it's the distance travelled. Please, don't anybody think I'm trying to equate a disability with any lesser thing and saying that they're equal. I'm not.

The point I'm going to try and make is that in Ontario distance discriminates against many more people than the disabled. The person who wants to make his views known to this committee or any other committee, who happens to live in Kakabeka Falls, or anywhere else in Ontario, is discriminated against because of travel. The person who wants to reach a site that has jobs is discriminated against because of travel.

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I would think most provinces in Ontario, and most areas where there are large, we'll call them rural areas that extend to the far north, are going to have the same kind of problem.

The matter of travel costs should be reviewed right across the board, and again I'm not lessening the disabled person that can't get here. I'm saying travel costs for a number of different factors, because distance in this province discriminates. If you happen to be close to what you want, you're laughing. If you happen to live in our pristine north -- near north, not far north, because there are arrangements made for some of those things -- in our near north, you fall into the slot between the ones that are a long way away and the ones that are close. I think distance, being the discriminatory thing that it is, travel costs across the board should probably be looked at -- not necessarily granted but looked at.

The Chair: Very good.

Mr Len Wood (Cochrane North): Being from the north, if this person was living in Hearst or Long Lac or some area rather than Ottawa, where people are being partially subsidized -- they're not fully subsidized for travelling to medical centres or to doctors or to specialists -- is your feeling there would have been some aid available?

Ms Jamieson: Yes, it's my understanding there would be some aid available to them to get there.

Mr Len Wood: In the case of Mr S, was there any attempt by the agency that was going to evaluate him to see if he was available for this device, was there any attempt made to them to offer to go to Ottawa to assess him rather than having him travel?

Ms Jamieson: As I understand it, the ministry has looked at providing in-home assessments, or travelling assessment centres to accommodate this problem, but it was not seen to be a practical or reasonable thing to do because you can't get all the specialized equipment to move around that easily. There has been some consideration to accommodate that, but it's not easy to do. That's why the requirement to come to the assessment centre continues, and they've tried to compensate in part by opening other centres.

Mr Len Wood: So there is a centre open in Ottawa now, and one in Toronto?

Ms Jamieson: There is now.

Mr Len Wood: The other two centres, where would they be, do you know?

Ms Jamieson: I'm sure they'll be able to speak to this as well. If I'm not mistaken, they are also in Sudbury and Hamilton, so we've got Hamilton, Sudbury, Toronto, Ottawa, and do we have Waterloo? And Waterloo.

Mr Len Wood: And Waterloo, okay.

Interjection.

Ms Jamieson: And Brantford, of course.

Mr Len Wood: Thank you. In most of these cases, they're brought to the Ministry of Health. In this case, a further step was taken and it was brought to Premier Mike Harris's attention. There was lots of media coverage on the case. Was there any attempt to mediate or negotiate a solution? I guess not, because we're here today. You're at the last step, and the Premier went golfing instead of sitting down to care whether this person gets the devices or attempt for travel or whatever. That's the same thing as when he walked away from the teachers and went golfing. He walked away from the Days of Action in North Bay and went fishing.

Mr Gerretsen: In Iowa.

Mr Len Wood: In Iowa. You're saying in years gone by, when it was brought to the attention of the different ministries, that mediation or some attempt was made to resolve the situation so the discrimination, or the seeming discrimination, was eliminated. In this particular case, nothing was done?

Ms Jamieson: In this case, that's why I'm here, because we have not found a solution. I put forward two options to solve it. One is you make the envelope bigger for the program, because nobody wants to say that people with disabilities should be turned away because they're increasing the availability of travel assistance for some. So increase the envelope, provide people with disabilities who can't afford to, as well as who are far away from -- and they're two different things -- to get there for the assessment. Increase that envelope so that they get assistance for the device, assistance for the assessment fee, and assistance for getting there.

The other option was, okay, if you cannot increase the envelope, look again at the envelope and look at a sliding scale for those who should be granted assistance. Maybe some people should only be getting 10% assistance as opposed to 75%. Maybe others should be getting a larger percentage or completely subsidized if you really can't afford it. I explored options to try and come up with a solution to this that would be fair and equitable and address the problem that S raises. Neither of those were seen to be acceptable and nothing else was seen to be acceptable, with the exception of opening more centres, and I must say I applaud that but that has not fixed the problem.

Mr Len Wood: The northern travel grant over the years has run into some difficulties because of financial constraints. I remember when we were in government the expenditure controls and social contract and one thing or another, and changes were made to it so that, for example, instead of having people travel all the way from Kapuskasing, for example, to Toronto or to Ottawa on every occasion, any further follow-up would be done through the closest specialist, whether it be Sudbury, Timmins or whatever. The follow-up subsidy to that person would be to those areas. It was an attempt to cover more people and yet live within the budget that the Minister of Finance struck at that point in time. Would this be an acceptable solution right across Ontario for the ADP plan, so that people in Windsor, people in Sarnia or people in any other area who are considered to be partially disabled would be able to tap into that fund?

Ms Jamieson: If travel assistance were made available, would it solve the problem? Is that what the member is asking?

Mr Len Wood: They could put a cap on it and say you're going to get 10% of your costs of travel, or 20% of your costs of travel, or whatever, the same as the northern travel grant is.

Ms Jamieson: Particularly in the case where government is saying that ADP is available to all residents of Ontario, regardless of income or means, if that is being said, then I think there's an obligation to make it truly accessible, regardless of income or means, and that is not what's happening here.

I have not examined areas beyond this program in this regard which I think the member is asking about, a broader kind of landscape, and I don't feel comfortable talking about that, but I am saying that in the case where you're saying we have got a program that's universally available, and then to build a barrier into it is really contradictory, and that's what's happened here -- not only contradictory, discriminatory against people who are poor, and many people with disabilities are poor or are located a far distance from the centre.

Mr Len Wood: Thank you.

Mr John L. Parker (York East): You said that you haven't investigated other provinces, but the ministry has suggested to you that they feel Ontario's program on ADP matters is more generous than other provinces. Did I understand that correctly?

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Ms Jamieson: You might want to ask the ministry about other provinces. I did not investigate other provinces; I investigated only what went on here. I can tell you that the point about this not being a requirement under the Canada Health Act was raised. But that's not the issue for me. The issue here is, we have a program that is said to be universally accessible and available, and it is not. Whether other provinces are more progressive or less progressive is of interest but it wouldn't be compelling in this circumstance.

Mr Parker: What does the Canada Health Act require?

Ms Jamieson: If they want to rely on that, I don't think it's persuasive. The Canada Health Act has to do with health services. We're talking about a benefit that people are eligible for once they pass the assessment. So I think it's quite a different matter.

Mr Parker: What is the legislative requirement? Whatever the source, whether it's the Canada Health Act or provincial legislation, what's the legislative requirement?

Ms Jamieson: I have not examined anything to tell me there is a legislative requirement for this, with the exception that if you qualify for assistance under FBA or under the new Bill 142, the assessment fee, that part, will be covered. But there are whole groups of people, as you know, who don't fit that definition.

Mr Parker: When we get into matters of travel allowances, you've mentioned the travel allowance for the north. Is that inherently discriminatory because it's available strictly to people who reside in the north and is not available to others?

Ms Jamieson: No. On the contrary, it is a measure that has been taken to accommodate the fact that people in the north are different -- differently located, located farther away -- and have hardship in accessing services as a result. It's a measure that was taken to bring people who were not equal to the rest of the province up to a level where they can access services. It was a special measure that was taken, quite rightly, because we're not all the same. We are different in this province. Some of us have greater needs than others.

Government, in developing the northern health travel grant said, "We know it's a hardship for people to travel to access health services, therefore we will make this available." It made the system more equitable. That is the problem here. What needs to be addressed is to make the situation more equitable so that all people will have access to the ADP assistance: those who can't afford it and those who are located far away and need special accommodation.

Mr Parker: Does the northern health travel grant inquire into matters of income? What are the criteria for it?

Ms Jamieson: On the specifics of that, you might wish to ask the ministry, or I'm happy to send that to you. I have not come here with the detailed policies and procedures attached to the northern health travel grant. I can only tell you that, as regards this system, the assistance would be taken care of for the ADP centre. I don't believe it measures income, but I could be corrected.

Mr Parker: You say that the northern health travel grant is not discriminatory, but wouldn't it be true that somebody who resides north of the line would benefit from the program and somebody who resides south of the line would not benefit from the program, and the travel costs for someone who resides south of the line might be as great as for someone who resides north of the line?

Ms Jamieson: I think there is that difference, yes, which is why I think that now we've recognized the north and their particular challenges, we need to recognize the poor and people who are geographically distant from the assessment centres if we're truly going to say, "This is universally available."

Mr Parker: Who mandated that it be universally available? Where are the requirements for that? That's getting back to the question I began with.

Ms Jamieson: That's government policy. Government, in correspondence back to me, has in fact said -- just a moment, I'll find it -- "The ministry's position is that ADP is available to all residents of Ontario regardless of income or means."

Mr Parker: Regardless of income or means.

Ms Jamieson: Right.

Mr Parker: If I understand you correctly, that's not a legislative requirement, that's a ministry policy.

Ms Jamieson: Right. That stands open to be quite readily amended as a result. We're not looking for a legislative requirement; I'm looking for the ministry to change its policy, its practice, so that its policy, which is that it's available to everyone, will be carried out in practice; that they will extend the assistance availability to travel as well as to the purchase of the equipment itself.

The Chair: We're nearing the conclusion. We are going to hear from the Ministry of Health, but there are two more questioners, and at that point we'll move to the ministry.

Mr Preston: I just have a short one. This is not about distance, this is about means. Whether 50 miles or 500 miles away, you would object if somebody couldn't get to what they need because of means. Distance really means nothing.

Ms Jamieson: In this case, it was about both. It raises both questions. Actually, I think in the S case, it was more distance than means. In other cases, it's more means than distance. Or they can be a combination of the two. Would I object if someone couldn't afford to get to an assessment centre in downtown Toronto from Orangeville? Yes. If the ministry says, "It is a program; you are eligible for this benefit if you pass the assessment test and you are eligible therefore, as of right, for a subsidy for the purchase of this equipment," yet it says, "Unless you can get here, you can't get it," I say that is discriminatory. That is not making the assistance available to people generally.

Mr Preston: I have a problem with this word "discrimination." The line that's been drawn between the north side of the grant and the south side of the grant, that line is discriminatory. People make choices --

Interjection.

Mr Preston: Well, it discriminates against the person who lives on the south side of the line. He can't get the same grant as the person who lives on the north side of the line.

Mr Gerretsen: Why can't you guys fix that?

Mr Preston: The fact that people live a certain distance from any given thing, whether it's the assistive devices assessment or a Blue Jays baseball game -- again, I'm not trying to equate the two. Please, I'm talking about distance.

Mr Gerretsen: There's a difference.

Mr Preston: I know that. I started off at the beginning -- please, I'm trying to make a parallel, but not a parallel in the seriousness of the problem -- to parallel distances. People choose to live in certain areas. Certain areas have benefits. I feel very badly about a person who lives in the north who can't get to a major centre for their health needs. I also envy them for living in the north. You choose where you live. I believe there should be some way of mediating distance, but I don't like the idea that we're calling distance discriminatory.

Ms Jamieson: Let me be clear: I'm not calling distance discriminatory. I too am troubled by the use of the word "discrimination" as it's being invoked time and again for things like discriminating taste and that society is inherently discriminatory. Let me be clear: What is wrong here is that people with disabilities, who earn less, by our statistics, who have less means than the rest of us in Ontario, are trying to access a program which government says is equally available to everyone. The reality is, it is not equally available to everyone if you cannot afford to get there, as many people with disabilities cannot. Plus, if it's a further distance, it compounds the problem. Then it is inherently discriminatory against those who cannot afford it.

Why am I talking about discrimination here? Because it is the task of government, of ministries that are delivering services to the public to do so in a way that does not provide barriers to the very public they're trying to serve.

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In this case, there are barriers. They have taken corrective steps for the north and corrective steps for locating assessment centres closer to people, but they have not taken into account corrective steps for people who can't afford to get there, and that is discriminatory, pure and simple. It undermines the basic standards that we in this province stand for and in fact publish in our pamphlets and advertise to the very people we're trying to serve. It's that which I focused on. That is clearly a fundamental, self-evident case of discrimination against the most vulnerable. That's what makes it particularly compelling for me.

Mr Agostino: I find some of the comments on the other side to be absolutely bizarre. We talk about distance. You talk about people making choices and then you say, "If you live in Windsor, you have to travel just as far for a Blue Jays game." We're talking specifically here about a program for disabled individuals; we're not talking about choosing to go to a baseball game, for God's sake.

Mr Preston: I'm sorry you don't have the capacity to understand what I said right at the beginning.

Mr Agostino: I think I have the floor. I gave him a chance to speak.

I just think, first of all, it's absolutely bizarre to make those kinds of comparisons. The bottom line is this: Someone on a disability pension of $8,000 or $10,000 a year who lives in Toronto and someone on a disability pension of $8,000 or $10,000 who lives in Windsor should have the same access to assessment, to see if he or she is able to get a wheelchair. I think that is a basic principle that this program has to address. That's really what the Ombudsman is suggesting here today, that access to the assessment should be the same. It doesn't matter where you live in this province, we believe that program should be equal.

If we believe this program should basically discriminate, as it does, against people who live in areas where the centre is not available, and they can't afford to get to that centre, we're going to say: "If you need a wheelchair in Toronto, you can get it because there's a centre right near you. If you need a wheelchair and you're in Windsor, you can't get it because there isn't an assessment centre near you." I think we have a role to try to compensate for that.

This has to be looked at, and you can address it. You talked about it earlier. I think the program itself is flawed in some ways where there is no income limit. I don't necessarily object to the principle of looking at the limit. Frankly, someone who's making $200,000 a year and needs some assistive device in my view should not be eligible for a government program, as someone should who's making $5,000 or $6,000 or $7,000 a year. This is where you can balance that. If we're talking about containing costs, I would say restructure this program. Someone who makes $200,000 a year can afford a hearing aid.

I'm not sure why the program, when it was structured, had absolutely no income provision in it. That is one way of redressing the imbalance without adding to the cost of the program, by putting a reasonable limit on eligibility. I think the members across the way would probably agree with that to a great degree, to ensure that the people who really need it have greater access to it.

I am a little surprised by the fact that the program is totally open-ended -- maybe the Ministry of Health folks can address this -- from the point of view of eligibility. I just don't understand why someone having an income of $200,000 a year should be eligible for a program that someone who's making $7,000 or $8,000 a year through a pension cannot get because they can't travel to a centre. This is one solution to addressing the issue and giving the full access.

Mr Preston: It's called a means test.

Mr Agostino: It's an eligibility requirement. Many programs have eligibility requirements. Social assistance has eligibility requirements. Many government programs have eligibility requirements. It's a reasonable part of things. We're not suggesting that anybody who's making $100,000 a year should collect welfare, obviously. There's an income limit there, an eligibility requirement. The same eligibility requirement, to some degree, whatever that level is set at, could be looked at for this program, to offset it and give people who have a real need access to it.

The Chair: We'll hear now from the Ministry of Health. I'd call on Mary Catherine Lindberg. I would ask you to take your place and introduce those people who are going to be making the presentation. I gather you have not provided the committee with any written input.

Ms Mary Catherine Lindberg: No.

The Chair: Will you be providing the committee with your comments in writing?

Ms Lindberg: I've just got notes this morning, but I can give them to you, yes.

My name is Mary Catherine Lindberg. I'm assistant deputy minister of health insurance and related programs at the Ministry of Health. I have with me today Laurel Montrose, from our legal branch; Eileen Mahood, director of the northern health travel grants; and Gordon Kumagai, from the assistive devices program.

We'd like to thank you for inviting the Ministry of Health here today and providing the opportunity to explain the ministry's position on the case of Mr S. As the Ombudsman has indicated, the ministry's position on the case has been, and continues to be, that funds would not be provided to Mr S to travel to a high-technology vision and assessment centre.

The Ministry of Health has one geographically determined program to pay for travel. Since 1985, the ministry has had a northern health travel grant. This program pays a travel grant to those from the north required to travel for specialized services.

It is also a program intended to put more specialists into Ontario's north, to ensure that those in the north have access to northern services. We have, over the past years, escalated our efforts to increase the number of health care specialists located in northern Ontario in order to increase the access to health care services in the north. This two-pronged approach, with heavy emphasis on the second, exemplifies the Ontario government's commitment to increase access to health care.

First, I would like to indicate that the ministry disagrees with the recommendation of the Ombudsman in this case. The Ombudsman has recommended that the Ministry of Health should ensure that appropriate financial assistance is available to applicants to the assistive devices program to offset the cost of their travel to and from program-approved assessment centres where such assessments are necessary for the purpose of determining their eligibility under the program for high-technology visual aids.

As we have indicated to the Ombudsman in our correspondence and in meetings with her during the investigation of the case, the assistive devices program is funded outside the requirements of the Canada Health Act. It is not a mandated universal program. Ontario is one of the few provinces that provides funding for certain assistive devices. Only two other provinces, Quebec and Saskatchewan, pay for devices for the visually impaired, and one province, British Columbia, pays for augmented communications devices.

Providing funding assistance to people requiring assistive devices gives them increased independence and control over their lives. Assistive devices may allow an individual to avoid costly institutional settings and help them remain in a community. The program provides funding assistance towards the cost of devices and is available to all eligible Ontario residents, regardless of income and means.

To qualify for assistive devices funding, a person must be an Ontario resident with a valid health insurance number issued in their name and have a physical disability lasting six months or longer. People who access the assistive devices program have a wide variation of disabilities.

Assistive devices currently has 127,000 clients. In 1996-97, 14% of these clients were under 19 years of age; 29% were between 19 and 64; 23% were between the ages of 65 and 74; and 35% were over 75 years of age. About 31% of all the applicants in 1996-97 were required to be seen by health professionals for assessment at an assistive devices assessment centre. These clients received custom-made prosthetics or orthotics, life-support ventilators, nasal continuous positive airway pressure devices and high-cost, high-tech visual and communications devices.

There are 297 of these approved assessment centres throughout the province of Ontario. As we have indicated to the Ombudsman in our correspondence and meetings, Ontario is committed to putting the patient first and ensuring access to health services. We are also committed to ensuring that every dollar spent in health care is spent on health care services for patients. The government is committed to the principles of the Canada Health Act, to provide accessible, universal and comprehensive health care to all Ontarians in every part of the province.

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The ministry wants to put access to services as close to home as possible. The preferred Ontario solution regarding access to assistive devices assessment centres is now being acted upon and is increasing the number of assessment centres.

In 1996-97, $5 million was reinvested in the vision and communications category. Some of this funding was used to increase the number and location of assessment centres. Since November 1996, assistive devices has established new technology visual aid assessment centres in Ottawa, Sudbury, Toronto and Hamilton.

The ministry's approach to geographical access is to provide necessary regional centres. This approach has been taken for a number of reasons. Specialists, by their very nature, are few in number and not available everywhere in the province. Maintaining specialty skills requires a certain minimum practice volume and these volumes can only be met if there are enough patients. Support to such facilities, equipment and specially trained staff are expensive and can only be justified if they serve enough patients.

Most people can be assessed locally for many assistive devices, but some require very specialized professionals and supports, clinics and labs. These are organized on a regional basis.

Clearly, the Ministry of Health must be concerned with the serious implications and possible precedent which would be set by a departure from the Ministry of Health's policy not to pay for travel except in very restricted circumstances for those in the north. Were we to pay for ADP assessment centres and for assessment of one type of device as recommended by the Ombudsman, wouldn't it be considered unfair not to pay for travel to an assessment centre for a different type of assistive device such as a prosthesis?

People now know that they have to travel to centres of excellence, such as the Princess Margaret Hospital for cancer treatment or the Hospital for Sick Children for specialized paediatric care. Specialized cardiac care like bypass surgery is not available in every community in Ontario. The cost of these surgeries and the need for a highly developed level of expertise leads to the development of specialized services in specialized centres.

If Ontario Health began to pay for travel for all specialized health care services, where would we draw the line as to what travel we pay for or what travel we do not pay for? If we were required to pay for travel to specialized health care services or even all health care services, the cost would be high and an unreasonable burden would be placed on our current health care budget.

The ministry's decision not to pay for travel outside of the travel to specialists by residents in northern Ontario is based on our need to use all available resources for the provision of health care services themselves. Our position on travel has been consistent over time and is consistent with the general policy of other jurisdictions in Canada. The health care system is based on making health care services universally available and as close to home as possible.

If you like, I can now answer some questions.

The Chair: Thank you very much for your presentation to the committee. I will now open it up to members of the committee.

Mr Agostino: I have a couple of questions. You talked of the fact that it wouldn't make sense financially to open up an assessment centre in every community across the province, and I agree with you there. Obviously if you've got a community where the need is not that great, you may not want to spend that kind of money to bring in the high-tech equipment and what's necessary to do that.

Based on that, wouldn't it make sense to compensate for that by allowing some help for people who don't have an assessment centre in their own community? Wouldn't it make sense to say, "We understand the gap that is there, we understand that it would be financially unreasonable to put a centre in every single town and city across Ontario, therefore we're going to compensate for that by helping you get to that centre," instead of making the decision to put a centre in a small community where the need is not that great, as an example, and it wouldn't make sense financially? Doesn't that seem a reasonable tradeoff?

Ms Lindberg: The issue is, if we pay for high-tech vision aids, because you have to travel from Windsor to London or Hamilton or Waterloo, why would we not pay, then, for travel for any other health services? That's the issue. We don't want to set a precedent based on one high-tech vision aid, because you really do have to travel to get a number of other health care services in the south. We prefer to spend our money actually on the provision of health services.

If there is a critical mass of enough people, we will establish those centres as close to home as possible, but where do we put the limit for the payment for one vision aid or communications device, versus paying for somebody who needs a very expensive and personally fitted prosthetic which they have to go to Toronto for because they are the only people who make it, versus paying for somebody who has to travel for an MRI? We have decided that what we would like to do is make sure that we're spending all the money on health care resources.

Mr Agostino: The concern I have with that principle, and this is not the time for that debate, is that you really are moving clearly away from a universal health care system based on ability to pay. What you're saying is that the principle you're applying -- for instance, if a parent has a sick child who has to go to Sick Kids in Toronto and has the ability and the means to take that child to Sick Kids, that child will be guaranteed access to the best medical care we have in this province for kids. If a parent next door has a sick child in the same condition and doesn't have the means or the funds to take that sick child to the hospital in Toronto, that child, as a result of being in a family whose income is not the same as their neighbour's who can afford to take their child, is denied the health care that may only be available at Sick Kids. Is that a principle you are saying you agree with?

Ms Lindberg: No, that is not the principle at all. Our principle is that we want to spend the money on health care. There is available means -- and currently we have no complaints -- that if your income is low and you're on a disability pension especially, you can make a special application and get special funding from your family benefits group in Comsoc. There are other ways of getting travel costs. Easter Seals helps most of the people who need prosthetics with their travel costs. There are other ways.

We are not trying to say that we have a two-tiered system and are keeping people away from access to health care. What we are saying is that it is important that we are able to supply the health care that is essential for the people of Ontario. That's where we put our resources. There are other ways of getting some support. We have other programs that help do that. So we are not promoting a two-tiered system at all.

Mr Agostino: At the end of the day, though, if someone has no access to the programs, if someone cannot get Easter Seals to pay for their trip to where they have to get the assessment or to go to Sick Kids, if someone cannot get a neighbour or a friend, if someone is exhausted, all those, you do not believe there should be a government program at the end of the day that would kick in and help that person have access to the centre if they've exhausted all the other means you've suggested here that are available. So of two people next door to each other, if one can get there by one means and the other one can't get there after they've exhausted everything, I guess it's tough luck. They're stuck and they can't get that assessment.

Ms Lindberg: But I don't know that it should be the Ministry of Health that gives that, that spends their resources. There are places you can go --

Mr Agostino: So you're not arguing with the fair access, you're asking who should be paying for it, whether it's health or another ministry.

Ms Lindberg: Yes, that's right.

Mr Agostino: It's not a question of the access. Do you not agree, though, that once someone has exhausted all of the available community resources or opportunities to try to get assistance for that, there should be some program in place by government that would help that individual make sure they access that centre or that hospital or that clinic if nothing else is available in their own community? I'm not asking who should be paying for it, whether it's health or Comsoc or anyone else, but that that principle should be established as part of our health care system or our system of helping people in Ontario.

Ms Lindberg: Yes, I think we want to make sure that people have access to the health care they need. One of the basic principles of the Canada Health Act is accessibility to health care.

Mr Agostino: So your major concern is that it shouldn't come out of the health budget.

Ms Lindberg: The money we spend should be spent on providing health services.

Mr Agostino: But you would have no objection to other government budgets that would pay for this program.

Ms Lindberg: I can't make policy for the government. What we're looking at here is whether we should be paying travel grant money to somebody to access a high-tech vision centre. We're saying we don't think that that is where we should be putting our resources. We should be putting our resources in providing for other devices or these devices to the people who require them.

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The Chair: Just to verify, Mr Gerretsen, did you raise your hand? I have a number of speakers: Mr Wood, Mr Preston and Mr Gerretsen.

Mr Len Wood: Thank you for coming forward. There are a number of different ways of making sure that people have access to this assessment. I don't know whether the type of equipment in this particular case is portable and could be moved around. But one of the ways of reducing the costs of the northern travel grant is, as you had said in your comments, to encourage specialists and various people in the medical field to move to the north, or if they don't stay there permanently, to go up on tour and treat people.

We have large numbers of communities that don't have any dentists; they don't have any doctors. There are 1,000 or 1,500 people living in towns where they don't have any specialists whatsoever, yet the Ministry of Health makes sure that dentists go there on a regular basis, that general practitioners go there and other specialists go to those communities and treat a number of people at the same time. Would this not have been possible in the case of this person who seems like he's at a very low income level, a poor person, where he's being told, "If you can get to the centre, if you can scratch enough money to get to the centre, the Ministry of Health will probably pay for this equipment, but if you can't make it there, you're out of luck"? Would it not have been possible to have a mediation process kick in and say we have to find a way of assessing this person in Ottawa rather than just letting him fall through the cracks?

Ms Lindberg: We got the centre opened in Ottawa so that didn't happen again. As I understand it, this person actually has withdrawn his application -- could now access this centre and has now withdrawn the application.

Mr Len Wood: In this particular case the situation could be resolved, but there are other situations, as I talked about earlier, that I'm sure are going to develop.

Ms Lindberg: I don't really want the Ministry of Health people to think we're not compassionate. We'd really like to be able to focus on making sure that people have access as close to home as they can. However, our budget is set very restrictively according to what we can pay for. We would like to pay for devices because there is a huge demand for all kinds of devices; we try, and we have people go to their local assessors and look at what can happen. We work with these people to try to get them accommodated. We don't have very many complaints about people not having the ability to access these centres, because we work with the people to get them to the centres in whatever mechanism we can.

Mr Len Wood: Your argument is that if another case were to happen in Sarnia or Windsor or in North Bay, you would attempt to either get the service to this person or get the person to the assessment.

Ms Lindberg: We'd work with the person to make sure they were not denied access to that. We would not necessarily pay for their travel, but we would make sure there's some mechanism available for them, and tell them the mechanisms that are available.

Mr Len Wood: In this particular case they went to the Ministry of Health, went to Premier Mike Harris, and everybody just ignored the situation, from what I can gather in the information I have.

Ms Lindberg: I don't think the individual came to us and asked for this. The Ombudsman's recommendation has now proceeded through. Our argument to this day is that we, as the Ministry of Health, should be paying for health services. That's where our money should be spent. We don't think we should take the limited money we have for this particular program and use that money to pay for travel, which would give us less money to pay for the devices, and the precedent that would set for other devices.

But if individuals phone us and say, "We can't access, we have no means of accessing that centre," we work with the person to find them a mechanism that will help them get there, whether we work with the Ministry of Community and Social Services through their disability pension, whether we work through a service club, Easter Seals, however; we work with them. When they call us individually, we have people who will work with them to get them access to that centre.

Mr Gerretsen: I have a number of questions. It just seems to me that the program is not universally accessible if people can't get to the program. What's your total budget for this program?

Ms Lindberg: It's $80 million. That's not just for vision aids. That's for the assistive devices program.

Mr Gerretsen: How much does it cost you on an annual basis to operate the centre in Ottawa?

Ms Lindberg: I don't know; about $50,000.

Mr Gerretsen: How many people are seeing this centre on an annual basis?

Ms Lindberg: I don't know. I just started. About 408 people access high-tech vision aids. That's for 1996-97. We had 408 people access the high-tech vision aids.

Mr Gerretsen: Just so that I'm clear, this is not a program that is mandated under the Canada Health Act?

Ms Lindberg: No, it's not.

Mr Gerretsen: It's just a program that Ontario got involved in a number of years ago.

Ms Lindberg: Yes.

Mr Gerretsen: According to the pamphlet that you hand out -- and I assume that the assistive devices program pamphlet is something that comes out of your branch of the ministry.

Ms Lindberg: Yes.

Mr Gerretsen: It only deals with people who have long-term physical disabilities, so if you have a short-term disability, you're not eligible under this program. Would you say that most people on this program, from the statistics you gave us earlier, are seniors? I believe you said 68% were over 65 and are either seniors or are living on a disability pension.

Ms Lindberg: I would assume the number would be at least that high living either on disability pensions or seniors, because the program is based on having a long-term disability. Usually those people are on some kind of disability pension or they're retired and are seniors on a pension.

Mr Gerretsen: With all the statistics you keep, you must have some idea of what the average income is of the person who applies under this program.

Ms Lindberg: We have not and do not have the right to ask anybody their income.

Mr Gerretsen: Okay. I find it very strange that a person only goes through this process, according to your pamphlet, after examining the individual. "The doctor" -- who I presume is the person's own doctor -- "will describe or confirm your physical problem on the form." So this person has already gone through the medical examination with their own doctor. Then, "You will be asked to sign the form so that your doctor can release your diagnosis to people who will help you select devices best suited to your needs." That goes to an authorizer, I assume.

Ms Lindberg: Yes.

Mr Gerretsen: Then you say, "Usually your doctor will refer you to an authorizer." That's the individual who is in these authorization centres, correct? That's the person hired by you to make sure that -- no?

Ms Lindberg: No. They're registered with us, but they are assessors who do the work for us. They get paid by OHIP if it's a doctor. We don't pay them from the program.

Mr Gerretsen: Are these people, the authorizers, the 292 people you were talking about?

Ms Lindberg: No, there are thousands of authorizers. You can go to a local physiotherapist and get authorized to get a wheelchair, or you can go to the local optometrist and get authorized for a low-vision aid. There are all kinds of authorizers across the province. These 297 specialized centres we have are for high-tech, especially those who require different kinds of assessment, whether it's a titanium prosthetic, when a child needs an artificial limb or that kind of thing. Then they must travel to one of these assessment centres.

Mr Gerretsen: So there are two processes. You have to be assessed by one of these 297 assessors, who I assume are across the whole province, and then you have to go to a centre.

Ms Lindberg: No. It's a progressive thing and depends on your disability and on what device you're accessing. If you just need a wheelchair, then you go to your local physiotherapist, who will then measure you up and do what is needed to get you a wheelchair. If you need a magnifying glass for your eye, you can go to an optometrist who is registered with us and they can order that and we will pay for it. But if you need a titanium prosthetic artificial limb, then you might have to go to Bloorvale to get that assessment, because they are the people who make those very specialized items. So there's a range of where you have to go, depending on the specialized expertise required for the fitting or the requirement of those types of things.

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Mr Gerretsen: Yes, but what I'm trying to get at is, what percentage of people who get help under this program actually end up at one of these centres you've now set up across Ontario? What percentage are we talking about?

Ms Lindberg: There are only 408 people who need high-vision aids, and we've got eight centres now and we're going out for four more, so we'll have 12 vision aid centres and there are 400 people across the province who require it.

Mr Gerretsen: So each one of these vision centres would on average serve about 30 people.

Ms Lindberg: Could be, yes. They're not a separate infrastructure centre. They're usually a specialized centre that becomes an authorizer for us and does this for us. They're doing a lot of work other that our work.

Mr Gerretsen: Right, but it would still average out to about 30, and the one operation in Ottawa costs you $50,000, so that's about $1,500 dollars a patient. What I'm asking you is: Wouldn't it make a heck of a lot more sense to pay the travel costs of these people than to set up all these centres that are used by the relatively small number of people who are eligible for your program?

Mr Gordon Kumagai: The centres have equipment etc, so there's an infrastructure they have to have. If you were to pay the travel, you'd still have the problem of having the infrastructure. There are staff salaries etc, so there are various components, and $50,000 in itself is not large enough. It would be the equivalent of maybe one FTE, one full-time equivalent person. It obviously is a limited amount.

The 400 is currently with the four existing centres. The four that started up are in the startup state, so they're not at full capacity. The number they're seeing is more than the 30 each that you're suggesting. It's not really 400 divided by 12, because four aren't established yet. The four are in startup phase, so they're not in full operation, if you like.

Mr Gerretsen: What I'm getting at is, has anybody in your ministry -- you're so concerned about the dollars and cents, and I totally agree that the dollars and cents ought to be used for health care. But if people don't have access to the health care, then they cannot benefit from it either. I think the question of access is integrally related to the extra health care dollars. That's why I don't buy your argument at all that you don't want to use your money for travel in these particular cases. The travel cases get these people the access. Has anybody done a study, a financial study, as to whether or not it would make more sense to pay the travel expenses of these people to go to two or three of these centres across Ontario rather than setting up all these individual centres that, as you said, have their own infrastructure costs? They've got their own staff costs, and what have you.

Mr Kumagai: The money we're providing is temporary funding to get them established. It's not the ongoing operating costs, so there is the equipment etc that they're buying with it. If we went to paying for people to travel to these centres, you couldn't just take the $50,000 and apply that to the case, because they still have to go someplace and have the work done. It's an add-on. It's not really a substitution.

Mr Gerretsen: No. But do you have an answer to my question, that before you went into this program of establishing the centres, did you actually do a cost analysis as to whether or not it would make more sense to bring people to the existing centres rather than to set up all these individual centres?

Mr Kumagai: I'm relatively new in this position and I'm unaware of whether that was done, but I can't say with certainty.

The Chair: We have a number of other questioners and it's time to return, if you will.

Mr Douglas B. Ford (Etobicoke-Humber): I'm listening to this conversation here. There are very few things in this world that are absolutes, and that's a situation where it's nice to think theoretically that you can do all these things. But if somebody lived up in Churchill, say 100 miles off the Saskatchewan border in Ontario --

Mr Gerretsen: Manitoba border.

Mr Ford: -- if they radioed to you that they needed this type of service, you mean you would fly an airplane or something within 100 miles and track through, pick them up, bring them out, get them back here and service them? This is ridiculous. You can't take people constantly by these things.

You're providing a service. That doesn't mean you have to go and get them, bring them in, service them and take them back. We service in everything we have, in all the health care, regardless of whether it's for transportation or whether it's hydro power. We don't set up a hydro line way out in the boondocks for these people. We put a generator out there or something to assist them. You can't have airports in every little vicinity. It's ridiculous. The same with this travel thing; it escalates.

It's nice to say, "We'll pay your fare here," and all of a sudden somebody says: "I'm going to get a blood test. Will you pay my fare?" The whole thing escalates into one big mushroom, and that's where it starts. I think you're providing an excellent service regardless of whether it's in health care or any other services. You're providing a service for them. You don't take them by the hand, everybody in this world. If they had to have a heart bypass or something like that, they would have to travel to wherever it's being done, either in Toronto or Montreal or wherever they specialize in these cases.

There are indigent people who do not have the money to do these things, but you assist them if it's possible. If it's not possible, then it's unfortunate. That's the way the whole world revolves.

The Chair: Mr Ford, do you have any further comments?

Mr Ford: That's all I have to say, that everything is not an absolute. If you'd like to start and say it is, well, it's not. I could name hundreds of situations like that and they're just not absolutes. It's like somebody living in the wilderness up north wanting their roads plowed out. I've been up north. I've lived up north, I've lived down south and there are certain things you have to put up with. If you're living in the backwoods there, you can't expect a snowplow. If you say we're plowing the roads, that doesn't mean you're plowing for every little Tom, Dick and Harry with a cabin out in the wilderness. You know that. That's a fact.

Mr Len Wood: Why do they plow the 401?

Mr Ford: Because there are several hundred thousand cars paying for the 401.

The Chair: Mr Wood, if you'd direct your comments --

Mr Ford: So one guy lives out in the boondocks and you're going to plow his road?

The Chair: Mr Ford, if you would direct your comments to the Chair; and Mr Wood, Mr Ford has the floor. The next speaker to be recognized is Mr Pettit.

Mr Pettit: There's no doubt this is a complex issue, but I'd like to get back to the "limited means" thing a little bit. Are people of limited means eligible for, or do they have recourse to, out-of-pocket expenses such as, let's say, if it were Mr S? I just want to cut to the chase.

Ms Lindberg: Not from our program.

Mr Pettit: You say that someone in that situation can apply to other groups for funding, such as the Easter Seals etc. Is that correct?

Ms Lindberg: Yes.

Mr Pettit: What if someone in that situation cannot get the funding from Easter Seals or whoever the case may be?

Ms Lindberg: If they're low-income and they're eligible for social assistance, social assistance will give them a special grant to travel.

Mr Pettit: What if they're not? What if they're just above the line?

Ms Lindberg: If they phone us and talk to us, we would probably go to a service club such as the Rotary and ask them.

Mr Pettit: You would, on their behalf?

Ms Lindberg: We would work with them to help them get some kind of means.

Mr Pettit: So in the end, one way or another that person will get to that assessment centre?

Ms Lindberg: We work very hard to make sure there's nobody denied assessment.

Mr Pettit: But will they definitely get there, yes or no?

Ms Lindberg: We'd work very hard. If they decided they didn't want to go or wouldn't take the money from the service group that was offering to pay for it -- we can't make them go, but yes, we would work very hard so that they would have a means to get there.

Mr Pettit: Okay. I'd like to get back to the member for Kingston and The Islands, his point, and that is: Yes or no, was there a study ever done on paying travel costs versus just saying, "We'll open assessment centres here, there or anywhere else"?

Ms Lindberg: No, but if --

Mr Pettit: No?

Ms Lindberg: No.

Mr Pettit: Why not?

Ms Lindberg: One of the things I just indicated was that 127,000 people are eligible for ADP. The average travel cost in our northern travel grant is $100. That's $1.27 million it would cost us if we put $100 on each person who was eligible, and that's pretty low, to travel to these assessment centres.

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Mr Pettit: On the other hand, how much does it cost to open up all the assessment centres?

Ms Lindberg: Probably not a lot of money. These centres are already there. They are ophthalmology centres for high vision and there are ophthalmology centres that are already doing other kinds things. It might be a physician doing cataracts as well and looking after glaucoma who will also be an assessor for us and he happens to have this extra equipment he can use for high-vision aids.

We're not setting up an infrastructure centre. The centres are already there, in existence. All we're doing is assisting them to maybe purchase a different type of equipment or do some training for some existing staff. They become what we call an assessor and then the people go there and get assessed. We're not putting out millions of dollars on equipment to these centres. We're assisting them to get some training and to maybe upgrade some of their equipment, but very little money. They're already there. They're usually run by ophthalmologists in these centres who are doing other things than just the assessment for the high-vision. It's not a separate little centre you go to and get this work done.

Mr Preston: It's private enterprise already and then they take this on.

Mr Pettit: In questioning the Ombudsman, I think she indicated that she was unaware of any complaints other than Mr S's. Is that correct?

Ms Lindberg: Yes.

Mr Pettit: Did you not say that? Since Mr S's complaint, were there any other complaints?

The Chair: Mr Pettit, if you could confine your questions to the delegation before us --

Mr Pettit: Are you aware of any other complaints since Mr S?

Ms Lindberg: On vision?

Mr Pettit: Yes.

Ms Lindberg: No. We are aware of no other complaints on --

Mr Pettit: The bottom line here is that you say you will go out of your way, or the ministry will, to help anyone through any avenue to get access to this centre. What if I am very hard-pressed, I live in Timbuktu and you can't get Easter Seals or Comsoc or anybody else to help me? Where am I left? What happens to me? Or in 99% of the cases --

Ms Lindberg: We do not have and could not pay for that out of our program because it would be counter to the Provincial Auditor's rules about where we spend our money. Our money is spent for devices, so we could not spend it. But we would work with the local hospital, with the local long-term-care people, with whoever we could to try to find a means to get that person where they have to go. We do that not just for assistive devices; we do that if they have to go for cancer treatment and they don't get cancer treatment.

Mr Pettit: If I've overlooked something here, what was done in the case of Mr S in terms of helping him to pay any costs?

Ms Lindberg: I don't think we should get into an individual's case. That's probably not what we should be discussing. What we've been told and what we know now is that he actually decided to do something different. We don't know.

Mr Pettit: Okay. Thank you.

The Chair: Very good. We've got a number of questioners now. It's getting a little more interesting: Mr Preston, Mr Wood and Mr Gerretsen, and with that we'll try to conclude the questions at this point.

Mr Preston: I think what's you're saying, and despite the attempt at a cheap shot what Mr Agostino was saying, and what I said right from the beginning was --

Mr Agostino: On a point of order, Mr Chair: For Mr Preston to suggest that there was an attempt at a cheap shot --

The Chair: I would ask you to confine your comments to the subject of the moment. Thank you.

Mr Preston: Okay, I'll do that. Point made.

We all kind of agree that possibly travel grants for the whole spectrum, not only for health, should be looked at, and not by health because health should be spending money on health; possibly by Comsoc, possibly by -- whatever. The situation of distance is partially being ameliorated by your not setting up but your taking on new testers all over the country. At the end of the day, when everything has been exhausted as far as the person's means and the government's means, that in theory a person can't get to where he wants to be, in fact there is somebody out there who helps them get what they need. Is that what you're actually trying to tell us?

Ms Lindberg: Yes, I think so.

Mr Len Wood: The cost of transportation, whether it be train, bus or car from Ottawa to Toronto -- you're saying this particular individual dropped the case, but the frustration he must have gone through in exhausting all the avenues he had and end up going to the Ombudsman, which is the last resort. Has there been any follow-up to find out what his needs are now, whether he's still permanently disabled and needs this particular device or whether because of a $25, $30 or $40 additional cost -- I'm sure it wouldn't be much more than that from Ottawa to Toronto. What kind of life is this person living now when he knows the equipment would have been available to him? But I guess he had exhausted all the avenues, whether it be Easter Seals or whatever, because of a small fee.

What kind of situation is he living in now compared to what he could have been living in if we had either sent a person to his residence to have him assessed and get him the equipment or leave him in the condition he's in right now? Has there been any follow-up on that?

Ms Lindberg: No, we wouldn't follow up because we probably wouldn't interfere with his privacy. We were told that he has a satisfactory solution. Whatever that means, I don't know, and I can't get into specific comments about the case.

The Chair: I would caution that we need to deal with the very broadest definitions in the case here. I would ask members to contain their questions that would perhaps create any indiscretion in the information provided to us.

Mr Len Wood: I agree with you, Chair. But I'm not saying anything here that is any different than what was in the Toronto Star on October 1, 1997. I'm concerned.

It's quite obvious from the media attention we've had here today that there is going to be more coverage of this particular battle between the individual with the support of the Ombudsman and the Ministry of Health. I point out that it's also gone to the Premier, Mike Harris, for him to intervene and the Premier hasn't taken any action on it.

The Conservative members on the committee are saying that it's okay that people in Toronto or in the large centres are treated in one way and people in remote areas and other areas are treated another way. An example, "We plow the roads in Toronto, but why do we have to plow the roads in some of the remote areas in other communities?" It's ridiculous, some of the comments that we're hearing today.

As far as I'm concerned, if a person has a serious car accident in Toronto and needs a helicopter or a plane to get him to a hospital, he gets it. In Kapuskasing or Hearst or whatever, if a person has an accident in the bush and needs a helicopter or an air ambulance, we don't question the cost. The doctor phones up for an airplane or a helicopter and they're delivered to the proper place they need treatment in. This is the way I would like to see it continue, rather than hearing some of the comments like, "If there are only three or four or a dozen people living in a community, we can't plow their roads and we can't give them the services they need." It's ridiculous.

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I know you're not going to be able to respond to that situation, but it's frustrating for me as a northern member hearing some of the comments that come out, that because we get assistance to travel to specialists or hospitals we're being treated in some special manner, or because our roads are plowed in northern Ontario we're being treated in some special manner compared to people who live in the big centres.

I think I've pretty well exhausted my frustration at some of the Conservative members on this committee, the way they are speaking on a case of this kind and drawing in the other examples.

The Chair: I guess we'll conclude with a comment. Mr Gerretsen, please.

Mr Gerretsen: They're not just comments, but also some questions. By the way, the reference to road clearance is rather a bad example to use since the province has just about downloaded every road in Ontario. In eastern Ontario we've got four highways left, so local municipalities will now be doing the snowplowing across the province.

I'm somewhat concerned that some of the government members feel that this particular case has been solved because the gentleman gave up and therefore there's no problem here at all and we can somehow do away with it. It's the principle we're dealing with here. It's because of the principle that I take it the Ombudsman brought this matter before us, that if we really want this program to be universally accessible, then the question is: If a person cannot get to the place where they can become eligible for the program, are we truly making it universally accessible? That's the situation we're dealing with. Whether or not this particular case has been resolved in a certain way is not important.

What I'm also concerned about is, in answer to a question the assistant deputy minister asked, that she's not aware of any other complaints of this nature going to the Ombudsman and therefore it's just an isolated case. I don't think the government members can have it two ways. If it is an isolated case, then why can the ministry not make funding available in emergency situations where all other resources such as Easter Seals -- I've got some familiarity with that. I was involved in my Rotary Club for a number of years. Rotary Clubs across the province are very heavily involved with Easter Seals and they provide this kind of funding for people. But I can tell you there are many people who, if it weren't for those kinds of programs, probably couldn't access a lot of programs such as the assistive devices program if it weren't for that kind of funding.

There are people out there who simply don't have those kinds of facilities available, and they're probably in the more rural areas. There may not be a Rotary Club that's involved with Easter Seals or there may not be other services available so that they can access funding that way. Surely to goodness the ministry can adopt a policy, in situations where all other resources have been looked at and have been found lacking and the person still doesn't have money to access this kind of program, that case money can be made available.

It seems to me -- and I don't mean to take a potshot at you or at the ministry -- that it's a question of turf protection. You don't want to see your money being used for services other than health care, yet these centres are being opened up. We all know something about what it costs. Sure, other services are provided at these centres as well, but there are costs connected with that.

I just wonder, if a financial analysis were done, whether or not it wouldn't be a heck of a lot cheaper to assist those people who really need the financial aid to access the services in three or four centres across the province than setting up all these different centres across the province. To my way of thinking it's a question of turf protection. Let's not blame another ministry. If you send it to Comsoc, it will take years to get that resolved. There are people out there who need access to these services right now.

Why don't you people in the ministry, with all the brain power you have there, come up with a solution so that you can help those people? I'm quite sure we're not talking about that much money, particularly if you say these kinds of situations don't occur all that often. That's the challenge I leave with you and with your minister, to do something about it.

Mr Parker: I just want to return to the specific case of Mr S for a second, because after all, that's the case that has been brought before us. I presume he brought his difficulty with travel arrangements to the attention of the ministry. Is that correct?

Mr Kumagai: Yes.

Mr Parker: What steps were taken to assist him?

The Chair: Would you mind introducing yourself for the Hansard?

Ms Carol Jones: I'm Carol Jones. I'm a manager, professional services, with the assistive devices program. It's my understanding, because unfortunately what you're seeing are a few new faces here, that some attempt was made to have someone sent to his home. We were not able to get an assessor out there. He did go to an ophthalmologist for a low-tech assessment and received some funding from ADP that he put towards the cost of the device he finally purchased.

Mr Parker: If he had been on social assistance, would there have been a fund available to assist him with travel costs?

Ms Jones: I believe there are some discretionary funds through social assistance, but I'm not sure if he was eligible for social assistance.

Mr Parker: Can you just review again the types of steps that are taken by the ministry to assist with travel arrangements for people who find it difficult to travel to assessment centres?

Ms Jones: Generally speaking, the individual would contact one of the professional staff at the program. Often they will contact social assistance. If the person is on the home care program, they may go there. We then try to see with some of the non-voluntary agencies if we can get some help there, or with the Rotary Club, that type of thing. Basically it's contacting these at different agencies and asking if they will help. We can't really make them do any of this but we will try to make every effort to have that happen. It does not happen very often.

Mr Parker: This has been brought before us as a case where access to the ADP program was denied because of difficulty with travel. How many cases do you have where access to the program has actually been denied because of travel problems?

Ms Jones: I'm not aware of any being denied, and in this case the person received some funding from ADP, so it wasn't denied in the sense that he didn't receive any dollars from us.

The Chair: If there are no further questions, thank you very much for your time.

Mr Gerretsen: I have a motion, Mr Chair, that the Minister of Health should ensure that appropriate financial assistance is available to applicants of the assistive devices program to offset the cost of their travel to and from program-approved assessment centres where such assessments are necessary for the purpose of determining their eligibility under the program for high-technology visual aids.

This is the recommendation of the Ombudsman.

The Chair: Is that written?

Mr Agostino: On a point of order, Mr Chair: Before we go further, can I ask for unanimous consent of the committee to allow the Ombudsman to clarify the issue -- I think there's a tremendous discrepancy here between the number of cases, or whether this case is resolved -- to give the Ombudsman the opportunity to simply clarify the issue or the resolution of the case and whether other cases are available? There is contradictory information there.

The Chair: First, we have a motion. We should deal with the business in sequence. The motion is first.

Mr Agostino: The point of order is important to the motion, Mr Chairman. I would ask you to ask for unanimous consent to have the Ombudsman clarify that.

The Chair: We can defer the motion.

Mr Agostino: Mr Chairman, I believe a point of order is allowed.

The Chair: Do we prefer to deal with the point of order first? Is it the wish of the committee to deal with the point of order?

Mr Agostino: We have to. We have no choice.

Mr Pettit: We'll deal with the point of order.

The Chair: Dealing with the point of order, the request, I gather is to --

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Mr Agostino: Do we have unanimous consent to allow the Ombudsman to clarify the point of eligibility with this case and other cases that may be available. It's simple; no questions or anything like that.

The Chair: Very good. Perhaps we could ask you to join us at the table again for a clarification.

Ms Jamieson: It has been the practice that I'm asked to speak to whatever the ministry has raised and try and sum up, and I will speak to the issue the member is raising about clarification.

In the case of S, S did receive assistance for low-tech vision assistance, gave up on the question of high-tech and so made the personal sacrifice to do without that assistance from ADP because that was not available. So yes, there was some assistance, but it wasn't what he was after. It wasn't what the program is supposed to provide, the high-tech vision assistance which is different than the low-tech. Low-tech: There are many more facilities available to manage that. There is not for high-tech. So that is the case of S.

Much has been made about numbers of people and complaints and so on. It is in the nature of this kind of issue -- let's remember who we're talking about, people with disabilities, people who are among the most voiceless in our society, people least likely to complain, least likely to raise the issue and push it forward and have the assistance available to them to bring these issues forward time and again. You are less likely to hear from them, frankly, so I would ask members not to put a lot of eggs in that basket.

I would also clarify that I did not say this is the only case of which I am aware. This is the case I have brought forward to the committee and on which I've tabled a special report. Any other inquiries I may have in the field, whatever, I can't talk about as yet, nor would I. Under the act I'm not allowed to, but I ask you to look at the statistics the ministry has brought forward, the numbers of people who've come forward for this assistance. The clarity of our own statistics: We know how many people in the province are disabled. We know what their income level is. We know they are poor.

The other thing I want to just review is the ministry's reasons for not taking this step: "We don't want to set a precedent. We can't address the barrier here because we'll have to do it everywhere." I think in those cases what you end up with is a situation where the only alternative then is to fortify the barrier which exists today and which my investigation has shone a light on. That's what happens when you get to the end of that rationalization.

You are basically saying: "If you cannot get yourself to an assessment centre because you are too poor or too far away, you do not have access to this program. We will not address the problem, because although we recognize it, we'd rather spend our money elsewhere." That's what I'm hearing from the ministry.

I applaud them for wanting to spend money on the health services in the province, but I think if that's the case, and if they fortify this barrier, then they are basically saying, "This program is not universally available." It is fundamentally flawed for the ministry to make that statement because accessibility is fundamental to universal availability and it's the access that is being denied in this case.

Finally, let me say to the committee that it is in this committee that you have the opportunity in a non-partisan way to address these issues, to balance the policy considerations that are inherent in this case and I think the self-evident unfairness that is here against the fiscal considerations. I say again there are a number of options available to the ministry to deal with this which involve expanding the envelope or leaving the envelope like it is.

One of them is to guarantee that at the end of the road, if people have tried to access every available means and they can't get it, then will the ministry undertake to make up that difference and make sure that person with a disability in fact has access to the program?

I just seek again the committee's intervention in this, the committee's support for my recommendation, so that those people out there who need these assistive devices will truly have access to them as the rest of us do in Ontario.

The Chair: Thank you, Ms Jamieson. With that, we have heard the Ombudsman's report and the response from the ministry. We also have before us a resolution or a recommendation by Mr Gerretsen. I would ask if the committee for its full deliberations could move in camera to discuss the resolution, which I think is perhaps the expected action of the committee. With that, if there's no objection, I'll ask for permission of the committee --

Mr Gerretsen: Why are we moving in camera?

The Chair: Most frequently the decisions of the committee or the discussion about the actions to be taken by the committee are made and done in camera.

Mr Gerretsen: I don't agree with that at all. I think people have a right to know the rationale, how we come up with a decision, whether we support something or not.

The Chair: I could ask for information on what the protocol has been. It's my duty to act upon the wish of the committee. The clerk could perhaps tell us what has been the past practice of the committee in its deliberations on issues of this nature.

Mr Pettit: I don't think the government members are opposed to staying on camera.

The Chair: That's fine. But what has been the past practice? I think we should know up front.

Mr Pettit: Has it always been one way or can it go either way?

Clerk of the Committee (Ms Tonia Grannum): It seems as though it has been that in the past the committee has gone into closed session.

Mr Pettit: For what reason? Do we know?

Clerk of the Committee: Probably just precedent, history, but it's totally at the wish of the committee.

Mr Preston: I think if we're dealing with a name or something like that, we should do it in camera, but all we have is a Mr S here and Mr S is not really the problem, the travel is the problem. I don't have --

Ms Jamieson: Mr Chair, this issue has been raised with me and I neglected to raise it in committee. I apologize because I did raise it with the Chair and the clerk privately. I know committee has on occasion deliberated in open session and in private session. They have also come back to vote in public session, and indeed two or three cases ago there was a request from one committee member that there be a recorded vote.

The last two times that has not been the case. We've merely reconvened and then you've told us what the result was, but I don't know how the vote is coming out or the reasons for the committee's decisions, and I have then asked, quite a bit actually since the last case, what all this means, why the vote is not recorded when there have been instances in the past where that has been the case.

I merely want to raise for you that I have had occasion to have a peek at this issue, trying to figure out what my answer would be and that's what I've learned.

Mr Gerretsen: I think Mr Pettit made a very valid point. We have not discussed individuals' names in this particular case. There's absolutely no reason why the discussion can't take place in public and I would move that unanimous consent be given to have this matter dealt with in public.

The Chair: Without any further delay, the Chair has heard that we will stay in open session, and let's continue. What we have before us now is a resolution. The resolution is on the floor and address your comments to the resolution. The first speaker in order of recognition is Mr Agostino.

Mr Agostino: I obviously speak in support of the resolution. Sometimes when we hear cases like this, and we've had the ministry say these cases are few and remote, you wonder what the bureaucracy is here to serve. You think of the fact it's one of the few cases I suppose that's come to attention. There clearly is a gap there. Let me suggest with all due respect that it has probably cost the taxpayers of Ontario significantly much more to have this process this morning than it would've to get this gentleman from Ottawa to Toronto and get that damned assessment done.

There's got to be some flexibility and discretion within bureaucracies. It can't be this massive thing somewhere that people can access. There's got to be some room there for some flexibility in individual cases to apply that. A person's exhausted the community resources to try to get there, the service clubs and so on. A decision to spend $100 or $200 to get this person from Ottawa to Toronto to get an assessment done should've been made at the ministry level. It would cost taxpayers a hell of a lot less than it's costing taxpayers this morning to have this thing on.

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We've got to think a little bit of user-friendly bureaucracy and access to government. That thing has got to start happening more. I don't think it's happened in this case. To me it's not an issue of a lot of money being involved; it's simply a question of ensuring we don't deny people access to programs based on where they live. If you live in Windsor and you can afford to go to Toronto or London for an assessment, then you may get that hearing aid. If you live in Windsor and can't afford it and you've exhausted the resources, you can't get it. Most of us would agree that is wrong.

That being said, there's also a need to review the criteria. This is not a question of a government policy and an opposition-government issue. It really is non-partisan. The program was established three governments ago. There are flaws in the program. Often it's a program that's difficult to access. The program may be too generous from the point of view that it's open-ended. That's a question that maybe needs to be addressed as well. That could offset some of that.

It's not a question of partisan and the government and the opposition in this case; it's a question of knowledge. There's a weakness within the program that we have a responsibility to fix. If there's blame here, probably it has to go around to all governments that have been involved in this program. They haven't fixed those things in the past. It's not a question of the Tory government is doing something wrong and the Liberals and NDP before that did something right. The program is well-intentioned; it's a good program; it helps a lot of people. It's not perfect. It has room for fixing.

I think we've got a responsibility to help that along. I would urge the government members to support this. It's not going to be a lot of money. At the same time, if there's any pressure that can be put upon the government to review the eligibility criteria, I would urge the government members to do so as well, because I have a problem with someone who has an income of $200,000 a year or $100,000 a year -- as an example -- accessing a government program that someone who has $8,000 or $10,000 cannot. I'd rather help the individual who has a pension of $8,000 or $10,000 access that program than someone who can afford to buy a hearing aid and to access that.

It's not part of the motion, but it's part of what I'd like to see done with this as well. I urge the government members to look at this, support it and realize it's not a government-opposition issue. It's just a question of fairness that we all agree has to be addressed.

Mr Len Wood: I also am supporting this motion brought forward by Mr Gerretsen for the simple reason that I don't believe, from hearing the presentation, that this situation has been resolved as yet. We have an individual here who was asking for some type of assistance in his travel from Ottawa to Toronto to be assessed for high-technology visual aids. He's been denied that. He went to the Ombudsman and the Ombudsman tried to intervene at the Ministry of Health level and at Premier Mike Harris's level. The situation, as far as I'm concerned, is still not resolved.

I personally don't know the financial situation of this individual, but his priority obviously is keeping a roof over his head and trying to get a little bit of food to eat and proper clothing, and not being able to spend the extra $50, $60 or $100 that it costs him to improve the quality of his life. I believe that moving from the low visual aid that he's getting right now to high visual aid is probably going to improve the quality of his life. If we have one person out there who is caught in this vicious circle, it's one person too many.

Northern travel grants: Nobody gets the full cost of what it costs them to travel from a northern community to a specialist in southern Ontario or to travel within northern Ontario, especially if they fly or take other means of transportation. But there is some assistance available. In this particular case I would encourage the Ministry of Health to look at individual cases of this kind and say that there is no other alternative but to find some way of subsidizing this person for travel.

It's in Ottawa. It can probably be resolved quicker. But if other cases of this kind come up, this resolution would help to resolve it so we don't have people out there caught in a vicious circle, and at the end of six months or a year saying that we've exhausted everything and there's no other place to turn so that I just have to sit back and live in the condition I'm in, even though I know that, if I could reach long enough, there is assistance available, but I'm being denied it because I don't have that extra 10 cents in my pocket to be able to get that service.

Mr Preston: I will be voting against this motion, not because I'm against assistance for travel but because the money will be coming out of the wrong pot. Comsoc has discretionary funds that, when everything else is denied, can be accessed. Health funds should be used for health, not for travelling, not for bus fare, not for plane fare. If it is absolutely necessary that any person get assistance, it should come from another source other than health care. We have many, many things we have to spend money on in health care that we can't afford and are looking for money to be able to buy. Bus fares should be somewhere else.

Mr Gerretsen: I'm very surprised at Mr Preston's comments because health money is already being used for travel purposes. I come from Kingston, as you know. I know that on a regular basis patients are being brought in from Moosonee and Moose Factory to Kingston General Hospital. They fly them in with planes and helicopters etc. Air ambulance is being used all over the place. There's nothing new about this.

I'm afraid that even though good intentions may be there by the person who just spoke, in effect all we're doing is just pushing it on to another department within the government. Basically we're not helping those who should be helped. It's all the same taxpayer. We hear about it from the Premier all the time. It's all the same tax dollars. Whether it comes out of Ministry A or B or C really doesn't matter.

The bottom line is there are people out there who need these services. They need to be able to access them. If there's any way we can help that, then we should be doing it. The resolution is broad enough that it doesn't say the money should come out of the Ministry of Health; it simply places the emphasis on the Ministry of Health, that they should help and assist the people to ensure that financial matters do not stand in the way of accessing the services in this particular program.

I hope other government members would agree with us and vote in favour of the motion.

Mr Parker: In all of this it's important we remember that the program in question is not mandated by any legislation. This is not mandated by the Canada Health Act. It's a program that's offered by the Ontario government. It's not offered by all provinces. It's offered according to its own terms. I haven't heard evidence that access to this program has actually been denied. I've heard it's been difficult. I've heard it's more difficult for some than it is for others. That in itself doesn't particularly shock me. I don't know that we will ever eliminate discrepancies in the ease with which certain people can gain access to certain programs.

Mr Preston made that point very effectively. I agree with the point he made. I've heard some argument whether the ministry is wise in addressing the problem of access by opening up new assessment centres rather than by providing travel allowance or travel assistance. I've heard speculation on that point, but frankly I haven't heard any figures so I think any speculation on that point is highly suspect.

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The ministry has addressed the issue of access. It has chosen to address the issue of access by increasing the availability of assessment in various centres across the province. Maybe that's an effective means of addressing the issue, maybe it isn't, but there hasn't been evidence brought before us this morning to enable us to make a judgement on that point. The ministry has taken its view and has pursued its policy and it's important for us also to bear in mind that the ministry has acted on the issue of access since the case of Mr S arose.

Whether Mr S had difficulty with travel or not is, as the Ombudsman has pointed out to us, entirely irrelevant to us; the issue is at most a question of access in principle. The ministry has addressed that question, in principle. The ministry has addressed it by opening up new access centres. We don't have a case before us dealing with issues of access under the current system, under the current day, with the number of access centres that are available out there. There are more access centres available out there now than there were when the case of Mr S arose. There are more access centres that are going to be opened in the future.

It's an issue that is being addressed by the ministry. It has been addressed since the case of Mr S arose, and as we heard in the evidence before us today, the issue continues to be addressed. The issue is being addressed by the ministry and this committee lacks the evidence to determine whether it is being addressed adequately or not.

It is prejudicial and it is presumptuous of this committee to suggest we have the answers to the issue. Bear in mind that access, according to the evidence before us, has not been denied to anyone, under the case of Mr S or anyone, or to anybody else. It is a matter of it's more difficult for some than for others, but it's not impossible for anybody, according to the evidence before us.

There are cases out there where programs are in place, and have been in place, and were in place at the time Mr S's case arose. We have the northern health travel grant program. That has been in place for some time. That is a program to assist a certain group of people in dealing with the cost of travel to gain access to this type of treatment. Whether that is an appropriate program or not is not before this committee to judge, but that is a program that is out there to address this issue.

We've also heard evidence that for someone on social assistance travel assistance is available to that person. So it's not as though somebody on welfare is denied access to this kind of treatment because of the cost of travel, because there are programs directly targeted to assist people who are on social assistance. There are programs in place to deal with this matter. There are programs in place to deal with the north, there are programs in place to deal with people on social assistance, and the ministry has taken the step of opening up new access centres since the case of Mr S arose. Anything else on the question of what the ministry should do and what would be more cost-effective is strictly a matter of speculation on the part of this committee.

But one thing that is not, and need not be a matter of speculation, is the point the ministry made, which is that if the type of recommendation that has been put before us in this motion is passed, then there are any number of other cases that could be brought forward to say, "If you get travel allowance for high-technology visual aids, why not a travel allowance for my particular situation?" There would be a whole host of applications for travel assistance. Bear in mind that this program, the visual aid program, is not mandated by legislation.

Mr Gerretsen: So what?

Mr Parker: Mr Gerretsen asks, "So what"? As everyone in this room has conceded, either explicitly or implicitly, we are ultimately involved with drawing a line. Ultimately that's what has to happen. A line must be drawn. Unless you're just going to open up the pot and say, "Help yourself to whatever you need, and come on in and be assessed," there is going to a line --

Interjections.

The Chair: Direct your comments to the Chair, please.

Mr Parker: Some people are going to fall on one side of the line and some people are going to fall on the other side of the line, and the question that ultimately has to be determined is, where do you draw that line and who's in and who's out? One of the pressures that will be brought to bear by the reality of that is, if the line is drawn at too high a level so that generous travel arrangements are made to gain access to an optional program, there will be pressure on the government to begin questioning whether it can afford to carry those optional programs.

Those are the kinds of decisions that are going to have to be made. I don't believe those are the kinds of decisions this committee should be making. Those are policy matters. Certainly those are matters that the Legislature can guide the government on, and the government will ultimately establish its policy, but that's the kind of pressure we would be inviting if we moved ahead on the recommendation made by Mr Gerretsen.

We are dealing here ultimately with determining where to draw a line which must be drawn. We are dealing here with a matter where the service being provided is not mandated by legislation, and we are dealing here with a matter where there is no evidence before us that treatment was denied. We are dealing here with a matter where treatment is more readily accessible to some than it is to others, and as Mr Preston points out, that's a fundamental reality of life that must be dealt with as matters of policy, but I don't see that as a matter this committee needs to get involved in in the degree of detail suggested by this recommendation by Mr Gerretsen.

The Chair: I will recognize the people who had raised their hand. We have Mr Pettit, Mr Agostino and then Mr Gerretsen.

Mr Pettit: I think the member for York East most eloquently addressed the fact that the access in principle question has been addressed by the ministry. To my colleague from Hamilton East I would say he somewhat craftily tried to turn what he's calling a non-partisan issue -- he described that in a very partisan way, somewhat craftily.

To the member from Kingston and the Islands I would say that I don't believe this is a money issue, personally. If he thinks it's just small amounts, as small as that may be, he may want to go to his federal counterparts and ask for some of the money back that they extracted -- some $2 billion from us.

Beyond that I would suggest we should put this to a recorded vote.

The Chair: You're asking for the vote. We have speakers recognized by the Chair, Mr Agostino and Mr Gerretsen and Mr Wood.

Mr Agostino: First of all, what I said earlier, and frankly the comments by government members have changed my view, was that this was a non-partisan issue. I said that if there is blame for the gaps in this program, it should be spread out to all three governments that have been involved in the administration of this program. If you check back in Hansard, it would totally say the same thing I've just said now.

Obviously, it's unfortunate. You wonder why people get cynical about governments and members and how we operate around here. Here's an issue to me -- these government members like to talk about common sense, the whole thing, the Common Sense Revolution, everything's common sense.

Here we've got a situation where clearly, when you look at it on its merits, it makes a great deal of common sense to allow some discretion in how it's applied. We've got a situation where people, whether it's one or 10 or 20, are falling through the cracks; a pretty good program that needs some fine tuning. Of course the government members must toe the government line and say no, because the government, the Minister of Health, the bureaucrats and the Premier's Office don't want us to do this. I find that extremely frustrating and I get angry because we are talking about a group of people who are vulnerable here.

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We talk about drawing a line. Frankly, when it comes to wheelchairs, when it comes to hearing devices, when it comes to visual devices, when it comes to respiratory devices for people in need in this province, I'm not going to draw that line. That line is not important to me. If you're talking about someone who is disabled and cannot afford this, we're saying: "Well, we're drawing that line. I'm sorry, buddy, it's tough luck. You don't get that wheelchair because we have drawn that line for you." That is not something I buy into. I think it's disgraceful that we have a government that thinks in such a manner.

We're not talking about choices here. Someone doesn't choose to be confined to a wheelchair. Someone doesn't choose to need an artificial limb. Someone doesn't choose to need a respiratory device. If we can't be compassionate enough, as members of the Legislature, and can't find some way of saying to those five, 10, 15, 20, 100 people in this province who fall through those cracks of a program that we can help them, there's something wrong. What the hell are we doing here? What are we here for?

I get extremely annoyed. I've dealt with disabled people in my working life and in my private life since I started working, since graduating from school. I see the hardships and difficulties people face, I see the struggles people face, and I see government, instead of helping, getting in the way of that. If we can't find it within ourselves to say, "We're going to allow some flexibility in this program to help those few" -- Mr Parker tells us, "We're going to open up new centres." Mr Parker tells us that many of the issues have been addressed.

If we are to believe and agree with what he says, then obviously we're talking about a few people who are caught here, who fall between the cracks. Why can't we have some flexibility in this huge bureaucracy that we call government to help those individuals? As members, when we've identified those gaps, if we can't stick up and try to help those individuals who fall through the cracks, where do they turn to? Who are they to turn to? That's what I think I'm here for. That's what I think you're here for.

I just get extremely annoyed that we stick to this bureaucratic approach to how we run this place and how we run this province and what we say to people who are most in need. I say to you again, it is not a matter of choice. These are people who have this need and these are people who often will have gone through -- I've been involved in a program. I spent years working at the Ontario March of Dimes. Yes, our service clubs help. We've been involved with service clubs. We've also been involved in car washes, for God's sake, to try to get someone a wheelchair. Those things happen. But at the same time, there are people who can't get the help and can't get some more access to the program. We're not talking about a lot of money. If that expands to a wheelchair, I have no problem saying to the public and the taxpayers of Ontario, "Yes, I believe it's appropriate for the government to pay for someone to have an assessment so he can get a wheelchair if they can't afford it."

I have no problem defending that principle, in here or anyplace outside of here, or any of these other devices that are provided. I'm not afraid of that. I think most Ontarians are compassionate enough and frankly much more compassionate and understanding than members of this government who are going to deny this basic, fundamental right of Ontarians. I think it's absolutely disgraceful.

Mr Gerretsen: It's unfortunate this matter has taken the turn it has. As you know, many of us are from local government and in local government we pride ourselves on the fact that we deal with problems the way they're presented to us and we try to find a solution. It's perhaps unfortunate that we, as a Legislature or as a committee, don't get involved in enough policy matters like we have an opportunity to do here. I would have thought this would be a situation that could be fairly easily resolved.

For Mr Parker to somehow suggest, "The problem was resolved in this case by the minister getting the money somewhere," that's exactly what this motion is addressing. This motion isn't saying the Ministry of Health should pay; it's saying the Ministry of Health should ensure that the appropriate financial assistance be made available. Whether it's through private sources like Easter Seals, whether it's through other service clubs, whether it's through other ministries, somebody should be advocating on behalf of those people who don't have access to these programs. That's what it's all about: access. It's all right to say, "We've got a program out there," and whether or not it's mandated by the Canada Health Act is totally immaterial.

The government of Ontario decided 10 years ago, 12 years ago, that this was a program it wanted to get involved in, and it has been adopted, I assume, by every government since then. Now the question is, do we want to make that accessible to as many people or not? If the person gets the money from some other source or can make their own way down to the interview centre, obviously they should pay for it. Nobody is going to deny that. Somebody over there talked about generous travel allowances. Who has said anything about generous travel allowances? We're talking about the actual cost of a person being able to access this particular program. That's all we're talking about.

If the money can be found somewhere else, fine, but let somebody advocate on behalf of them. We're saying the Ministry of Health are the people who should be able to do it. They've got the knowledge. They've got the resources. They know where the money can be made available. For a member to say, "It's not a money issue," it's a money issue to the person who cannot access a particular program. It's a money issue to them or else they wouldn't be applying for it, they wouldn't have gone to see the Ombudsman about it. Sure it's a money issue to them. If they had the money in their pocket, they wouldn't be going through all these steps. They'd get on the bus or on the train or what have you and go to one of these centres. Access in principle has been denied if a person cannot get there because of a financial lack in order to get there.

About drawing the line, yes, I draw a line here: that for everybody who has a right to a particular program, that program should be made accessible to them. If they don't have the financial means to get there, then somebody ought to step in and help them get those financial means. If it's from the private sector, a private source, more power to them, but if not, then surely the ministry has an obligation to see these people can in effect get the necessary assessments done.

I'm going to ask the government members to take another look at it and see if you can support this resolution, which is a very general resolution.

Mr Len Wood: I hope the government members would support this resolution as well because it seems there is a clear pattern that's been developing over the last two years plus a few months. Three or four years prior to that, during that whole span, most of the cases citizens had that were brought to the various ministries and to the Ombudsman were resolved with the involvement of the ministries, whether it be the Ministry of Health or other ministries. If it couldn't be resolved there, it was brought to the Premier's attention and mediated, negotiated and resolved. But now it seems there is a pattern being set that the almighty dollar means more than anything else in this province.

Mike Harris has sent out the word clearly: "I'm not going to listen to citizens' complaints. I'm going to use my backbenchers and the Conservative majority I have to brush all these citizens' complaints under the carpet, and as the complaints come up, we're just going to ignore them. I'm going to close the door. I'm going to go fishing or I'm going to go golfing, and I couldn't care less, unless you're talking about cutting money and giving money to the rich taxpayers in this province, or cutting people off welfare and reducing the amount of money they have."

It seems there's a pattern that has been set over the last two years plus a few months that was not there during the three years prior to June 1995 when this government was elected. I would hope that the Conservative members would finally be able to stand up and say, "Okay, if Mike Harris is not going to do his job, we're going to raise it in caucus and we're going to raise it publicly out there," as some of the backbenchers have done. They've spoken out against what the government is doing and spoken out against what the Premier is doing. That's what it's going to take to get this Premier and the cabinet and the government heading in the right direction and saying that citizens who have complaints should be heard. If they're justified in their complaints, we should find a way of mediating them and dealing with them, rather than having them come to this committee where there is a majority of Conservative members on the committee. Mike Harris is going to get his wish again. He's going to have another complaint swept under the carpet and pretend everything is well in Ontario when everybody knows it's not.

The Chair: Any further comments?

Mr Preston: I call the question.

Mr Pettit: A recorded vote.

The Chair: I would ask members to review the resolution before us: "The Ministry of Health should ensure that appropriate financial assistance is available to applicants of the assistive devices program to offset the cost of their travel to and from program-approved assessment centres, where such assessments are necessary for the purpose of determining their eligibility under the program for high-technology visual aids." It's a very specific resolution.

You've heard the question. I'll call the vote. This is a recorded vote.

Ayes

Agostino, Gerretsen, Len Wood.

Nays

Ford, Parker, Pettit, Preston.

The Chair: The motion is defeated.

There is one other item on the agenda but I don't think the committee has time to consider it, so I'd ask the clerk to schedule a committee meeting some time next week.

The committee adjourned at 1231.