ANNUAL REPORT, PROVINCIAL AUDITOR, 1991
CONTENTS
Thursday 7 May 1992
Annual report, Provincial Auditor, 1991
CUPE local 2001
Roman Schyngera, president
Roy Flemming, member
Steve Eadie, secretary-treasurer, Ontario Council of Hospital Unions
Al Wahid, president, CUPE local 1744
STANDING COMMITTEE ON PUBLIC ACCOUNTS
*Chair / Président: Mancini, Remo (Essex South/-Sud L)
Vice-Chair / Vice-Président: Cordiano, Joseph (Lawrence L)
Callahan, Robert V. (Brampton South/-Sud L)
Cousens, W. Donald (Markham PC)
Duignan, Noel (Halton North/-Nord ND)
*Frankford, Robert (Scarborough East/-Est ND)
Haeck, Christel (St Catharines-Brock ND)
*Hayes, Pat (Essex-Kent ND)
Johnson, Paul R. (Prince Edward-Lennox-South Hastings/Prince Edward-Lennox-Hastings-Sud ND)
*O'Connor, Larry (Durham-York ND)
*Sorbara, Gregory S. (York Centre L)
*Tilson, David (Dufferin-Peel PC)
Substitutions / Membres remplaçants:
*Fawcett, Joan M. (Northumberland L) for Mr Callahan
*Murdock, Sharon (Sudbury ND) for Mr Johnson
*Owens, Stephen (Scarborough Centre ND) for Ms Haeck
Sutherland, Kimble (Oxford ND) for Mr Duignan
*In attendance / présents
Clerk / Greffière: Manikel, Tannis
Staff / Personnel: McLellan, Ray, research officer, Legislative Research Service
The committee met at 1007 in room 228.
ANNUAL REPORT, PROVINCIAL AUDITOR, 1991
Consideration of section 2.8 of the Provincial Auditor's 1991 annual report regarding the inspection audit of the Toronto General division of the Toronto Hospital.
CUPE LOCAL 2001
The Chair (Mr Remo Mancini): The standing committee on public accounts is called to order as I see a quorum. The standing committee had promised Local 2001 of CUPE that we would hear its views. They have been kind enough to join us this morning. We have with us this morning Roman Schyngera, president; Al Wahid, president, Local 1744, Toronto Western Hospital; Steve Eadie, secretary-treasurer, Ontario Council of Hospital Unions, and Roy Flemming, Local 2001.
The committee had previously agreed to allow the representation this morning to conclude within one hour. I believe we'll break it down to 30 minutes for your presentation and 30 minutes for questions and answers. So I'd like to turn the floor over to you.
Mr Roman Schyngera: If I may, can I give the copies of the brief?
The Chair: Absolutely.
Mr Schyngera: First of all, I'd like to thank the committee for inviting us here. I'd like to introduce -- oh, I guess you've introduced us.
The Chair: You can do it again.
Mr Schyngera: I'll dispense with that, if I may, then.
I'd like to note just a couple of corrections to the brief. I want to apologize. We didn't realize it was the committee "on" public accounts rather than "of" public accounts on the first page. There are a few other references, if you will bear with me. When we talk about the Charlie Conacher wing through the brief, it'll be the Max Bell wing. It was an error there. When we talk about the tropical disease unit, it should be referred to as a high-isolation unit. It's the generic name, I guess.
The Chair: When you get to those points, you can help us along.
Mr Schyngera: Okay. There was a time when the Toronto General Hospital and the Toronto Western Hospital were vibrant and flourishing members of the health care community. Prior to the merger of the Toronto General and Toronto Western hospitals in 1986, Toronto General Hospital had a staff of approximately 6,000 to 7,000 employees, of which 1,500 were represented by CUPE. Toronto Western Hospital had approximately 4,500 employees, and CUPE represented 800 of those employees. The two hospitals had approximately 1,800 beds between them -- Toronto General had approximately 1,000 and the Toronto Western Hospital had 800 beds -- and combined operating budgets of over $280 million.
This was the time before the merger that was allowed to take place between the Toronto General and Toronto Western hospitals in 1986. These hospital administrations claimed that about $2.5 million could be saved by amalgamating the two institutions. There are some references to appendix 1 there to look at. It was claimed that if the administrative services for the two hospitals could be amalgamated there would be benefits from economy of scale -- that is, it would cut down on the number of staff needed and mass purchasing could be done at a lower cost for both hospitals.
As will be seen in the rest of this brief, these cost-saving theories have not proven to be true. In fact, the number of administrative staff at the two hospitals has increased since the amalgamation, at the cost of decreasing the front-line service employees and of bed closures. The proposed cost saving for bulk purchasing has also not materialized. There has been a series of costly purchasing choices that have proven to be ineffective and a waste of valuable resources.
We have five basic recommendations we believe will be an effective way to bring the Toronto General and Toronto Western hospitals back on track, as well as being a good plan for the future of health care in Ontario.
1. We call on the provincial government to launch a royal commission into the future of health care in Ontario, one that will accept input from not only the employees involved in health care but also the users of health care in this province and the communities that benefit from having health care facilities.
2. We would like to see a moratorium on job cuts or layoffs in the hospital sector for at least two years, until we can sort out the long-term reform of our health care system.
3. We believe it is time for an impartial investigation of the financial dealings of the Toronto Hospital dating back to the merger, one that is similar to the recent investigation carried out at St Michael's Hospital.
4. We believe the hospital should be required to be part of an open financial registry, which would allow the citizens of Ontario to be sure of where their money is being spent at hospitals. This should be accompanied by an equally open tendering process for contracts or moneys that are to be given by the hospital.
5. We believe full democratization of all hospital boards in this province is required. The current arrangement which gives the board of directors and trustees control over hundreds of millions of dollars of public money is an unacceptable arrangement. It should be required that these officials be responsible to the citizens of Ontario.
When the merger between the Toronto General Hospital and Toronto Western Hospital was first proposed, many business efficiency arguments were put forward as the reason why the merger should go ahead. There was no effective consultation with the members of the community that is serviced by these hospitals, nor was there effective consultation with the employees of the hospitals. The two boards of directors claimed this was a cost-saving measure that would greatly benefit both hospitals and proceeded with the merger as if that was the only consideration. There were constant statements to employees that no jobs would be lost and they should trust management to take care of their interests. See appendix 2 in this regard. As we have seen, this was a false promise.
As well, management made representations to the public that both hospitals would continue to be general service hospitals that would provide basic care to everyone. This turned out to be a false promise. In November 1991 the board of trustees of the Toronto Hospital, which is now the name given to the combination of Toronto General and Toronto Western hospitals, approved a new mission statement for the hospital which states that they no longer will be full-service hospitals. Rather, it establishes a number of specialization areas of the hospitals. See appendix 3 in that regard.
In addition, the Toronto Hospital has laid off over 300 employees in recent months from CUPE and Ontario Nurses' Association bargaining units. There has been a decrease of staff in all of the bargaining units at the Toronto Hospital through both layoff and attrition of employees. That is, when an employee leaves for any reason, he is not replaced. As well, the Toronto Hospital has shut down approximately 145 beds in the past months, in addition to the 200 beds that were closed in 1990. Due to attrition and closings, Toronto General Hospital now utilizes approximately 650 beds at its full capacity and Toronto Western has 230 beds. This is a considerably smaller number of beds and staff than were in place at the two hospitals in 1986.
Management has projected that there will be a $7-million to $15-million deficit for the Toronto Hospital -- this figure, by the way, is based on the 1991-92 calculation that we were given back in November -- although this figure is constantly under adjustment and it's difficult to know exactly where the possible deficit may be. According to the most recent documents from the Toronto Hospital, with payments from the Ontario government with respect to pay equity and other promised funds it is possible that there may be no or very little deficit from the coming fiscal year of 1992-93. However, it is difficult to judge from the hospital's budget whether this is a realistic expectation on its part. See appendix 4 in regard to the budget. This is a problem with hospital administration in this province that will be dealt with later in these submissions. There will likely be a deficit for the fiscal year 1991-92. This is a first such deficit for the Toronto hospitals in many years. The question is, where have all of the proposed savings gone?
When one examines the situation at the Toronto General and Toronto Western hospitals, a very real question arises as to why the savings have not materialized. There needs to be an independent investigation to determine if there has been mismanagement on the part of the board of directors and trustees of this institution. There does appear to have been inappropriate and excessive spending. Conflicts of interest have developed that are indeed staggering.
What is very apparent is that the supposed advantages of the merger have not emerged. Indeed, matters have worsened at both hospitals since the merger. The business efficiency model that has guided the management of these hospitals and which pushed for the merger has proved to be a great failure. They ignored the wishes of the employees and the community when they entered into this merger. They are still ignoring the concerns of their staff and community. The point is that management is ignoring these concerns because it can. There's no democratic accountability for their actions and for the way they have used public funds. The merger was pushed on to staff at the hospitals, and now the staff is having to pay the price of the merger. Clearly, someone other than the boards of hospitals needs to be making decisions about the future of our hospitals and our funds.
The spending that has gone on at the Toronto Hospital is truly astounding. We will document below just a few of the many spending habits of the hospital that raise serious concerns about the use of public funds. Since the merger there has been extensive and continuous contracting out of maintenance and renovation work at both the Toronto General and Toronto Western hospitals. F. D. Begley and Associates has been given a considerable number of contracts by the hospital administration to carry out numerous projects, and it is unclear the dollar value of the work that has been awarded to it. In fact, on the corporation information that has been filed with the Ministry of Consumer and Corporate Relations, the address given for F. D. Begley and Associates is 200 Elizabeth Street, which is the mailing address for Toronto General Hospital (Appendix 5).
I may note here that the auditors were told by the hospital when we went to lobby them some time ago, back in early 1990, that Begley didn't exist as far as an entity within the hospital is concerned. After going through three corporate searches, we found that indeed the address of F. D. Begley had been in our hospital and has been part of our hospital since roughly 1983. That's just for your notation and it's part of the appendix.
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This company has been reaping what are believed to be enormous profits from its activities at Toronto Hospital. Many of the jobs that have been contracted out to Begley and its subcontractors could have been done by plant operations departments at both hospitals at a much cheaper cost and time efficiency. The employees of plant operations have spoken to the union about countless examples of contracted work that has had to be redone because it has been done poorly or because it was done in an unsafe manner.
It is difficult to estimate the final amount the hospital has paid for all the work that Begley and Associates has done at the hospital. In the past four or five years Begley and Associates has been involved in major projects in every building in our hospitals (for example, see Appendix 6).
While more and more work has been given out to the contractors, the plant operations staff has been reduced to about 30% at the hospitals. The plant operations staff could do the same work for approximately $18 per hour, which is their rate of pay under the collective agreement, whereas the cost to have Begley and Associates complete the work is from $30 to $65 an hour. There is no reasonable explanation for why so much work has been contracted out by the hospital administration.
The hospital administration has told CUPE that all work by Begley and Associates has ended and all capital projects will cease for the next five years. However, Begley employees and subcontractors are still at the hospital completing work on projects that have already been started and there's no reason to believe that Begley and Associates will be leaving the hospital premises in the near future.
In this time of financial restraint and cutbacks at the hospital, all possible savings measures should be utilized and this includes having in-house maintenance done by staff of the hospital rather than contractors. Since this report was written, Begley is in fact vying for other contracts in the hospital that we know of at the present time.
Many years ago the process for the operations staff and management was to sit down and go over the bids and possible work that would be required of contractors. There were consultations to decide whether it would be feasible to proceed in that manner. With the Begley contracts, there was no discussion with staff as to whether this was a viable alternative. In fact, there was no open tendering process at all.
No one knows whether in fact Begley had the lowest bid for the work at the hospital and no one really knows what the true cost of having this work contracted out has been. Secrecy in the use of hospital funds must end. Also, the use of contractors at the hospital should end immediately and any work that needs to be done given over to plant operations departments at both hospitals.
The situations that are described in the following pages are just a few examples that raise questions of poor management and lack of quality assurance by the hospital and its administrators.
This is where the tropical disease unit should be noted as a high-isolation unit for specific reference. We always refer to it and that's why we put it in there as a tropical disease unit.
The Chair: It's the what again?
Mr Schyngera: It's the high-isolation unit. It's intended for exotic types of diseases they were going to study and were funded for, I believe.
The unit was built at the hospital. Approximately $11 million was spent on the unit that was meant to be a high-isolation unit. However, when it was built, the plumbing from the unit was not kept separate from the existing plumbing in the hospital, with the result that it cannot be used. By the way, there's more to that. There were knobs that were left inside which would have contaminated people. The dial systems and knobs should have been on the outside. So it was a mess from top to bottom in how they'd completed the project.
It appears this $11 million has been spent on something that will never be used because of the poor planning in the development of the unit. Likewise, the Charlie Conacher wing, which should be referred to here as the Max Bell research wing, was built at a cost of approximately $26 million and has hardly been used since it's been built.
A revolving door at the Toronto General was obtained free by the hospital administration in Nevada at a gambling/gaming house that was going bankrupt at the time. Somebody got it for free because they were closing down there. This should have meant a great cost saving for the hospital. Instead the renovations associated with the door have cost approximately $1 million. From the time of its installation the door has never worked properly and the hospital has had to pay for a maintenance employee to come up from the United States to fix and maintain it, as well as the cost of normal maintenance (Appendix 7).
The door was built to be used in the American south and no one knew whether it could actually work in the winter weather of Canada. In addition, the hospital had to build a sliding door beside the revolving door to accommodate wheelchairs. This was a problem that was anticipated by staff before the revolving door was put in, but the administration proceeded with the revolving door at this great cost.
The clocks at the hospital were recently replaced so that digital clocks are now in use, at a cost of approximately $1 million. Surely this was an expense that was not needed at this time.
New electrical beds were recently purchased for the intensive care unit at Toronto General Hospital at a cost of approximately $1.2 million for approximately 60 beds. Initially the plan explained to the staff was to buy five of these beds, as well as others, and give them a trial period before deciding on a model to buy. Instead the hospital went ahead and purchased 60 beds without consulting the employees working in the unit. The beds that were bought do not work properly and are already requiring a great deal of maintenance after less than a year in use. This is another example of the hospital administration ignoring the wishes of staff and proceeding with the costly purchase of something that is not what staff required.
As well there has been a mass purchase of beds for other wings of the hospital. However, since many beds have closed in the hospital, these new beds are not now needed, and someone has failed to cancel the ordered beds for the units that are no longer open. Approximately 50 of these new beds, and I've heard there are more, are now stored and not in use in the Max Bell wing, at a cost of approximately $10,000 to $15,000 for each bed.
There are seven skids of new and unused IMED pumps that are stored in a wing of the Toronto General. They're not being used because the doctors do not like to use this kind of pump that the hospital bought. They're also not in use because the hospitals have reduced the number of beds by 500, and so there is not a great demand for these pumps. The pumps cost approximately $2,000 each. Money has been spent for products that will never be used.
By far, however, the greatest apparent waste of funds in recent times has been the purchase of the computer system. The hospital administration has spent $85 million, on the direct purchase of the system itself, for a computer system that does not work. This figure does not include the cost of increasing the complement of clerks to deal with the computers while decreasing the number of front-line service personnel at the hospitals. There have been numerous and very serious problems with the system. There have been patient files that have got lost; there have been billing statements and billing accounts that have been mixed up or lost in the system.
Overall it is a computer system that does not work. What is worse is that it is a computer system that staff do not want and cannot use. Each department has developed its own internal system, and the proposed benefits of an integrated computer system have disappeared because of the poor system that the hospital has attempted to force on staff (Appendix 8).
As a result, we know of computer terminals being stored in the basement of Eaton Building at the Toronto General and the Toronto Western Hospital. These are computers that have never been used and probably never will be. As well, we know of computer terminals that have been compacted and destroyed before they have ever been used.
We are aware the hospital cannot return to the days of paper and pencil. However, surely there is a computer system that is reliable for the hospital. The one that has been put into place is not working and in fact is a detriment to the hospital and a risk to patient safety.
We have seen documents showing that operating money has been used to cover the cost of computers, which should be a capital cost (Appendix 9). This is a reverse of what was done at St Michael's Hospital, where they were borrowing capital funds to cover operating costs. In either situation, funds are being used for purposes they were not designated for.
This computer system is useless and is actually dangerous for patients. On top of the initial $85-million cost of this system, it was purchased from California and cannot be serviced locally, which also increases its cost. A $5-million computer mainframe, which is unusable, was bought to go into the system. It has been sitting, uncrated, for many years in the loading docks. This mainframe was bought from a manufacturer in Korea in anticipation of an acquisition of a computer system. However, the mainframe cannot be installed because it does not meet CSA standards for electrical equipment.
All this can only lead to the asking of questions as to whether the hospital administration has mismanaged an immense amount of money and is now unwilling to discuss with staff a way of making the system workable. There are numerous examples of poor purchasing and bad administration by the hospital, as seen above. We have beds that are not used and are stored, equipment that doctors do not use because they do not like it and so it is stored, and there are many other examples at the hospital. Mass purchasing, because of the merger, was supposed to be one of the areas where money could be saved, but because of the poor management of the hospital administration, purchasing is actually a drain on the resources of the hospital. This cannot be allowed to continue.
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The hospital administration also claimed that by amalgamating the administration functions of both hospitals, much money could be saved. However, instead we have seen the clerical staff at the hospitals increasing since the merger. At the time of the merger the clerical staff was approximately 500 to 600 full-time employees. In 1991 the clerical staff numbered approximately 900 full-time employees at TGH.
There has been an equally dramatic increase in the number of part-time clerical staff. This has happened at the same time that approximately 600 beds have been closed and hundreds of front-line service positions lost to layoffs or attrition. It seems apparent that the hospital does not have a priority of patient service. By its actions, the hospital has shown that it is more concerned about pushing paper than about the care given to patients in their hospitals. Patients seem to come second in the model of hospital administration that has been set up at Toronto Hospital.
Toronto Hospital estimates it may be $7 million in the red for the fiscal year 1991. Those estimates have also gone up to as high as $15 million. No one knows what the deficit truly is because the hospital refuses to let anyone look at its books.
Provincial Auditor Douglas Archer reported major problems when he tried to do an audit at Toronto Hospital in 1991 (Appendices 10, 11 and 12). He said that management was unable to document any savings from the merger and had also refused to allow him access to certain documents. The hospital's response was that the Provincial Auditor only had the right to look at how provincial funds were being spent and not at how money from other sources was spent. They said that since computer equipment was purchased with funds other than ministry funds, they did not give him access to the records in relation to the computer purchases. They also claimed that they could point to savings of $3 million to $5 million a year because of the merger, but they do not track these savings.
This is clearly an untenable position to allow the hospital to maintain. Even if it is true that ministry funds were not used in the purchase of computer equipment, it is important to know what funds were used for that purchase and whether ministry funds had to be used to cover another cost that would otherwise have been covered by funds wasted on the computer purchases. Especially since the computer system has been so widely criticized by the staff and the union, the hospital should have opened its books and made it clear where the funds had come from for that system and how much was actually spent on it. Their failure to do so just leads to more grounds for criticism.
Toronto Hospital would appear to have shown itself as an administration that believes it is above being accountable for the funds it receives from the public. It acts as if it is a private corporation accountable to no one for the way it uses its funds. However, it is a public institution that receives public moneys to provide services to the public.
The problem is that the government has not put in the proper safeguards to ensure that such a public institution is actually accountable. As one critic has said, we have a public payment for private medical practice. The government has not put in place any systems that would require accountability for the funds sent to the hospitals. Such systems are normally put in place where the government awards public contracts, but have not been a part of the health care system. The government has no way of knowing whether the money it gives the hospitals is being spent effectively or with the proper degree of quality.
We have seen at St Michael's Hospital, and the same is true for Toronto Hospital, that the administrations believe they can spend funds they have not yet received from the government, even when the funds have never been promised. They seem to believe they can just spend the money and that the government will bail them out and cover the costs once the funds have actually been spent.
The hospital administrations are exploiting the concern of Ontarians that there be proper health care available for them. Hospitals should be required to stay within the funds provided by the ministry and, if they exceed the funds given to them, the hospital itself should have to come up with the solution, one that does not involve the layoff of employees who have done nothing wrong or the closing of beds and services. Instead, we have seen that the solution of the hospitals to their own possible mismanagement and improper spending has been to penalize their employees and the communities they serve.
Toronto Hospital and other hospitals around the province need to be made publicly accountable for the funds they receive and for the way they are spent. If there had been public accountability, there is no doubt that many of the concerns CUPE now has about the spending habits of Toronto Hospital would not have occurred.
Apart from accountability for funds, there is also a need for a more open and democratic form of management at Toronto Hospital. A regulation under the Public Hospitals Act that requires hospitals to amend their bylaws so that staff of each hospital can be on each hospital committee has not been implemented by Toronto Hospital. In fact, ONA had to take the hospital to court to get a staff member on to the fiscal advisory committee. ONA has also been denied the position of ex officio member on the hospital board when it so applied apparently. The hospital board seems to feel it is not required to report to anyone on the way it manages the hospital.
The most recent round of layoffs is a prime example of the problems with the management style of the Toronto Hospital. The unions and employees found out about the layoffs from the media and not from the hospital administration at first hand. CUPE has had to go to a board of arbitration in an effort to force the hospital to abide by its responsibilities under the collective agreement with respect to the process for layoffs. The collective agreement requires consultation and input from the unions. No such opportunity was given to the union. Management has been reluctant to do something as simple as providing up-to-date and accurate seniority lists to the CUPE locals, as is required by the collective agreement. The result is that layoffs have not occurred in the way that is contemplated under the collective agreement and has led to unfair results for some employees. This autocratic style of management is not acceptable in a public institution. If anything, such institutions should be more democratic and more open than others. Unfortunately, such is not the case with the Toronto Hospital.
Another example of actions by the Toronto Hospital that need to be scrutinized is the number of serious conflicts of interest that have been allowed to continue in the management of Toronto Hospital. Begley and Associates is headed by James Boles, who also holds a number of positions with Toronto Hospital aside from his responsibilities with Begley and Associates. One can only question if his relationship with Toronto Hospital is one explanation for why Begley and Associates has so many and such lucrative contracts in the hospital.
Similarly, the computer system was purchased from an American company, Health Data Services. We understand the director of nursing for Toronto Hospital holds shares in HDS and also has shares in a company from which the hospital bought its case management system, a system which is on the verge of being abandoned by the hospitals. This conflict of interest seems patently obvious. These are only the examples we have become aware of. No doubt there are many others.
By the way, I guess under the freedom of information in the United States, ONA had done a search of some sort and found the previous president, Vickery Stoughton, had shares in the company itself while he was president of our hospital previously. We have also noted that previous directors of labour relations are now working with the company in a high administrative capacity down in California, so there are many members in high administration levels that were part of that system when it was brought in.
In a private corporation, the board of directors and officers are accountable to the shareholders and any conflicts of interest are not allowed to continue, both by legislation and by government regulation. No such controls have been put in place over Toronto Hospital and other hospitals. Toronto Hospital may have a policy against conflicts of interest, but there are no penalties for abrogating this policy and indeed there is no investigation of any violations of the policy that we know of. This is just another example of the way Toronto Hospital is not accountable for the funds and the management style it has adopted.
Overall, we see a picture of a hospital administration that wants all the advantages of being a public institution, such as full funding and government funds to compensate for overspending, without any of the responsibilities that go along with that money and indeed without even the basic safeguards that are applied to private corporations, such as accountability to someone other than the board itself for the funds that are spent and control of the activities of the boards of directors and trustees.
It is CUPE's position that basic safeguards must be put in place immediately by this government in order to ensure that the mismanagement and blatant disregard for employees and patients does not continue. It is up to this government to make Toronto Hospital and other hospitals in the province accountable for the money they receive and for the way it is spent. No other option is possible. The health care system in Ontario is in crisis right now, at least partly due to the lack of attention from previous governments to the ways in which hospitals were spending the moneys they were receiving. Continuing disregard by this government will only lead to further crisis in the health care system, which can only result in serious harm to the patients and workers of Ontario.
Again, we would like to urge you strongly to go with the five points we have raised earlier in our brief in terms of setting up a royal commission and a moratorium on layoffs until the commission has reported. Particularly we would like to emphasize an open investigation, which really needs to be done, because today, if you look at the appendices of our budget of this year which we just recently received from the hospital, it's very suspect. They claim a balanced budget, but it's based on a lot of faulty assumptions and funds are still to come in. Otherwise we could be anywhere from $15 million to $27 million in debt. It all depends on how you look at the budget.
In summation, the situation in Toronto Hospital and other hospitals has been allowed to continue for too long. Hospitals must be made publicly accountable for the moneys they have received and for the ways in which they are spent, as well as the way they treat their staff and patients. We believe these concerns should be at the top of the list of priorities of the New Democratic government. On behalf of the employees and the patients in the health care system, we are counting on you to ensure that the future of health care in this province is not one that leads to collapse of what is an otherwise admirable public health system.
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The Chair: I want to thank you for your brief. It's an astonishing number of pieces of information that you've brought to our attention. We have until 11:10 am to deal with our questions, so that will give each caucus 10 minutes.
Mr Stephen Owens (Scarborough Centre): It's unfortunate that we're so time-limited, because I think this issue bears some close scrutiny. I guess my initial reaction to the brief, Mr Schyngera, is outrage that these kinds of practices have gone on and subsequently that people who bear absolutely no responsibility for the decisions that have been made are faced with losing their jobs in order to recoup some of the moneys that have been lost.
I have some questions with respect to the issues you raised. In terms of the computer system that has been purchased by the hospital, you alluded to the fact that the computer system may in fact be dangerous to patient care. Could you expand on that, please?
Mr Schyngera: The reason I make that comment is because of several observations on a personal as well as anecdotal level. Jim Fraser, the president of the nurses' union, Local 97, of our hospital, works in the operating room, which was one of the first areas of hands-on use with the computer system for patient care. Over the period of the last couple of years he has made submissions to people in Quebec who were buying the system that it was a dangerous system. An example that he gave, and which is common knowledge throughout the hospital, is that a patient who went into the OR last year some time ended up having the wrong information printed on the screen as far as drugs and was inappropriately given some sort of drugs, which caused a great deal of alarm and concern by the doctors present once they found out. This has not been an isolated incident, he claims.
Further to that, I just know the horrendous mess and poor training that has been involved. I work in intensive care in the Toronto General Hospital. I do know that there have been frequent and many mistakes, either through accessing the system -- the information that comes back out is inappropriate, and if it's caught, fine; if it hasn't been, there have been more uses of inappropriate drugs, prescriptions and that type of thing. There have been lost patient records or mislabelled records because of it. The system frequently is on downtime, so people are ending up working more stressfully.
As an example, going back to the OR case, people end up having to do manual in trying to access the system, and trying to get the workload done causes errors and confusion. So, as I say, we're concerned about that type of example of anecdotal evidence. But there are so many others. That's why the investigation we're trying to encourage by this committee or the government is so important, because there is such a wealth of information, of people willing to come forward if they were given that opportunity.
Mr Owens: Again, in terms of the moneys that you perceive as being misspent, through my life as a former worker in that institution we were involved in an Ontario Supreme Court decision. The former government had set down an order by the former Minister of Labour, Gerry Phillips, and the institution at that time decided not to comply with that order. Subsequently, it was ordered by the court. Has the situation with respect to the spending of funds to ensure worker health and safety and ultimately patient care improved since that time? Can you comment on that?
Mr Schyngera: I'd like to comment, yes, but I'm afraid the situation has deteriorated. In fact, we are currently involved with the ministry in an exercise to try to get the main committee working. It has failed to produce. Last year the hospital was fined one of the highest fines in the province, I guess, to that date, $37,500 approximately, for 27 outstanding charges that it pleaded guilty to, uncontested in court.
Since then very little has been done on projects, such as ethylene oxide, that have been running for five and six years, orders by the ministry over five and six years on asbestos removal. The committee is now virtually functioning as far as the joint mandate of the numbers and physical bodies of people is concerned, but the actual results of the committee have produced very little. We've had our co-chair of the health and safety committee confined forcibly in a room when she was investigating an area. All these types of things have cost the hospital dearly. They continue on the path of not trying to get involved with the joint committee. The ministry is now trying again to develop some sort of mandate they can live with, hopefully, and we can live with. We're involved at this point. So no, there has not been an improvement in any sense of the word.
Mr Owens: I have just one last question, Chairman. I'd like to make a comment. In terms of the perceived conflict of interest by having service providers like Begley construction, as you pointed out in your brief, as members of the board, do you perceive any other conflicts existing on the current board?
Mr Schyngera: Again, these are only highlights, examples, but we have many people. For instance, it was curious that the hospital dealt with the Royal Bank of Canada prior to merger. The Canadian Imperial Bank of Commerce person who sits on our board -- I forget the chap's name right now, off the top of my head -- came to the board just after merger. They ended up having a direct deposit system, I believe. The bank manager I dealt with, who was dealing with the hospital, because we deal with the same bank manager, suggested that his bid was lower but he didn't get the contract for the direct deposit system that the hospital instituted.
We have Ron Fell, who sits on our board, who is a chairman or some high officer of AEtna Life Insurance; I believe Excelsior Life is the name in Canada. They took over our benefit carrier coverage for all our benefits, previously Blue Cross before merger. All these things, we don't know whether they're less expensive. The hospital claims they were when it bought into the contracts, but we have no way of knowing that. There's been no disclosure on that, but we have these examples.
There are more examples on the board itself. We have a vice-president at the hospital who had some interest in direct dealings. I'm not sure how recent, if he's still part of it, but Bill Louth has been an officer of the hospital for quite some time, a vice-president, a corporate vice-president now. There are other examples.
Mr Owens: Just, Chair, in terms of my --
The Chair: Sorry, Mr Owens, your time has expired.
Mrs Joan M. Fawcett (Northumberland): One hardly knows where to start with what you have presented to us this morning, especially when I really don't have the background. I guess right off the bat, with so many allegations that you have here, do you have absolute proof of these? I just shudder to think of the suits that may follow if you don't. You put this in print so I assume you must therefore have some kind of proof.
Mr Schyngera: Well, some of the documentation, if you peruse it -- we have other boxes. The allegations that we're making simply are based on what I know publicly, either in print media or when we have gone directly to people and had information like the public auditor's and that type of thing and anything we've put in here. Yes, we could probably substantiate at least -- the rest is just a question, I believe, because we don't know. In fact, we've looked at some of the accounts, and we have some information that there are many accounts, but are those the only accounts, the private accounts and that type of thing in the hospital? So we're most concerned about how moneys are spent. I think some of the appendices do show transfers where we make the allegation of transfer of funds from operating to capital. They're in the appendices, out of the hospital's own notes. Yes, we are prepared.
The brief itself is a more or less then-and-now situation. It's a period of several years and I guess that's where it may be somewhat confusing. The perspective as of today -- I realize the reality has changed somewhat in our province, but what we're trying to get at in this brief is that our hospital never lacked money. It never had a deficit and curiously we're at a point in time now, all of a sudden, with one of the highest deficits. In terms of the impact on staff, employees, services and whatever, I believe it's probably greater than the St Mike's situation.
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Mrs Fawcett: Are none of the contracts then open tendering?
Mr Schyngera: No, not that we know of. We talked to a plant operations person -- this is a vice-president of the corporation for both sides, Neil Crane, and others that we've talked to in bargaining over a couple of years -- and in fact he's encouraged us to try to get something resolved here. The hospital used to do the in-house. We're proud of our plant services. We're one of the best public institution hospitals for trades. We have a wide range of trades in both hospitals. We've developed that and it's been disseminated.
He's concerned about that. He knows that the contracts -- he's given us figures, and I'm just trying to quote these again from figures that he can only ascertain, but he doesn't know the exact costs. He did give us approximations of well over 100 projects a year. If you cost-estimate those in terms of the figures that we can give you, you can extrapolate your own figures, but they're rough and obviously crude figures.
Mrs Fawcett: So to your knowledge, they are not open tenders.
Mr Schyngera: No.
Mrs Fawcett: Now, just following up on what Mr Owens was saying about the improvements that were suggested and not followed through on, what do you feel is the reason that things got stalled and the committee did not suggest those improvements go forward?
Mr Schyngera: The best way I can describe that, to make it simple, I guess, is that most people, including ourselves, can only take the period of merger from 1986 to the present. From what the hospital has given us -- it seems to confirm that in the last budget, and it's in the appendices -- the three major expenditure areas throughout this period have been the computer system, to try to get it operational -- it was a mess -- and the second is the refurbishment of our hospital. From the time we built the Eaton wing, which is when I started with the hospital, October 1980, that new building that was built, the Eaton building, all the other buildings in the complex -- and we have five major hospital buildings and then some small operations, research and that type of thing -- we began construction that has been unabated, virtually.
We felt it to be a construction zone. Every part of our hospital, from top to bottom, has been a virtual construction zone. It's been like an obstacle barrier to work in throughout. Everybody has commented on it.
To look at the type of costs over those periods, we're looking at substantial amounts of money. When I look at our budget, it still staggers me that we're getting over $400 million this year with capital, $370 million roughly, estimated by the hospital's own estimates in its budget. That's a lot of money, and if you add that over several years, I guess prorating it down from 1986, we look at that as a major expenditure, and these are the areas where people complain.
The tradespeople we have here will give you example after example of horror shows, where lights are for years underneath false ceilings. It's not only a health hazard but poor workmanship and all kinds of things like that. But it has been massive, so that's a major area.
The third area is the purchasing, because we went into an assembly line medicine system rather than floor area coverage after the merger. Staff morale has decreased. Productivity definitely has decreased. Some of the front-line doctors and all kinds of other people have left because of the merger. I know there has been nothing good said about it. I know that at one time doctors, the residents, refused to use the computer system because they felt it to be unsafe. We have a whole series in that area and then the type of purchasing that we've mentioned in there.
If staff were to come forward, I could give you example after example, like fixing bushes with a little spray outside on College Street. They're going to pull the bushes a month later and put all kinds of new bushes in, when in fact the gardener who has been there for over 20 years tells us it's easy to fix. You just give it a little spray and you don't need new bushes.
You put an island out in front of our revolving door in the Eaton building for -- I'm not sure, they estimated it at anywhere from $90,000 to $130,000. Staff used to sit there. It was comfortable. It looked nice. They put in a rock garden that nobody likes. It makes no sense.
We're talking about a period when we're now approaching deficits, apparently. So ripping out carpets, during the period they claimed a deficit last year, all of a sudden in one wing of a floor, spending another $50,000 or $60,000 to recarpet -- our chief officer -- we can only estimate; there's no way of finding out his salary but everybody claims it's over $400,000 -- and expenses, who knows? I don't know. It's been claimed; the hospital refuses -- I'm just saying that the three areas are probably broken down as the computers, Begley, the construction and the purchasing. Those are the main areas and all the workers in the hospital, right up to the supervisory or middle administration, give me daily examples of waste and that type of thing. As I say, we'd like to emphasize that an open investigation would be useful to bring people's concerns forward, maybe.
Mr David Tilson (Dufferin-Peel): As I'm sure you know, this committee has received a delegation from the Toronto Hospital and we spent some time asking a number of questions. I would have appreciated it, of course, if we'd had your information when we were asking those questions. We may have another opportunity to do that because certainly the allegations you've made are most serious and have to be answered. Either that, or you're going to get sued. I will assume the information is correct because obviously a committee such as this has an obligation to pursue matters when allegations are being made as serious as that.
The government, of course, has known about the difficulties in the health system. Mr Archer made comments in his report and you referred to that. Their response to some of those difficulties has been the reorganization of the Ministry of Health as opposed to dealing with some of these issues you've raised, because these issues I believe apply to a number of hospitals. Can you tell me what your thoughts are about the reorganization of the Ministry of Health?
Mr Schyngera: Frankly, you could say that, but the hospitals are also saying, for instance, that the deficit created is because of pay equity. The two issues they have claimed to us until recently are pay equity -- what is the other one? There's the ONA salary contract last round bargaining, which they claim at 29%. Of course, if you spread it out it's actually less than a 15% increase, which everyone received, by the way, in the hospital sector at that time. Those are the two main factors they claim if you put those into the budget, so I find it difficult to say that -- I suppose if you take your balance sheet over here and say everything's okay except for the reorganization because that's where it comes from, I suppose that's the view.
Mr Tilson: My question, sir, is really that specifically the Ministry of Health has been aware of these problems because these problems, not to the extent that you've raised -- you've made some astounding and very serious allegations that certainly members of this committee, at least publicly, have never heard. Some of the members may have heard them privately. Certainly the tendering practices have been questioned and that's not news to us. Some of these other allegations are very serious indeed and I assume Mr Decter and members of the Ministry of Health have been made aware. I assume that your union has made the ministry aware of those. I guess my question deals with what your understanding is of what the Ministry of Health is doing about some of the allegations you've put forward.
Mr Schyngera: I can only comment that back in January we met with Michael Decter. You're quite right; we never met with the actual minister, Ms Lankin. In our presentation with all the union presidents present from the two sites respectively, we brought in all of these and more allegations. Believe me, I wish the ONA was here today, but the person's away on vacation and some of the other people, because they would've loved to have been here today and added weight to some of these things. We did much more than what's in this brief, to Mr Decter.
Since then, what we've been told only briefly, as in various other bodies -- we have never got a formal response back other than we're short of money and whatever, but that in other forums they would look at the Public Hospitals Act in terms of some sort of accountability, better auditing. That's about the extent of what we got. I believe Ms Lankin in another forum at another time just recently indicated that the ethic of -- we're also, you know -- what was the other thing? Public Hospitals Act.
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Mr Tilson: In short, the ministry's doing nothing, as far as your allegations are saying.
Mr Schyngera: We haven't got any formal response back from the bodies.
Mr Tilson: All right.
Mr Schyngera: Also, by the way, the presentation we just made here, in a more shortened form, as you can appreciate, was also sent -- which is also on our behalf from the Toronto board of health. We presented on December 17 a similar, abridged version of this type of allegation, and more extensive, because all the union presidents made that presentation. A letter was sent. The Toronto health board adopted unanimously our report to it and sent a copy to the minister, and we've received nothing back again from the minister so far.
Mr Tilson: And when were your representations made to the Ministry of Health?
Mr Schyngera: What was the exact date? January -- I can't --
Mr Tilson: In January of this year?
Mr Schyngera: In January this year, yes.
Mr Tilson: All right. One further question: This government, and before it the Liberal government, has started a process that patients should spend less time in hospitals, that after operations or whatever they're in for they should go to their home. Assistance would be given in that case and therefore the need for hospital beds would be reduced. Can you, on behalf of your union, tell us what you think of that proposal that's been put forward by those two governments?
Mr Schyngera: We believe very sincerely, and I think our union does in general, that we're not in disagreement with that principle. However, that's the recommendation we're trying to draw forward, either a royal commission or some way of putting a moratorium so real input can develop.
We're concerned right now that what's happening is that you have a layoff, you reduce beds, you reduce services, and you're putting -- for example, my mother-in-law had a stroke. She's at home, and trying to get provided health care services is going to take eight months to a year to get all those things in place. Meanwhile, she still needs help and care and she's at home. That type of thing concerns us.
We'd like to see really, ideally, a discussion of retraining for our current workers who are health care professionals or service workers like ourselves to be able to go and take those jobs and go into the community then with collective agreements and that type of thing intact so quality health care can be maintained. You know, we're concerned that a model doesn't occur like the psychiatric patients well over 10 years ago where we deinstitutionalize and they're on Yonge Street begging with tin cups, basically, without really a lot of support services. There are some out there, but not well enough and they're very difficult to receive and achieve.
Mrs Fawcett: If I could just make an addition there, I think, with all due respect, the Liberal government was prepared to put $2 billion in to get those support services in place before all these cutbacks started to materialize, but then that was put on hold.
The Chair: I'm sure Mr Tilson appreciates that information.
Mrs Fawcett: I thought he would.
Interjections.
The Chair: Order.
Mr Owens: On a point of clarification, or however you want to put it, in terms of following up -- I'm only a guest on this committee today -- what would be the process? I think Joan Fawcett made an excellent point with respect to serious allegations having been made. What is the expectation the presenters of this brief can have that this issue will be pursued?
The Chair: I was just going to deal with that and I would like to take a moment to talk to the committee about it. As Chair of the committee, I would like to recommend to the committee that we get together at the appropriate time, as quickly as possible, and draft a motion for this committee to conduct an all-inclusive review of the matter that has been initially looked at by the auditor and that has been further commented upon by the group before us this morning.
I would suggest that the review be extensive, that the review include Ministry of Health officials, that we do a review of all the allegations made this morning, that we ask the auditor to do an audit as to value for money, that we look into the purchases of the gigantic computer program that is not working at the hospitals, that we look into the Begley contracts and that we look at the construction that's been going on. That was going to be my recommendation to the committee.
Mr Owens: If I can make a helpful suggestion as well, and I'm not sure this can be done, one of the highlights that was pointed out both in the presenter's report as well as in the auditor's report was the ability to track information with respect to private moneys. Is it the office of the public trustee that regulates that function?
The Chair: I don't consider any of the moneys given to the hospitals to be private moneys.
Mr Owens: What I mean is, by public donations through various funding arrangements they have set up.
The Chair: I still would not consider those to be private moneys. I would assume a hospital, this one in particular, would get 80% to 85% of its budget through general transfers and any other moneys it would receive through donations would have tax credit purposes and tax credit values. Therefore, the tax system would be indirectly helping these donations to be made. So I don't see any of this to be private at all. Let's all remember this is a public health system. This is a public hospital; it has nothing to do with being private at all.
Mr Owens: Much appreciated, thank you.
Mr Tilson: Notwithstanding that point, Mr Chair, that was one of the difficulties the auditor's office told us it had. There were certain funds it simply can't look at, because of the jurisdiction it has.
Mr Owens: That's right. That's my concern. You get told to buzz off.
Mr Tilson: The point that you made about tax deductions is an interesting one, but that's what the auditor's department has told us.
The Chair: I take the committee to the Audit Act, page 7, section 17. Under our instruction the auditor can perform special assignments and it states the duties of the auditor under this act. The beginning of section 17 clearly states:
"The auditor shall perform such special assignments as may be required by the assembly, the standing public accounts committee of the assembly, by resolution of the committee, or by a minister of the crown in right of Ontario."
To me that's clearly indicative that we have the authority to ask the auditor to do any number of things. I think what we need to do is have a special meeting so we can thoughtfully put together a motion to put before the full committee, and the repercussions of that motion, and then start working on how we will govern ourselves during the course of this investigation, whom we are going to call, whether or not we need outside help to assist the auditor or whether or not the auditor can do it with his own staff and what other needs the committee might have. I don't think we can accept this submission we've received this morning and just file it away.
Mr Tilson: I agree, Mr Chairman.
Mr Robert Frankford (Scarborough East): Could I raise another area that I would be interested in looking at, which is around the comprehensive health organization proposal. That is something this hospital was working on and I think this is potentially another very major aspect of the organization of health care. It would bring in considerable revenue, because, as I understand, each patient enrolled in it would bring in a revenue of something like $1,600. If you do some multiplication, this could have a very major financial impact on the place of this institution in this system and what we hear about consultation and planning. I think it would be interesting to know what moneys were received by the hospital to do this, whether it used outside consultants and how it impacted on the whole management and planning of the hospital.
The Chair: That's something the committee will have to consider.
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Mr Owens: You may also want to take a look perhaps at the role of private enterprise within a publicly funded health care system with respect to contracts for service provision within the institution and to investigate the appropriateness of private enterprise within a publicly funded health care system, as you so accurately pointed out.
The Chair: Well, I mentioned the Begley contracts --
Mr Steve Eadie: Mr Chair, I would like to make one point regarding the recommendations that were put forward this morning on the inquiry into the health care system generally. I'd just like to point out that in the estimation of our union, this is not an isolated situation. In magnitude, it may be much easier to identify than others, but there is no comprehensive accountability in the health care system across the province, and we know of other hospitals where various things are happening of a similar nature. We would suggest to you, if you are able to make recommendations to the ministry or to talk with the ministry, that this not be reviewed in isolation.
The Chair: I appreciate that. I don't want to get our work lost in general overall government policy that would cause debate to go on endlessly without maybe any specifics being looked at.
I firmly believe that if we are able to do our job appropriately, if we're able to look at all of the allegations that were made this morning appropriately, if we're able to allow the auditor to do a value-for-money audit in this particular situation, that in itself would send a message out to everybody as to how they're running their institutions and what changes they may wish to make in light of what we're going to do in this specific instance.
I would counsel the committee against making the investigation so large and so overall that we'll lose ourselves in the process. I don't know if we're really talking about a royal commission with three to five years worth of work and everybody, by the time they're finished, will have forgotten what they were to do. So I would counsel the committee on making the work so overwhelming that we'll never get it done. I think we've got a lot here to deal with that we can appropriately deal with under the rules by which we work. Anything else?
Thank you for appearing before us this morning.
Mr Schyngera: Thank you very much.
LETTER TO TREASURER
The Chair: We have a letter to the Treasurer that we'd like to discuss and approve if possible. Has everyone reviewed the draft letter? It's three pages. We're all going to have to sign it, so let's be comfortable with it. That is the draft letter to the Treasurer concerning the committee's work concerning the Audit Act. Let's take five minutes and look at it.
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The Chair: Any problems with the letter? Ray had one or two minor corrections to make the letter more up to date. Could you tell the committee about that, Ray, please?
Mr Ray McLellan: When this letter was drafted immediately following the February meeting with the Toronto General division of the Toronto Hospital, I was awaiting the steering committee report on the Public Hospitals Act. That document is now out. It was received at the end of February or early March, I believe. I would recommend that we delete the last sentence of the second paragraph in the letter: "The members are awaiting the report of the steering committee reviewing the Public Hospitals Act, prior to reporting on the hospital inspection audit." It wouldn't be necessary to have that in there.
Also, if this committee decides to go on and address the issues brought before us this morning, obviously we'd be going off on another tangent and looking at other issues. So it wouldn't be necessary to have that sentence in there.
We're still saying in that paragraph that we've reviewed universities, the public boards of education and also a hospital, and the committee has decided to report on the universities and the boards of education, which we have done.
The other point I wanted to make concerns the top of page 2, the indented quote from report 2, June 1990. The first paragraph is a quote and a comment from that report; the second paragraph is a recommendation. So technically it would be helpful and correct to say in the second sentence on the top of page 2, "The committee made the following comments and recommendation on the audit of government agencies and transfer payment recipients."
I think too that this letter has, from the last day, that Thursday that we finished off looking at the Toronto General Hospital, covered off the main points, the three or four points that we wanted addressed. We wanted to make reference to our reports; we wanted to emphasis the importance of accountability; we wanted to make reference to that report 2 of June 1990 and the difficulties the auditor had with respect to the inspection audits and what the committee had encountered in terms of the inspection audit reviews it has undertaken.
There is also, on the last page, page 3, that the committee request a response from the Treasurer, and that's been done. The final point was that the committee ask that provision be made so that all members could sign the letter if they so choose, and on page 3 we've made provision for that.
Also, I should say that the committee asks that this draft prepared by legislative research be considered by the Clerk's office and also the Office of the Provincial Auditor, and I had a meeting and that has been done.
With the exception of those two changes, I think hopefully that captures the committee's needs.
Ms Sharon Murdock (Sudbury): Being new to the committee and having heard today's presentation, my concern in the letter is that there is no indication of how non-transfer amounts of money would be addressed. If that was one of the problems that Mr Archer had in terms of being able to do an accounting of the system and in terms of what this letter is saying, it doesn't address that issue. I think it's pretty evident it's a problem.
Mr Larry O'Connor (Durham-York): Mr Chair, further on that?
The Chair: Sure.
Mr O'Connor: Some time back, when the past auditor was here, we had discussion around it. It's referred to on the third page, "Proposed changes and amendments to the Audit Act." Would those proposed changes then cover off the areas my colleague has mentioned?
Mr Jim Otterman: Yes. What we have prepared, which we presented to the Management Board of Cabinet staff who are coordinating the proposed amendments, we feel would cover it, in that it would give us access to related institutions. That's always subject, I suppose, to a legal interpretation.
Mr O'Connor: That was one area where we did run into problems when we had Colleges and Universities before us earlier on in the mandate of this committee. We ran into problems where the auditor never had full access to all the finances of some universities that it had audited in the past, which pointed to some problems. I guess the difficulty we'll have in further deliberations of this committee is, if we so direct the auditor to further investigate something, if this area isn't covered off, then we're going to continue to have the same sort of response and the same problems.
Perhaps a suggestion or a motion should come forward recommending that this matter be brought to the attention of the House leaders, and it could be perhaps discussed as well. Where that falls within the purview of what the House leaders are going to decide and where it ends up on the legislative agenda -- I guess it has been sitting there for some time anyway. Perhaps this committee should address its concern to the House leaders.
The Chair: Right off, in response to your comment, without giving it a lot of thought, if it's something we want to do, I don't know why we would need the House leaders, if it's the wish of the committee to do so.
I would think that unless an institution went out and said, "We're going to do project A, and every penny of project A is going to come from private contributions; there's going to be no money taken from our operating or capital fund or from anything else," unless it was that specific -- I'd find it hard for anybody to do it that way. Yes, go ahead.
Ms Murdock: Just in relation to that point, Mr Chair, frankly, when publicly funded agencies and institutions go out on fund-raising drives, the reason they get the money is because they are a publicly funded institution. If they were a private industry, it's unlikely that the people would be as forthcoming with their own dollars as they would if they weren't a hospital or a school or whatever. Therefore, I believe that publicly funded institutions should be required to provide all their accounting documents, regardless of where the money came from.
The Chair: Yes. I have no basic arguments with that. It doesn't offend me in any way that that's the way it should be done.
Ms Murdock: No. Even if it was directly stated that, "We are going to do this expansion project at this hospital, and all of it will be paid for by public funds donated to our cause," I still think that even under those circumstances they should be required to give an accounting.
The Chair: You're right. There are tax benefits for individuals and corporations for making those types of contributions, so there is tax money involved.
Mr O'Connor: Further along that line, when we did have the universities before us, I believe the University of Toronto was an example of one of the ones that had been audited and something this committee had looked at. There are substantial reserve funds that are accumulated by some learning institutions, and I'm not sure whether there would be the same in the hospital, but I would imagine there are some fairly substantial foundations related to it. If we're going to take a look at the whole area of accountability, whether in the past, when we did take a look at the colleges and universities and school boards and hospitals as well -- the concerns have been raised, and perhaps what we need to do then is somehow get the proposed changes to the Audit Act.
The Chair: So you're telling me then that you want to have more time with this letter? Are you telling me that you want Ray to redraft the letter?
Mr O'Connor: I think we need to make sure that our concerns about the Audit Act get brought forward so we can get those changes.
The Chair: Can you make changes to the letters to take into account these concerns?
Mr McLellan: Yes.
The Chair: Thank you, Ray. I would suggest, so we can approve this letter next week, that, Ray, as soon as you get finished with your next draft you can fax it to all the members and that way next week we could just approve the letter. If there's anything missing or if there's anything you find objectionable in the letter, let's know in advance so we could try to -
Mr Tilson: Just as a point of clarification, you want that the government or the Provincial Auditor will have the right to audit a hospital foundation, which might be separate and apart from the hospital. Is that what you're saying?
Mr O'Connor: If there are opportunities and avenues in the accounting of a hospital for transfers from one direction to the other direction and back and forth, then I think that for a true audit to take place there has to be that accountability. That's an area we did see when we had the universities before us. It was one area the auditor had raised as a concern, and all the members of the committee. I believe you were with us at the time. So I think if that capability is there, then it should be addressed as far as accountability is concerned.
Ms Murdock: Not on that point, but just for the record, I believe that I'm going to be subbing for the next period of time, so if you wouldn't mind, please send it to me rather than to Mr Johnson.
The Chair: Okay, then the letter will be brought forward for next week's committee meeting. We have 30 minutes left for this morning. We have the draft reports we've been wanting to review and approve of for the last month. May I recommend to the committee that we do that within the next 30 minutes, because we're going to have a lot of other work to do and we've got to get this work that we've already done behind us. So I'll ask Ray to take us through those two draft reports. It's normal for us to go in camera when we do these draft reports, so the committee will now go in camera, and hopefully within the next 30 minutes we can complete our work in regard to these draft reports.
The committee continued in camera at 1128.