The House met at 2 p.m.

Prayers.

Mr. Speaker: Statements by the ministry.

DISTRIBUTION OF GAINS CHEQUES

Hon. Mr. Meen: Mr. Speaker, my ministry has now finalized arrangements for distribution of November GAINS cheques during the mail strike. Details of our procedures are contained in the information kits that have been placed on the desk of each member, and I would like to take a moment now to outline them.

Outside of Metropolitan Toronto, on and after Tuesday, Nov. 18, GAINS cheques will be available for pickup at local municipal offices, except in the cities of Hamilton, Kitchener, London, Ottawa, Sudbury, Thunder Bay and Windsor. In these seven cities, GAINS cheques will be available for pickup through Ministry of Revenue district retail sales tax offices.

Within Metropolitan Toronto, cheques may be picked up at the St. Lawrence Market under the procedures outlined in the information kit, or after Nov. 25 at the Ministry of Revenue office at 77 Bloor St. W.

Undoubtedly, hon. members are aware of the problems we face in distributing 272,000 cheques across the province without the mail service. There will certainly be delays and I want to assure this House that as soon as postal service resumes, my ministry will give top priority to mailing out GAINS cheques to those who do not, or are unable to, pick up their cheques.

The advertisements in the kits will appear in all Ontario daily newspapers during the latter part of this week. I would ask the members to do their utmost to bring this information to the attention of their constituents.

In conclusion, I will be making a special request of all media to publicize these arrangements as broadly as possible. To help in this effort, I have asked them to meet with my GAINS staff and in the media studio following question period.

TAPED TELEPHONE HATE MESSAGES

Hon. Mr. McMurtry: Mr. Speaker, as the members of this Legislature may be aware, the matter of taped telephone hate messages has long been a matter of personal concern to me. Since assuming the office of the Attorney General, I have pursued this matter with the officials of my ministry and more recently I had the opportunity of discussing this matter at the federal-provincial meeting of Attorneys General in Halifax. I have also had correspondence with the former federal Minister of Communications and the chairman of Bell Telephone of Canada.

Our experience in recent years has shown us that existing laws, including the hate propaganda sections added to the Criminal Code, are ineffective and, because loopholes and exceptions abound, a conviction is almost impossible to achieve.

With the co-operation of my colleague, the Minister of Labour (B. Stephenson), we hope to convince the federal government that Bill C-72, the proposed Canadian human rights Act presently before the Parliament of Canada, be amended by including taped hate messages to the list of discriminatory practices in Part I of the bill. We also suggest that the proposed Canadian Human Rights Commission be given overriding authority, upon ex parte application by any person, to order Bell Canada or any similar utility in Canada to cut off service forthwith to any number offering a taped hate message.

I would appreciate the support of all members of this House in attempting to influence the federal Parliament with regard to the proposals so that these repugnant activities can be stopped.

Mr. Speaker: Oral questions.

AIR POLLUTION STUDY

Mr. Deans: Mr. Speaker, I have a question of the Minister of Health. Can the minister explain, so that any reasonable person might understand it, why a report, prepared under the joint auspices of the federal and provincial governments on the state of air quality in the Sudbury area and the effects of it, was suppressed by this government during the months of July, August, September, October and to this date?

Hon. F. S. Miller: Mr. Speaker, first of all, that is not a true statement. That report was not suppressed by this government. In fact, this government has not yet received that report.

Mr. Martel: Does the minister want my copy?

Mr. Deans: Why?

Hon. F. S. Miller: I want to tell members a few things about the report.

Mr. Nixon: The CBC has it.

Mr. Martel: I have it.

Mr. Speaker: Order.

Hon. F. S. Miller: Lots of people have it, but I don’t.

Mr. Laughren: Why doesn’t the minister have it?

Hon. F. S. Miller: Give me a chance and I’ll explain to the House. I think it was in 1971 or 1972, on a routine application for a research grant, the kind of thing we give to many people in the health or related fields, a professor at a university in Ottawa --

Mr. Mattel: Dr. Neri.

Hon. F. S. Miller: Yes, Dr. Neri. He applied to this ministry, and I believe at the same time to the federal government, for moneys to pursue a relatively interesting project. That was to see the effect of chest diseases and try to relate it to the amount of sulphur dioxide in the air in two cities, Ottawa and Sudbury. I understand the funding for Ottawa was federal; the funding for Sudbury was provincial.

It is the kind of grant that we give to technical people all around the province. The Funding for the last section of it ended in March of this year, I believe. There was $6,000 for that section. The stated requirement was that he turn over to us a copy of his report by Sept. 30, 1975. We have been in contact with Dr. Neri, because naturally we are embarrassed at the comments made through the press that we were suppressing it. He is rather concerned because as yet he hasn’t produced a final report. But what mystifies me is that: (a) He has given a speech in England last year on the topic --

Mr. Martel: Dr. Cowle from the ministry did.

Mr. Speaker: Order, please.

Hon. F. S. Miller: -- (b) He gave a copy to the Canadian Medical Association for publication, which I understand will be published in December; and yet he has never honoured the obligations of the commitment. He has sent us status reports which were received in a routine way at a low level and have never come to the deputy’s attention or mine, because they were simply information. My staff at that time countered in documented form saying: “Look, we disagree with some of the things in terms of procedures that are going on in your report.” In his latest comment to us he said that he is embarrassed, or wondering where these copies are all coming from. He admits that as yet he hasn’t given us the report requested of him, even though we have asked him to do so.

Mr. Deans: One supplementary question: Do the status reports normally contain the information that has been gathered up to the point of that interim report being made? If so, why would the ministry not call him in, given that the minister says his ministerial officials disagree with some of the findings that he had reported to discuss the matter with them and determine whether or not there was a danger to the health of the people in the area?

Hon. F. S. Miller: First of all, it wasn’t a question of disagreeing with the findings. I think that should be clarified. It was an argument between two doctors as to methodology and whether the methodology was going to result in meaningful conclusions at the end of it. That was done by Dr. Cowle, who died some months ago, and it was done at that level.

We simply took as information the material coming forward, because I think one must realize many of these individually-handled research projects are open to considerable technical scientific argument; and that is the nature of this one. I am not going to say it is or is not accurate. I had no need to hide the information from anyone. Since it was never brought to my attention, I can assure the House it wasn’t suppressed in any political sense at all.

Mr. Nixon: Supplementary: Since the report makes it quite specific that the pollution still in the atmosphere in the Sudbury area is a serious health hazard, is the minister moving toward checking the results which he may question, or is he moving toward taking some position that will remedy the situation?

Hon. F. S. Miller: Certainly, I am going to listen to the arguments. I think the steps to remedy it were taken some while back and are better answered by the Minister of the Environment (Mr. Kerr) than myself, because they involved, as I understand it, the restrictions put on Inco’s Sudbury operations and the high stack in 1971. When I see the evidence and listen to the counter arguments, I will be in a better position to answer the member’s question.

Mr. Martel: Supplementary: Is the minister aware that we became aware that this document existed as a result of Dr. Cowle’s making reference to it in articles he was writing concerning Elliot Lake; and if Dr. Cowle knew, why didn’t the rest of the ministry know?

Hon. F. S. Miller: Mr. Speaker, the very fact that we weren’t trying to suppress it is proven by this kind of point. There is nothing secret about the thing. Any time somebody stands up at a joint international conference and talks about a paper, I think one cannot be accused of secrecy. Any time the report is handed in to a magazine for printing, one cannot be accused of secrecy. It is simply that this is being dealt with like hundreds of research projects by the ministry in routine ways.

Mr. Cunningham: The report indicates that both Ottawa and Sudbury have a much higher standardized rate of mortality. I am wondering, in the light of what appears to be a clear definition of this, what direction the ministry is going to take to rectify this rather sad situation, especially in Sudbury?

Hon. F. S. Miller: I know one of the conclusions that Dr. Neri has come to somewhere along his line is that he finds cigarette smoking has an important effect. That is what he told us on the telephone today.

Mr. Martel: Well, much less than the sulphur dioxide.

Mr. Speaker: Order, please. There have been several supplementaries on this. There will be opportunity for further questions. Does the hon. member for Wentworth have further questions?

[2:15]

FALCONBRIDGE SMELTER EMISSIONS

Mr. Deans: A further question of the Minister of Health: Can the minister explain how it could be that Falconbridge, which was under ministerial order to clean up the environment in the Sudbury area to the tune of nearly $90 million and to eliminate the degree of SO₂ emissions, have had that project either curtailed or drastically reduced?

Hon. F. S. Miller: Mr. Speaker, that should be addressed to the Minister of the Environment.

Mr. Speaker: Would you like to readdress it?

Mr. Deans: I’ll readdress it to the Minister of the Environment.

Hon. Mr. Kerr: I didn’t quite hear the question, Mr. Speaker.

Mr. Speaker: Repeat the question.

Mr. Deans: Can the minister explain how it can be that the ministerial order, which has been in place for some time on Falconbridge, to reduce the SO₂ emissions at a cost somewhat in the order of $90 million over three years or thereabouts, has been either curtailed or eliminated?

Hon. Mr. Kerr: Mr. Speaker, I am not aware that the ministerial order to which the hon. member is referring has been curtailed or eliminated. They are still under a ministerial order. There has been a request by the company to extend the completion date of that order, but certainly nothing has been done by our ministry in that regard.

Mr. Laughren: Mr. Speaker, is the minister not aware that when Falconbridge announced plans for their massive layoff, that in part meant not completing the new smelter which would have allowed them to meet the new emission standards set down by his ministry?

Hon. Mr. Kerr: I’m quite aware of that, Mr. Speaker. Those are plans and announcements by the company. All I’m saying is that the order that is placed on that company has not been changed nor have any dates been changed. The order still exists and it will continue to exist.

Mr. Singer: Is the polluter, paying, like the minister said?

Mr. Speaker: Order, please. The original question had to do with ministerial orders, not the whole broad subject. Is this on the ministerial order part of the question?

Mr. Laughren: This is the final supplementary, Mr. Speaker: How does the minister propose that the company will meet the new emission standards without that new smelter? Does he propose to let them start up operations again with the old smelter after the ministerial order deadline has passed?

Hon. Mr. Kerr: Mr. Speaker, the ministerial order provides for certain levels to be reached at certain times and certain dates over a period of four or five years. As of now they have complied with and met those emission standards. The next date, I believe, is sometime in 1976 --

Mr. Martel: Right; 1976.

Hon. Mr. Kerr: Yes, and we expect that date will be met -- otherwise they will be in breach of that order. The company realizes, as a result of discussion with officials of my ministry, that it must meet that criteria; and I expect that it will.

Mr. Speaker: Final supplementary on this.

Mr. Martel: Would the minister tell us that there is no way in which he will allow Falconbridge to go back to using the old smelter and dumping the amount of effluent they are dumping presently when they go back into full operation next year?

Hon. Mr. Kerr: I will repeat, Mr. Speaker, that they will be required to reach the emission standards we have set.

HEALTH OF STELCO COKE OVEN WORKERS

Mr. Deans: I have a question for the Minister of Health. Can the Minister of Health explain how it can be that those working in Steel Company of Canada coke ovens, who it is becoming more evident are suffering lung disease as a result of their employment --

Hon. Mr. Bernier: The onus will be on members opposite.

Mr. Laughren: The fearmonger.

Mr. Deans: -- are not being given the same close attention with regard to x-rays and tests that is being given to uranium workers in similar situations?

Mr. Laughren: The member for Algoma-Manitoulin (Mr. Lane) tried that in Elliot Lake.

Mr. Speaker: Order, please. The Minister of Health is answering a question.

Hon. F. S. Miller: When the leader of the NDP is here, I get a lot fewer questions. I’ve been enjoying the relatively easy time of the last week or so.

Mr. Deans: He likes the minister.

Interjection.

Mr. Deans: That doesn’t say I don’t.

Hon. F. S. Miller: But not as much.

Mr. Speaker: Let’s get on with the questions and answers.

Hon. F. S. Miller: Mr. Speaker, first of all I think one will have to determine that the premise the member made in his question is correct. The issue of lung cancer relating to tars in the coke ovens is a relatively new one, compared to the silicosis problems in the mines. I became interested in it about a year ago. I know a good deal of research is going on and I’ll be pleased to find out if the member’s statement is correct; that they are not receiving a high degree of attention.

Mr. Mackenzie: Has the minister done recent testing at Stelco and has he set threshold limits for the coke oven workers? If he has, when will the union and the safety committees be notified. If not when can we expect those limits to be set?

Hon. F. S. Miller: I cannot answer that out of my head, Mr. Speaker. I’ll be glad to get the answers to it. I have looked at the problem but I can’t be categorical by memory. I know the whole question of setting threshold limits is the purpose of the occupational and environmental health group that we named last week. We recognize that setting limits when diseases are hard to define is not easy. That group’s going to have to look at the amount of data available and decide on practicable threshold limits for such eventualities.

Mr. Speaker: Further question, the member for -- order please. We’re spending a lot of time on original questions and supplementaries which --

Mr. Mackenzie: A further supplementary, Mr. Speaker.

Mr. Cassidy: Very important question, Mr. Speaker.

Mr. Speaker: That’s alright. Order, please. There are complaints that we have too many supplementaries.

Interjections.

Mr. Speaker: One more supplementary. Who wishes it? All right, the member for Hamilton East.

Mr. Mackenzie: Has Stelco given any information to the Ministry of Health as to the number of workers being found to have lung problems as a result of a stepped-up medical examination? What is being done at Dofasco where there is not the double-check involved at Stelco with the union safety committees?

Hon. F. S. Miller: Mr. Speaker, as I said, I’m glad to get the information for the hon. member and I’ll make it available.

FLOOD DAMAGE

Mr. Deans: Does the Premier intend to declare the north shore of Lake Superior and Lake Erie disaster areas and eligible therefore for whatever grants are available in Ontario? Does he intend also to take any further action similar to the action undertaken with regard to the flooding a year and a half ago and to male moneys available to those who have suffered severe losses?

Hon. Mr. Davis: Mr. Speaker, this matter has not been determined by the government. If there is any such thought, we shall communicate it to the House.

Mr. Haggerty: Has the Premier considered meeting with the mayors of the municipalities of Fort Erie, Port Colborne and Wainfleet to discuss the problems of flooding along the Lake Erie shoreline, particularly as it relates to the storm on Nov. 10? Are there any changes in government policy as it relates to the financial assistance given to municipalities in case of a disaster such as the storm which occurred on Monday last?

Hon. Mr. Davis: Mr. Speaker, I’m informed that the Minister of Natural Resources (Mr. Bernier) is having a meeting on this subject this afternoon.

PAYMENT FOR CATTLE PURCHASES

Mr. Deans: I have a question for the Minister of Industry and Tourism. Is the minister in a position to indicate whether or not his ministry is going to make a grant available to Essex Packers in Hamilton in order that it might continue the operations there and secure the jobs of some 550 people?

Hon. Mr. Bennett: Mr. Speaker, first of all may we be very careful that the ministry does not make grants; we’re in the position of loaning funds.

There have been discussions with Essex Packers and with the receivers as to the position they are in and what viable position we would be in if the loan was to be extended. We believe from the information we have that the principals who own the firm at the moment have sufficient personal capital to put the firm back on solid ground. The advice given to me, as the minister, and to the development board is that we should not be participating because the line of equity, as far as we are concerned, to confirm or to back up our loan is not there.

Mr. Deans: A supplementary: Is the minister prepared to put before the House the information available to him which brings him to that conclusion, in order that the people of Hamilton, the employees in the plant and the people who are served by that operation might fully understand all of the ramifications of this near bankruptcy?

Hon. Mr. Bennett: Mr. Speaker, I am not in a position to produce for this House information which is of a confidential nature; that is the property of the firm and the receiver. I will not table the information I have in the House.

Mr. Nixon: A supplementary, Mr. Speaker, on that matter. Can the minister assure us that everything is being done to see that, since the provincial government has assisted Essex in the past, at last some of its resources are going to be directly allocated to pay off the farmers who are still holding NSF cheques in payment for livestock delivered?

Hon. Mr. Bennett: Mr. Speaker, the commitment the Ministry of Industry and Tourism, through the development corporation, has with Essex Packers, of course, is the export credit loan of which most has been repaid. We have sufficient shipments in other countries to pay off the balance of that export loan, which is against goods shipped out of the country. As far as payments to the farmers or to other creditors are concerned, that is a decision that obviously will have to be made by the receiver.

Mr. Nixon: A supplementary, Mr. Speaker: Wouldn’t the minister think it would be part of his responsibility to discuss this matter with his colleague, the Minister of Agriculture and Food (Mr. W. Newman), who has already indicated his personal concern for the farmers in this area? Why should the minister give us an answer like that, which has involved, in the past, a decision to assist this company, when we cannot bring some pressure to bear on them to fulfil their commitments, and their legal commitments to the farmers who have been supplying these cattle? How can he sit there and indicate that --

Mr. Speaker: Order, please. I think the question has been asked.

Mr. Nixon: -- he has not consulted with the Minister of Agriculture and Food on that?

Hon. Mr. Bennett: Very obviously, Mr. Speaker, if the leader of the third party would look at the situation --

Mr. Nixon: You and your external commitments; what good are you as a minister?

Hon. Mr. Bennett: -- and listen just for half a moment --

Mr. Roy: Get your hands out of your pockets.

Hon. Mr. Bennett: -- he would find out that the development corporation’s loan is to develop and expand an operation. We were never brought into being to bring people out of an insolvent position. We are not the bankruptcy specialists.

Mr. Nixon: Leave it to the receiver, the minister says.

Hon. Mr. Bennett: The fact is, if the leader of the third party would read the Bankruptcy Act he would find out exactly the credit position therein.

Mr. Nixon: The minister can do nothing but let the farmers rot.

TORONTO TEACHERS’ NEGOTIATIONS

Mr. Nixon: I’d like to put a question to the Minister of Education pertaining to the unfortunate situation which none of us wanted, and the minister predicted might not happen but has now happened -- that is, the strike of the secondary teachers in Metropolitan Toronto.

Can he clarify for us the position taken by those people applying the price and wage control legislation federally, as to what extent this present situation comes directly under their jurisdiction? Has there been an indication from Ottawa that there will be a partial exemption because of the dating of the previous agreement, or are we to accept at face value, statements that have been reported and allegedly made by the Minister of Finance that this particular situation falls directly under the regulations, and that, in fact, no wage settlement of more than 12 per cent would be permitted?

Hon. Mr. Wells: Mr. Speaker, I think I can clarify that for my friend. In fact, I clarified it for both sides in the dispute yesterday in the meeting that I had with them. I indicated that I hoped they would understand the implications of the federal wage and price guidelines regulations. Insofar as they apply to this particular dispute, and this was agreed to by both parties, the parties are not exempt under the guidelines; I think everyone agrees to that. The guidelines apply to the secondary school teachers and the Metropolitan Toronto school boards.

However, there are sections in the guidelines which indicate that, perhaps, special considerations might be given. There are a couple of sections. One says: “Special consideration will be given for those who are negotiating a new contract for one that was signed prior to 1974.” The other is a very unexplained section, and certainly one about which no one has given any explanation as yet, concerning historical relationships. Under both of those, I think these people could put a case to the Anti-Inflation Board.

The procedures that we outlined to them, and the procedures that Ottawa has outlined to us, say that they should get a settlement, and when they have a settlement, both parties should go down with their settlement to the Anti-Inflation Board and seek clarification from that board at that time. But the board doesn’t want to hear or see them until they have a settlement.

Mr. Nixon: A supplementary: Wouldn’t the minister agree, since the area of negotiation is far beyond the boundaries of wage control as enunciated by the federal legislation, that it might be, at least, what politicians would call a step in the right direction if the minister would use his good offices to allow the people from Ottawa to sit down with the negotiating sides here in Toronto, because it may be that this whole strike is a bit academic in that --

Mr. Speaker: Question?

Mr. Nixon: -- we don’t know, as the minister says?

Mr. Foulds: That would be quite a problem.

Mr. Nixon: Is there no way that the minister can do anything but just sit back and say, “It will have to take its regular course”? If it does, I’m afraid the classrooms are going to be closed for a long period of time.

Mr. Speaker: Order, please. Does the minister have an answer?

[2:30]

Hon. Mr. Wells: I feel that in the general discussions of how these guidelines will apply in this province and in the specific way that the Anti-Inflation Board will handle the problem from this province -- for all sectors, public and private -- they’ve suggested people under the normal collective bargaining procedures should go ahead, bargain and get an agreement and, when they have an agreement, then see the Anti-Inflation Board.

I’ve given assurances to both sides that, once they have an agreement, we will do everything possible to be sure that the board hears their case very quickly. We’ll add our support to them hearing their case very quickly so they can get an answer.

Mr. Nixon: Meanwhile the classrooms are closed.

Mr. Foulds: Mr. Speaker, is the minister prepared to go with both sides, if a mutually satisfactory agreement is realized, to Ottawa to make representation on their behalf?

Hon. Mr. Wells: No, I’m not prepared to do that.

Mr. Singer: Could the minister explain what sense it makes to have two parties to a bargaining dispute arguing about something obviously over the guidelines and to have the minister saying that if they come to an agreement about a figure, he’ll go with them and see what Ottawa might do? The minister is not even saying he is going to say that Ottawa should accept what they agreed upon.

Mr. Speaker: The question?

Mr. Singer: What’s the necessity for the exercise in frustration?

Hon. Mr. Wells: It is not an exercise in frustration. If my friend understood how this programme was working and was a little more co-operative toward it, he might understand --

Mrs. Campbell: Well, the minister doesn’t.

Mr. Nixon: It’s not working very well.

Mr. Singer: The minister’s statement adds confusion.

Mr. Speaker: Order, please.

Hon. Mr. Wells: There is no confusion on the part of the parties who are negotiating in Metropolitan Toronto.

Mr. Singer: No, that’s why they are out on strike.

Hon. Mr. Wells: I met with them face to face yesterday. They understand how the procedures work.

Mr. Nixon: It didn’t take long to dispose of the minister.

Hon. Mr. Wells: The way the procedures work is that they get an agreement first and then go to Ottawa and see what the Anti-Inflation Board has to say about that agreement.

Mr. Nixon: Oh, nonsense!

Hon. Mr. Wells: If the member is suggesting that the Anti-Inflation Board should offer some suggestions as to what it would do beforehand, I just don’t think they want to do that.

Mr. Singer: It is obvious the minister doesn’t understand.

Hon. Mr. Wells: Oh, yes, I understand.

Mr. Foulds: Why did the minister leave it so late to meet personally face to face with the two sides in that dispute to explain to them what --

Mr. Speaker: Order, please. That is not supplementary to the original question; it’s branching out into a much broader field.

Mr. S. Smith: When the federal government pointed out that the collective bargaining procedures should take place first, an agreement be reached and then be taken to Ottawa, is it the minister’s understanding that this bargaining procedure included a prolonged and difficult strike which is completely contrary to the public interest? Is it his understanding that this was considered part of the bargaining procedure which had to be placed before a solution could possibly be obtained from the tribunal in Ottawa?

Mr. Speaker: Order, please. I believe the question was asked.

Interjections.

Hon. Mr. Wells: I’m not so sure what my friend is trying to suggest, except that perhaps he feels the teachers --

Interjections.

Mr. Speaker: Order, please. A question has been asked; we’ll allow the opportunity for an answer.

Hon. Mr. Wells: Mr. Speaker, I guess we are witnessing the kickoff for the leadership campaign.

Interjections.

Mr. Nixon: That is the minister’s best answer? That every classroom in the Toronto area close?

Mr. Speaker: Order, please. We are wasting time.

Mr. Nixon: The minister is taking his reviews too seriously.

Interjections.

Mr. Speaker: Order, please. Can we get on with the question period?

Hon. Mr. Wells: All I can interpret from the question that my friend has put is that he would remove the rights that labour has in this province to certain sanctions during a contract dispute. The federal people have not said that should happen. No one wants a strike. No one wants a strike that is perhaps not going to be fruitful, but that is part of the rights that these and other workers in this province have. The federal legislation doesn’t take that right away.

Mr. Nixon: There isn’t one person who can do anything about it.

PAPERWORKERS’ STRIKE

Mr. Nixon: A question of the Minister of Labour: Now that the negotiations between the pulp and paper workers at Abitibi seem to be where they were, that is, before the minister used her good offices to bring them together a week ago, has she got any comments to make as to where the negotiations may proceed? Is she contemplating the BC solution or is she just going to let it continue to take its course after a three to four-month strike?

Hon. B. Stephenson: Mr. Speaker, I would tell my worthy colleague that in fact the position is not exactly the same as it was before the meeting last week; there is a difference.

Mr. Haggerty: There hasn’t been a settlement.

Hon. B. Stephenson: There isn’t any settlement as yet. They are presently in a recess, one might call it, because the negotiator for one side is presently off in another part of Ontario discussing problems with yet another paper company. We would hope as a result of his efforts this week and as a result of some further discussions which we are to have this week, that there may be a further return to the bargaining table.

The BC solution looks very intriguing, I must say. Whether we’ll wait for that, hold it up for examination or put it on the train and see if it gets off at Whitby --

Mr. Nixon: I have a supplementary: I would like to ask the minister if it is part of the intended procedures of her negotiators to deal with all of the companies or are they just directing a solution toward Abitibi as sort of the benchmark or bellwether of the industry?

Hon. B. Stephenson: The answer to that question, as I said almost two weeks ago, is maybe.

Mr. R. S. Smith: I have a supplementary to the minister, Mr. Speaker. Could she explain to me what she meant by saying one of the mediators, or one of the people taking part in the negotiations, was off somewhere else? The company put its offer on the table last Thursday; the union put its counter-offer on the table and the company got up and walked out. Is that not the end of negotiations or des she consider that to be a recess?

Mr. Singer: Maybe.

Mr. Nixon: Maybe.

Hon. B. Stephenson: Mr. Speaker, I think my learned colleague has been somewhat misinformed, nonetheless, the two offers are presently on the table. I should perhaps have said one party to the negotiations was required to leave for a previously-made commitment to discuss problems with yet another paper company.

Mr. R. S. Smith: A further supplementary?

Mr. Speaker: I’ll allow one more supplementary. We are just about out of time. The member for Welland with a supplementary.

Mr. Swart: A supplementary on the negotiations: Is the minister then prepared, through her department, to call together some of the other companies and the Canadian Paperworkers Union to start negotiations in that area?

Hon. B. Stephenson: Mr. Speaker, my ministry is prepared to go to almost any lengths to ensure that negotiations will continue between the Canadian Paperworkers Union and the paper companies.

Mr. Speaker: The member for Oriole.

Mr. Ruston: Here we go again -- another planted question.

Mr. Gaunt: The tiger from Oriole.

Mr. Cassidy: You have now asked more questions than the entire Conservative caucus.

Mr. Speaker: Order, please. We are wasting valuable time.

HYDRO RIGHTS OF WAY

Mr. Williams: Mr. Speaker, a question of the Minister of Energy.

Mr. Ruston: He’s right in front of you, just lean over and ask him.

Mr. Williams: There appears to be a conflict between the recommendations of the Solandt commission with regard to the location of new Hydro transmission line rights of way north of Metropolitan Toronto and the location as recommended in the parkway belt plan. This conflict is causing a great deal of concern --

Mr. Speaker: Your question is?

Mr. Williams: My question is coming.

Mr. Speaker: Order, please. You must get to the question.

Mr. Cassidy: Is this of urgent public importance?

Mr. Williams: It is.

Mr. Nixon: He wants to get into the cabinet. He is knocking hard.

Mr. Williams: The residents, industrial owners --

Mr. Nixon: He could replace any one of them.

Mr. Williams: The residents, the institutional, commercial and industrial owners in the area of Highway 7 located east of Yonge St. are apparently threatened with expropriation of their lands.

Mr. Speaker: Order, please. You must ask the question.

Mr. Williams: I ask the Minister of Energy if he is prepared, through his good offices, at the earliest opportunity to arrange a meeting between the top officials of his ministry --

Mr. Singer: What are you going to do about it? He comes from North York.

Mr. Cassidy: You made a mistake putting him in the corner.

Mr. Williams: -- the Ministry of TEIGA, the Ministry of Transportation and Communications and representatives of the Langstaff community to meet to clarify and resolve this problem?

Mr. Singer: Order.

Mr. Roy: You should dock some time; that was a statement actually.

An hon. member: He didn’t hear the question.

Mr. Singer: Repeat the question.

Mr. Williams: I will be willing to repeat the question, Mr. Speaker.

Hon. Mr. Timbrell: No, I heard it.

Mr. Cassidy: Because you are in the cabinet -- you should still speak to the backbenchers, you know.

Hon. Mr. Timbrell: Mr. Speaker, I have met with the representatives of the Langstaff community association on, I think, three if not four occasions now.

Mr. Stokes: You need a parliamentary assistant.

Mr. Foulds: Don’t you talk to each other in caucus?

Hon. Mr. Timbrell: The last time I met with one of the representatives was last Friday at my riding action centre. The president of the association and one other gentleman did, at the time, bring me up to date on their negotiations with staff, with whom I put them in touch several weeks ago, and indicated that due to a change in staff in one of the ministries they would like to sit down with some of the ministers. I gave a commitment that I would try to set up such a meeting involving the Ministry of Energy; the Ministry of the Treasury, Economics and Intergovernmental Affairs; the Ministry of Transportation and Communications, and Ontario Hydro, and I will try to live up to that pledge.

Mr. Philip: Can the minister give us some rationale why the Langstaff jail farm was excluded from the parkway belt?

Hon. Mr. Timbrell: The question should be directed to the minister responsible; namely, the Treasurer (Mr. McKeough).

FRENCH-LANGUAGE BROADCASTING

Mr. Samis: Monsieur le président, je voudrais diriger une question au ministre de la Culture et des Loisirs. Quelle ligne d’action le ministre est-il prêt à prendre afin que le présent pourcentage de langue française télédiffusé sur les ondes du canal 24 à Ottawa, soit augmenté du minable 17 pour cent présent à un niveau plus représentatif du caractère bilingue de la région d’Ottawa?

Knowing of your concern that this would be an unfair question to the minister, Mr. Speaker, I have given him an advance copy of it in English.

Mr. Cassidy: Excellent.

Hon. Mr. Welch: The member spoiled it; I was going to answer just as if I understood.

Mr. Cassidy: Let’s hear the answer. Are you better than Diefenbaker?

Hon. Mr. Welch: What a spoilsport.

Mr. MacDonald: You should answer en français.

Mr. S. Smith: En anglais.

Hon. Mr. Welch: What do you think this is? Good gracious.

Meanwhile --

Mr. Nixon: Back at the lottery.

Hon. Mr. Welch: Meanwhile. I am advised by officials at the OECA that there has been an increase this year of about 10 per cent in French-language broadcasting over channel 24, and that the board itself is very anxious to study the ways by which this can be increased and is presently planning to establish a French advisory committee to advise it on French-language broadcasting. I will be in a better position to respond in a more detailed and precise way once I have that particular report.

Mr. Nixon: The member for Ottawa West (Mr. Morrow) could chair that committee.

Mr. Samis: En anglais cette fois: Could the minister assure the Franco-Ontarian population that he will do everything within his jurisdiction to increase the two-hour-a-week prime-time broadcasting in French on that channel to something more equitable?

Hon. Mr. Welch: The members of the board of OECA are very anxious to see this expanded and this is why they are asking for the establishment of the advisory committee before they take any further steps.

MISSISSAUGA INQUIRY

Mr. Singer: Mr. Speaker, I have a question for the Attorney General. In view of the statement in writing by His Honour Judge Stortini that there were facts in the municipality of Mississauga that warranted a judicial investigation, and in view of the fact that the divisional court ruled the investigation that Judge Stortini had commenced an invalid one because of its terms of reference, does the Attorney General intend to take any steps that will bring about an investigation, as Judge Stortini recommends?

Hon. Mr. McMurtry: Firstly, with respect to the ruling of the divisional court. Mr. Speaker, it was more than that the terms of reference were certainly invalid in the widest sense; as a matter of fact, the court referred to denial of natural justice.

I would like to inform my hon. colleague that Judge Stortini’s counsel, Mr. Bates, was advised over a period of many weeks with respect to whether or not there would be certain extraordinary powers granted to the commission. The counsel, Mr. Bates, was advised that unless he indicated some very good grounds for the granting of these extraordinary powers they would not be granted.

The fact that the divisional court has ruled the inquiry invalid, as stated by my friend, would indicate the wisdom of that course. I should like to state that Mr. Bates was also in receipt of some correspondence from Mr. Greenwood, in my ministry, the director of Crown attorneys, indicating to Mr. Bates that a full police investigation had been carried out with respect to some of the allegations of the laying of possible criminal charges and that there was no possible information made available to the police authorities to warrant the laying of any such charges. In view of the information which I have at the present time, there certainly would appear to be no action that I intend to take as Attorney General at this point in time.

[2:45]

Mr. Singer: By way of supplementary, Mr. Speaker, what the Attorney General has stated is based on information of early last week. Judge Stortini’s letter apparently was written on Thursday or Friday, and in view of Judge Stortini’s apparently positive statement that there were still facts that warrant a judicial investigation, is the Attorney General prepared to ignore that recommendation or is he prepared to take any action about it?

Hon. Mr. McMurtry: I should hasten to add, and perhaps I should have made this clear to my friend in the first instance, I have not seen Judge Stortini’s letter, and if Judge Stortini were able to particularize any specific circumstances that would warrant an investigation, I would certainly consider the matter very seriously --

Mr. Singer: Why doesn’t the minister talk to him?

Hon. Mr. McMurtry: -- but at the present time, my information, and it may not be complete, is that Judge Stortini did not particularize the circumstances that he felt warranted further investigation. If Judge Stortini would like to do that, we will certainly consider the matter further.

Mr. Singer: The minister and he should talk together.

BEAR DAMAGE COMPENSATION

Mr. Wiseman: I have a question for the Minister of Agriculture and Food.

Mr. Roy: The minister ought to get his backbenchers and cabinet together some time.

Mr. Speaker: Order, please. We are wasting valuable time.

Mr. Wiseman: Is the minister aware that the farmers of eastern Ontario are having a problem with bears killing their livestock, and six such kills have been reported in Lanark county alone? Would the minister consider some sort of compensation similar to the compensation paid for damage done by wolves; and if so, would he consider making this retroactive to Sept. 1, because most of these kills occurred in September-October?

Mr. Roy: Tell him what you think of wolves.

An hon. member: We are right behind you, Albert.

Hon. W. Newman: Yes, Mr. Speaker, I appreciate the problems the member for Lanark has brought to my attention, cot only here but by correspondence on this matter. I have looked at the matter very recently and am prepared to allow compensation for damage done by bears. Whether I can legally make it retroactive or not, I am not sure at this point in time, but if it’s possible I will do just that. I am aware of the particular problems the hon. member is faced with this year.

ANTI-INFLATION PROGRAMME

Mr. Swart: Mr. Speaker, I would address this question to the Treasurer: In view of the strong objection voiced by the municipalities and by the school boards to the Treasurer’s announcement that the increases in assistance to school boards and municipalities next year will be cut back to a five or six per cent increase, and in view of the fact that they have indicated that it will be difficult for them to keep their expenditures to even a 10 per cent increase, which would mean --

Mr. Speaker: No debate, just ask the question.

Mr. Swart: -- a property tax increase of at least 15 per cent --

Mr. Speaker: Order, please.

Mr. Swart: -- on average, is he willing to reconsider his indication that he is only going to give them a five or six per cent increase?

Hon. Mr. McKeough: Mr. Speaker, I am sorry. I wasn’t paying as close attention to the question as I should have. I thought it was to my colleague.

Mr. Cassidy: He sure wasn’t.

Hon. Mr. McKeough: I gather the question is, are we prepared to reconsider our decision?

Mr. Swart: That’s correct.

Hon. Mr. McKeough: No.

Mr. Swart: Supplementary, Mr. Speaker.

Mr. Nixon: Supplementary, Mr. Speaker.

Mr. Speaker: Order, please. We are just about out of time. Is it an essential supplementary? All right, the hon. member may ask one supplementary here.

Mr. Swart: If the minister is not prepared to reconsider, is he going to budget sufficient funds in the property tax credits so that there will be, on the average, no municipal tax increase above 10 per cent in next year’s property taxes?

Mr. Speaker: That is not supplementary to the original question but we will allow it. Does the minister have an answer?

Hon. Mr. McKeough: Mr. Speaker, that would be in the following year rather than the next year.

Mr. Nixon: Supplementary, Mr. Speaker: Would the minister then indicate that he is going to restrict the expansion of our own expenditures to five per cent if he is prepared to impose --

Mr. Speaker: That’s not a supplementary.

Mr. Nixon: Sure it is.

Mrs. Campbell: You allowed that one.

Mr. Speaker: Order, please. The member for Ottawa East, a new question.

Mr. Cassidy: You are trying to act like Gerry Ford on New York City.

VIOLENCE ON INDIAN RESERVES

Mr. Roy: Mr. Speaker, I’d like to ask a question of the Provincial Secretary for Justice and Solicitor General; I guess that is his full title, is it? I wonder if the minister might advise what steps he’s going to take to curb the increasing violence on the Indian reserves; more specifically, on the Whitedog reserve, which we’ve been hearing about lately? What steps is he going to take to curb that, apart from stationing maybe a couple of police officers there?

Mr. Yakabuski: Been watching television again, Albert?

An hon. member: The law and order Liberal.

Hon. Mr. MacBeth: Mr. Speaker, we have been proceeding with our plan in connection with the native police constables and they are working out very well. I would hope that a continuation of that plan would help solve the problem. It’s not an easy one. That, among other initiatives, will be followed up.

Mr. Roy: Just a quick supplementary: If the plan is working so well, how come violence is increasing? Secondly, what steps has he taken to satisfy the Indian chief of the Whitedog reserve who mentioned that one of the reasons for the violence is that their livelihood has been taken away?

Mr. Speaker: Order, please. This is a quick supplementary?

Mr. Roy: Yes, it is.

Mrs. Campbell: About as quick as some of the others.

Mr. Roy: How about an answer?

Mr. Speaker: Does the hon. minister have an answer?

Hon. Mr. MacBeth: I’m afraid I don’t have a quick answer.

Mr. Roy: He doesn’t have any answers.

Mr. Singer: Consult with Ed Havrot.

Mr. Speaker: The member for Renfrew South.

Mr. Cassidy: This is a put-up job.

Mr. Ruston: Who is the next one?

WINTER TRAILS PROGRAMME

Mr. Yakabuski: Mr. Speaker, I have a question of the Minister of Natural Resources.

Interjections.

Mr. Speaker: Order, please.

Mr. Yakabuski: Does the ministry have any plans, similar to what it had the past winter, to assist snowmobile associations, cross-country skiers and other similar groups for developing and maintaining trails this coming winter?

Mr. Reid: That’s a high priority!

Mr. Roy: Mr. Speaker, since we’ve had no snow it is not of urgent importance.

Hon. Mr. Bernier: Yes, Mr. Speaker, about a week ago I had the pleasure of meeting with the new Ontario Provincial Trails Council at its inaugural meeting. I announced to the council that cabinet had given approval for an extension of last year’s programme, which will basically be the same.

Mr. Cassidy: Does the member sell Ski-Doos?

Mr. Roy: Does he sell snowmobiles on the weekend?

Hon. Mr. Bernier: I also indicated that in response to a number of requests, as the member has mentioned, we will include some form of assistance to long-distance skiers to assist them in a trails programme. Those programmes will go ahead this year and the exact amount of the funding will be determined by Management Board.

Mr. Cassidy: Would you buy a Ski-Doo from a man like Yakabuski?

Mr. Moffatt: A supplementary: Will the funding be equal to or better than last year’s funding?

An hon. member: It’s got to be better.

Hon. Mr. Bernier: Mr. Speaker, those details have yet to be worked out.

Mr. Speaker: Order, please. The oral question period has expired but the Minister of Transportation and Communications wishes to table a couple of answers. I think we would allow him to do that.

ONTARIO NORTHLAND RAILWAY STAFFING

Hon. Mr. Snow: Mr. Speaker, I have the answers to two questions asked on Nov. 4 by the hon. member for Timiskaming. In order to save time, if I may, I will just table these and forward a copy to the member.

Mr. Speaker: Petitions.

Presenting reports.

Mr. MacDonald: Mr. Speaker, on behalf of the select committee reviewing the proposed Hydro rate, I’d like to make a report to the House concerning the situation that has developed in connection with the media. I understood that it was the right of a select committee to order its own business as it saw fit. Therefore, when approached on the first two days’ meetings of the committee by the media as to whether or not they could take camera shots, I granted approval subject to any objections from the committee in review of the issue. There were no objections during those first two days. Today, further camera shooting took place but with more light and there were no objections to that taking place by members of the committee although it was pointed out that it was in violation of what have been the rules of the House until now. Those rules apparently require that a committee get permission from the House if it wishes to permit camera shooting.

I repeat, members of the committee have no objection to this procedure continuing, particularly since this whole issue of TV coverage is now before another select committee investigating the Camp commission recommendations in that connection. Therefore, it would be my request to have House approval to permit this procedure, pending a report from the select committee reviewing the Camp commission proposals.

Mr. Speaker, perhaps in all fairness I should say that it was raised today because of lights that were shining in the eyes of some people who happened to be facing the lights and the heat and the request was made of the media people to reduce that as often and as quickly as possible, and they did.

Mr. Speaker: I think before we make that decision we should enlighten the House, particularly the new members, concerning the situation. This came to my attention just a few moments ago, and I have had a ruling prepared.

The question of the coverage of proceedings in the House and its committees is, as all members are aware, one that has been raised in the House many times over the years.

Except for one or two special exceptions, the rule that has been followed is that no such coverage will be permitted until such time as the House itself may decide to change the practice.

Specific mention should be made of the exceptions. Firstly, the ceremonial part of the opening of a new session has customarily been televised and broadcast, but even here it is to be noted that such coverage stops as soon as the Honourable the Lieutenant Governor has left the chamber and the House enters upon its own business. Secondly, on two or three occasions, by unanimous agreement, the presentation of the budget has received such coverage.

Committees are emanations of the House and they are bound by the rules and precedents of the House itself. No committee, and certainly no chairman of a committee, has authority to give permission for coverage which is not permitted in the House.

However, the most important aspect of this incident is that the commission on the Legislature has made a specific recommendation to the House that coverage by the electronic media be permitted in the House itself and all its committees. The report containing this recommendation has been referred to a select committee for consideration and recommendation.

It would seem to me, therefore, that it would be an affront to that committee and to the House to anticipate what its recommendation in this area will be, and to take the action that was taken before the committee has had a chance to make its recommendation.

I think the select committee has been especially delegated to study this question, and I really believe we should wait for that report to come before the House and be adopted or otherwise. To make a ruling in the face of that study going on right now would, I think, be taking the place of the committee. So I would think the chairman, and the committee, is out of order to continue to televise its proceedings.

Mr. MacDonald: Mr. Speaker, may I make clear what I am requesting. Since that committee is considering a recommendation from the Camp commission to permit televising, and since the select committee of which I am chairman has, without objection from any member of the committee, agreed to permit televising, on an experimental basis if you will for guidance of the other committees, my request to this House is that we permit this procedure to continue for the sittings of this committee.

Mr. Speaker: Really, this should be a decision of the House, and I think it is wrong to make this decision. I think the committee should make its recommendation first of all, and then the House decide whether it shall report. I think you are negating the function of the committee if you go ahead and unilaterally make a decision on your own. I think the committee is completely out of order and that --

Mr. MacDonald: Mr. Speaker, I move that the House give permission to the select committee investigating the Hydro rate increase to permit television coverage --

Mr. Speaker: Order, please. I might point out to the member that such a motion would require notice. You may, if you wish, give notice to the Clerk. But we are really arguing about a technical point; we are really talking about changing the rules of the House, not just one committee.

Mr. MacDonald: That is what I am asking the House to do, Mr. Speaker.

Mr. Speaker: A procedure has been set up in order to facilitate that, if that is the wish of the committee and the House leader, but we are out of tune and out of time to do it now.

Hon. Mr. Welch: Mr. Speaker, I have listened to your ruling with some interest and I know of the interest of the members of this committee.

In view of the fact that the matter can’t come forward as a motion today, we might want to consider the possibility of using what is going on in that particular committee as some type of an experiment. It might be of some assistance to the select committee of the Camp commission to have some first-hand experience as to how it does operate in a committee.

[3:00]

Mr. Speaker, you may want to consider that strictly on an experimental nature. I assume, if the House generally agreed with respect to this matter without creating a precedent, this would not necessarily determine the outcome of the consideration of any particular recommendation by the select committee considering the Camp recommendations.

I’d like to put that forward as a possible solution to this particular issue, providing it be confined to this particular committee and its hearings, that it be without precedent and that it he part of the experimentation which would help the other select committee in giving some consideration to the recommendations.

Mr. Singer: Why doesn’t the member give notice of motion?

Mr. Roy: Give your decision in writing.

Mr. Breithaupt: Mr. Speaker, we find most acceptable the approach taken by the government House leader. I think it would be a useful experimentation to give the opinion of this committee as to how this whole procedure might develop, for the convenience not only of the members but also of the various areas of the media. If this is acceptable as an experiment for the future guidance and benefit of the committee dealing with the Camp commission report, without the acknowledgement that it must be a precedent, then we would certainly support it on this side.

Mr. Deans: Before you decide to ask for unanimous consent, which I’m sure you are going to do, I would like to point out that we agree with the House leader for the government, but beyond that it is quite within the right of the House at any time to alter the rules by unanimous consent. In fact, we do it relatively frequently. I would like to suggest that it’s in order at any time for any member to ask for unanimous consent, and if it’s the opinion of the House that unanimous consent should be given, then that is the end of it. It is not a matter of whether it’s in keeping with what the Speaker thinks the rules should be or what the Clerk thinks the rules should be.

Mr. Singer: Why doesn’t the member challenge his ruling and divide the House?

Mr. Speaker: I just want to make the position quite clear that we really are changing the rule of the House, if this is considered a precedent. I’m perfectly willing to allow it to proceed, with the unanimous consent of the House, providing it’s not considered a precedent and doesn’t subvert the work of the committee, because they may decide otherwise or they may decide that way. As a matter of fact, I’m quite familiar with most of the argument.

Do we have the unanimous consent of the House to allow the televising of the proceedings of this particular committee?

Some hon. members: No.

Mr. Speaker: We didn’t have unanimous consent.

Mr. Williams: Mr. Speaker, I don’t think that we can legitimately classify this undertaking as an experimentation unless we first have the consent and approval of the commission that is studying the subject. Without their consent --

Mr. Speaker: Order, please. I think the arguments have been put forward. I asked for unanimous consent of the House and we did not get it.

Mr. Cassidy: Could you try again, Mr. Speaker? They may have been facetious.

Mr. Speaker: Do you think they didn’t hear me? I think it was quite clear. That is not to say that the appropriate standing committee may not make a further recommendation.

Mr. MacDonald: Do you mean to say that unanimous consent was not granted?

Mr. Speaker: Yes.

Mr. MacDonald: Could I have an indication as to who objected?

Mr. Speaker: There were a number of objections from around the House.

Mr. MacDonald: Mr. Speaker, I would like clarification of that because I think unanimous consent was granted, except for facetious interjections. It wasn’t?

Some hon. members: No.

Mr. Speaker: No, I heard several nays.

Mr. MacDonald: I would ask for a recorded vote on that, Mr. Speaker.

Mr. Speaker: How do you get a recorded vote on that? It was not unanimous. Many other people heard nays too.

Mr. Martel: Challenge the ruling.

Mr. MacDonald: Mr. Speaker, I have no alternative in this instance but to challenge your ruling. I think there was unanimous consent given. We’ll call for a recorded vote.

Mr. Speaker: Do you want me to ask for unanimous consent again? Would that simplify matters?

Interjections.

Mr. Speaker: All right. Order, please.

Do we have unanimous consent -- let’s get clear on this -- to televise the proceedings in this particular select committee?

Some hon. members: No.

Mr. Speaker: I heard some noes down here someplace.

Interjections.

Hon. F. S. Miller presented the annual report of the Ministry of Health, 1974-1975.

Hon. Mr. McMurtry tabled a copy of an order in council approved in regard to expropriation approved under subsection 3 of section 6 of the Expropriations Act, as required under subsection 5 of section 6 of that Act.

Hon. Mr. McMurtry tabled part 2 of the report of the Task Force on Legal Aid.

Mr. Speaker: Motions.

Mr. Bain: Mr. Speaker, I stand on a point of privilege.

Mr. Speaker: A point of privilege. The member for Timiskaming.

Mr. Bain: I would like to thank the Minister of Transportation and Communications for this report, but if you’ll cheek Hansard, the question was asked on Oct. 31, not Nov. 4, if that correction could be made when it is printed. Thank you.

Mr. Speaker: Introduction of bills.

PROFESSIONAL FUND-RAISING CORPORATIONS CONTROL ACT

Mr. B. Newman moved first reading of bill intituled, An Act to control Professional Fund-Raising Corporations.

Motion agreed to; first reading of the bill.

Mr. B. Newman: Mr. Speaker, the purpose of the bill is to provide for the licensing and control of professional fund-raising corporations. The bill is not aimed at Red Feather, United Appeal or other similar drives where a great deal of the organizational work is voluntary and expenses incurred are a very small proportion of the total proceeds.

There have been many instances of charities netting only a very small percentage of gross proceeds from fund-raising drives organized by professional fund-raising companies and it is these boiler-shop operations which must be licensed and controlled. These professional fund-raising companies that I want to see controlled at present operate on a basis of splitting net profits after expenses, and the split is usually on the basis of 60-40 or 50-50, and without adequate controls there is a possibility of overstating expenses in addition to skimming off extraordinary profits.

Mr. Speaker: Orders of the day.

Clerk of the House: The 12th order, House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH

Mr. Chairman: Estimates of the Ministry of Health. Vote 2901, items 1 and 2 are carried; we start on item 3, health services.

Hon. F. S. Miller: Mr. Chairman, in view of the considerable interval since the discussion of the last part of this vote some six months or thereabouts, and in view of the fact that there are a number of members in the Legislature who were not here for the first section, I would like to make a brief statement to summarize not only what went on but perhaps also what’s happened since we last sat here. As the members are no doubt aware, the estimates for my ministry were discussed in a series of sessions commencing June 2 last. The questions raised, and ensuing comments, covered a large number of the programmes within my ministry, although I believe we were still on vote 2901 -- as you just mentioned -- in the final session on June 9. In all honesty, I wasn’t sure we had passed any up to that point. I’m glad that the Clerk claims we did.

Mr. Foulds: That may be all you get.

Hon. F. S. Miller: It’s true. If by doing that you can stop the spending, I’m right with you.

Mr. Foulds: Is your salary passed?

Hon. F. S. Miller: My salary? No, it’s coming up. I’ve already pledged it to the bank.

I do not think it’s necessary to review any events prior to June, but I believe it would be helpful to summarize important developments, in various sectors of the full circle of health care, that have occurred since the last session.

Successful negotiations with the Ontario Nurses’ Association were conducted by representatives of the public hospitals and a further contract covering the period July 1, 1975, to Sept. 30, 1976, has been concluded. This provides the registered nurses with salary and fringe benefit gains of about 15 per cent over that period. In respect of conception control and family planning, developmental work related to the family planning programme has been conducted with local boards of health throughout the province. Funding for 41 programmes has been provided so far and, of these, 25 clinics are already in operation.

Following the discussions which took place concerning health service organizations, the council of health, the senior advisory body to the Minister of Health, has submitted its report on methods by which the operation of health service organizations shoal be evaluated. Their recommendations have been accepted and I’ve asked my staff, who have the responsibility in this connection, to proceed along the lines outlined.

In the area of occupational and environmental health, the advisory council has now been formed and its membership was announced last week. One of the early considerations of the council will be the possible establishment of an occupational and environmental institute. Such an institute should be able to help with this difficult problem by organizing expertise to deal with both known and suspected occupational and environmental conditions and with substances used in industrial settings that could be harmful to human health.

Also in connection with occupational and environmental health, I can report that with the co-operation and under the direction of the medical officer of health for the borough of Scarborough, arrangements have been made extending the study of asbestos-related illnesses to anyone who lived three months or more in the same homes as past or present workers with 20 or more years’ service in Canadian Johns-Manville’s asbestos plant in the east end of Scarborough.

Arrangements have also been made to examine families of former employees of the Reeves mine in the Timmins area for possible identification of any health symptoms related to asbestos.

On the question of federal-provincial cost sharing, members will recall the budget speech made in Ottawa in June by the Minister of Finance, then the Hon. John Turner. His announcement, made without any prior consultation with the provinces, and at variance with the spirit of federal-provincial negotiations of only one month earlier, applied arbitrary and unrealistic limits to federal cost sharing on the medical component of health care, while also giving notice of termination of the existing Hospital Insurance and Diagnostic Services Act in the shortest time permitted under that Act.

Taken at face value, the changes proposed carried the gravest implications, since our own projected estimate of the barest essential increases in health care costs went considerably beyond the arbitrary percentages announced. Since then, I have discussed the proposed legislation with other provincial health ministers, who view it with as great concern as we do. The Hon. Marc Lalonde embarked on a province-by-province fence-mending tour with the purpose of giving reassurance of a greater flexibility in federal thinking than Mr. Turner’s speech had indicated.

I met with the Hon. Marc Lalonde myself in Toronto last month. I can only tell you that he appeared to show an understanding of the points that I expressed and that he told me that it was his intention to call another federal-provincial meeting of health ministers either before the end of this year or early in 1976.

[3:15]

In the meantime the general economic climate of our country and province is inevitably continuing to put special pressures on the cost of health services since most of them are highly labour intensive. While the recently announced federal prices and incomes guidelines should assist somewhat in 1976 in easing the continuing rate of cost escalation for health services, they will have limited effect on the cost of services contained in the estimates now before you.

I think at this point the critics for the other two parties have indicated they’d like to give their points of view on how to run my ministry.

Mr. Chairman: Before the member for Parkdale continues I would like to remind the committee that we are down to 21 hours and three minutes in total, for supply in the committee. While I think it’s understood that the critic for the official opposition and the critic for the Liberal Party have general statements to make, I hope you will keep in mind that time is passing and will keep your general remarks in response to what the minister has said to a minimum so we’ll provide maximum time for all the members who have something to say on the remaining votes. With that caution or admonition, the member for Parkdale has the floor.

Mr. Good: Did you stop the clock while you made your speech?

Mr. Dukszta: Mr. Chairman, I will speak at some length but I promise not to come in again to allow everyone else to have their say. Imbedded in my speech there will be a number of very strong statements and also questions directly to the minister which he can answer. As I said, I promise not to enter again.

Mr. Foulds: You may not be able to.

Mr. Dukszta: I wish to take this opportunity to address myself not only to the specific issues raised by the current estimates of the Ministry of Health but also to some more general issues of health care, specifying their applicability to the Ontario situation and using them to put into perspective what needs to be done, what is not being done and what must be done in the field of health care.

In other words I want to do what this government and this minister have so far failed to do: Namely, to put health care problems into their proper context rather than dealing with them as ad hoc problems in watchdog accounting.

I want to bring forth proof of the government’s continued and increasing mismanagement of the health care delivery system in this province and the inability of the present minister to perceive or define, let alone act upon, health care problems in their broader environmental, social and self-imposed lifestyle aspects.

Health care problems can be broadly organized into four categories. First, health and lifestyle; second, health and social organization; third, health and biological problems; and finally, health and the environment.

Each of these problem areas is affected by a number of contemporary factors. The first of these are rising societal expectations. People expect, in fact demand, that their doctors will keep them healthy and even happy and that they will do so free of charge.

Then there is the rapid growth of the elderly, financially and medically-dependent population. In Canada over the next 10 years, the number of people of retirement and, I may say, of doctor-badgering age, will increase faster than the size of the working population which supports the health care system.

In addition, there are the consequences of those advances in medical science and technology which all enlightened people welcome. Doctors understandably want to employ costly and sophisticated new equipment and techniques which they know will enable them to do a better job. An ever-increasing number of chronic patients, kept alive by science, need more care for longer periods of time.

Against all this is our increased awareness of the importance of prevention. We know that public health measures are more efficient, more economical and more effective than treating clinical problems when they occur. Prevention must be seen as a three-fold activity: Primary prevention eradicating the potential health problem before it occurs and requires treatment; secondary prevention, immediate curative action to combat the problem which has become clinical; and tertiary prevention, treatment of after-effects, rehabilitation and so on.

Many may ask why we must go back to such a dull-sounding preventive approach when medical science is glamorously producing for our edification, if not for our benefit, a new wonder surgery almost daily. A heart transplant operation is rather like a circus: The media, the surgeons, the team, almost everyone in the hospital, not to mention the patient, are involved in a dramatic event. Two hundred and fifty people work for days and rejoice when the last stitch is finally sewn.

This is modern medical science at its most miraculous and dramatic. But after all, do such isolated incidents not pale into insignificance in juxtaposition to the much more fundamental and ongoing failure to reduce or even contain deaths and injuries from environmental pollution, from industrial disease such as asbestosis and silicosis, and from automobile accidents?

We must bear in mind the historical lesson that the major advances in health care, and the consequent improvement in general health and the prolongation of life, have come about not from advances in medicine per se but from such improvements as better nutrition; safe water; domestic sanitation; control over pests, rodents and bacteria; sterilization and vaccination.

We are still faced with a plethora of obvious social problems such as environmental pollution, and yet we continue to devote almost all of our health care resources to dealing with the consequences of these problems, in terms of treatment or secondary prevention, rather than attacking them at their sources.

With this basic principle in mind, let us look more closely at the four broad areas in which I feel this ministry’s shortcomings can clearly be seen: health and life-style, health and social organization, health and biological problems, and health in the environment. Granted, not every aspect of each of these categories can be laid at the minister’s door alone. The gross failure to protect the health of Ontario’s miners, for instance, is an ongoing disgrace to at least four different ministries.

It is the government as a whole, and the minister in particular, who must take responsibility for this failure to treat health-care problems within a broad social context -- the only way in which they may be properly understood and solved.

It is precisely this broad social context to which I wish to draw attention in the first and second of my four health categories -- health and lifestyle, and health and social organization. On the subject of Ontario lifestyles, the minister is most eloquent, in a highly moralistic vein. “Moderation in all things,” he says. “Behave reasonably and many of our health problems will disappear.” Not without some smugness, he points to cigarette-smoking, out-of-shape individuals both inside and outside this chamber.

Granted, those health problems which arise from one’s lifestyle are by and large self-imposed problems. This does not alter the fact, however, that once they manifest themselves clinically, they become serious and expensive. They stop being private problems and start being public problems, because they are a major drain on our health-care resources. Among these self-imposed risks are excessive use of alcohol, cigarette smoking, abuse of pharmaceuticals of all sorts, obesity and automobile accidents.

With this list in mind, it is instructed to look at the principal causes of early death and the chief demands made on acute hospitalization time.

On the basis of years of life lost, measured against a life expectancy of 70, the principal culprit in 1971 was motor vehicle accidents followed by ischaemic heart disease. All other accidents, including industrial, were in third place.

“Looking at acute treatment hospitals morbidity measured by the number of hospital days, one finds that diseases of the cardiovascular system, injuries due to accidents, respiratory diseases and mental illness, in that order, are the four principal causes of hospitalization, accounting for some 45 per cent of all hospital days.”

It is clear that these self-imposed lifestyle-related health problems are most expensive, both in terms of human lives and in terms of their significance to the financial, capital and manpower resources of the health care delivery system.

I mentioned earlier that prevention, properly understood, includes three levels: primary -- before the problem manifests itself; secondary -- curative, clinical action; and tertiary -- mopping up of after-effects and preventing recurrence. These lifestyle-related health problems are particularly susceptible to the most effective, economical, efficient and humane level of treatment of all -- primary prevention. But in order to stop these individual problems before they start, more than moralistic exhortation is needed.

An intensive educational programme should be instituted with the aim of teaching people about their bodies, about good health and good nutrition, and about the deleterious effects of alcohol, drugs and tobacco on the human organism. Such a programme should begin as early as possible in the school system -- say at the grade 2 level. It should include a training programme for teachers to make them more aware of health care problems and to show them how they can inculcate desirable attitudes in their students. It should involve the public health nurse in educational programmes both inside and outside the schools.

Only after some time will we be able to see the results of a changed attitude on the part of people toward their own bodies and then only if concentrated educational efforts are applied to the problem, beginning at the earliest possible age and continuing throughout the rest of an individual’s life. When will the minister be ready to start such a programme?

As for automobile accidents which, remember, were the principal cause of early deaths in the 1971 survey that I quoted a few moments ago, it is a fact that such accidents are reduced by a full 50 per cent if everyone who drives or rides in a car wears a seat belt. In the face of such statistics, when are you going to begin working hard for the introduction of compulsory seat belts in every car on the streets and highways of Ontario?

Of health and its relation to the overall organization of society, I shall speak only in passing on this occasion, for it is an issue of gigantic proportions in its own right. Suffice it to say that crowded, unsanitary and alternatively stuffy and draughty living conditions, insufficient and unbalanced nutrition and other physical effects of prolonged poverty and social deprivation are in themselves likely to produce health care problems which will sooner or later manifest themselves at the clinical level, even though they do not have their source in organic dysfunction at all.

I am not asking the minister to eliminate social inequity from our province with the resources at his disposal but I would remind him that here again primary prevention would do much and do it, in the long-run, more economically as well as more humanely. Widening the sphere of influence of public health to embrace housing, food and other social services can only help to nip such problems in the bud before they reach clinical proportions.

Health and the organism; the health care delivery system. The health care system has largely been devised to deal with illness after it has occurred with what I have been calling the secondary level of prevention. Let me now turn to some aspects of the Ontario health care delivery system as it attempts to meet the clinical needs of the human organism with particular emphasis, unhappily, on the many ways, in which our health care system as presently constituted falls far short of meeting the demands made upon it.

Dental care in Ontario. In a 1972 study it was found only 21 per cent of school children had no cavities. It was also found that the average number of decayed, missing or filled teeth per child was 4.4. Further, it has been found that only 25 to 30 per cent of the general public of Ontario receive adequate dental care, which is not surprising due to the fact of the high fee-for-service of dentists as well as the low ratio of dentists to patients. There is now one dentist for every 2,400 residents in Ontario; the last figures available were for 1974.

Clearly the emphasis must be placed on preventive care. The Saskatchewan model of preventive care using para-professionals -- nurses in schools -- and free dental clinics for children aged four to 12 is the reasonable answer to an increasing health programme. Again, the prevention of health problems should be the emphasis of the Minister of Health.

Pharmacare. In August, 1974, only 538,000 people were eligible to receive drug benefits from the government of Ontario. In British Columbia all prescribed drugs are free for all people of 65 years and over. Surely, a province of the status of Ontario could devise a more comprehensive drug programme for its citizens.

Availability of physician services. The regional disparity of the availability of health services is nowhere more clearly reflected than in the distribution of doctors by geographical area. The doctor-patient ratio for Metro Toronto was one to 426 patients in 1974; specialists were one to 915 patients. When this is compared to the doctor-patient ratio in northeastern Ontario, of one to 2,931 patients for specialists and one to 968 patients for all doctors, the fact of the inaccessibility of health services in northern Ontario becomes clear. What is the Minister of Health prepared to do to correct this imbalance?

[3:30]

Premiums. Residents of Ontario paid the highest health insurance premiums in Canada. The Maritime provinces, Manitoba and Saskatchewan have no premiums at all. Why should one of the richest provinces in the country continue to charge premiums which are regressive rather than finance health care from general revenues which are collected in at least a somewhat progressive fashion? Are you planning to abolish premiums?

Birth Control. $1.7 million was allocated by the Ministry of Health for the 1975-1976 fiscal year for birth control. This represents a minimal part of the total health budget. At the Planned Parenthood Ontario’s Birth Control and Sex Education Conference in October, 1974, Dennis Timbrell estimated that it costs the province “$45.5 million for medical services, family benefit allowances and homes for unwed mothers for the 8,437 children born out of wedlock”.

Hon. F. S. Miller: That’s for him to know.

Mr. Dukszta: I wish the hon. minister would not act this way sometimes. That is one of the few times that I would just like to walk over and bash him on the head, when he talks like that.

Mr. Samis: You are talking to a psychiatrist now, Frank, be careful.

Hon. F. S. Miller: Don’t get vicious.

Mr. Samis: He’s just extending his inner aggressions, that’s all.

Mr. Dukszta: Not inner aggression. It is very much outward aggression.

This does nothing to alleviate the circumstances of others having no opportunity to plan the births of their children. Further, there is no requirement that local medical officers of health provide these services, and no attempt made to involve Planned Parenthood which has already been in the field for 40 years in Ontario with almost no provincial support and has been providing an excellent service on a purely voluntary basis. Surely, this is a clearest example of lack of leadership. Incidentally, the minister’s attitude underlines what I am really talking about.

Community Health Centres. The province has for several years funded a number of community health centres across the province. Initial funding for these centres was provided in response to pressure from various communities as an experiment in finding a means of reducing the high cost of health care delivery. These centres, there are 10 in Metropolitan Toronto, are beginning to demonstrate their economic and social viability.

According to a national health and welfare study, in economic characteristics of community health centres “there is evidence to show that the community health clinic, as observed in a few communities in Ontario and Saskatchewan, has a lower hospitalization rate than either solo or physician-sponsored group practice.”

A recently appointed committee, Spitzer et al, has produced an extensive document outlining methods of evaluation of community health centres. Of increasing concern to patients, workers and boards in these centres is the fact that there may be few of these centres around to evaluate in the near future if the ministry does not immediately begin to take a more encouraging and supportive role. Doctor and board turnover has been high, due in part to the frustration of working under oppressive contracts with the Ministry of Health.

These contracts impose far more control on the centres than they do on the existing physicians in the primary care sector, as well as a higher degree of interference with patients. For example, only full-time physicians are permitted to work in some centres, thus militating against employment of doctors who are mothers and often would prove to be ideal in these settings.

Under the contract, physicians employed in these centres are not permitted to do any other work, such as in emergency departments, or to see any non-health centre patients in their free time. These restraints are not placed on other practicing physicians.

These and a variety of other clauses in the contract indicate that the minister is attempting to control, and perhaps even to strangle, the community health centre movement. Staff members from such centres as the Niagara Neighbourhood Community Centre, Lawrence Heights and the Don District Community Centre are of like mind in the criticism of the contracts with the Ministry of Health. They are also very critical of the lack of definition on the part of the ministry as to what a community health care centre is and how it should relate to and involve the community it serves.

If the high turnover of doctors, board members and patients continues, or if the centres close voluntarily because of these restraints, no valid conclusions will ever be reached as to whether the community health centre can represent, in the long run, a cheaper, more comprehensive type of primary care than the more traditional forms of practice.

Clearly, in a province with rapidly accelerating health care costs, the ministry would be highly remiss if it contributed to the demise of such centres when they have clearly demonstrated their potential to cut down on these costs. I hope you’ll continue supporting them.

Rehabilitation. For rehabilitation to be successful it must take cognisance of the individual and his environment. It must be concerned with the interaction between the disease, the individual, the community and the environment, and requires a broad ecological approach to care. Establishment of an accurate medical diagnosis is only the first step. Many needs can only be identified, at the moment, by agencies outside the health service. Assessment of disability and its correction requires an integrated team, with knowledge of medical, social, educational, psychological and vocational factors.

In this multi-disciplinary approach, communication, co-operation and continuity are all-important. This is another type of tertiary prevention which is equally important, and which is also grossly neglected by the ministry.

District health councils. The concept of district health councils, as recommended in the Mustard Report, has some attractive possibilities. I recognize the fact that the Ministry of Health has instigated five district health councils, and is regulating the existence of a further 21 councils.

The concept of involving the community in comprehensive planning seems to have been borrowed from basic New Democratic Party thinking. The basic divergence from NDP thinking on health policy is the total impotence of these councils and the lack of elected representation.

It seems ludicrous to me to conceive of an effective district health council where planning and financing are not related. I wonder if the minister would consider giving these councils elected representation, and the necessary power to function effectively.

Further, since the British Columbia experience with district health councils shows that there are problems with these councils in large urban areas, I would like the minister to address himself to this problem, especially in Toronto. Is Toronto to have one or five councils? And when?

Teaching hospitals. In 1973, 14,620 out of a total of 43,348 general hospital beds were in teaching hospitals. This is 34 per cent of the total acute care beds. These teaching hospitals are scheduled to receive 57 per cent of the ministry’s transfer payments for capital construction and acquisition. They are all located in the major urban areas. There are 23 of them; 12 in Metro, four in Hamilton, two in Ottawa, two in Kingston and three in London. Why this discrepancy? At a time like this, increasing funding of the tertiary centres -- centres for highly specialized and very expensive care -- seems inappropriate. Is it reasonable to expect, for example, that students trained in centres such as this will want to practise outside cities? Why should programmes not be expanded to hospitals which more accurately reflect subsequent practice possibilities?

General hospital beds. The Hospitalization International Comparison, 1969, from the report of the Ontario Council of Health, states that Canada has 5.7 beds per 1,000 population -- which puts Canada ahead of England and Wales, with 4.1 beds per 1,000. We don’t need that many beds. Incidentally, in 1932, the bed capacity in Canada was 3.95 per 1,000.

In Ontario, hospital beds are now often used inappropriately. One in five of the patients now occupying beds could be treated either on an ambulatory basis or in a different setting, depending upon conditions. Some of these patients could be treated in the doctor’s office, the community health centre, or even the hospital outpatient department. Some of the psychiatric patients undoubtedly could be treated in day care or other types of partial hospitalization programmes.

Some people are in fact chronically ill and in need of institutional or nursing care, yet no bed can easily be found for them. However, let me tell the minister very plainly that though he and I both agree, this time, that this type of patient does not belong in hospital, you cannot cut one in five beds until you provide alternate community based services. You are taking a real risk with your heedless, unplanned economizing.

[3:45]

Long-term psychiatric patients. During the years 1960 to 1971, there was in provincial psychiatric hospitals a decrease of 43 per cent in the in-patient population. In 1961 there were nearly 16,000 patients in Ontario psychiatric hospitals, a small percentage of whom were mentally retarded, and hence, the responsibility of the Ministry of Community and Social Services. Now, there are 6,000 to 7,000 patients in the 15 provincial psychiatric hospitals.

This change has been welcomed by almost everyone in the mental health field and by the community at large. Large, overcrowded, prison-like wards began to open their doors -- patients were admitted and discharged more easily. New treatment methods designed to rehabilitate patients were tried and the whole mental health field became more open, therapeutic and oriented toward problem- and goal-solving. Patients, at last, were becoming people.

What happened to these thousands of discharged patients? Are they living at home or with their families? If not, are they alone, are they working, are they able to care for themselves physically and mentally? If not, who supervises them and pays for their keep? Who ensures that they are capable of maintaining themselves in the community?

In the first flush of enthusiasm about clearing out these “total institutions,” as Goffman describes mental hospitals, and getting people into the community and back to life, so to speak, many of these patients were placed in community and boarding homes. However, there have been increasing numbers of disquieting reports about the living conditions of discharged ex-patients published recently in Great Britain, the USA and Canada.

These facts can only lead me to believe the Ministry of Health is merely paying lip service to the policy of integrating these patients into the community. The lack of adequate resources for them -- financial, recreation, employment and housing -- is such that patients are merely vegetating in boarding homes throughout Ontario. This has created a situation which probably provides less sufficient supervision for those people than they have received in back wards of the mental hospitals.

These boarding houses have been condemned by the Psychiatric Hospital Patients Welfare Association and I quote, as “houses of dl repute.” In a newsletter put out by the PHPWA, the following observations were made:

“The patients, heavily drugged, huddled together in a state of squalor reminiscent of Oliver Twist. There was no interest in clothing or in getting out of doors. Weak, and almost comatose from excessive sedation, these ‘lost’ people -- despite the potential for rehabilitation in some cases -- spend their days staring at the walls, waiting for death.”

Yet, these boarding houses have been paid handsomely for providing these dysfunctional services for patients. It was reported in the same article that one landlord, who does not live in the boarding house himself, had prospered to the point of being able to purchase two additional houses within the past four years.

Surely the minister must be ignorant of these facts, otherwise I am certain he would not allow such injustice to continue.

I must ask you, Mr. Minister, to tell me who is responsible for these disenfranchised people. I speak not merely of the financial responsibility, which I know belongs largely to the Ministry of Community and Social Services, but, more importantly, the responsibility of integrating those who are capable back into a productive role within our society. Is their physical and emotional care to be supervised by a family doctor, or by the hospital where they previously resided, since they are often still recorded as outpatients on daily census sheets?

Given that I recognize the incestuous relationship between the Ministry of Health and the Ministry of Community and Social Services, I charge both to define clearly their responsibilities and then ensure proper supervision and service for these people.

Mr. Moffatt: Don’t strike him, now.

Mr. Dukszta: I am not going to do anything to him.

Regarding adequate services, why did the Ministry of Health “freeze” the hiring of social workers, occupational therapists and psychologists -- and not the hiring of doctors and nurses -- if the ministry did not intend to adopt simply a policy of custodial care? For example, the unit at Lakeshore Hospital known as the DARE project and responsible for these patients, has recently lost one-third of its staff. Such a loss virtually means that more and more “discharged” patients will be placed in homes where supervision, encouragement and support for self-sufficiency are left to chance. There is little doubt that this, in part, accounts for an increased readmission rate.

Surely, in the face of the evidence of successful programmes elsewhere, the ministry does not intend to allow such inadequate policies to continue, with a greater burden on themselves as more and more patients come to be readmitted. It has only to consider the success of part-time hospitalization programmes -- daycare, night and weekend hospitals -- to realize the therapeutic and economic advantages of an effective community psychiatric treatment model -- not to mention, of course, the greater success rate for the integration of patients into a completely self-sufficient, productive community existence.

As to children and mental health, the CELDIC report of 1970 stated that up to 12 per cent of the child population needs some form of intervention for emotional problems, while only one in 10 receive the help indicated. There’s little evidence to suggest that these forms of early intervention are any more readily available five years later, the result being that we are too often faced with adolescents with serious problems and an even greater lack of resources at that point.

It would appear that the young persons in conflict with the law Act will soon become law. This will mean that a whole new group of children under 14 years of age will need service from the community. While it seems a positive step that no child under 14 will be subjected to the court system, it raises even more urgently the problem in service delivery to children pointed out in the CELDIC report.

A year ago on Nov. 5, I’d like to remind you, the Leader of the Opposition (Mr. Lewis) spoke in the House on Ontario mental health services during the debate on the estimates of the Ministry of Health. He started by discussing the death of Derek Halanen and pointed out to mental health workers, the public and the Legislature, the horrifying mess in Ontario involving mental health services for children. The death of 15-year-old Derek in the Queen St. Mental Health Centre shocked us all. I would like to refresh the members’ memories with some of his statements, for he might just as well have been speaking in November, 1975 and not in 1974, 1973 or 1970.

“Mr. Lewis: To read about the transfer of this young man (Derek Halanen) from institution to institution -- some six of them I think, in a period of 18 to 20 months prior to his death -- is to read an indictment of the system.”

The leader of the New Democratic Party then elaborated on the desperate inability of Children’s Aid Societies to find placement for disturbed teenagers. He concluded:

“Mr. Lewis: There is some kind of desperate roadblock in the treatment facilities for disturbed children and adolescents. There is something profoundly wrong about it all. I don’t know how it is allowed to happen.”

The need became even more public in December, 1974, when the Toronto Daily Star published a series of four articles on the mental health problems of children and adolescents written by Marilyn Dunlop and entitled, “Nowhere to Treat Troubled Teenagers.” In one of these articles, she reported that there were some 70,000 emotionally disturbed children in the province ranging in degree of disturbance from mild to severe. Again, the problem was clearly specified and case histories were given of typically disturbed “untreatable children.”

Statistics were again given by the various Children’s Aid Societies. Again Derek Halanen’s death was described as a pointless death. Then based on the purported lack of facilities for these adolescents, the ministry undoubtedly felt that it had to devise a new system to provide a completely new dimension of service in addition to and presumably to be integrated with existing services.

What exactly did the ministry do? Lying on the shelves of the children’s services branch, there was an old paper written in 1969 by a social worker and a psychologist working for the ministry. This paper was called “Treating the Untreatable Adolescents” or, simply, “The Four-Phase Programme.” Let us attempt to understand why this paper, which has been on the shelves of the children’s services branch since 1969, was unearthed.

To begin with, we must take a look at juvenile and family court system. Many new judges have recently been appointed by the government. These new judges, in their idealism and desire to understand and help children with social problems, have begun to refuse to send children to training schools. They have asked questions, and it bothers them what is happening around them.

As we all know, it takes some time for a judge to become accustomed to the system. As he does, he no longer asks questions. He simply does what he is told to do by the people who bring the child before him. Then the judge, who has become accustomed to the system, asks no questions when he’s told that the best place for the child is training school. He does not see that the child before him has been psychiatrically assessed several times, and has been to foster homes, to group homes and to treatment centres and that the training school is yet another place where the child will be passed around.

The new judges perceive there is something very wrong about all of this. They might even ask themselves what happens to the child after training school. They do not like the possibilities which go through their minds and they refuse to send more children to the training schools. In combination, their refusals are so strong that they now want training schools completely abolished.

But then each considers “Where will I send the child? What am I going to do?” He puts pressure on the Children’s Aid Society and a public outcry follows. Then there is the pressure on the ministry. The children’s services branch of our present government has not been known to date for any creative or forthright thinking. The plan on how to treat the untreatable adolescent is then brought to the fore to appease the public and to save the ministry.

What are the phases? They can be outlined as follows. Phase (1). Assessment and recognition of degree of untreatedness. Phase (2). Treatment in a closed setting. It elaborates that the goal of this setting is the gradual establishment of a basic trust in the child’s relationship to others. Phase (3). Placing the child outside the city. It is explained, “Some youngsters will need the chance to get away from the contaminating and/or disturbing influence of their home and community environment.” Phase (4). This is seen as a city life re-integration programme.

Let us take a critical look at the four-phase plan.

Phase (1). Psychiatrical assessments are extremely variable from person to person and most often reflect both the personality and the orientation of a particular psychiatrist. The child found sadistic, dangerous to society and hence in need of at least two years of institutional care can be seen by another as anxious, tense, inhibited and in need of socialization with his peers.

Many children sent to me by social workers, psychologists or psychiatrists have been described as having brain dysfunction or labelled as psychopaths or schizophrenics. To my amazement, I have found some of these children basically normal. But I have also found a great deal of confusion around them to have been generated by those who have assessed them previously.

One must question: who are the psychiatrists appointed by the government to delineate the untreatable child? How arrogant, blind and insensitive such an individual must be, to send to others a child he himself has deemed to be untreatable.

Phases (2) and (3). It is a known fact that no genuine sense of trust has ever been born out of enclosure and fear in those deprived of individuality and freedom; one only has to know children discharged from training schools or adults from penitentiaries. Even if the government premises were correct and trust could be established and could grow in such a situation, how does the ministry explain that a child, who has never before related to others, should be sent away as soon as he develops his first sense of trust to a placement away from society? Why should he be seduced to stay for a longer time when he has already been able to develop a sense of trust? It simply makes no sense.

Phase (4). The final phase is seen as a city life re-integration problem where it is described that social education is particularly emphasized. The programme is still designed to help adolescents who have a near-delusional misinterpretation of life and what it may have in store for them. If one thinks seriously about the stated purposes of the first three phases of the plan and how the adolescent is viewed when he reaches the final phase it becomes very clear that the basic lack of trust does not lie with that adolescent.

This paper, a plan from the ministry to help children, has been severely criticized by many others before me. What answers has the ministry? They have said that not all children in need of help must go through the total four-phase plan. The plan applies only to the child who has been before the court or other helping agencies. It could be that the four-phase child is a child who can no longer be tucked away safely in a training school.

The minister says in defence of the plan that it is a system of alternatives. The child does not have to go from one phase to another. He can jump phases or he can even be returned from the last phase to the first. Is the ministry serious about that? Again, it does not make much sense.

Conceptually, it seems that the basic premise underlying this programme is that the unwanted child is seen as an industrial piece of goods on the assembly line as he passes through several hands and is completely robbed of his family and community. This is precisely what happened to Derek Halanen who was sent from one facility to another until he met his death at the Queen St. mental health centre.

I would like to ask the minister a few important questions about this programme. (1) How many people have been hired by the ministry to implement this plan? (2) How many beds have been taken away from psychiatric hospitals and other helping facilities for the ministry to be able to hire all these people? (3) How much money has already been spent on this project? (4) What has this four-phase plan achieved? (5) Have you actually dealt with any people? (6) How much does it cost, if you have dealt with one individual, to treat one adolescent?

[4:00]

To me, all this plan has accomplished is that children can now “jump” much more easily from one facility to another and all children who come to the attention of the four phase programme will be tracked until they are at least 20 years of age.

Recently I was told that some particularly enthusiastic four phase youth workers spend as much as 20 hours tracking adolescents in the community. I can easily foresee that the number of disturbed children will of necessity increase. I would like to suggest to the minister that the very idea of such a tracking plan verges on the absurd. It is scientifically unsound if, as presumed, basic research is the intent.

Except for the fact that the minister can now justify to the public that potential problems are being tracked down at all costs there seems to be little value to this new system. As one four-phase psychiatrist recently commented, when attempting to explain the benefits of the programme: “There is no longer any need to get stuck with any child. Don’t you see how he or she can always be sent to another phase?”

As more and more adolescents are becoming disturbed and more and more workers are hired, not only to staff the places to keep them but also to track them through various phases and after, when they return to the community, it would seem that eventually the cost and confusion could reach such proportion to be a full time job for many just to keep track of those tracking.

To set up the four phase programme, the ministry is taking complement from psychiatric hospitals and regional centres. Does it make any sense that complement is being taken from the very facilities that the four-phase programme is dependent on for beds and treatment? Where will the adolescents who are being tracked be placed in time of crisis unless the ministry intends to continue to build more and more facilities at greater cost?

What seems to be happening is (a) more and more privately run institutions are allowed to select their patients -- even suggesting as one did recently: “We must fill the beds quickly. Call any child in.” -- in an effort to receive their per diem rate; (b) other centres who have agreed to be part of the four phase programme are currently arguing with the co-ordinators of this programme as to who has first access to existing beds. (c) Still other centres which, as stated above have handled our most difficult adolescents are in danger of having to reduce their services due to the present proposed budget cuts.

In visiting several centres recently, I wondered why the ministry has never considered putting more funds into existing programmes which have a proven record of treating difficult and unwanted adolescents.

I think of the child and adolescent unit of Lakeshore Psychiatric Hospital which is presently in danger of another cut in budget. This facility, which manages to include all four phases of any child or adolescent treatment into one facility, has been asking necessary increases in staff and renovations for over three years now. The unit over the years has housed some of the most difficult adolescents, but it has not been fully renovated since it opened some four and one half years ago. At this centre, no child or family is refused an assessment and they rarely have a waiting list for admission.

I cannot help but comment that due to intelligent allocating of responsibility on the part of the unit director (a child psychiatrist) they manage to run a programme of 32 -- I think now 26 -- in-patients and, at times, 200 out-patients, with approximately the same number of staff that another unit of the four phase programme has for six in-patient adolescents.

Additionally the ministry should consider combining its services with those of Community and Family Services as well as those of Education and Correctional Services to help understand the supposedly untreatable adolescent within the context of his society.

It should also consider increasing outpatient facilities for children, adolescents and their families across this province. These facilities would then hire experienced, competent people who in turn could keep children with their families in the community. Fewer treatment facilities would need to be built and those existing could then be easily seen as a backup resource to those larger, community involved, out-patient departments.

Psychiatrical care generally. Psychiatrical care in Ontario is provided (1) in general hospitals, and (2) in government-operated psychiatric hospitals. It is largely a bed- and hospital-oriented system of care with few and far between community based clinics that are social-psychiatric in orientation.

Additionally, there is private psychiatric practice, which in terms of social utility is on the level of body rub parlours partially supported by OHIP. One out of three hospital beds is occupied by an individual with an emotional, mental or social psychiatrical problem. Countless hours of productivity are lost with these three kinds of problems. The loss in well-being and the human misery involved is beyond calculation. Psychiatry in the general hospital is not integrated with psychiatric care in the government psychiatric hospital. The two systems meet on the level of occasional reciprocity. The general hospitals specify their need for backup facilities as they become necessary for dealing with the long-term, so-called “chronic” patient.

Additional to hospital-based psychiatry, there is a large amount of ambulatory psychiatric care called private psychiatric practice, conducted in private offices, sometimes provided gratis by the hospitals, but largely out of well-appointed offices such as those on St. Clair Ave. in Toronto, or in other equally socially-approved streets in other urban Ontario settings. There are very few rural-based psychiatrists in private practice. Private practice psychiatry has connections with the general type hospital psychiatry. The private practice psychiatrist often has a hospital appointment but very rarely, if ever, is there any connection between private psychiatric practice and the provincial psychiatric hospitals. There are some major differences between the two subsystems. A different set of laws and regulations govern the patients in the two systems.

It is much easier for patients, in terms of their future, if they are psychiatric patients in a general hospital, where they can pass for patients with a physical ailment; while after a sojourn in a psychiatric institution like the Queen St. Mental Health Centre in Toronto, one tends to be stigmatized as being mentally ill. The nature of treatment in both settings tends to be now similar. In most hospitals, especially in a university setting, more socially oriented treatment like group psychotherapy predominates; though in some non-university psychiatric units the psychiatrists still zap patients somewhat indiscriminately. Zapping is slang for that intrinsically useless form of non-treatment known as electro-convulsive therapy. But the groups in general hospital psychiatric units are run largely by psychiatrists, while nurses and other staff do this in psychiatric hospitals.

Psychiatrists in general hospitals are paid on a fee-for-service basis, while in psychiatric hospitals they are on salary. The differential between the earnings of the two groups may be as much as $20,000, which in itself is enough of an incentive for the bright new psychiatrist to move immediately, upon completion of its requirements, to a general hospital -- though at least two have moved to politics, I think. Consequently, psychiatric hospital staffing reflects a significant proportion of captive psychiatrists -- psychiatrists who are not licensed to practice outside the psychiatric setting. Psychiatrists who do move to the general hospital -- where not only do they get paid better, but often have more educational and social contacts with their medical colleagues -- also say, as if it was a reason in itself, that the patients are “nicer.” What do they mean by that? This statement needs to be examined in some detail.

Patients in general hospitals tend to be less disturbed; less acting out or violent; fitting more easily into the general hospital ambience; better educated, and employed; first time in hospital rather than second time around; referred by a physician or even a psychiatrist.

The psychiatric hospital patient, on the other hand, is more disturbed; occasionally violent; less well educated, and unemployed or under-employed; second time in hospital or even a repeater; and referred quite often by the police. The social problems of the patient and his or her family are invariably multiple and more difficult to solve.

Private-practice patients, of course, are ambulatory. They are well-educated, well employed and well paid for their work, or at least married to well employed and high-earning partners. They are often of the same social class as their psychiatrist. The private-practice patients seek help for problems which are often minimal and cosmetic in nature, or in the form of a self-desired, self-prescribed course of self-employment. It must be sheer coincidence that this type of patient is believed by the psychiatrist to benefit most from the exalted attention.

A study conducted by me of the Queen St. Mental Health Centre on the characteristics of patients admitted during the years 1968 to 1970 -- a copy of which the minister has -- shows that the patients admitted were of strikingly low socio-economic status.

Ninety per cent of the individuals served by the centre fall into the two lowest classes defined by Hollingshead. Individuals in the lowest class, that is class five, are described as semi-skilled or unskilled labourers who often do not keep regular jobs; whose median education is only the sixth grade and who recognize their low position in the community. Individuals in class four are described as skilled manual workers; semi-skilled employees; clerical and sales workers or petty proprietors who identify themselves with the working class.

The absence of the middle and upper classes from the population of Queen Street Mental Health Centre is not an indication of the relative mental health of the middle classes, for mental illness strikes at everyone generally; but it is a searing indictment of the psychiatric system in Ontario which allocates scarce treatment resources, including the expensive manpower of psychiatrists, according to dearly differentiated class lines.

Six hundred and seventy-eight psychiatric beds in general hospitals in Toronto are largely for the use of middle class patients consuming a significantly greater portion of psychiatric manpower, while over 1,000 beds in the three provincial psychiatric hospitals meet the needs of the more disadvantaged segments of our population and receive minimal attention from the psychiatric profession.

In bitter summary I can say that if the patient is poor, really mentally ill, out of control and in need of nil the professional help he can get, he is hardly likely to see a psychiatrist at all, but to be referred by the police to a psychiatric hospital.

Who is responsible for the creation and persistence of this system? The departments of psychiatry at the Universities of Toronto, Ottawa, Queen’s and elsewhere, who have trained residents in psychiatry for the nice middle-class private patient, deny their basic responsibility for the treatment of the mentally ill; the psychiatric profession which blithely accepts the high rewards of private practice; the governmental, university and professional complicity of general hospital psychiatry which implemented that intellectual abortion, the Tyhurst Report, and now perpetuate the two-class system in the psychiatric hospital; the government, the Minister of Health and his cowardly -- and I say that consciously -- short-sighted senior civil servants from the Ministry of Health who have allowed the progressive deterioration of the mental hospitals, the winding down of its community and social psychiatry programmes, abandoning virtually whole categories of mentally handicapped people in the new “backwards” in the community, while accentuating and rewarding general hospital psychiatry and psychiatrists in private practice. These are the people who are responsible.

Yet the intensity of the budget cuts continues to progressively demolish preventive and community programmes. For example, at the Lakeshore Psychiatric Hospital, about six months ago, the entire crisis intervention service (a relatively new service) was closed with only a few weeks’ notice. The children’s service was cut from 32 to 25 beds. At the last minute, the day care programme organized in co-operation with the Etobicoke Board of Education was not funded. The recreation staff of the hospital was reduced from eight in early 1975, to two in October, 1975. This recreation staff is responsible for rehabilitation, for managing programmes like sheltered workshops, and in co-operation with occupational therapy, for running industrial therapy programmes.

The Lakeshore Psychiatric Hospital is not the only one that has suffered immense and destructive cuts. Over the last year I have repeatedly brought to the hon. minister’s attention how destructive his cuts in psychiatric hospital budgets have been.

In the Whitby Psychiatric Hospital, the letting go of part-time physicians, cutting down children’s services. At the Queen Street Mental Health Centre, not allowing new community-based programmes. Even at the Toronto General Hospital, the Medical Advisory Board has ordered the cutting back to half of the social work department, a department which more than any other is charged with responsibility for the chronically ill and emotionally disturbed.

All these examples show the consistency of the minister’s approach; the wholesale cutting back of all preventive psychiatric services.

Physicians are in the midst of demanding an increase in remuneration. Those increases in the basic fee schedule have not kept up to the general increase in wages of other occupational groups. The total income of physicians has actually gone up, as figures quite clearly show. Partially, this is due to the general increase in the utilization of medical services but it is largely due to the increase of services provided by the physicians.

[4:15]

To discuss physicians’ incomes meaningfully, it is necessary to compare the incomes that physicians received 10 years prior to the last available figure, and to compare them in turn with the incomes of other workers in the health field and of other professionals, with those of the average industrial worker.

Comparing fee-for service incomes of physicians we find that in 1962 the net income of the physician was over $18,000 and his expenses were 34 per cent of the gross income. In 1972, expenses were still 34 per cent of gross income but the net income was by then over $40,000. Both these figures are after expenses, before taxes.

In the period of 1962 to 1972, the increase in income was 124 per cent. Even if we take the cost of living into account, using the consumer price index, net income for physicians rose by 62 per cent between 1962 and 1972.

Compare this with nurses. Using salaries for nurses in hospitals as set out in the old OHSC guidelines, their salaries rose 93 per cent between 1962 and 1972. Doctors’ incomes were five times as high as nurses in both 1962 and in 1972. Even if we assume that doctors’ incomes stabilized over 1973 and 1974, the net incomes for physicians are still 3.5 times as high as those for nurses, even given the 1974 portion of the recent wage settlement.

Compare them with other hospital workers. Again even assuming the physicians’ income remained stable between 1972 and 1974 and that the wages of hospital workers increased by $60 per week across the board -- this was the metro settlement of May 1974 -- physicians make 4.75 times as much as the average male hospital worker and 5.2 times as much as the average female hospital worker.

Compared with average industrial workers: In 1962 the average wage, using the industrial composite, was $4,350 per year, assuming 52 weeks of work. In 1972, the industrial composite was $8,054 per year; the increase between 1962 and 1972 was 85 per cent. Physicians made 4.2 times as much in 1962 as the average industrial worker and five times as much in 1972.

Compared with other professionals: Here are some figures for all of Canada -- lawyers and notaries went up by 81 per cent; engineers and architects, in the same period, by 49 per cent; dentists by 88 per cent and accountants by 67 per cent.

Let me repeat some key figures for incomes. The average industrial worker’s wage between 1962 and 1972 increased by 85 per cent. Lawyers’ incomes in the same period increased by 81 per cent, nurses’ incomes in the same period increased by 93 per cent while doctors’ incomes increased by 124 per cent.

The physicians are obviously concerned to keep this income differential but the question needs to be examined in terms of the service provided. The nearest professional category is the lawyers whose incomes are up by 81 per cent in the same time period. The obvious explanation for the increase is that the combination of a restricted field, fee-for service and full coverage by the state for the services rendered has produced optimum results for the physician.

I wonder if the community at large should not now question this income differential. Should not other professions over a period of years be allowed to catch up while the physicians incomes are held steady? The anomalous situation of these large physicians’ incomes is further compounded by the fact that the physicians earned 3.5 times as much as a nurse and 5.2 times as much as a female hospital worker. Since many nurses, especially new nurse practitioners, do at least partially coterminous tasks with physicians, should there be such a large discrepancy?

If the educational criterion is used in comparing physicians’ incomes with the incomes of roughly comparable occupational groupings, such as social workers with MSW or registered psychologists, the discrepancy of incomes between these occupational categories can only he explained by other than the educational criterion.

Aside from the obvious mystical factor that the physician deals with matters of life and death, as the present Minister of Labour, (Hon. B. Stephenson) used to say in her previous avatar as a strong unionist, there remains the fact that the physician belongs to a super union with the unique power of virtually writing a blank cheque.

The recently passed Health Disciplines Act has of course locked the health profession in a straitjacket of qualified professional law, with clearly differentiated roles establishing the primacy of the medical profession and the total inability within existing law to allow for the introduction of new health professionals like the nurse practitioner -- over 100 new McMaster graduates cannot find an appropriate job -- or augmenting the function of other professionals such as psychologists or social workers.

On the one hand the ministry has given permission and support for some innovative training programmes for new health professionals, and on the other hand has locked them into a rigid professional law which does not allow them to practise.

Brown points out that “Medicine for profit leads inevitably to conflict over occupational territories, to the distortion of the division of labour for the sake of income rather than service and results either in the exploitation of the workers through low wages or the exploitation of the consumers through high prices.”

I would like to deal with occupational health, and will proceed now to the last of my four broad categories of health problems: health and the environment. For brevity’s sake, I will zero in on just one aspect of this problem: the work environment.

Every year, several hundred people are killed at their work and many more suffer work-related injuries and develop work-related diseases. Every year, as well, industry introduces many new products and processes, the nature and potentially dangerous or even fatal effects of which are often not known until the product is already in wide use, and health complaints begin to arise among the workers or consumers.

For example, a case in point: PCB -- polychloral biphenyl -- is an extremely useful chemical which is inert, non-biodegradable, waterproof, and non-inflammable. It is used in manufacturing electric transformers, fluorescent lights, polystyrene cups and herbicides, for waterproofing and fireproofing textiles, and in the photocopying business. But even in very small quantities, the chemical has a deleterious effect on human health.

In Japan in 1968 to 1971, the Yusho disease was described, affecting multiparous women, and producing spondylitis, spine deformation osteomalacia, micro-fractures, the acceleration of the production of liver enzymes, and the accumulation of PCB in the body fat. Because it is so inert and resistant to sewage treatment and incineration, the chemical is ubiquitous. It is even found in cereals which have absorbed it from the cardboard boxes in which they are packaged, and in shellfish. The final extent of its effects has yet to be fully determined.

I have described PCB in detail to illustrate a common problem in our industrial society. Again and again new compounds and processes come on the scene, but some of their most injurious effects are not known until much later. Here, as elsewhere, what is needed is a three-fold approach to prevention.

In the first place, society requires a mechanism by which all such innovations are exhaustively analyzed and tested for health hazards before manufacturing or release on the market is permitted. This is the primary level of prevention. This preventive level has up to now been left in the hands of the federal government, with whom responsibility for examining and testing new products largely lies. But, it should not stop there. The provincial government in general, and the Ministry of Health in particular, must become involved and take a more active role in testing, setting standards, and distributing information about potentially harmful industrial compounds.

At the secondary prevention level, a two-pronged thrust is needed to protect exposed individuals before they are affected and to treat affected people after they are exposed. A vigorous clinical system of detection supervision and monitoring of the levels of noxious and dangerous chemicals is one half of this programme. The other half involves treatment of anyone even suspected of a dangerous level of exposure. Concurrently, of course, a strict and fast-moving mechanism is required to halt production of the dangerous chemical or continuation of the malfunctioning process -- and to enforce the stoppage until the situation is fully rectified.

At the tertiary level of prevention, we must deal more fully with the after effects: rehabilitate the injured or disabled worker, compensate him or her for loss of earnings, protect the financial security of his or her family and clean up the polluted environment so that the effects of the disaster are eradicated.

We need not look as far afield as Japan, however, for a horrifying example of the effects of environmental disorders on health. The story of Elliot Lake is instructive, not only for this reason but because it illustrates the Health minister’s ineffectuality and irresponsibility in the face of that challenge. There has been evidence in Czechoslovakia since as long ago as 1926 that radiation in mining operations is a cause of lung cancer.

In 1967, correspondence between Dr. Wheeler of the Workmen’s Compensation Board and Dr. Sutherland, chief of occupational health in the Ministry of Health, was already dealing with excess lung cancer among Elliot Lake uranium miners. Yet no secondary preventive steps were taken. The miners were not told of the hazards and no attempt was made to control the radiation. Only this year were the radiation levels of 0.3 WL appended to the regulations of the Ministry of Natural Resources.

Why has the occupational health branch of the Ministry of Health asleep for eight years? And why is it still failing to live up to its responsibilities? In March, 1974, the ministry conducted a voluntary health survey of 36 cases of silicosis at Elliot Lake and 53 cases of radiological dust effects. Of these 89 men who showed some lung damage due to silica dust inhalation, 66, or 74 per cent of them, are still working in the conditions of silica dust exposure. Why are they still working? Why have the obvious secondary preventive measures not been taken?

At the tertiary level, can you do no more than encourage the silicotics and pre-silicotics to find other employment? Is it not your responsibility -- yours or specifically your government’s responsibility and your responsibility in combination with other ministers -- to move decisively to develop other jobs, provide funds for relocation and retraining and offer full compensation to miners rendered unemployable through disability? Until you do, the miners will have no option; they will continue to stay in the mines and work until they are full-blown silicotics.

One cannot help but ask why the Elliot Lake problem has been handled in such a criminally inept fashion by this government and this ministry. One need not look far for the answers. At least four provincial ministries are involved in safety and health at work. There is no coordination between these ministries. There is a lack of both will and leadership on the part of the government to attack the problem of occupational health from a unified perspective.

The budget of the occupational health branch of the Health ministry, which ought to be spearheading the government’s occupational health campaign, is just 0.4 per cent of the ministry’s total budget. This reflects, I suggest, not so much a statutory arrangement as a singular lack of interest in the field of occupational health on the part of the ministry and its successive ministers. The need is imperative for an overall, well-funded agency, or the ministry, to co-ordinate those programmes currently scattered through at least four different ministries if Ontario is to solve its occupational health problems.

The minister may reply to this criticism by pointing to the recently appointed Advisory Council on Occupational and Environmental Health. The council is expected, as the minister put it:

“To provide a formal mechanism for industry, labour and other interested parties to advise government on health standards and to recommend new policies and programmes. It will also assist government in defining how health safeguards can be engineered into new plants at the design stage.”

But this council will not serve to integrate the fragmented field of occupational health, since the inspection, monitoring and enforcement of health standards will continue to be the responsibilities of the Ministries of Labour, Natural Resources and Environment, while the advisory council will report to the Minister of Health.

A number of just people have been named to this council, but it contains no significant representation from the workers it presumably exists to protect. Furthermore, the council has no real power at all. Its part-time and advisory status reduces it to insignificance. It is more political window dressing. It is hard to believe that the advisory council will offer any real assistance towards mitigating the plight of the many workers affected or threatened by unsafe working conditions right now.

[4:30]

One further aspect of the ministry’s occupational health policy needs to be mentioned. In its brief to the royal commission, the ministry recommended that mining companies should hire a fully qualified doctor to provide occupational health services, and that: “Management and union will be encouraged to promote and support an advisory health and safety committee at mining companies.”

Has any such action been taken? Does the ministry seriously intend to urge, through the ministries of Natural Resources, Labour and Environment, that the primary responsibility for occupational risk prevention should rest with those who create the risks and partially with those who work with them?

Furthermore, what follow-up procedures are contemplated to ensure that reliance on the goodwill of the employer is well-founded? How will the standards of employer-retained doctors be monitored? And will there be a statutory insistence that the creation of such on-the-job health and safety committees be mandatory and not just simply voluntary? In the field of health and the environment, as in so many other areas of provincial health services, it is time that the Minister of Health took its life-and-death responsibilities more seriously.

Let me reiterate that although Mr. Miller as the Minister of Health is far from guiltless, the point of my criticism of Ontario’s health care policies and practices must be borne by the present government. In fact, Mr. Miller’s principal shortcoming may well be his inability or unreadiness to stand up to his colleagues in the cabinet -- I continue to give you more credit than you deserve -- to convince them of the need for a radically different, more progressive approach to health. It may be that he has failed to assert his leadership in this area within the government itself, as well as in the province as a whole.

Until such time as that happens the Treasurer’s (Mr. McKeough) statement on the place of health care in provincial financing, delivered to the Ontario Hospital Association on Oct. 28 of this year, must be considered to set out the basic policy guidelines of this government in the health care field. And we must also assume, I am afraid, that the Minister of Health implicitly endorses, or at least does not dissociate himself from these guidelines.

In his statement to the OHA, the Treasurer (Mr. McKeough) tells us that he is worried about the projected 18 per cent increase in hospital spending in Ontario and the 15 per cent increase in medical spending. I am worried, too; though for quite different reasons.

According to the Treasurer, these escalating costs are due to two factors. I quote: “Aside from the obvious effect that wage inflation has in the health field which is so labour intensive -- the two factors are,” and again I quote, “high and growing utilization rates and a cost-sharing structure that inhibits the development of low-cost alternatives to hospitalization.”

High utilization rates are in turn, says the Treasurer, the result of two things: availability of medical care and universal programmes of hospital insurance and Medicare. I have already had a good deal to say about the extent to which availability of medical care may not be as great or as consistent as the Treasurer suggests, and I have also drawn attention to the ministry’s failure to foster the kinds of alternatives to hospitalization which Mr. McKeough himself sees as desirable.

Let me concentrate on the question of Medicare. “It is a matter of simple economics,” says the Treasurer’s statement, “that when a service suddenly becomes cheaper and more accessible, the demand for it goes up sharply.” This is not simple -- rather it is over-simplified -- economics which uses verifiable statistics to reach untenable conclusions. It is correct to say, as Mr. McKeough does, that medical visits per person are 20 per cent higher today than they were four years ago; but it is misguided and incorrect to say that this is because Medicare has made the service more economically accessible.

In Great Britain, where universal Medicare has been in existence for a quarter century, the number of initial demands made on the health service by patients has declined. The obvious difference is that British doctors are paid by a combination of a capitation fee augmented by a bonus; while our doctors are paid on a strict fee-for-service basis, which can become a veritable licence to print money.

I have a friend -- a social worker -- who is more aware than most people of the potential abuses and discrepancies in medical practice. Recently he had occasion to consult his family doctor. The doctor examined him, reassured him that the problem was self-limiting, prescribed medication and told my friend to return in a week’s time. My friend said: “Do I need further tests?” “No,” replied the doctor; “I just want to make sure.” “But if I am going to be well, why do I need to come back?” The doctor responded: “Don’t you want to be sure?”

Needless to say, the doctor would be paid by OHIP for two visits. This is the phenomenon of the “multiple visit;” which Mr. McKeough identifies, though he attributes it to the wrong factors. Not all Medicare systems increase the utilization rate, but a fee-for-service system does legitimize and encourage a physician’s decision to unnecessarily multiply medical services.

It is in the nature of the human organism to require medical care and every civilized society requires a means of providing that care on a universal, affordable, efficient basis; that is by comprehensive health insurance. But it is surely just as much in the nature of human psychology that if the government institutes that comprehensive health insurance scheme on a fee-for-service basis, and lets the physicians run it as they please, then at least some of the increased cost of providing health services will be due to those same physicians encouraging duplication of service, not out of real need but in response to the glint of gold. Mr. McKeough himself admits the 10 per cent federal wage guideline now regulating professional fees, like the eight per cent fee increase settlement of 1974, “will have only a marginal impact on overall programme costs, since the pressure will be responded to by yet further increases in the number of billings.”

Then why, we may ask, is the government not changing the fee-for-service system? Why is the government not moving to work with doctors in an effective, equitable mechanism for controlling and regulating the uses and abuses of the health insurance system? It is so much easier to do as Mr. McKeough does: blame the federal government, even blame the patient for getting sick so often and staying in hospital so long. As a psychiatrist, I have often encountered this particular aberration: one refuses to deal with one’s own problems by insisting flat they are really somebody else’s problems.

Changing the fee-payment structure is obviously only one of many reforms that need to be implemented at once. The kind of sweeping change which the Ontario health care delivery system desperately needs is a major, long-term undertaking. When the Minister of Health says that he will not institute such change, he may well be acting on his perception of how short his own tenure as a minister may he, and how equally short, in fact, this government’s tenure as the government may be. Nevertheless, the health care delivery system must be changed and it must be changed fundamentally, not merely superficially.

This government has exhibited a failure of leadership and a failure of nerve in approaching the very real problems of health and illness in this province. The best that can be said of the present minister is that he takes a managerial approach. He sees the health service as a great factory or corporation, and with the help of accountants and efficiency experts he hopes to run it as a tight ship, increasing productivity while limiting costs.

This is an approach which demonstrates a complete lack of understanding of the basic, underlying human and medical issues. Worse still, however, is the government’s tendency to sit on its hands and refuse to accept any responsibility at all while fixing the blame on somebody else, anybody else it can think of; on the lazy, self-destructive nature of humanity itself -- a theme perhaps more appropriate to an hysterical preacher than a practical politician; or on the patients themselves -- if only nobody got sick we wouldn’t have all these health care problems; on, in extremis, on that perennial bête noir and whipping boy of the provincial Conservatives; the federal government.

Let me conclude by saying that as a result of this governmental maltreatment, health care in Ontario is a depressed, out-of-shape, sick patient indeed. But what it needs in medical terms is not a change of diet or a bit more exercise or even cosmetic alteration; it needs -- it must have, if it is to survive -- nothing less than immediate and radical surgery. Is the hon. minister man enough to put on the mask and gloves, pick up the scalpel and go to work? If not, perhaps it is time to call in another specialist.

Mr. S. Smith: Mr. Chairman, I will not try to emulate the very fine address by my friend from the official opposition. He pretty well considered his realm to be the entire health policy of the province. I will try, instead, to highlight certain aspects of health policy and hope that I can be constructive in my criticism of the government and in the way it has treated health up until this point.

I was told before I entered this House that the present Minister of Health is a very decent fellow and a friendly and charming man. I have seen nothing so far to make me change that particular assessment. In fact I feel that anybody who can stand there with two psychiatrists as critics surely deserves the compassion of all human beings.

And this is particularly true in view of the minister’s comments to the House in recent days that from time to time he is troubled with random thoughts coming into his head as he stands to answer questions. I even heard him confess something of a fear that he had an ailing mind, I believe, at one point he may just be terribly fortunate that if he could manage to sort through the undoubtedly conflicting opinions that the two critics could offer him, at least he would have some sustenance in an otherwise hostile environment.

I am a little concerned, however, that as we sit to look at these estimates -- and the minister has kindly handed as just now the annual report -- that nowhere in the annual report from the Ministry of Health is it indicated whether or not Ontario is becoming more or less healthy.

I bring up this point because any system is fine and looks all right as long as there is plenty of money available. When money is virtually unlimited you can set up any sort of halfway rational system to do anything you like; and then when problems arise you throw money at the problem and you can pretty well get away with that sort of thing. But the time that a system is put on its mettle is the time when money is short. This is the time when you have to really see whether the objectives of the system have ever been clarified, have ever been stated; whether the goals have ever been agreed upon and whether there have ever been criteria by which to judge whether the objectives are being attained; whether these objectives are being approached or whether they are receding further and further into the background.

The problem we face in the Ministry of Health, it strikes me Mr. Chairman, is very similar to that faced by the Ministry of Education and, furthermore, very similar to that faced by the Ministry of Colleges and Universities. There is a long history, far antedating the present minister, of building buildings, trying to supply services of some apparently definable kind and counting one’s success strictly in terms of quantity of such buildings, the number of people who pass through them and the number of people hired to work therein. The Ministry of Colleges and Universities, for instance, really has shown no sign whatsoever of having a clearly-defined idea of what universities are about in today’s society.

Similarly, I present to you, Mr. Chairman, my point of view that the Ministry of Health really has no clear idea of what constitutes health in Ontario; of what their real task is; and of whether they are approaching success in that task or falling further behind in their efforts.

It seems to me that the real objectives of the Ministry of Health have been -- to be kind and to be somewhat charitable -- to try to make sure there is a doctor available to every citizen of Ontario when the citizen feels he or she needs such a person; and have been also to try to make sure that theme is a hospital bed available to every citizen in Ontario if the doctor suggests they need such a bed.

Roughly speaking, it seems to me, these have been the objectives of the Ministry of Health. The problem is, of course, that the number of doctors or the availability of doctors, and the availability of hospitals, in no way argues that health is being achieved or not being achieved.

An absolutely infinitesimal amount of money is spent each year by the Ministry of Health in what it should be doing; which is surveying the health of this province, developing measures which are applicable and understandable, developing regional measures so as to be able to compare the state of health between different parts of this province, developing cost benefit analyses so that we know whether or not a new programme or a new hospital or a new way of paying for things has or has not been worth the money.

Now as long as money was plentiful they didn’t have to do that; but now money is not plentiful and they scurry about looking for ways to cut back. And they don’t know what ought to be cut back, because the fat is in no way differentiated from the lean.

[4:45]

What we have is a situation where money will be cut, probably in an across-the-board way. As a result of that, we will probably end up with more inefficiency rather than less. Let me give you an example, taking some of the figures the government already has but won’t use. Even back in 1973, for instance, the average length of stay for a patient in the Toronto Western Hospital -- in an active treatment bed -- was 11.5 days; at St. Joseph’s Hospital in Hamilton it was 7.1 days.

Before the argument is made that really they were different kinds of patients, let me assure you these figures are available by diagnostic category and therefore differences among the patients mean very little.

The difference in money expended between those two hospitals alone, if you take about $150 a day as a rough cost for a hospital, is approximately $13 million. Does the ministry have an answer as to why it takes four days longer to treat a patient in one hospital than it does in another hospital? If the ministry has that kind of answer why has it not made these answers public?

If public education is needed, if medical education is needed and if certain types of penalties are required or certain types of incentives, let the ministry use them; we will support that. What we cannot support is the threat the ministry has already issued publicly, that across-the-board cuts in beds will be implemented. We cannot accept that because that means the careful, the thrifty and the efficient will be cut back as well as the careless and the spendthrifts. As a consequence of that, what will happen is that the doctors who function at efficient hospitals, where they have learned to trim their waste, will end up having to admit their patients all over, at other hospitals, because the efficient hospitals will be full. Perhaps that will cause the inefficient hospitals to improve, but I suggest to you it is a very inequitable way of doing things.

There are other figures the ministry has had for years and refuses to deal with. Take unnecessary surgery. It is an open secret that there are groups of doctors in this province and elsewhere who perform hysterectomies and tonsillectomies when they are not necessary according to modern medical opinion.

These people are identifiable. There is no reason to believe that the incidence of uterine abnormalities, for instance, is any higher in one part of the province than in another. Why, therefore, should there be such discrepancies in the incidence of hysterectomies? But the government refuses to act on these figures.

Similarly, we all know there is a tremendous tendency to the over-prescription of certain drugs. In this regard I would particularly mention tranquilizers and certain antibiotics. The government knows and the ministry is well aware that this happens. What is the ministry going to do about that?

It is not sufficient to send around a leaflet once in a while to the doctor in practice or to occasionally go on the radio and say a few words -- admirable as all those things are, I am not knocking them. There has to be a system of audit whereby the ministry can be kept informed of the kinds of prescribing habits of Ontario physicians and can take remedial action. But the ministry has failed to show -- I don’t want to be inflammatory in any way today -- in a sense, the courage to do these things.

The Ministry of Health, it seems to me, would be better termed the ministry of treatment because, in point of fact, they have shown very little concern with health and most of their efforts are expended in terms of treatment.

As my colleague from the official opposition, the member for Parkdale, has already said, the preventive measures that the government has taken have been pitifully few. What, for instance, is the Ministry of Health really doing about the physical fitness of the population? What about seatbelt legislation? How about alcoholism? We know the costs of alcoholism and the use of tobacco on health care, for instance, are enormous; and what happens is the hon. minister’s budget ends up cleaning up after all these other private sectors in the population. When the steel makers pollute and cause illness and when the people who smoke tobacco and produce tobacco cause illness, and when the distillers indirectly cause illness, that doesn’t show up in the cost of alcohol, tobacco or steel. It shows up in a different part of the accounting, namely in the public sector, in the health budget.

It seems to me that the Minister of Health ought to be -- perhaps he already is -- struggling with his colleagues to have a little more accurate cost accounting so that in point of fact the health budget is not constantly thrown around as a $3 billion drain on the province. In point of fact, it’s really an attempt to clean up after everybody else.

There are some things the government can do. I asked them to implement seatbelt legislation. I asked them to implement the law which forbids smoking in certain public areas, especially in hospitals. I ask them to show a little ingenuity and instead of having smoking lounges in various places, why not have some non-smokers’ lounges? Why not make it a point that the non-smoking lounges should be somewhat better appointed than the smoking lounges? It may seem like a facetious and trivial point. Unfortunately, it is this kind of creativity that has been absent in these huge advertising campaigns which have allegedly been designed to curtail drinking and excessive smoking.

What we do find is that there has, unfortunately, grown up a certain mystique in our society that smoking is a terribly fashionable and manly thing to do. This probably explains why so many more women are doing it now than used to, and also so many more youngsters are doing it now than used to. It seems to me the government has failed miserably in its efforts to deal with these matters.

The Addiction Research Foundation has come under heavy criticism and we are still waiting to see what the government is going to do with that institution. I am sure the hon. minister doesn’t seriously believe that the incidence of alcoholism in Ontario, or the incidence of heavy smoking in Ontario, has been affected one iota by the millions that have been poured into that particular institution.

What is the ministry going to do about that? If they’re looking for something innovative, why don’t they look for instance at the antabuse clinics which Stelco and Dofasco have set up in Hamilton? Why has the ministry not in some way encouraged smaller industries to band together to set up jointly-administered antabuse clinics at their own places. That would be one awful lot better than the sort of advertising campaign which says “you will be your own liquor control board”; or something of this kind, which I’m sure hasn’t stopped a single person in Ontario from taking a single ounce of alcohol.

Mr. Nixon: You don’t hear much about that since the election.

Mr. Ruston: No, not since the election.

Mr. S. Smith: This is the Greek chorus again.

Mr. Nixon: Well, we just want to help you.

Mr. Ruston: How about the new commercials, the singing commercials on the radio?

Mr. S. Smith: If I may, Mr. Chairman, I’ll take your attention for a moment to some of the points made on the question of payment of physicians.

Unfortunately, I cannot agree totally with my friend from Parkdale who suggests that salary is the only way to pay physicians. I believe there are drawbacks to each form of payment. When you put people on salary, there is always the problem that they might find themselves having discussions and coffee breaks more than seeing patients. On the other hand, when you put them on fee-for-service, there’s always the --

Mr. Yakabuski: Professional development days.

Mr. S. Smith: -- there is always the danger they will be just putting patients through a revolving door as quickly as possible to make as many dollars as they possibly can. Clearly, that is a tough spot. I don’t envy the minister that particular decision.

It seems to me, though, that more and more physicians want to go on salary, and the appropriate response of the Ministry of Health ought to be to make possible a number of alternatives so that those physicians who would like to come up with innovative approaches which combine fee-for-service and salary should be able to do so.

More important, it is well known that physicians practise better medicine when they practise within a group setting, and the government has had many reports encouraging this. Yet, the government has done pitifully little -- I won’t say they’ve done nothing, because they’ve done something -- but pitifully little considering the amount of money spent, to make it worthwhile for physicians to band together and to collectively hire some non-physicians to carry some of the health care load, part of the load which they could do a lot better, such as handling certain of the psychological and social aspects which physicians are faced with all the time.

Again, it seems to me there’s been a certain timid attitude on the part of the Ministry of Health in this regard. Although they deserve full marks for funding certain innovative experiments, I’m afraid I cannot give them full marks. They have done much less than they know has been required for years, and that several reports have already instructed them about.

I also agree with the Minister of Health on the other point. His point about curtailing the number of doctors being probably the only to cut down on utilization of various health services is correct in my opinion.

Here I disagree with the NDP, which has made the point that there should be an unlimited number of doctors. They say doctors’ salaries would go down because of the marketplace effect of having a whole lot of doctors around. That would be true, I think the salaries would go down if we had a whole lot of doctors around. But these doctors would use laboratory facilities, x-ray facilities, hospital beds. There I agree with the ministry wholeheartedly.

However, what I am concerned about is that while curtailing the number of doctors, the ministry has done nothing in terms of the distribution of these doctors. The incentive programmes have had some results. I think there has been a movement of doctors to certain rural areas. But several areas of this province are still terribly under-serviced, and I’m sure the minister would have to agree with that. I would like to know exactly how he suggests that’s going to be remedied.

I also feel that the place of paramedical personnel has not been recognized. I feel there are many jobs that can be done by less highly paid individuals than physicians, and there is no good evidence that the ministry takes this matter very seriously.

Let me say a few words on the matter of industrial health. I hope industrial health doesn’t become a political football, because if there is anything on which we ought to have tripartite agreement it should be in this area.

I would respectfully request that the minister instruct his newly appointed group of people, whom we all wish very well in their deliberation, to think about the following concept. Surely the working man has a right to know what he is breathing just as everyone else has a right to know what he or she is eating at any time. I would suggest exactly the same kind of mechanism as we presently have in the food and drug directorate; that someone require a licence in order to put into a person’s breathing atmosphere certain substances which have not been proven safe to breathe.

Just as you require a licence to put a drug, cosmetic or certain other internally-consumed items on the market, you should also require a licence for things that people have to breathe. This can easily be handled by having industries present their inventories and their processes to an institute for environmental and industrial health and require a licence where the onus is on the industry to prove the safety of what it’s going to have its workers breathe.

That is something, I would imagine, which we could get all parties to support and I would hope it does not get bogged down in a game of political football. It’s not something on which I wish to score points at all. It’s something that is terribly important to every family, every breadwinner, every man, woman and child in Ontario.

In the field of mental health, let me point out one interesting discrepancy the ministry has known about for years and done nothing about. Why it is that the psychiatrists of Ontario are not treating the mentally ill of Ontario? That is a fundamental question. The minister is well aware that the bulk of psychiatrists in this province are seeing people in private practice who are not mentally ill. They may be in some way uncomfortable, they may be somewhat maladjusted, they may be unhappy; but they are not mentally ill. The mentally ill are being cared for by a pitifully small group of psychiatrists and a dedicated group of paramedical personnel. It’s not to downgrade the paramedical personnel to lump them together in one group, but rather to save the House from a long list of these other professionals.

It would take courage to set up a system of incentives and disincentives to make sure that psychiatrists, instead of sticking to themselves in their offices on St. Clair in order to see a bunch of basically healthy people, start to actually concern themselves with the mentally ill of this province. But the ministry must do this, and the ministry has shown very little stomach for the job up until now. It is no way intended as a personal slur but as a general report as to what seems to have been happening over the past few years.

[5:00]

The ministry seems to lack alternatives to hospitalization and yet the ministry is well aware that hospitalization has become prohibitively expensive. The explanation given by the Treasurer is very interesting and there’s even a bit of truth in it, unfortunately. I hate to say this in a cynical way, but it is true. Let me put it to you this way: what the Treasurer says is that the federal government won’t cost-share for these more efficient ways of treating people but it will cost-share for the inefficient ways of treating people.

As a consequence of this, the Treasurer says, we have little choice but to continue treating people inefficiently. After all, that way is still cheaper in the long run to Ontario taxpayers even though it’s more wasteful of the taxpayers’ money in total.

Let me make this very real. If you could get a patient out of an expensive hospital bed into a less expensive ambulatory facility, and you are only keeping him in the hospital bed because the federal government pays half of that but doesn’t pay half of the ambulatory care, then in the first place you are wasting the federal government’s money. This is not, in my opinion, the mandate of this particular government. In the second place, may I tell you that most of the federal dollar comes from Ontario anyhow, so you still end up wasting the Ontario taxpayer’s money.

Now, the politically courageous thing to do, if the federal government is wrong -- and I think they are wrong in not cost-sharing these more ambulatory programmes -- the political courageous thing to do is to put the patient in the more efficiently-run place anyhow and then to demand of the population that it take note of the fact that a saving has occurred and that the province demands its share of that saving from the federal government. That would be the correct, the moral and the politically courageous thing to do. To continue to treat people inefficiently, by the Treasurer’s own admission, because in the long run the Ontario budget will look better even though it makes the federal budget look worse, is dishonest, distasteful and disreputable.

I don’t want to take up the time of this House unnecessarily on general items because there will be opportunities for us to comment on individual matters that come before us in the estimates. If I sit down very shortly, I hope it will be taken as my way of reserving my right to question the hon. minister as each item emerges in the estimates; a right which, unless I misunderstood, has been at least partially waived by my friend from Parkdale who spoke at some length.

I will therefore conclude my remarks, basically by saying that what we need in this Ministry of Health is a series of objectives that can be clearly defined; goals that can be consensually accepted; criteria that can be measured, even if they flow have to be developed; a desire to report to the people on how the dollars are being spent; an interest in cost-benefit analysis; and the courage to use the figures already available to punish those who are inefficient and to reward those who are efficient rather than to simply make across-the-board cutbacks.

We also need the courage to implement some of the more difficult decisions that I have pointed out, to stand up to various professional groups where necessary and to assist other groups to have their rightful place in the health care system. We need a greater emphasis on prevention, on fitness and a government that basically means business when it talks about health. Thank you very much.

Hon. F. S. Miller: Mr. Chairman, after the last hour and 45 minutes of attention by two psychiatrists, I probably have been diagnosed in my ministry as having paranoia, schizophrenia, mental depression and a few other things. Retardation was a necessary prerequisite for my appointment. However --

Mr. Nixon: On whose behalf?

Mr. R. S. Smith: On the one who made it or --

Hon. F. S. Miller: Yes.

Mr. Ruston: He is the one to blame.

Hon. F. S. Miller: I have tried to make notes as the two speakers went through their list of things. I can’t disagree with lots of the things they say.

I have to congratulate the member for Parkdale on his thorough statistical review of facts and figures. I have many of them myself, and I review them often with the same conclusions he arrives at.

I have to admit though, I can’t compete with either of the two critics in terms of medical knowledge -- maybe that’s an advantage. Maybe the fact that I am not committed to a predetermined point of view allows me to be more rational and objective about the things I see.

Mr. Nixon: Maybe.

Mr. Ruston: Possibly.

Mr. Nixon: As long as you don’t make a stronger claim than that.

Mr. R. S. Smith: Ignorance is bliss.

Mr. Nixon: You are a blister.

Hon. F. S. Miller: Yes it is.

I suspected I saw in the member for Parkdale’s four points something similar to Mr. Lalonde’s lumping of the four categories of health care. He went through a whole list of comments -- about people demanding free service, the elderly being kept alive by science, public health being more economical than treatment. I think these are all fairly true statements.

Sometimes I wish the television doctor shows that dramatize the very things he talked about -- the heart transplant and all the fancy things that have people believing they can ignore their own health, that there will always be somebody to bail them out in the end -- I wish some of those programmes would show the patients who don’t make it; perhaps it would destroy some of the illusions we have about the ability of the system to make up for our unwillingness to look after our own bodies.

So we really don’t have too many major disagreements in those areas.

I think we have begun the programme. In fact if I’ve done anything in the last year, it’s been to continue preaching that we have to educate people -- we have to work in the school system, we have to work with the individuals.

Yet I’m not really an optimist when it comes to education’s effect upon our willingness to look after our bodies. We as a group, at this point in our history, are probably the best educated people this country has seen, but I don’t think we are the healthiest people this country has seen over many years.

The question -- that we’ve spent a lot more money and what has it done in terms of health? -- is very valid. I don’t think it has done a heck of a lot. The question then, is why?

I am glad to hear that both of you are in favour of seatbelts. I suspect, then, that if legislation was promoted -- and let me assure you, I’m doing my best to promote it --

Mr. Nixon: We have it before the House now.

Hon. F. S. Miller: I know that we do from that side, but it’s from this side too. I’m sure we will get your support. May I ask you, will we get your support?

Mr. Sweeney: We will carry it over with us when we move over,

Mr. Nixon: The bill is before the House. Will we get your support?

Hon. F. S. Miller: You will get my support. But will I get yours?

Mr. Nixon: But will we get yours?

Mr. Yakabuski: You will welch at the last minute, Mr. Nixon.

Mr. Chairman: Order please. I wonder if we could return to the estimates.

Hon. F. S. Miller: The member for Parkdale implied that the provincial drug plan was not comprehensive; he referred to one in British Columbia. It is interesting to notice that some of the other provinces -- such as Saskatchewan -- have copied ours because they believe ours is better than a universal drug programme. I think you would accept that.

We have a list of 1,553 drugs in Ontario; they are available free of charge to all people over 65. I’m sure you accept that. They are those drugs acknowledged to have proven therapeutic value at the best possible cost. A number of combination drugs have been included because for some of the elderly there are advantages to combining the component parts of some drugs, allowing them to take only one pill. I think our programme is to be emulated, rather than criticized.

We can always add to it as combination drugs are proven to be of value. But we are following the best medical advice we can get and we are trying to educate doctors, in fact, to prescribe in better ways.

I think you should help us in that programme, rather than assume that we should fall into the trap of allowing easy prescribing where brand name products are selected by memory just because some salesman has made a pitch quite recently or because we are used to them.

You know, we are trying a hit of an education job with our drug formulary; and I think at the end of a year and a quarter we are proving that it’s working. I hope you would grant that. We have, for example, the lowest prescription costs in Canada. I think we are about $4.63 per prescription. We have dearer prescription drugs --

Mr. Dukszta: I meant for everybody.

Hon. F. S. Miller: Oh, for everybody? Oh no, I am not going to say everybody. I think we have gone for enough right now when we cover the over-65s. We are spending some $46 million a year on the programme now.

Both of the speakers talked about the distribution of doctors, and if my notes are a bit scattered it will be because I am trying to combine some of the comments they both made. Everybody claims we haven’t done anything in Ontario to improve the distribution. We referred to this in June.

I simply say; sure, we have problems with mal-distribution. Look at the Lake Nipigon riding. To pretend we don’t have the problem would be foolish. But we have done a pretty good job of trying to come to grips with it. I think the latest moves taken and worked upon through the summer to tie immigration of physicians to Ontario to their willingness to serve in these areas -- is the most powerful thing we have done in several years to make sure that those areas in need get doctors and that we don’t add to the surpluses we acknowledge exist in the major cities in Ontario.

Mr. Stokes: Would you agree there was a shortage rather than mal-distribution?

Hon. F. S. Miller: Of doctors? No, just the opposite. If anything we have a slight surplus by world I standards; that is assuming the world’s standard is fair. But knowing the way they are chosen, I would think the standard errs, perhaps, on the side of having more physicians than are needed rather than fewer. I think the standard is one for every 650 people. We are probably --

Mr. Dukszta: It is one for 1,000 in North America.

Hon. F. S. Miller: Well all right. One of the reasons for that, of course, is because doctors tend to centre around those institutions that have highly specialized facilities.

Mr. Dukszta: You need more health centres.

Hon. F. S. Miller: Let’s be honest and say that as time has gone on highly specialized facilities have become more and more common across the northern parts of Ontario.

Mr. Dukszta: They are all here.

Hon. F. S. Miller: No, they are not all here. I can go to towns or cities like Kirkland Lake where the hospital isn’t open yet. It was started, I guess, in 1972 or thereabouts. It will be open very shortly -- I guess it is open now. Yes, it is open now; I should have stopped to think of that because of the questions that were raised the other day for that area.

Before it was finished enough specialists had moved into the community to put demands upon that hospital for highly specialized services that weren’t dreamed of in the design stage. As our surplus of specialists builds up, they tend to move out. Muskoka has ophthalmologists now, whereas you used to go to Toronto when I was a kid, and then it was to Barrie and then it was to Orillia. Finally, they come to Bracebridge two days a week. I think we will find this is happening more and more around the province.

Birth control was referred to very briefly, and I am afraid the member for Parkdale misinterpreted what I said. I wasn’t implying that he should know. I was implying that the Minister of Energy (Mr. Timbrell) should know because the member was attributing the comments to him and --

Mr. Dukszta: I only got mad because you think I took it so lightheartedly. It was a serious thing I brought forth.

Hon. F. S. Miller: Oh I think that may indicate --

Interjection.

Hon. F. S. Miller: I indicate simply that one can be serious and smile --

Interjection.

Mr. Stokes: What have you got against bachelors?

Hon. Mr. Timbrell: I am used to that.

Hon. F. S. Miller: I am just the devil’s advocate for him.

Hon. Mr. Timbrell: More than an advocate.

[5:15]

Hon. F. S. Miller: Now listen, your Honour, let’s not have a debate in public.

Referring to premiums, you asked why do we keep on collecting premiums. You know, we probably have a fundamental disagreement in this area. Premiums right now are not accounting for one-sixth, or not much more than one-sixth, of the cost of my ministry. It is my opinion that the money has to be raised either in premiums or in tax or both.

We have had constant premiums for some years; I think since 1972 if I am not wrong, or even 1971. People over 65 are free; people without taxable income are free; people with less than ci coo taxable income have half premium. Therefore, we have in effect token the load of premiums away from those least able to pay. Also, industry in general pays a share of many employees’ premiums.

The fact is, though, that the tax or the premium is a visible means of relating a service to a cost. I would argue that with health costs going up two or three times over the past four or five years -- whatever the number is -- we should be collecting mere premium rather than less. I fundamentally believe the premium is a good way of reminding people of the cost of health care, a fact that should be kept before them. However, the decision will rest with the minister responsible for the Treasury.

I was interested in your comments that there were proven documents to I show that community health centres have lower hospitalization rates. I would be very interested in seeing them, and I would appreciate your giving them to me sometime, because that’s the kind of information we are looking for. We are looking in documents to help us to find ways and means of evaluating community health clinics or health service organizations. I thought the paper the Ontario Council of Health presented last summer -- and which I trust will be printed very shortly -- on trying to arrive at measurable indices was very interesting. We did accept it and we will be trying to measure certain factors relating to quality of care, cost of care and so on through the health service organizations that have been set up and that will be set up.

How many will be set up remains to be seen. The Ontario Council of Health said that probably a minimum of 50 need to exist to give them a statistical base. There was some dissension, in fact a minority report said this should not be true, that fewer than 50 could work. I am inclined to listen to the minority point of view, but I am not going to set any arbitrary limit on the number. I am very anxious to continue experimenting with them to see if they in fact work.

I don’t have an either/or point of view about the way we should run the health care system, If health service urysni7a9ons are the best way to deliver health care the gradual creation of them, as we prove they work and as the medical profession accepts them, will, I think, justify and cause them to proliferate.

I listened to your comments on the district health councils and I was intrigued when you said you thought we had accepted basic NDP thinking. I suppose if you cover the waterfront we are bound to accept some of your thinking sometime. We have been stressing health councils for some time. I visited Ottawa the last few days and had a very interesting visit to our first operating health council. I had the opportunity to see it help me solve a major problem in a very short time frame.

In other words, rather than our ministry getting to work and looking for a solution to the chronic care bed situation in Ottawa, the Ottawa Health Council did, and I want to commend them for it. They got the various deliverers of health care together and from them found the places for us to put the chronic patients. I think that’s great. It had a measure of support that was far greater than anything that would have ever been imposed on them by our ministry, even if our answer had been right. I am just delighted to see a health council functioning this well at so early a point in its history. It augurs well, I think, for the future.

They also have done some very interesting work in trying to establish their relationship with the consumers and providers in the community, all those disparate groups that function in the health field. That, I think, is very useful for future health councils. I believe that when they have had another short while functioning we should gather the members of other health councils and let them profit from what is going on there.

We’re creating health councils quite quickly. You had the numbers. I’m not sure whether you’re right. It’s five right now; and 21, did he say, in progress? That’s quite a few. We’re not pushing them down anybody’s throat though, yet; and I say that because I don’t believe that something that depends upon co-operative effort in a community can be pushed down their throat. If, in fact, they’re going to work, they’re not going to be pushed down people’s throats. They’re going to have the time to be accepted as a proven better way of integrating health care.

As far as elected representation goes, I never rule out what might happen in the future but I have to say that one of the major criticisms of the health councils in the beginning was that they were another layer of government. I don’t believe they are another layer of government. They are an advisory body to the minister who is responsible for spending the health care dollars in the province. They contain some governmental people, some consumers and some deliverers. I do not think they should be elected because the moneys they spend are not being collected by them. I think other boards that are elected are usually of that basis.

Secondly, I’m not interested in a person’s ability to stand up in public and convince somebody they are worth voting for. I’m interested in their technical expertise at this point.

For these reasons I think the present method of having a steering committee look through the area of a health council to choose geographic and technical expertise, on a balanced basis, is very important. I think it’s the best model to stay with; and in fact to some degree is why I find the proposals from Sudbury, that I accept elected representatives, not acceptable to me yet.

Now you got to the teaching hospitals and said that 34 per cent of the beds were getting 57 per cent of the money, if I recall the figures you used. You ask me why. Our teaching hospitals, and I’ve seen quite a few of them, in the main are some of our oldest hospitals. I think you would agree with that. It’s not true in Hamilton, where you’ve got McMaster University Medical Centre. It’s not quite true in London where you’ve got University Hospital. But basically, when you look at the major teaching institutions, Toronto General, Western, at some of these hospitals we’re dealing with some pretty old plant. They needed upgrading, perhaps worse than some of the other hospitals around the province.

Secondly, my ministry was committed to increasing the ability of the system to produce Canadian-trained doctors. This required an upgrading of the teaching facilities; and the upgrading of the teaching facilities required an upgrading of the clinical and hospital facilities, which in turn has required us to put a fair amount of money into those areas.

It’s a staged programme I think we allocated $300 million in 1973 dollars to the programme and we’re still trying to get it underway.

I’m glad to hear you say we should close more active treatment beds. I think you should realize we have closed many. I think Ontario has 4.8 beds per 1,000 right now.

An hon. member: Yes, that’s right.

Hon. F. S. Miller: It is 4.8 or 4.9. The number of active treatment beds is one of the arbitrary figures in the health care field as far as I’m concerned. Whatever number we provide will be used, I think you would agree.

We have provided the alternatives, contrary to the comments of the member from Hamilton. We have provided nursing home beds: 25,000 or 26,000 of them in Ontario, plus another 10,000 or 11,000 in the homes for the aged. We have provided home care. We have provided a lot of out-patient service.

In fact, I was very impressed in going through Ottawa in the last couple of days to see what a tremendous job they have done, in some of the hospitals like the Civic, in dealing with day surgery. I went through a new section of the Ottawa Civic yesterday where patients come in, stay for the day and go out without ever taking a hospital bed up at night. They’re serving a lot of people on that basis; things we just didn’t dream of years ago.

It is interesting to find that as the number of patients admitted per year to hospitals goes up the average length of stay goes down. That makes me wonder if we weren’t in the past allowing people to stay in too long. I think we have done a lot of things in these areas to improve the efficiency of the hospital system.

A sister taking me through her hospital yesterday, perhaps unwittingly stated exactly my philosophy about making the system more efficient. She was taking me through the most hard-pressed Ottawa hospital -- the General -- and as we went through it she kept stressing there were no empty beds. At the same time I said to her: “Sister, there are no beds in the aisles. When I go to hospitals that want to impress me with their problems, they usually have the patients out in the halls.” “Oh,” she said, “I solved that problem. At one time we would have at least 20 in the halls all the time; I sold the beds.”

I say unwittingly because that was in effect the main reason for the closure of units of beds in some of the hospitals. If the beds were left there, of course they got used whether they needed to be or not. One tends to keep on expanding until all available space is in use.

If you see us doing some of this I hope we will have your support, because I think I will have to be faced with some of these moves in the next while to make the system more efficient so that the moneys can be diverted to the alternative and preventive fields. I have learned one thing. There is no use providing the alternatives unless you tighten up on the high cost ones simultaneously. I hope you would accept that fact.

The member asked a number of questions, some of which I can’t answer, about long-term psychiatric care and the drop from 16,000 to about 7,000 patients over the past few years. He asked what happened to them; were they at home; were they at work; and who looks after them?

Some were moved out of the hospitals because they were chronics and they were moved into homes for special care. I don’t mean boarding houses when I say that. Homes for special care in the province have all the requirements, physically and staffing, food and all these things, that nursing homes have. They come under the same regulations generally.

Others were moved into residential homes, but a goodly number of them are in less institutional settings. Happily though, we aren’t putting as many people, as I am sure you know, into the hospitals for long-term care because of the improved treatment procedures that psychiatrists have come up with, whether it be chemotherapy or whatever other means they are using.

By getting people back into society we know we are taking some risks, but we are also minimizing the number of people who end up as permanently institutionalized patients, something that happened in the past. The old insane asylum unfortunately was a place where society got rid of people who had mental illness and forgot about them.

I think the hospital you worked in was a classic example, wasn’t it, of that very philosophy? I wish some of the members around here would take the time to visit some of our institutions. They are welcome to and I will gladly arrange it when they want to see them. Nothing shocks me more than to see patients who have been in an institution for 25 or 30 years and to realize just how we can destroy the flicker of life and desire to live in people when they are in a hospital for a long time.

I don’t think we have been unkind if the physical plant around them isn’t all it should be. It is perhaps a measure of society’s unwillingness to put them in the homes where we would like to see them. At the same time, physical plant doesn’t make a person’s life altogether happy. I would rather have some of these people out in society in homes that aren’t all they should be, rather than sitting in our institutions safely “protected” from themselves and from society.

To show the openness of our ministry, I think you must admit that we never try to deny you any information you want, do we?

Mr. Dukszta: That’s very true.

Hon. F. S. Miller: I have an eight-page commentary on what you had to say the last time you visited us. Would you like me to read it bit by bit?

Mr. Foulds: After these estimates where does it go? Are you keeping a dossier on him?

Hon. F. S. Miller: I am. This is dossier No. X912; and frankly, it indicates he needs some treatment.

Mr. Foulds: Where was he last Thursday night?

Mr. Makarchuk: Are you practising without a licence?

[5:30]

Hon. F. S. Miller: What I found most interesting is that you and your leader don’t agree on the four-phase system. However --

Mr. Dukszta: He agrees now.

Mr. Foulds: He is not here to defend himself.

Hon. F. S. Miller: The fact remains we recognize some of the limitations on the children’s mental health programme from staffing. At the same time, I have to tell you, it’s going to be one of those programmes that we believe needs to be enriched even while others are being curtailed. All the other black books -- and their colour is indicative -- all the black hooks tell me how to cut costs but this one I have beside me. This one tells me how to increase the costs of services for children’s mental health.

I think we should point out some of the things we’ve done since 1971. We’ve doubled our expenditures on children’s mental health services. In those four years we’ve more than tripled our new programmes. Our children’s mental health centres have increased from 20 to 40. There are 100 per cent more beds than ye had in 1971. Licensed mental health centres have increased their services from 198 children to 539 by 1974. It goes on and on.

The four-phase system, I think, is just entering the period of time when we can appraise it. It took some time to get it off the ground. We believe it’s good and we wish to give it the chance to prove that it is.

It invariably involves moving some children from one place to another as their need for care changes. But I think we talked about this at some length in June. We found that the old methods of all the bodies looking at their kids, depending upon the trouble they were in when they got to their agency, just wasn’t working. We were treating the children with the same problems in many different ways and we feel this new system has gone a long way toward eliminating that, and there’s a lot more co-operation between the ministries than we sow in the past.

I’m going to skip over a few thugs more there. When we get down to the discussion of physicians’ salaries, it made me realize you must be cunning for the presidency of the OMA. Your figures and mine are exactly the same. I guess we used the same source. Either that or we gave them to you.

Mr. Foulds: No, you took them from him.

Hon. F. S. Miller: The fact remains that doctors’ salaries did go up considerably. We have been using these statistics in our arguments in the past three years where we’ve been trying to maintain the increase in the fee schedule relatively constant. I think you’ll admit that we’ve maintained that fee schedule below the inflationary levels. What was it; 7% last year after two years without a change? Four per cent this year, and as yet an unnegotiated amount for next year.

I’m quite aware that utilization has gone up in that time and that individual net incomes have gone up. Doctors hotly contest this with me, because I talk in averages and they claim they’re not average. I’m sure the statistics -- well I saw a flicker of a smile across your face there; average in terms of income, I mean. I’m satisfied though, that the mechanism for discussing their salaries is working pretty well, even though as yet we haven’t got a settlement. That’s the Clawson committee.

We got onto environment next and you used polychlorinated biphenyls -- I think it was, wasn’t it, PCBs? -- as an example. You said we should protect men before they are affected.

Well if I’m proud of anything, I’m proud of the influence the Ministry of Health has had in the last year within government in terms of centralizing responsibility and control for occupational and environmental health programmes.

Four ministries are now working together, three of them with the direct operating responsibility, in a sense -- Natural Resources for mines; Labour for industrial plants; Environment for emissions. They all relate to health, with Health having the senior authority for the programmes. Out of that new amalgamation came the statements we made in Elliot Lake this year, und that were made by the Minister of Labour, about benefits to be paid to people who evidenced silicosis.

I don’t know of any jurisdiction in North America that tries to encourage a worker to change from one occupation at high risk to another occupation at low risk before in fact he is disabled, and encourages bins by making three-quarters of the pay differential available to him as a bonus. I think that was one of the major steps. We do pay for retraining if a person needs to move. We do pay for total loss of salary if there is not a job for them to go to.

If one examines the statements made by the Minister of Labour back in June or July -- I’m not sure which month -- and the programme as we are planning it and putting it into force, you’ll see that it does allow the worker this option. We do, for example, indemnify new employers against the built-in compensation risks of the employees coming to them, so that if International Nickel plans to hire an Elliot Lake miner, they won’t refuse to do it because they are taking on a high-risk case that will be charged back against their workmen’s compensation rolls. That used to be a problem, but we now indemnify them against that. I think those are major steps we should be commended for.

We went the next step and it’s great to criticize -- the member for Hamilton West said, “Let’s not make environmental and occupational health a political football.” Well, I can’t blame anybody for making it one. It is such a perfect subject. You can sit there and say, “why didn’t you do this? Why didn’t you know that? Why didn’t you prevent this?” It’s very easy. But it’s not half as easy to deal with when you are charged with the responsibility of solving the problem.

I don’t want it to be a political football, and I would charge any one of you over there to say I have ever held back any facts or figures from any of you who asked for them. I don’t want it to be a political football, and I don’t want you sitting there thinking I am hiding facts and figures from you. We are trying to treat it as openly as we can, even though it is embarrassing at times.

Last week I gave your leader all the data on the Reeves Mine. I think he mentioned that on the weekend. I think that kind of tiling would not have been expected a few years ace. Sure, he can come back, as he did, and hit me, saying, “Why didn’t you do something?” That’s where the political part comes in. I have to work with you if we are going to solve the problem. I am trying to make that point. I’ll be very open; I expect and trust that you will be fair in return if I work that way with you.

We are setting up this council that we talked about, the occupational and environmental health advisory committee. You pointed out the worker isn’t represented on it. I find that difficult to understand because it’s got 13 members, of whom five are from management, five are representing unions and three are there as technical or lay people. If the representatives of the unions aren’t representing labour, who are they representing? The system will only work if it has credibility on both sides and acceptability, which means looking into possible risks and appraising fair and practicable threshold values. There are some products that shouldn’t be made at all if they can’t be made safely. But to assume that you can take all risk out of all work areas is foolish.

Driving a truck down the highway is a form of risk, as anyone knows. But no one clamours for trucks to be taken off the highways; they clamour for safer rules for the conduct of trucks so that we minimize the number of accidents. So, in the industrial scene, I am trying to minimize the exposure of people to health risks, knowing full well that there will be unexpected ones pop up, such as the coke ovens and vinyl chloride monomer.

To the members who are doctors I should say vinyl chloride monomer is a great example of an unsuspected risk. Not too long ago, weren’t you using it as an anaesthetic? Weren’t you? Vinyl chloride monomer was an anaesthetic for a while, wasn’t it? And yet we find out that it should be limited to 0.1 parts per million or billion -- I’m not sure which -- or else it causes cancer of the liver.

Hindsight is great. I can’t really accept that one must licence products in advance. Unfortunately knowledge isn’t gained that way. I wish it were. Vinyl chloride monomer would tend to illustrate the point. People looked at it, tested it, made a whole bunch of evaluations of it, but didn’t know, because they didn’t find out until it was in general use, that it caused cancer of the liver. Now that we know, we act. We have to act.

So, let me say that in the ideal, I accept what you say. In practice, I don’t think we’ll ever achieve it. I hope that the occupational environmental health group will start looking for more suspected products so that they won’t hit the market. I suspect that many of the things we take for granted today are going to turn out to be dangerous in the future, as our ability to diagnose and track down evidence improves.

That’s another part of our plan that I talked about earlier. We are trying to keep records of people who work with chemicals that are known risks, so that we will build up information on a compulsory basis for our Workmen’s Compensation records, a compulsory knowledge base. So when people are taken ill, years from now, we’ll be able to find out from our information what common exposures they had. That’s the most frustrating thing today. You try to find out but don’t have the data on why or where a person worked. You just guess in many instances.

I can only say that great though urn problems may be, we in Ontario -- because we are the most highly industrialized part of Canada -- lead the way. I am not ashamed of that. We lead the way in environmental control and in occupational and environmental health awareness. And I just challenge you to some of the other provinces, including B.C., or Quebec, to see if they care as much about the workers’ health as we do in Ontario. I have worked in a few industrial plants in Quebec. Look, for example, at the asbestos mines and their restrictions in Quebec versus ours. See if there are any restrictions in Quebec.

You say we are only spending 0.4 per cent of my budget on occupational and environmental health. That’s true, I guess. But that sounds mighty small until I say that each percent is $3 million, and going up fast. In a ministry like mine, where you spend $3 billion, each little per cent is a lot of dollars.

You both talked about capitation fees. I am interested in them. I am interested in all payment mechanisms. Sometimes I wish I had a decapitation fee.

Mr. Foulds: Would you care to explain that?

Mr. Dukszta: On the critic or the doctors?

Mr. S. Smith: How long have you been feeling that way?

Hon. F. S. Miller: Jim, I didn’t think you were listening.

Mr. Foulds: Oh, we have grown used to that.

Hon. F. S. Miller: I’m losing some of my notes, so if I aim disjointed, please forgive me. You were talking about the Elliot Lake Mines and the risks of radon gas. I think one has to realize that it was in the mid-Fifties that we improved ventilation -- mid-Fifties or mid-Sixties, I’m trying to remember which. Mid-Sixties. As far as we know, we have no evidence since of a person contracting cancer of the lungs through radon gas or radon dotters since the ventilation was improved.

I think if you review all the data we gave last fall, you’ll find that was true then. We are the first to tell you ye don’t know that it has, in fact, worked. But the evidence is encouraging. That was true of silicosis too. So that we feel we have taken a number of steps in that area and have really improved the situation.

[5:45]

I think that concludes my comments on the remarks that the member for Parkdale made. I should point out to the member for Hamilton West that the very things he conjured about as he started his remarks, struck me early in my time as Minister of Health. I wanted to know if Ontario is healthier now than it was. I wanted to know what the major causes of premature death were. I wanted to get a plan of action for long-term health care. I recognized the problem of dealing with day-to-day problems that often put you off your long-term planning.

I can tell you, without revealing anything, that we are a long way down the road towards that. We have done a massive evaluation of the statistical data. I hope to have a report some time not too long from now that will give you some interesting insights into these things. I think I can say that, while we have made some improvements, spending money obviously didn’t make people healthy. I think that’s why I am not so anxious to spend more until I have learned how to spend wisely what I am spending.

You said something about being obsessed with physical plant, or words to that effect, with hospital plant. I am concerned about this. I made five hospital visits in the past two days in Ottawa, and I think they would be quite similar to those that I make anywhere in the province. I delivered, not a lee-hire, but I guess it could be called that, to the boards on the problems of health care coat escalation; of the real constraints placed on the province’s ability to borrow for deficit financing; of the need then to look at the ways we are spending money and the demands for expansion.

I always get total agreement from the people on the board, and then I get a presentation which says, great, but this hospital needs the following things.

The public is not the least bit receptive to cuts in the health field as far as I can see. It’s tremendously receptive to costs in the education field. The average person is complaining bitterly about wasted money in education. I equate that with the fact that is shows very directly on their home tax bill. Would that I had 25 or 30 or 40 per cent of my budget on a local mill rate. Then I think we would see the greatest revolution since time began, or since the Boston Tea Party, if we did it that way.

Yesterday in Ottawa, I pointed out that the hospitals alone there get $120 million a year from us. That’s a pretty big industry.

Mrs. Gigantes: It’s a pretty big town.

Hon. F. S. Miller: A pretty big town, yes. I think you must represent a part of it then.

Mr. Swart: What is the unemployment cost?

Hon. F. S. Miller: I don’t equate unemployment with a job in a hospital. They are both paid out of tax dollars and there is no use getting into that argument. Unless we transfer tax money to the producers, we have not solved any of the problems. If I create work just to make somebody think they have got a job, I have done no good at all.

Mr. S. Smith: Would the minister permit a comment?

Hon. F. S. Miller: Sure.

Mr. S. Smith: I think your response on this, like a lot of the other things you have said, is appealing and quite acceptable to myself and, I am sure, to my colleague, inasmuch as you as minister have made an effort to get people to think about some of these unpalatable things, about having to close physical plants and not always to be demanding more and to get people over this need to see a hospital nearby as a sign of security and so on. But I do think it’s necessary, with respect, that you refer back to some of your predecessors in office. What I am saying is that there has been a long tradition of offering people physical plants and offering people more doctors, when that has turned out in the long run to be an easy solution when money is plentiful but has obscured the fact that a real system with cost benefit analysis has not yet been developed. I hope the minister will understand that nobody is suggesting that he himself is obsessed in this manner, but rather that over the years the ministry has had that particular policy.

Hon. F. S. Miller: I agree with you and I think the previous ministers would agree with you too. One has to look at what the communities felt they wanted. The communities felt they wanted these services with a kind of pride that I have seldom seen equalled. They still feel they want them, and I think you and I and the rest of us in this Legislature have a job of re-directing some of the wants of the communities.

Mr. S. Smith: If I do, I will have to bill you.

Hon. F. S. Miller: When I grew up as a kid, I wasn’t spoiled -- you can tell that. It was very simple. My parents didn’t give me a lot of things because they had nothing to give. Today I find it very hard not to give my kids things because I can. That is really the story of our health field.

But suddenly the end has come as I see it. The ability to give finally has been tested. This is what is going to make us face some of these real problems and change some of the wants of society -- tailoring them to our ability to meet the costs of those services.

I am glad that we don’t have too great a difference of opinion because I am going to be striving mightily in the next short while, having had 18 or 20 months to study the problems, to effect some of the things that I think all three of us would tend to agree with. Perhaps we don’t agree in total, but perhaps enough in principle that you won’t throw me out when I try to do them.

Mr. Foulds: Just throw your government out.

Hon. F. S. Miller: I will have to change parties I guess if I want to stay Minister of Health then.

Mr. Foulds: I think the Premier (Mr. Davis) is going to come in before 6.

Mr. Chairman: Order, please. Would the minister complete his remarks?

Hon. F. S. Miller: I am trying to, sir, but they keep provoking me.

The availability of service, I have to agree, is not directly related to health. You just said that and I agree completely. The cost benefit analysis is something that appeals to me very greatly as an engineer. I think you were right, when I was talking about the Ontario Council of Health’s attempt to do something like that along the HSO route. I don’t know whether you have got the paper or not but it is an interesting paper. I’d be glad to try and get one for both of you before they are printed, because I read it with some real interest. Whether the methodology is good or not, I don’t know but it is an interesting attempt to put figures on some of the things that are subjective in the main. It contains some measuring sticks for us to look at.

I am not going to be making across-the-board cuts. I tend to agree with you. Last year we made them, interestingly enough not because we thought they were the best thing but because after some patient negotiation with the hospitals of Ontario, it appeared to be the only workable solution. This year our restrictions on budget, with some luck, will be more selective. We’ll be looking at those places that can afford to take cuts and perhaps even giving more money to those places that, as you say, have done a very efficient job in the past of keeping down their hours per patient day.

So I agree completely. It makes for a lot tougher decision making. The great beauty of an across-the-board rule is that everybody is treated fairly in their eyes, or equally anyway. Therefore, the administrative problems of talking to those who want exceptions is minimized. The other route obviously is going to have almost every board who is penalized saying they are unfairly penalized. “Prove why it was us” type of thing. Then they will come back and say “but we are an exception because..."

Mr. S. Smith: Could I please suggest, Mr. Chairman -- the minister also used the length of stay by diagnosis by hospital figures which are in his possession. I think they could prove helpful.

Hon. F. S. Miller: Yes. I would agree there. In fact, when we analyze hospitals we use some of those figures. We are going to allow you to have 6.1 days if you had a gall bladder out, and things of that nature. I think some of the attempts to bring individual physicians into line in hospitals is being done that way right now, by good planning and discharge groups or whatever group it is in the hospital charged with that duty.

You mentioned a number of things that intrigued me. I guess one of the studies I am going to be doing, or the Council on Women has asked us to do, is to look at those treatments given to women excessively by physicians. You chose hysterectomies and you also talked about tranquilizers. I guess when we hit those two we hit two of the women’s diseases. Certainly hysterectomy isn’t a man’s disease, at least -- have I got two minutes?

Hon. Mr. Timbrell: This is getting dirty.

Mr. Foulds: You are displaying some of your biases.

Hon. F. S. Miller: But I have to say to those who criticize, that a good part of this is not the Ministry of Health -- it’s the medical profession that has to accept the responsibility for the operations it performs and for the tranquilizers it doses out, I cannot legislate those things.

Mr. Dukszta: Mr. Chairman, the responsibility may be the physicians’ but it has been given to them by the state -- by the government to which you are responsible. So you mustn’t deny it.

Hon. F. S. Miller: I know, but dear sir, I think you, as bright, well-trained people, cannot have the state leaning over your shoulder every time you make a diagnosis. A good deal of the responsibility rests with you and your peer groups who review what you do.

Mr. Dukszta: As an engineer you know that quality control is essential and that is what is lacking at the moment. Maybe you should introduce it.

Hon. F. S. Miller: Engineers manage to do it.

Mr. Foulds: At the moment he is peerless.

Mr. S. Smith: Mr. Chairman, may I make a constructive suggestion in this regard. I know that the doctors are very jealous of their autonomy in these things and they are basically medical decisions, but I’m sure the minister is aware that he has a number of tools at his disposal. If I may try to be helpful --

Hon. F. S. Miller: Is that fools or tools?

Mr. S. Smith: Tools at his disposal. I did not refer to the cabinet as being at your disposal.

Mr. Foulds: Not bad. Not bad.

Mr. S. Smith: The suggestions I’d like to make fundamentally are these: that if you know that in a certain region or a certain hospital, there’s an extensive incidence of hysterectomy -- just to use that example, and there are tonsillectomies and so on -- you do have at your disposal the ability to make that knowledge public. You have at your disposal the ability to draw the attention of the hospital administrators to these discrepancies. You can draw them to the attention of the Ontario College, and ask for some explanation. These are things at your disposal, and I would hope that you would utilize them.

Hon. F. S. Miller: Yes, though I’m not sure about going public on some of them until I’ve tried the other routes. I think it’s quite important for you and me to maintain a certain degree of confidence between the patient and the doctor without publicly saying you should ask your doctor if this operation is necessary. That can happen.

I don’t think it’s a bad question, but I’m saying that when you’re very ill and you do need an operation, you need to have confidence in the person looking after you. Believe me you do, I’ve had a few of them, and I would hate to have thought they were pulling out the wrong things. As it turns out they did.

We’ve got onto payment mechanisms with you, I think, too and I’ve talked about that earlier.

You talked about the Addiction Research Foundation -- what will I do? The Krever report was requested by the Addiction Research Foundation. It was received and I suspect, from what I’ve seen, it has generated a more self-searching review of that organization than I’ve seen done before. The executive director is on a sabbatical. Just this weekend you may have noticed in the press that ARF got together with all their staff and had, in a sense, a large group therapy session.

Mr. S. Smith: You don’t believe in that, do you?

Hon. F. S. Miller: And I think many steps have been taken that are of very therapeutic value in that area. I’m watching it with real interest for encouraging change. I’ll continue to watch it. I’m very anxious to see what they define their function as being.

I’m interested to see that they decided they shouldn’t be providing remedial care but rather advice. I think that’s encouraging because we have hospitals and other organizations set up to do these things. I believe the steps that were necessary are in motion and I will continue to watch with very real interest,

We spend, I don’t know -- about $13 or $14 million dollars a year there. What we do is highly respected in the rest of the world. Ontario does a lot of research there for other people that’s useful to all of Canada. I don’t think we begrudge that but we want to make sure we get our dollar’s value for it.

I talked about the distribution of physicians to the member for Parkdale. Paramedics; one of the reasons that perhaps we don’t seem to be creating paramedics, or giving them the roles that they are justifiably entitled to, isn’t because the ministry doesn’t believe in them. In fact we pioneered some programmes for nurse practitioners. We have a basic problem that we have too many doctors now. There is no use bringing in people who can add to the doctor’s productivity until you’ve trimmed your supply of doctors because they are a straight add-on cost.

I think the steps we’ve taken in immigration control will stabilize, or perhaps even improve, the present physician population ratio, We will be able to get into the use of the paramedics -- over a little longer timeframe, perhaps, than we had hoped. But we will. It is our long term objective. We quite accept the need to use these people.

You talked about the low-cost alternatives and you said that we were perpetuating the high cost ones because Ottawa shares in the cost. Ontario really was the only province to come in wholeheartedly with low cost un-shared alternatives in an attempt to lower the cost of health care.

Looking back, I can see some of the problems we had, just like the doctor situation. When you’ve already got too many active treatment beds, you are kidding yourself when you say that you remove a chronic patient from that hospital, build a new one across the road and put them in it or put them in a nursing home because it costs $18.50 instead of $122 a day. It only costs $122 on average. It’s an overall global budget that isn’t paid on a per diem basis. You know that.

If, in fact, the incremental cost of keeping a patient in a hospital is only $9.50 a day -- that’s pretty close to what it is I guess -- why pay $18.50 across the road, if the beds are there. This is one of the arguments I would use. As the population grows in those high-growth areas it is quite easy to rectify this problem. In the low growth areas, it is not. So we’ll have some problem, I would say, stabilizing or using the alternative care facilities in a cost-effective way in rural Ontario.

Mr. Godfrey: Reduce the length of stay then.

Hon. F. S. Miller: What we’ve done as an alternative, of course, in some cases, is closed blocks of beds so that we at least have some cost savings and put pressure on the system to admit only people who should be in hospital.

Mr. Godfrey: It is cheaper to keep them in hospital.

Hon. F. S. Miller: It is not cheaper to keep a person in the hospital longer than they should be there. I want to practise good medicine. Why keep them there 12 days if they only need to be there eight-and-a-half. Under any circumstances, I just don’t think it is necessary.

I am now through with my rebuttals to the opening remarks. We have 18 hours and 33 minutes left.

An hon. member: 21 minutes.

Mr. Chairman: Before we proceed to item 3, I want to remind the committee that we are now down to 18 hours and 21 minutes. When we resume at 8, we’ll be dealing specifically with item 3, health services.

The committee recessed at 6 p.m.