The House resumed at 8 p.m.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

On vote 2901:

Mr. Chairman: When we rose at 6 o’clock we were dealing with vote 2901, item 3, health services. The hon. member for Wentworth.

Mr. Deans: Thank you. That just affords me the opportunity to raise a matter that has been bugging me no end. Let me tell you, in the plain language of the people that I represent.

Mr. Nixon: We can hardly wait to find out what it is.

Mr. Deans: Well I am going to tell the member. As is my normal way, he won’t have to wait long.

Mr. Moffatt: Be patient.

Mr. Nixon: Right. It may take an hour, but share it with us.

Mr. Deans: But I want the member for Brant-Oxford-Norfolk to know if he can stick around it will be a pleasant change.

Mr. Chairman: Order please. On item 3, vote 2901, health services.

Mr. Eakins: Are you going to tell us what is bugging you?

Mr. Deans: Now I know the minister will recall that on Oct. 31, 1974 --

Mr. Nixon: Oh that’s what it was.

Hon. Mr. Welch: That was Hallowe’en.

Mr. Deans: As is found, starting on page 4747 of Hansard.

Mr. Nixon: The plot thickens.

Mr. Deans: It was an evening session. The minister will remember that I raised with him the whole matter of the hospital in the east end of the city of Hamilton. At that time, while I was in the midst of discussing it with him, pointing out the difficulties that people in the eastern portion of the Hamilton-Wentworth region were having with getting adequate health services, the minister interjected and said: “Can I answer that one specific thing?” He got up and said:

“I think this is probably news at this point in time, but I think I reached a fairly important conclusion and decision for Hamilton about 3 o’clock today. Because I have conveyed my decision to the Hamilton Health Planning Council, I am very pleased to make you aware of it. As you may know -- ”

The member for Lake Nipigon (Mr. Stokes) interjected -- and I won’t read his interjection; it was irrelevant. The minister then went on to say:

“On Monday or Tuesday, the Hamilton Health Planning Council came and made a presentation to me. They were deeply concerned that the lack of a decision on the rebuilding of the Hamilton General was throttling all the other problems in planning foe health care services in the city.”

As I mentioned, they have done perhaps the finest job of any group of people in Ontario.

He went on to say:

“I today notified them that I was prepared to have the hospital rebuilt on that site provided these considerations are included: (a) That they come up with a plan for the optimum use of the master site; (b) They reduce the total number of beds to 1,999, [Right? I don’t know what that means.] which was our 1979 planning standard; (c) They review the role of the new hospital in view of its other purposes in the community apart from being a specialized hospital; [And this is the part I want to deal with.] (d) They find a solution to the east end needs in the city, a health clinic or whatever it may be.”

I want to reiterate, it says, “a health clinic or whatever it may be.” He then said:

“Those are the riders we put to them in our letter today. We are asking them to work out the solution within these parameters.”

And then this exchange followed:

“Mr. Deans: That is interesting. If I had known that you were considering such a thing I would have been delighted to have made a submission on it because --

“Hon. F. S. Miller: It can be done now.

“Mr. Deans: -- I happen, for funny reasons, I suppose, not attributable to any effort on your behalf, to represent much of the east end of the city. I am concerned, and I recognize that many people might tend toward the centre. Everything seems to want to go in the core. Did you give them any timetable for their answer?”

The minister went on to say “no,” and the conversation carried on between he and I. But it was evident from that discussion that the health council was to find a way of providing for the needs of the people in the east end. The minister said, “a health clinic or whatever it may be.”

Now I took it to mean, quite frankly, that he had recognized that the eastern portion of the core city of Hamilton, from Victoria Ave. which is west of centre, geographically, all the way to the very far end of Winona, was not very well served in terms of adequate health care facilities. There were doctors with clinics, but there was nothing for the majority of the people by way of emergency care service. For that matter, there was nothing there in the event they needed overnight care, or perhaps to be confined to a health facility for a day or two for observation or immediate treatment.

So I waited. That was Oct. 31, 1974; over a year ago now. I waited for a while. I was pleased with the result.

I think the minister can probably remember that it’s been a particular concern of a number of people in Hamilton. My good friend and former colleague, Reg Gisborn who represented Hamilton East, raised the matter for at least 10 years consecutively in this House. He continually pointed out there was a desperate need for some kind of emergency care facility in the east end of the city. There were a great number of people who simply could not be expected to be transported to the core of the city; that all of the hospital facilities in Hamilton were centre and centre west in their location. It was extremely difficult during rush hours to transport people from the eastern parts of the city and the western parts of the county and the east end to Joseph Brant Hospital, because they had to go over a much travelled and very congested route. They had been deprived of ambulance service for some considerable period of time.

There once was a time when there was an ambulance located in the town of Stoney Creek, but for reasons that I don’t understand and no one there understands that ambulance service was taken out and put in the east end of the city of Hamilton. The people of Stoney Creek don’t have such a facility available to them now.

Anyhow, there’s a lot more to be said about it. But I, at that point, felt that for the first time in 10 or 15 years the government really did understand the problem and that we could expect to see some results. I noted that on Nov. 7, 1974, which wasn’t long after the debate between the minister and myself, the minister put out a press statement over the name of Douglas Enright, but with his authority, and it said, and I quote from one portion of it:

“In addition, the council is to review the health care needs of the east Hamilton community and the role of the new facility in light of changes occurring in the provincial health care delivery system.”

From that point to now, little if anything has been said or done by either the health council or by the ministry to reassure the people in the east end. They have been desperately needing this facility, and the minister was telling them it would occur, and that they could at some point look forward to seeing this materialize.

I have written a number of times, but I wrote this particular letter on Oct. 15 to Mr. Ray Auld, the executive secretary of the Hamilton and District Health Council. I wrote to him because I was concerned. I think the minister knows I was, because not a week ago I asked him personally about the progress on the matter. I quote:

“I’m writing in relation to the progress of the promised east end health care facility.

“In Oct., 1974, the Minister of Health advised me: Prior to the approval of any payment for the redevelopment of the Hamilton General Hospital, the health council would have to present plans and an implementation date for facilities to meet the needs of the east end residents.”

I’ve had no reply to that, but I can appreciate that it’s the mails, they’re pretty slow to say the least. Nevertheless what worries me is that the approval, as I understand it, has been given; the money has been approved for the redevelopment of the general hospital. It is now under way, as I understand it. They are currently in the process of the redevelopment that they asked for, and far be it for me to deny them that, because it’s probably needed. I don’t know, I’m not sure, but I’m prepared to give them the benefit of the doubt. It’s probably needed.

I now want to know from the minister in clear unequivocal terms --

Hon. F. S. Miller: Do I ever use any other kind? I talk right out.

Mr. Deans: No, you don’t.

An hon. member: Oh, yes you do.

Mr. Deans: Let me tell you, you’re very disarming. You’re queer and -- that’s clear and unequivocal.

Mr. Chairman: Order, please.

Mr. Deans: Thank you very much.

Hon. F. S. Miller: Strike that out.

Mr. Deans: Let me correct that; that’s not queer, he’s clear.

Mr. Samis: He’s seductive.

Mr. Deans: I don’t know about anything else. You are clear and unequivocal, but unfortunately the things you say don’t seem to materialize. Maybe today you are going to say, “Just yesterday I wrote a letter to the health council,” just as you did in 1974. Maybe you are going to get up and tell me that just yesterday or the day before you dictated a long letter and you asked the health council to provide you with the details. Maybe you are even going to tell me what they are going to build. It’s just lucky I happened to ask tonight.

Hon. F. S. Miller: Just lucky.

Mr. Sands: Must be another election coming.

Mr. Deans: Just lucky. In 1974 I couldn’t believe my good fortune that I should ask you on the day of the letter having been signed.

Are you going to provide a health care facility in the east end of the city of Hamilton? If you are, what is it going to contain? When is it going to be built? Is the commitment real? Can the people look forward to some kind of service? Can I tell them tomorrow morning that the Minister of Health is keeping his word; that there is going to be such a facility of the kind they have long been waiting for and desperately needing?

Hon. F. S. Miller: Mr. Chairman the hon. member did speak to me last week. I appreciated him doing that. He happened to talk to me within two or three days of a visit I had from Mr. Green, who is chairman or has been acting as chairman of the Hamilton Health Planning Council.

I am in a game in which keeping your word isn’t always the easiest thing in the world, but one of the few things I have tried very hard to do with those of you to whom I have given my word is to keep it. I don’t give it loosely and when I give it, I keep it; even sometimes when it isn’t very nice, as some people know in some areas.

The fact remains, I must have better mail service than you do because I have a copy of Mr. Auld’s letter to you.

Mr. Deans: When?

Hon. F. S. Miller: Dated Nov. 4. I don’t know how or why, I’m just saying I have it.

Mr. Deans: Why would --

Hon. F. S. Miller: Sure. I happened to take the time, once you asked me, to find out exactly what the status was and that uncovered the copy of the letter. Whether it came through our internal system, by hand.

Mr. Deans: Yes, he ran over with it, no doubt.

Hon. F. S. Miller: Perhaps after I called -- all I know is I got a copy of a letter which is in the mail to both of us, once I we inquired. That’s all I can say. In any case, we picked it up so we got it. Do you want the whole letter?

Mr. Deans: Why not? Is it any good?

Hon. F. S. Miller: I only got to grade 3 in reading.

Mr. Deans: Does it tell me whether there is going to be a health care facility?

Hon. F. S. Miller: It says:

“Thank you for your letter of Oct. 16 in relation to health care facilities for this district.

“You recall from your earlier inquiry and our subsequent reply of Feb. 22, 1974, I explained in brief the development of a 10-year health sciences plan for this district and the terms of reference we have been given by the Minister of Colleges and Universities and the Minister of Health; namely a 10-year allocation was to be spent for the upgrading and improvement of teaching facilities affiliated with the McMaster University health sciences complex.

“As you can well appreciate this is a tremendous task and we are experiencing the same kinds of problems that are being encountered in other health sciences complexes located in Toronto, London, Kingston and Ottawa. [A lot of those have to do with financing I would point out to you.]

“This health council, in full collaboration with McMaster University and all of the affiliated facilities, are continuing to work out this long-term plan within the guidelines of the financial constraints that have been placed upon the whole I health care delivery system. In our efforts to resolve these matters, council has been constantly working with both ministries plus the planning department of the regional government of Hamilton-Wentworth in correlating all of the data which is required to determine such a plan. But at the same time, council has recognized that it must take into consideration all of the elements within the total health care delivery system.

“In respect of the 10-year plan, council has received approval from the Minister of Health to proceed to develop finite plans of the following broad proposals.

“1. Hamilton General Hospital to be rebuilt to a maximum of 400 acute-care beds with the precise programme allocations as yet to be determined.”

[8:15]

I think I mentioned to you the other day that the very reason we put the provision in our overall permission to Hamilton for them to go ahead with the relocation of the hospital on this site was because both the regional and city governments and the health planning council had recommended that. It’s pretty difficult not to accept those three recommendations. Yet we felt we had to protect your part of the city and therefore we put that claim in.

“2. Pediatrics to be consolidated in order that there shall be only, at a maximum, two units containing a total of 100 acute-care beds for the whole district.

“3. Obstetrics to be consolidated in order that there shall be only, at a maximum, two units containing 150 acute-care beds for the whole district.

“4. Tertiary care programme distribution to be adjusted in order to meet not only the requirements of those consolidated pediatric and obstetric programmes, but also to meet the needs of the total community while ensuring elimination of unnecessary duplication.

“5. In keeping with the principle of consolidation, approval be given to the Hamilton District Hospital to proceed immediately with the redevelopment planning process within the 400 acute-care beds concerned. Reconstruction to be carried out on a phased basis, in order that as beds are taken out of service, the surplus beds, which are presently available in the district will ensure that there is little disruption in the availability of services and the high quality of service will be maintained. This process will allow the consolidation and redistribution of programmes to take place in concert. It will allow bringing into service on a phased basis the total complement of beds at the McMaster University Medical Centre and provide St. Joseph’s the opportunity to proceed to develop its master plan that will be complementary to the total district needs.

“6. This overall plan allows for the provision of 1,999 acute-care beds by 1979, which is the target the ministry set and to which we are committed.

“Now, in arriving at the foregoing, and as stated recognizing the need to develop other health care programmes, council has made a commitment to the Minister of Health that there will be established an ambulatory care centre in the east end of the district.

“This will have to be done in close co-operation with the Ministry of Health to ensure the exact site is geographically correct and large enough to accommodate the construction of an in-patient facility when there is more precise information available on population growth and distribution.

“In making this commitment, council recognized that present facilities can, and do, serve acute-care patient needs until the government is in a position to provide data and funds that will support the construction of a comprehensive facility that will have a catchment area that reaches into other jurisdictions. We’re expecting updating of population projections and spread, particularly at it applies to the east end district in which we understand there are some revisions.

“In addition, the Ministry of Health is determining plans from the appropriate ministries -- future long-range plans -- as to highways and traffic flow. This will have to be correlated to similar information which we’re obtaining.”

And so on. There are a couple more paragraphs that I think I can leave. But in any case, the answer is there specifically. It’s not just the provision of services from sonic point remote, it’s the provision of services from within; and the long-range plan would be for some larger facility with beds to eventually be built.

Mr. Deans: I don’t want to shock you, but there have been commitments made in this House -- I’m sorry, in a way, that my former colleague from Hamilton East is no longer here in the House, because he is better able to recall exactly how often, but I would not doubt for a moment that the truth would be maybe 10 years in a row -- that there would be some health care facility provided in the east end of the city. What I understood you to read in the letter, which is addressed to me but which I have not yet received, is that they’re really still studying it. They may build something in the future. It depends to a great extent on the Ministry of Health and its involvement, and the Ontario government’s involvement in the provision of any facility that might be built in the future.

There is no definite plan developed at this point with regard to meeting the needs. I’ve got to tell you that I took an entirely different meaning. Maybe I’m a bit gullible, I don’t know. I didn’t think so, but it’s entirely possible. The hon. minister has a nice manner and it kind of draws you in a bit. But let me read the paragraph that applies directly to this, from a letter dated Oct. 31, 1974 sent to Mr. Green over the signature of the hon. minister. It says, and I just want to read the lead-in paragraph, it says: “However, I would like your council to address the following problems.” That was prior to the approval of the moneys to be spent for the rebuilding of the Hamilton General, and the thing that concerns me most is the following: “Review the health care needs of the east Hamilton community and ensure that these needs are met in the planning of both in-patient and out-patient services.”

I really did think that the hon. minister was saying to them that we will approve the expenditures but you’ve got to prove to us that you have, in fact, conducted a sufficient study and that you do have a plan to meet these needs.

I don’t know, it’s hard to describe to you what Hamilton is like in terms of hospital facilities for people. McMaster University is inaccessible, virtually inaccessible during certain hours of the day, to people who live in the east end of the city. But unfortunately the Joseph Brant Hospital, which is in Burlington, is equally inaccessible at the same times because of the rush hour periods. So for persons to get to the closest hospital, which would be in another jurisdiction altogether and which would be in Burlington, requires them to make their way through the rush hour traffic. Though it’s closer, geographically, it is as inaccessible as McMaster University Hospital.

St. Joseph’s Hospital, in the centre of the city, faces the same problems. The General Hospital is in the centre of the city and faces basically the same problems.

Perhaps you can correct me if I’m wrong, but the action of the health council leads me to believe that this is some distance in the future. Maybe the minister could tell me. It’s a year; it’s more than a year, since I last asked him about this problem, and since he gave me the answer that I relied upon.

Okay, 12 months have passed. Surely to heavens they’re in a position now to tell us what they propose to do. Do they have any plan of any kind? Where; what; when? I suppose that’s what I want to know. I don’t want the hon. minister to tell me when they’re going to build a major hospital. I understand that might be some time off in the future. But when can we in the east end of the city and in the Stoney Creek area reasonably expect to see the facility in place, open and treating patients?

Hon. F. S. Miller: I can’t answer that, Mr. Chairman, because I don’t know how soon.

I want to point out one thing, that in the time of a year, which is a long time to you and me, that council has done a lot of work. It’s not a question of my ministry having done that. They have done a lot and I feel they’ve come a long way towards resolving the overall problems there.

The creation of the facility they talk about in that letter shouldn’t require all that time. But I’ll be glad to get a more specific answer for the hon. member. I can’t give it to him out of my head.

Mr. Deans: I just want to close it off for you then. Item six of the letter which is addressed to me -- interestingly enough it’s a strange looking letter, it has no address.

Mr. Bain: They don’t know where you live, Ian.

Mr. Deans: It has no signature. It’s obviously typed for the purpose of satisfying an inquiry, but that’s beside the point.

Hon. F. S. Miller: I don’t think so, Ian.

Mr. Deans: Well, it sure looks like it. But anyway, it’s not even on letterhead.

Hon. F. S. Miller: It’s a copy of a draft that was prepared.

Mr. Deans: Ah, I see. The draft is still in the typist’s typewriter, no doubt.

Hon. F. S. Miller: There’s a date on it.

Mr. Deans: I notice the date typed in the top left hand corner; hot that’s fine, although that’s not usually where they type dates. But that’s all right; I’ll accept that.

Let me say to you that when I read this thing, it says under item six: “This overall plan allows for the provision of 1,999 acute-care beds by 1979, which is the target the ministry has set and to which we are committed.”

Now 1979 is four years from now, that’s to begin with. “In arriving at the foregoing,” and I assume the part I have read is part of the foregoing because it’s ahead of it, and as stated: “Recognizing the need to develop other health care programmes, council has made a commitment to the Minister of Health that there will be established an ambulatory care centre in the east end of the district.

If they really recognize the problem, if they understood both the history of it and the emergency need, I’m sure they could offer, in a very short period of time, some kind of programme that will show the people that they mean what they say. I’m going to ask you, quite frankly, and I’m going to ask you next week in the question period so you know it’s coming: I would like to know within the next week or 10 days what do they really intend to do? When can we expect it? Do they consider it a necessity or is it a sop? Are they just complying because you made it a condition? Are you, at some point once the General’s rebuilt and $40 million is spent, going to be prepared, perhaps, to forego that condition? That’s what worries me.

I would like to have seen in black and white exactly what they intended to do before you agreed to the expenditure of the funds for the things they particularly wanted, recognizing that the need is both acute and immediate.

The development in the city of Hamilton is taking place to a great extent in the east end and there has to be something for those people. I ask you, please, when these estimates are over or even, if you can find the time, before they are over, get hold of Mr. Auld or Mr. Green; tell them I thank them for the letter I haven’t yet received; and ask them if they would be good enough to set out in more precise terms when, where and how they intend to meet that commitment.

Hon. F. S. Miller: May I point out that a goodly number of the people working are volunteers -- I believe Mr. Green is -- and I think one most appreciate the hard work they do. I have to point out also that they have no other community to serve but Hamilton in their planning. I would hope that in their planning they are taking the needs of your area into account without concern about the rest of the province, because that is their specific charge.

I don’t think I ever implied to you that you are getting a hospital in the near future.

Mr. Deans: No, I didn’t say that.

Hon. F. S. Miller: No; I just want to make sure that you and I agree that wasn’t one of the misunderstandings which could have crept in. The very fact that they insisted on the Hamilton Civic being rebuilt downtown was, to me, an indication that for the immediate future you wouldn’t be getting a hospital in the east end.

Mr. Deans: Let me save you a lot of aggravation. I don’t want you to be agitated by it. Let me read to you what you said: “To review the health care needs of the east Hamilton community and to ensure these needs are met in the planning of both inpatient and out-patient services.” Whatever that requires we’ll settle for. In-patient and out-patient services -- I don’t want you to build another general hospital. I don’t want you to build anything which isn’t necessary, but I do want you to build or have built what I believe and I think you honestly believe was a commitment.

Hon. F. S. Miller: That’s right.

Mr. Sargent: Mr. Chairman, may I talk, in this estimate, on hospital needs in Owen Sound?

Mr. Deans: No, that comes under vote 1703.

Mr. Chairman: Yes, you can proceed on that.

Mr. Sargent: Thank you. May I ask the minister how much of the $18 million in this vote is federal money? How much of the $18 million under health services is federal money?

Hon. F. S. Miller: That may take a moment to answer because we will probably have to look for details if, in fact, we have that breakdown.

Mr. Sargent: All right we’ll leave that.

Hon. F. S. Miller: I can tell you. Of this, the answer is none.

Mr. Sargent: My information is that you received --

Hon. F. S. Miller: May I explain for a second, since I have looked at the detail of the thing? The items we are talking about here -- psychiatric hospitals, ambulance services, clinic services -- were all non-sharable items. The items, as I understand it, in which the federal government shares are hospital operations costs and medical benefits indirectly for doctors’ fees.

Those are the two major items. There are of course some other minor items that are shared. In other words, the money you are looking for isn’t in this vote, but in any case talk about it.

[8:30]

Mr. Sargent: Mr. Minister, you will recall that a few weeks ago the Leader of the Opposition (Mr. Lewis) came to Owen Sound and stated publicly after visiting the hospital:

“The hospital situation is ludicrous, with surgical and medical equipment in the hallway, overcrowding and inadequacies in the levels of patient care. I don’t understand the political ramifications. What kind of twisted social priorities exist when the government frittered away $200 million in North Pickering ... when we have patients going to different levels of the hospital who must travel with supplies, visitors, soiled linens, sterile items, garbage and food all on the same elevator?”

In other words, he was shocked to see that this thing could happen and he planned to go to the mat with you and I and the leader of the Liberal Party on these estimates.

I don’t think it is becoming to the minister or to the House to talk about the dirty linen we have, insofar as political ramifications are concerned. But the facts are, Mr. Minister, that we have here a report by Woods, Gordon and Co., 88 pages in length. The fact that you are receiving in total about $700 million a year from Ottawa towards your estimates for reallocation in Ontario is a damning piece of evidence. Yet you refuse to acknowledge the fact that there should be equity in Owen Sound, that we pay the same hospital rates as the rest of Ontario. In fact we are talking, Mr. Minister, of putting signs on our highways saying: “Please drive carefully around this area because Mr. Davis has closed off all hospital beds.”

What do we do, Mr. Minister? You know the situation, and during the estimates I would like you to qualify what you said on the air three days ago, that you would change your policy now to be in excess of five years. It might be after 1980 or so before we could get a new hospital. Yet you are spending $1.5 million to put portable hospitalization on the lawn of our hospital. You are putting 30 beds or 34 beds two miles away for our chronic people.

In other words, I think you should be ashamed of the way you treat my people like second class citizens. In fact in the House last session, Mr. Minister, you said the reason they should be treated like second class citizens is because they have a second class member.

An hon. member: Oh, no.

An hon. member: Oh, no; that’s wrong.

Mr. Sargent: I take that, but that didn’t get your candidate any votes this last election up there. By and large I think that --

Mr. R. S. Smith: That came from a second class minister.

Mr. Sargent: You should tell the House, Mr. Chairman, that the --

Hon. F. S. Miller: On a point of privilege, Mr. Chairman.

Mr. Chairman: Point of privilege.

Hon. F. S. Miller: The gentleman is quite correct when he says that. He also knows I had a smile on my face because we were trading jokes at the time and he full well knows it. I didn’t mean that in any personal way at all. There are lots of times you say things in this House which taken out of context would be pretty damning.

Mr. Sargent: I have never yet talked personalities in this House. I talk about the office that you hold.

Interjections.

Hon. F. S. Miller: I hope the lightning doesn’t strike you right down.

Mr. Sargent: So if that is your point of privilege, it is pretty weak. Why can’t we get in our area -- at least closer than London, Ontario -- a kidney dialysis machine?

Mr. Givens: You got it right.

Mr. Sargent: Why don’t we rate one of those in our area? Any closer than to serve about 200,000 people, we can’t have one of those machines? I would like to ask why.

Hon. F. S. Miller: Mr. Chairman, I don’t know whether the Leader of the Opposition is willing to go to the mat and bring the government down on this issue or not -- let them do it, I’m quite willing to have it done -- because I can’t treat you any differently than other people. I am treating you fairly whether you want to accept it or not.

The interesting thing is I’m seeing the chairman of your board shortly -- I think it’s a week tomorrow --

Mr. Sargent: You refused to see him last week.

Hon. F. S. Miller: Pardon?

Mr. Sargent: He called me last week and said you refused to see him.

Hon. F. S. Miller: I haven’t refused to see him.

Mr. Sargent: He couldn’t get through to see you. Your aide said you would not see him.

Hon. F. S. Miller: That is not so. I have not, at any time, refused to see Mr. Hindman. He’s got an appointment with me right now, whether you know it or not. I thought it was this week; it’s next week.

The last time I saw your board was almost a year ago -- October, November or December. They came down to discuss short-term measures to help your hospital survive through the agreed-upon overcrowding.

Mr. Sargent: Because you wouldn’t give us a new hospital, that’s why.

Hon. F. S. Miller: That’s correct, I wouldn’t give you a new hospital -- there are lots of places I haven’t given new hospitals. But some of the places I have given new hospitals are Liberal, just as some of them are NDP, I think you should check with some of your members to verify that. Ask Pat Reid.

Mr. Johnston: Who is he?

Hon. F. S. Miller: The fact remains that your board came down and said that if they couldn’t have a hospital for five years or more -- and I said, incidentally, it would be no less than five years, my guesstimate was seven or eight -- they did not want to spend the million-odd dollars we were willing to share with them to add a permanent extension to the present building. They said they would rather put temporary service buildings up at lower cost that would be salvageable at the end of that time. They were willing to have us pay the cost of the renovations to the Mackinnon Phillips Hospital so 34 patients could be transferred there, giving you 34 more active beds in the hospital in the city.

Those things were agreed upon, and as far as I know the portable buildings are up, are they not?

Mr. Sargent: Yes, sir.

Hon. F. S. Miller: As far as I know too, allowing for the time it takes for the normal routine of government services -- planning, calling tenders and getting a job done -- the work at Mackinnon Phillips has been coming along. Not as fast as I would have liked, but I believe February or thereabouts we’ll be able to put the 34 patients in where they will be serviced by your hospital staff, rather than by the Mackinnon Phillips staff.

It is our long-term objective to give you a hospital there, but the current buildings do have a lot of value. They’re worth at least $25 million or $30 million to replace. We simply couldn’t justify stopping the use of those buildings while they were still usable, realizing how scarce assets for capital building are.

This year in Ontario I had capital of somewhere between $80 million and $100 million. It sounds like a lot, but of that some $65 million was under way when the year began, so discretion was very limited on the balance of the package. We simply are having to make a number of locations go forward for a longer period of time, and yours was one of them.

Mr. Sargent: Mr. Minister, the report recommends that we must have 355 beds. We have 237; we’re 118 beds short. You won’t let us put our beds in the hail. We’ve had our halls full for the past five years; you’ve blocked that off. You cut our budget by $200,000; we had to fire 28 people. You compound the programme, but 35 miles away you’ve given Mr. Winkler a $4 million hospital. They call it the Hanover-Hilton; the rugs are up to your knees, and half the facilities are empty. Just 35 miles away you have a $4 million hospital.

We are the area hospital with the best medical and surgical teams in the Province of Ontario and it is the biggest disgrace in the Province of Ontario. You tell me about beds in the Province of Ontario. We have 150 or 200 beds on University Ave. empty.

How can you tell us that we don’t rate the same treatment for our hospital care as the rest of Ontario?

Geographically in this province everybody should have the same rights. You shouldn’t suffer for education or jobs or help because of geography; but it is a fact in our city, in our area, no matter how you try to bend it. Federal moneys are coming in to you and you’re not pushing them or allocating them equally, yet the basis of democracy is a fair allocation of our assets across the province on an equal basis.

That is not the case when you give Mr. Winkler, who had charge of the Treasury, a blank cheque and he wrote himself a $4 million hospital which is half empty while we can’t serve our people. If you came up there next week and had a heart attack, you couldn’t get into our hospital and that’s a fact. My mother couldn’t even get a bed in the hail the night she died. And you tell me you’re giving fair treatment to people in this province.

I know you have problems with finances but those are self-inflicted wounds and we should not have to suffer for it. We’re talking about a long-term deal in this province and we’ve gone for one generation now without a decent hospital, and by God it’s not going to continue.

Hon. F. S. Miller: I don’t think anything I say will change the member’s mind. I think there’s been a pretty fair allocation of hospital funds around this province and we’re pretty well serviced. I would point out to you I collect $951 million from the federal government per year. I spend $3 billion. The federal government, in turn, collects about $1.4 billion from us, to give us back our $951 million by the way. I think one has to realize --

Mr. Nixon: That is half the cost of post-secondary education, plus half the cost of welfare.

Hon. F. S. Miller: I’m just talking health dollars right now.

Mr. Nixon: You are not talking about health dollars when you are talking --

Interjections.

Mr. Roy: Don’t you think we’re Canadians here?

Mr. Nixon: Don’t you think paying taxes is Canadian?

Hon. F. S. Miller: You’re a farmer; I doubt it.

Interjections.

Mr. Sargent: In the last session of the House, I said you received --

Mr. R. S. Smith: You are a used car dealer, what about that?

Mr. Nixon: That is another one of your facetious remarks that will return to haunt you.

Hon. F. S. Miller: That’s right.

Mr. Sargent: You do admit that you received $951 million from Ottawa for allocation in this province? In the last session, you accused me of bending the truth when I accused you of getting $750 million from Ottawa but today you admit you get $951 million from Ottawa. All we ask is that we have one day’s loss. You’re losing $8 million a day now in debt. The $6 million you’ve lost a day since a year ago today and the $2 million debt load is $8 million a day you’re losing. All we ask is one day’s losses for our area, for our hospital, to service about 200,000 people.

Mr. Nixon: What could be more reasonable than that?

Hon. F. S. Miller: I can’t talk logic with the member. I suppose your hotel is totally paid for?

Mr. Sargent: My hotel?

Hon. F. S. Miller: Yes. Is it?

Mr. Sargent: No. I have a pretty healthy mortgage against it. I’m paying 13 per cent on my mortgage because I can’t get an ODC loan from old satchel-ass over there.

Hon. Mr. Bennett: You’ll have to resign your seat.

Hon. F. S. Miller: If it makes you feel any better, neither can I, and I’ve tried.

Mr. Sargent: You know the business; you know all about it.

Hon. F. S. Miller: I do that. The difference is you succeeded.

[8:45]

Mrs. Gigantes: I would like to address myself to the part which concerns district health councils. One reason is because we have one of the four in the province in the Ottawa-Carleton area. I think our experience there and same of the questions which have come to my mind from what I understand to have been the experience of that council, raise some problems on which I would like your comments. When I look at the operations of our council, which has been in existence for two years and which only this May got its directors and finally started getting itself together, I ask myself, who does it represent, how is it supposed to have a relationship to the regional medical office of health and the board of health and the ministry under its present constitution, how can it exercise any real influence on provincial programmes in the Ottawa-Carleton area when it has no control over budget and no claim to an elected mandate, which might be a substitute to some control over a budget, particularly in terms of trying to deal with the ministry? I am not going to ask you for a hospital, you will be glad to know, but I will take you back over a chronic problem in the Ottawa area, which is the acute-care bed shortage problem.

We now have 2,314 acute-care beds in the provincially-chartered hospitals in Ottawa and there are 60 beds in the national defence medical centre; the total is 2,374. The provincial allowance, or the kind of quota that we are allowed, is 2,109; and that is based, I am told by people on the district health council, on statistics which are two years old. We are also allotted by the province the right to 255 beds, because we service patients from the Quebec side, from the Hull area. So our allotment under the provincial quota would be 2,364. Given that we have 2,374 beds, it looks like a surplus of 10 beds; but that is not what it feels like, and that is not what it is really like.

The basic provincial quota allowance for our area is 2,109 and that is too low because we are in a high growth area and we never seem to catch up on two-year-old statistics. About 300 of the acute beds that are included in our quota are now being used by chronic-care patients and the actual number of Quebec patients is not 255, but closer to 350. The upshot of all this is that we have a shortfall of approximately 400 acute-care beds; as you are well aware because you just visited the area and I am sure the minister knew it before.

The response we had from the ministry, and from you in your visit, was that we are going to have the release of 200 beds for chronic patients that will be provided in existing institutions, but the need right now is immediate, and the 200 beds that you have been talking about, by my understanding, will be phased in -- and I have read conflicting news reports on this -- over the period from January to June.

It is still only 50 per cent of what we need immediately in a critical kind of way. These beds that will be released will meet two-thirds of our chronic care need and it will meet none of the existing need created by the influx of Quebec patients from the Hull area. I know you refer to development at Sacré Coeur Hospital in Hull designed to help us on the Ottawa side deal with our bed shortage problem, but these developments too are many months away, and we have also in the Ottawa area come to be quite leery of promises by the Quebec government to look after the hospital situation on the Hull side.

So we have a critical problem which is not going to be met in time for us to feel the effect through this winter. The district health council has expressed, over the last long period of time, a great deal of concern on the subject. Even when all the points you outlined become real, we still have a need for 200 acute-care beds, for which there are no plans announced let alone beds.

I look at this problem in the light of the work the regional district health council has attempted to do in the Ottawa-Carleton area; we have had a report of the task force on hospital accommodation in Ottawa-Carleton, which was endorsed by the regional health council this summer and it was given to the minister. The report recognized that the immediate need for beds in the Ottawa-Carleton area is inter-related with deficiencies in other programme areas.

I think you should take note of the fact that this regional health council is doing the best job it can under difficult circumstances, and I will come again to its difficulties with its mandate. They have asked you to relieve deficiencies in other programme areas so that the bed shortage problem would be alleviated. They are not asking you to create a new hospital, and they are not asking you to build new facilities to put new beds into. Basically, they are asking you to release resources that exist and to give supportive action for existing programmes they think are going to help the bed shortage problem.

The first point in the task force report was an underline of the need for a placement assessment programme in the Ottawa-Carleton area. Then each facility, each hospital and the doctors, would know which place to be putting patients and how long they should be staving; releasing patients to facilities with lower levels of care as soon as that was possible. That is not happening now.

The council was told by the ministry that in order to get such an assessment programme going we have to wait for an evaluation of a similar programme in Hamilton, but it seems to me that’s too late. It is a programme that should be started now. The district health council has asked for it, and I think you should give more serious consideration to it for our area.

There is another problem associated with the placement assessment programme which has to do with the mandate of the regional district council, the health council. Even if it gets an assessment placement programme going it doesn’t have the power to make the institutions conform to the recommendations of that programme. That could be a very serious flaw; I think it is recognized by the Ottawa-Carleton District Health Council that it may be necessary for such an assessment programme to work properly that the council or the administrators of that programme have the power to make sure that institutions, hospitals and doctors conform to the recommendations.

The second point that was touched on by the task force on hospital accommodation was the shortage of support beds and it recognized a lack of at least 100 support beds. There has been consideration by the district health council, in a very serious way, to try and scrape up the extra beds in existing institutions. But they are going to need help and support in other programme areas to be able to do that.

Their third recommendation was that the social and nursing support programmes that are in existence should be integrated into senior citizen housing programmes. They feel that would tend to alleviate geriatric chronic care use of beds and the taking up of hospital beds by senior citizens who, given a kind of low-level preventive treatment in their own housing area, would not end up having to spend time in hospital.

Mr. Chairman: I must remind the hon. member that item 3, health services, does cover district health councils, but you seem to be dealing with things that may be mere appropriately brought up under item 2 of vote 2903, general hospitals and related activities.

Mrs. Gigantes: Mr. Chairman, I feel the recommendations of this task force report, which were submitted by the regional district health council to the ministry, and the fact that the ministry has not dealt with them, reflect directly on the mandate of the councils. This is why I wish to bring them up under this item.

Mr. Chairman: If you want to stick strictly with the activities of the district health councils that’s fine, you are quite within the vote.

Mrs. Gigantes: These are.

Mr. Chairman: When you start talking about active treatment beds and such like, it should come up under vote 2903, item 2.

Mrs. Gigantes: Mr. Chairman, with your permission, I would like to talk about the programme that has been proposed by our own regional district health council and the fact that the ministry is not responding adequately and why that means that the way the district health councils are working and their relationship with the ministry is not adequate at this time.

Mr. Chairman: You can continue, keeping in mind that this vote deals specifically with the activities of the district health councils as opposed to the operations of hospitals.

Mrs. Gigantes: Thank you.

Mr. Samis: A wise decision, Mr. Chairman.

Mrs. Gigantes: I will cut any points short.

The fourth point in the task force report calls for an extension of rehabilitation programmes at St. Vincent de Paul; and the fifth the creation of an open-ended home care programme. The limit for home care programme to one individual right now is 80 hours. The estimate of the task force was what an open-ended home care programme would permit 110 patients to stay at home.

All these are points which I feel have been the creation of a very earnest study by the district health council in the Ottawa-Carleton region. I think it’s a shame they haven’t all been taken with the same degree of seriousness by the ministry.

They are not major expense programmes. They are programmes which would help to relieve a bed shortage problem without building new facilities. I ask myself why the district health council is having this problem? The problem of creating and releasing and reassigning beds in the Ottawa-Carleton area, for both chronic and active treatment, relates directly to the questions I asked first about the role and the power and the mandate of the Ottawa-Carleton District Health Council. And I think it’s important to examine that experience before we get into the creation of other district health councils under the same set of guidelines.

The province has the money and makes the final decision on programmes. The district health council has no electoral constituency to reinforce its recommendations. School boards at least have that, though we know school boards can’t exercise a great deal of discretion in terms of the allocation of their budget. At least when they come to the Ministry of Education, they come with the power that comes from having been elected and chosen by the people of their area.

The Ottawa-Carleton District Health Council has so far shied away from tackling the primary care field in the Ottawa-Carleton regional area, and this relates to my second question. I don’t think they can be blamed for shying away from it, because there seems to me to be a confusion of mandate between the district health council, the medical office of health and the regional health board.

Probably many members in this House are aware that our medical officer of health is Dr. L. H. Douglas who is quite an extraordinary character, and who for many years in the Ottawa-Carleton area has provided leadership of an imaginative and dedicated and very determined nature. He is a veritable guardian of public health and he’s developed an excellent birth control clinic in the Ottawa-Carleton area and he’s taken some very brave stands in closing Ottawa area beaches.

Mr. Foulds: And he’s a good Liberal.

Mrs. Gigantes: But if I were on the regional district health council --

Mr. Foulds: He can’t be perfect.

Mrs. Gigantes: -- I wouldn’t try to put my foot on Dr. Douglas’ territory because he’s a man who constantly reminds people who ask any questions about his decisions that he is responsible only to the ministry. That’s what he tells people. I understand he is paid, appointed, hired by the ministry.

Hon. F. S. Miller: No.

Mrs. Gigantes: Who hires him?

Hon. F. S. Miller: You better check your facts.

Mrs. Gigantes: He is lying then.

Hon. F. S. Miller: He is approved by me.

Mrs. Gigantes: And for all my concern about preventive health and all my respect for Dr. Douglas, I wouldn’t be willing to sit on a non-elected district health council and try and convince Dr. Douglas he should modify any of his programmes in the primary health programme he runs. You’d have to be begging for punishment to attempt to guide Dr. Douglas from a base of so little authority.

[9:00]

In the long run, it seems to me, as the Mustard report said and as the experience of the Ottawa-Carleton District Health Council is demonstrating, district health councils will need a sufficient information base and sufficient authority to decide on what mix of medical professionals and paramedical professionals are needed within each particular district health area.

The ministry’s response to this, in terms of giving district health councils this kind of mandate, is presented in the booklet called “Report, Reaction and Response: The Health Care System in Ontario.” It’s a reaction that’s defensive and timid. It suggests that the control of the distribution of health manpower in Ontario is not an appropriate job for district health councils, and that the Mustard recommendation is, “a particularly strong one and gives rise to a number of complex concerns.”

The ministry shores up its defensive stand on this issue by alluding to consumer-group concern for the human rights of doctors. If I could humbly suggest to the minister, the consumer groups are not mesmerized by the human rights of teachers who must move to areas where the school boards have identified local needs for educational manpower; and this reaction on the part of the ministry and on the part of the public, is just one more indication of the success the medical profession has achieved in convincing government and public of the God-like discretion it must have about how and where and to whom medical service is provided.

I feel the right and the power to decide what mix of medical professionals and paraprofessionals are needed within a district health area must be given to the district health council. It’s meaningless to talk about planning unless they have those powers.

Following up this point, it’s not sufficient to say, as the ministry does in this booklet, that the under-serviced area programme is working. Communities are still without services in this province and large urban communities are over-serviced in some professional areas. That’s certainly true in the Ottawa-Carleton area. We have more specialists than we need.

Mr. Chairman: Order, please. May I point out to the hon. member that under-serviced areas do not come under this vote.

Mr. Foulds: It is covered by a health council.

Mrs. Gigantes: I am questioning the mandate which the ministry is giving and the experience we are having with the Ottawa-Carleton Regional District Health Council, and the areas where it needs new power in my view.

Mr. Chairman: As long as you relate it to the health councils you may continue then.

Mr. Foulds: This is simply detailed supportive material.

An hon. member: Picky, picky.

Mr. Samis: The Chairman is being liberal again.

Mr. Nixon: It’s a conspiracy.

Mrs. Gigantes: In order to indicate that I feel the ministry is being inconsistent on this very point, I’d like to remind the minister that the Treasurer (Mr. McKeough) spoke to the Ontario Hospital Association on Oct. 28 and made a direct relationship between the number of doctors in an area or in a province or in a country and the cost of OHIP. I think he’s right and I think that as long as we’re not letting district health councils decide how many medical professionals and paramedical professionals they need for their area, then we’re going to run into this problem again and again. It’s a social waste and if you’re going to have any meaningful planning by district health councils that has to be an item that’s included in their mandate.

Another area that’s examined by Mustard when he looks at the health care system and the role that can be played by the district health council is the need for and the recommendation for an area health services management board in each area, to be responsible for what is called a logical grouping of facilities and administrative resources. Again, the response of the ministry, in “Report, Reaction and Response,” is very defensive. It’s a response that almost suggests the Mustard report is being perverse in its recommendations, and it shores up its negativism again by referring to public opposition.

I think this is a totally inadequate response. I think the identification by the Mustard report of the need for this area health services management board to be attached to the district health council indicates the reality that a district health council of volunteer people is not going to be able to build up the information base and the planning that really is needed if district health councils are going to have any real meaning in planning local health services.

I have been called to order again and again, but the reason I have raised these points is that I think the district health councils cannot operate satisfactorily within the mandate the ministry is currently giving them. I would like to see them operate satisfactorily. I think the people who sit on the district health council in the Ottawa-Carleton area have a serious approach to the problem and are very dedicated to working out solutions. I think they are being hamstrung, as I fear other district health councils will be, by the ministry’s interpretation of how these health councils should work.

Hon. F. S. Miller: Mr. Chairman, I commend the speaker for taking the time to read as much as she did. She has talked about my inconsistencies and I listened to hers -- and I am just surprised. I am accused of being autocratic if I make a decision, and I am democratic if I don’t. First of all just before supper hour your critic told me I had stolen a plank from the NDP platform --

Mr. Warner: Do you know how to use it?

Mrs. Gigantes: We just wanted to thank you.

Hon. F. S. Miller: -- in creating these, and now you are telling me they don’t work. I am not sure I can follow that kind of reasoning. I would say that your health planning council in Ottawa thinks things are going pretty well. I would say that when they submit a series of recommendations on a Wednesday and have them accepted the following Monday, that we haven’t taken too much time in delays.

I would say that when they can provide a response to immediate chronic care needs in a two-month time frame, they have done very well with a complex job.

I would say that when they have to deal with Dr. Douglas and other people like him, who take tremendous pride in their autonomy -- and don’t forget he’s just one person you are familiar with; he is repeated many times in the community by heads of medical staffs and hospitals, by chairmen of boards, by groups of people who provide a health service; and every one of them prize their own autonomy.

Mrs. Gigantes: None like Dr. Douglas.

Hon. F. S. Miller: Perhaps not. By the way, as I understand it, subject to correction, he is hired by his board, who send his name to me for approval. I understand this is virtually automatic, and once appointed he can only be removed for cause. I haven’t found out what that cause is yet, in his case or anybody else’s.

In other words, they are virtually the authority you talk about. Once they are appointed, they are virtually insulated from the people they serve -- with good reason. Sometimes they do very unpopular things, and that is why they need to be protected from the vacillations, perhaps, of a board which has a great deal of local pressure put upon it to prevent the MOH from doing what he considers necessary. So I have never argued with the system; I am just explaining. That’s the system by which an MOH is virtually a law unto himself.

Mrs. Gigantes: The only one; that is the problem.

Hon. F. S. Miller: Interestingly enough, my lawyers say I cannot remove an MOH without very specific circumstances. This was brought up, incidentally, by one health board not too long ago. It did want to remove the MOH, and did feel that it had reasons, such as incompetence.

Mr. Shore: That is not reason enough.

Hon. F. S. Miller: That is not reason enough? It should be, but it isn’t. Apparently there has to be a much more specific reason under the law, for on MOH to lose his job. They are pretty well protected.

You talk about electing the health council. I told your critic I don’t believe in electing the health council, because they are an advisory body. They are advising me on your needs. They are not administering a budget. They are not collecting taxes from the people in Ottawa. The person who is elected sits in this Legislature. You are their representative in that sense. You and I are discussing those dollar matters here in the proper forum.

They are giving me advice like many other bodies created to give government advice, but giving it to me on a local priority basis. They are chosen for their knowledge of the community. Some of them are obviously elected councillors, some of them are obviously consumers and some of them are obviously professionals. The sum total of their experience, hopefully, will sort out some of the local wars that go on between bodies that compete in almost every community for health dollars.

You and I know we will never have enough dollars for all the people who want to provide services, we never will. You can take over this government tomorrow, but let me assure you, you won’t have either.

Mr. Foulds: We will.

Hon. Mr. Kerr: Don’t give in.

Hon. F. S. Miller: I am not giving in; I said you “could.”

Mr. Foulds: You are right.

Mr. R. S. Smith: No they couldn’t, Frank.

Hon. F. S. Miller: So in other words, at the best we can ask them to prioritize things so that if they have an endless list, the list tells me the order in which they want things done. Then when we run out of money, we stop at that point on the list.

I think that is a very good system, but I have been tremendously impressed at some of the obvious changes of heart that took place in Ottawa between September and November trying to find these 200 chronic beds we talked about.

The fact that Queensway-Carleton gave up obstetrics to put chronics in; that the Queensway-Carleton offered to me another 40 beds whilst I was there, providing they knew they could get them back some time in the future for active care; that the Perley Hospital showed me rooms on their property that were at one time nurses’ quarters and which they said they would be pleased to make available on a temporary basis; and so on and on.

People were looking to solve problems through that council and I don’t think in the past it would have happened. I think that council needs to be commended for that approach.

On the other hand, I think the solutions are more immediate than you implied. The fact that the 200 beds that are already in existence at Sacré Coeur, but are not in use will be in use should drain off a goodly part of the 120-odd surplus people from Quebec who are using your beds.

Admissions to hospitals are not arranged by this ministry. We are not going to draw a line -- because the Ottawa and Hull districts are the same, they are one community -- we are not going to draw a line and prevent people from going back and forth, but all things being equal, Ontario people with the same degree of illness should have some preferences. I think that is a fair statement. And all things being equal, the 200 beds built on the Quebec side should be fully utilized so that we aren’t bearing all of the pressures.

They had certain staff problems that prevented that in the last few months and the Quebec minister assures me he thinks they are over now. His assurances of the building campaign will take a little longer; the 85 beds won’t be built for a while, but at least I see him moving in that direction. So I think we will pull the plug -- on the 300-odd chronic beds -- and we will start to move out of the active beds and make room for your people.

Pressures have been great on the Ottawa system but I have to point out to you that the fact that all beds are full, whether it be in Ottawa or whether it be in Owen Sound, is not an indication that they are properly full. I will never get medical agreement on that. The fact remains that if we create beds they are filled. It is as simple as that.

Mr. Godfrey: What does that mean?

Hon. F. S. Miller: It means that admissions go on until the beds are full. I have suggested that the control on the system is the absolute number of beds and that one forces utilization of the beds for the uses for which they are properly designed. We can double the number and we will double the number of people in hospital and we won’t make us any healthier. That’s all I am saying.

Mr. Bain: Are you saying that if there are no beds people aren’t liable to get sick?

Hon. F. S. Miller: Oh come on now. Listen, 25 years ago we had nowhere near the number of beds we have today. What were we doing then?

Mr. Wildman: We didn’t have the population then.

Hon. F. S. Miller: No, but I mean per person. Be realistic, look back and see what we did get along with.

Mr. Godfrey: People weren’t getting the care then.

Hon. F. S. Miller: Oh come on.

Mr. Chairman: Order.

[9:15]

Hon. F. S. Miller: I am accused, if I listen to the public, of being defensive. Surely you are the one party that says I must listen to the public. Where have we done such a thorough job of listening to the public as in the Mustard report? There are some things that we listened to that I didn’t personally agree with but it happened to be the response of the people who were involved in the process, and they tell me that is the democratic process.

Mrs. Gigantes: The ministry accepts the reasoning behind the recommendations, yet fails to recognize the reasons why they have good recommendations.

Hon. F. S. Miller: I don’t say the recommendations weren’t good. I am just saying that right now, in this day, they are not acceptable to a large number of people. Talk to the Catholic hospitals in your city before you are so quick to talk about area service management boards. Please do that.

Mrs. Gigantes: I don’t care about the management boards, but you have to give the powers to somebody. District health councils will have to have the information base, or somebody else does.

Hon. F. S. Miller: I have talked to many members about the problem in Ottawa. The member for Ottawa West (Mr. Morrow) brought up the issue a number of times in previous discussions and I have taken it seriously. I think we moved with more speed and dispatch and kept our word in that area, and I think you will find the press think we kept our word in that area fairly well over the last few months.

I trust the council, given a chance, is going to do very well. It is searching for the ways of relating to places like the board of health. It is trying to get these groups to give up their previous methods of dealing directly with this ministry and insisting on running to the minister every time they didn’t get their way by dealing through them.

I don’t want to see power groups. I want to listen to an opinion that reflects the needs of the community rather than the relative strength of the people making the plea. That, I hope, is what your local health council does. They may well mature in five, 10 or 15 years to the point where certain budgetary authorities go their way. I don’t know. I am only saying they may well, and I think we welcome that. But as the first 17 members of that board have discovered, learning about, analysing, and co-ordinating health care is a far more complex job than those of us who are looking at it from the outside think it is. Once we get involved, the very real emotions of the issue --

Mr. McClellan: You sound like a colonial administrator in Africa.

Hon. F. S. Miller: Well, perhaps I am. I can only suggest you try it for a while; deal with all the people who are involved in the health process and I will wish you luck.

Mr. McClellan: How can you know, with such certainty and confidence, that the people --

Mr. Sargent: Mr. Chairman.

Mr. Chairman: Order.

Hon. F. S. Miller: You have to be recognized.

Mr. Chairman: Is the hon. member for Carleton East finished on this point?

Mrs. Gigantes: I would like to say to the minister that it is precisely because we are in agreement on the potential of the Ottawa-Carleton District Health Council that I beg him to take seriously his own recommendation that it be given a chance to work. I think to be able to work it has to be given certain kinds of support by the ministry. It has to be given support for its reasonable requests.

To say that the situation with the hospital beds is assured a happy solution now, well it will be a happy solution when we see it.

I also suggest to you that there has not been a positive response to the five recommendations of the task force on hospital accommodation; and that, incidentally, is a serious, well-considered request endorsed by the Ottawa-Carleton Health Council.

I also suggest to you that if you want to give that council a chance, and other councils like it, you are going to have to take very seriously the Mustard report recommendation which says that a voluntary district health council, such as the one we have in Ottawa-Carleton, must have the ability to gather together a good information base and a good basis of planning, which is what the proposal for the management board really means to respond to. If you leave that gap, that board is going to flounder because volunteers cannot spend the time on a problem which is, as you describe, incredibly complex and demanding. I think unless they have the support services of a management type staff, either directly under it or associated with it and working in correlation with it, there is no way the council can succeed. There is no way it can convince the community of its credibility and beat down all the parochial demands of which you speak.

Mr. Chairman: Does the minister want to respond to that? The hon. member for Renfrew North.

Mr. Conway: One question to the minister with respect to the area ambulance services: Some weeks ago I brought to the minister’s attention a problem and a concern that we have in our area. It’s one that relates to the hon. minister’s and the ministry’s approach to ambulance service.

How does the hon. minister feel the future of ambulance services is going to go; in particular this area of ambulances being tied to hospitals versus ambulances which are operated independently of hospitals? And in further particular, a question to the minister that I raised with him some weeks ago, and that is the question of the ambulance service in the Deep River area.

As the hon. minister is aware, there was a very attractive new hospital opened in that area a short time ago. The board of the hospital, when they were planning construction, consulted with the hon. minister and the officials of the ministry. They were led to believe that an ambulance bay ought to have been constructed, and it was subsequently constructed as part of the hospital complex. As they believed, it was the ministry’s firm intention that there should be, in response to an obvious gap in that particular area, an ambulance attached either to the community or to the hospital itself. I would simply ask what, if anything, the hon. minister has to tell me about the answers to the question that I posed some days ago. It falls, I think, very nicely under item 3.

More generally, what does the hon. minister see in terms of the future for ambulance services with respect to the connection of ambulances to hospitals?

Hon. F. S. Miller: First, I apologize for not giving an answer on that. I wrote the question down but I don’t appear to have got the answer yet. In fact, if you will just give me a second, maybe I will.

I am told that Atomic Energy of Canada has withdrawn the service that has been there for some time and that we are currently trying to negotiate between Pembroke and Petawawa to have coverage in the area, possibly with an ambulance on that site and possibly not. What is the distance? I used to travel around that way a hit from Pembroke and Petawawa to Deep River.

Mr. Conway: Well the distance between Pembroke and Petawawa is eight miles, between Petawawa --

Hon. F. S. Miller: It is pretty hard to justify satellites that short distance apart. It may well be, without prejudging the decision that our staff comes up with, that the response time over eight miles is often less than it is in the City at about two miles.

Mr. Conway: I think the interesting point here, Mr. Minister, is that the hospital was constructed and the area officials were told, as they tell me now, that there was concern in the ministry for a gap in the service in Deep River. As the hon. minister knows from his travels there is a very large area between Petawawa and the area towards Mattawa which is covered by one ambulance.

The ministry requested an examination of the service in that area. It was at the ministry’s urging, so I’m told, that an ambulance may be constructed at this particular hospital. According to the information placed before me in recent weeks, it was the ministry’s initiative that led that hospital board to do what it has subsequently done. So they sit today, very anxious about what it is they are going to do with the ambulance hay they have and what it is the ministry has in its mind with respect to bringing performance in line with the promise of what they were led to believe some weeks ago.

It is a very urgent matter in that particular area. We’ve had some deaths that ambulance people feel were attributable to that particular situation. The regional director in Ottawa, with whom I was speaking on this topic some weeks ago, in his plans for the reorganization of the ambulance services for that whole area, led me to believe that the ministry definitely wants a reorganization.

So my question is, essentially: Does the hon. minister plan to attach an ambulance to the Deep River hospital? I know the people in Deep River are very seriously concerned. They feel that this, together with the extended care problem, which is another matter I suppose, is a very grave and immediate concern to them. I would hope the hon. minister would look into the matter seriously and consider following the proposals that were established by the ministry some months ago.

Hon. F. S. Miller: Well in fact years ago would, I think, be the answer; because it predates either my time or that of the director of the ambulance services. There is no question that four or five or six years ago -- maybe less time than that, but certainly three or four years ago -- it was postulated that ambulances should be attached to hospitals. As time went on we had trouble with a number of the hospital-based ambulance systems, where the hospitals asked us to take the service back. Now I’m not saying we had trouble with the quality of service, I’m saying there were often internal problems such as ambulance operators who were also orderlies in the hospital.

Mr. Sargent: Such as budget.

Hon. F. S. Miller: Then they would not be available for orderly duties when an ambulance call came along, or vice versa. Ambulance drivers refused, through negotiation, to do anything, therefore orderlies resented the presence of ambulance operators doing nothing. I think this kind of irritation often drove administrators of hospitals to the point where they didn’t really want an ambulance service attached to them. Some opted out for one reason or another.

We haven’t got an “either or” situation now. In other words, if a hospital is anxious to provide the service, we’re willing to talk to them. At the same time, we’re quite prepared to talk with the so-called private operator and/or the municipal operator, depending upon the type of service we have in a community. I think, all in all, we have four types of services -- hospital, private, municipal and ambulance service branch, which is our own, and volunteer, that’s five.

Mr. Conway: Am I to construe from that, Mr. Minister, that the ministry plans to continue in the future with this mixed ambulance service approach?

Hon. F. S. Miller: Yes, it does. We are currently negotiating some terms with the Ontario Ambulance Operators Association for those who are private operators where in fact we’re paying them a global budget, in a sense.

The only thing I can say to you is this: we must provide you with adequate ambulance service. That doesn’t mean ambulances based in Deep River; it means adequate ambulance services. Until we’ve completed this review of Pembroke, Petawawa and so on, I don’t want to promise you that you will have an ambulance stationed there. It may well be possible to have a satellite vehicle functioning out of that area, dispatched somewhere else or something of that nature.

Mr. Conway: Is it the ministry’s intention to consider, as part of the reorganization, a redistribution of existing ambulances?

Hon. F. S. Miller: Yes; that’s it.

Mr. Conway: That is part of the consideration?

Mr. Sargent: Mr. Chairman.

Mr. Chairman: The hon. member for Beaches-Woodbine is next.

Mrs. Bryden: Mr. Chairman, I also want to raise an ambulance question with the minister, although it’s not related to my constituency.

I have heard that in the Port Hope-Cobourg area there is a problem. In Port Hope they used to have 24-hour ambulance service, before the ministry took over the service. But it seems to be that as soon as the ministry takes over the service, people find they get less service and don’t seem to have any means of getting the ministry to discuss with them how the service can be improved. The two areas are new serviced, I understand, by one ambulance from Cobourg, which gives Cobourg 24-hour service but does not give Port Hope 24-hour service.

The municipal council has had a committee looking into this and they feel that not only could the se-vice be given to both communities on a 24-hour basis, but at considerably less cost if tenders were put out for another operator. They apparently have another operator they think might be willing to do it.

I’d like to ask the minister when the franchise, or whatever it is, will be opened up for bids and whether the town council has been consulted about improving this service. I think they went to the government before the election and John White, who was considered special trouble-shooter on election problems, said, “Leave it to me, it’s all under control.” But they’ve heard nothing since. They are still waiting to hear from John White or his successors. That’s one question.

[9:30]

The other question I wanted to raise is what are the ministry’s responsibilities in connection with the three-ministry programme which was announced in Kenora to do something for the Indians of the Grassy Narrows and the Whitedog reserves where the mercury poisoning has destroyed their livelihood and has put them under a threat? I hope it doesn’t really mean that their health is in danger, but there is at least the suspicion that they may be in danger from the reports of what has happened in Japan.

I’d like to know what the minister’s responsibility is going to be in this programme. Is he planning, for instance, to monitor the health of all the residents in the affected areas? Is he planning to do more educational work to alert the residents to the dangers so that they will respond to monitoring and respond to the suggestions that they should not eat the mercury-polluted fish? What are the plans of the three ministries to provide alternative food sources and alternative forms of employment? How much in the way of funds is being provided for this alternative form of employment programme?

Hon. F. S. Miller: That is out of my ministry now.

Mrs. Bryden: Maybe the programme is, but not the monitoring of their health, surely?

Hon. F. S. Miller: The health part is okay.

Mrs. Bryden: Perhaps he has some information from the Treasurer (Mr. McKeough) as to how much funds are available for this programme in the employment field too.

Finally, what are the ministry’s plans to provide treatment and compensation for any that are found to be unfortunate enough to have symptoms of Minamata disease, if there are any? I would hope there aren’t, that maybe we’ve heard about it in time and can prevent the tragedy that happened in Japan. I think it is a very serious situation and the ministry should tell the House what the plans are. This statement on which I have the press clipping was made in Kenora not in the House, and we really haven’t had any detailed information on it.

Hon. F. S. Miller: Thanks for your questions. I’d say the ambulance service in Port Hope-Cobourg is not a ministry service. I guess who ever has given you these facts has not checked a few things out.

I’d like to point out what we have. It’s a private service covering both towns. There’s a vehicle in both towns. It’s not a question of it being in one town or the other. I don’t know if they told you that or not.

Mrs. Bryden: It is not paid for by the ministry?

Hon. F. S. Miller: All ambulance services are paid for by the ministry. You heard me mention the five types a minute ago.

Mrs. Bryden: Yes.

Hon. F. S. Miller: Those that we consider our own are the ambulance service branch vehicles that are staffed by civil servants who work for the Ministry of Health. Some are run by municipalities like the city of Toronto and within Metro Toronto; we have these in this area. Some are run by employees of private operators who don’t work for government.

Be that as it may, there is a vehicle in each town. One is on duty 24-hours-a-day and one is on duty during the day. They rotate towns on a shift basis; in other words, five days in one town and five days in the next town for the 24-hour vehicle.

The coverage is good. I can tell you one thing, based on the statistics the ambulance branch has, we are very able to predict the normal call levels and response times, so we feel we can give adequate coverage when this type of situation is carried out. The rationalization of two services into one was done partly as a cost-saving device and partly to get control over the situation.

We’ve been down a number of times to see the people in that area and discussed it with them, contrary again to the messages you may have. I quite agree that anytime there is a change in service there is some disruption. We had to start, literally, with hundreds of tiny ambulance services run by private operators around the province. We started out by trying to fund the mall with as little disruption as possible.

Over the years, as operators have gone out of business or as competition such as we’ve had in Belleville looms up, we’ve tried to bring the systems into one or more organized packages instead of two or three competing groups. They only used to get paid if they got to a call. We’re trying to get rid of that kind of competition by centralized dispatch. We think we’ve done a very good job. Let me say it can always be better. I only ask you to listen to some of the people outside of Ontario who see it from their point of view and think we’ve got a pretty good one to start with. You can go west to ask for some of those opinions, incidentally.

Mrs. Bryden: Could I ask the hon. minister a question? How often do you give the opportunity for another operator to make a bid on the service? How long are the contracts with the present operators?

Hon. F. S. Miller: I don’t know that we have a stated period of time for tender calling, if you can call it that, because I don’t think we do it. We do it on a proposal basis rather than a tender basis. I would say that as long as we’re relatively satisfied with the operations, we wouldn’t have cause to go looking for another operator.

Mrs. Bryden: So I take it it’s not done on a tender basis?

Hon. F. S. Miller: As my director points out, there’s an annual licence. In other words, they could lose a licence any time on an annual basis if we felt they were unsatisfactory.

Another thing, we just brought the ambulance regulations out. In those regulations, for the first time, will be a number of causes; for cancellation; things that didn’t exist before. We were really on pretty shaky ground because if you know the system the holder of a licence, for say a nursing home or an ambulance service, who for one reason or another loses that if our ministry cancels it, has the right of appeal. The right of appeal is to the Health Service Facilities Appeal Board. This group has to look at the reasons we, as a ministry, gave for taking away that man or woman’s livelihood. Therefore, we’ve had to have documentable, if that’s the word, reasons for doing this.

In the ambulance branch those were very tenuous things in the past because the regulations weren’t in place. Now they are. For example, they require them to be staffed with trained people and we set out what those levels of training are -- record keeping, and so forth -- and any of these could be considered to be reasons for cancellation of a licence in the future. Now can I go on to the other question?

Mrs. Bryden: The hon. minister hasn’t quite answered at what stage a potential new operator, who thinks he can operate it cheaper and perhaps more efficiently, can apply to take over the licence?

Hon. F. S. Miller: Any time. In other words, we’re open to talk to people. I’ve toyed with the idea of having actual public tenders -- that was when I was Dr. Potter’s assistant -- for services on a routine basic. No one else had any enthusiasm for that but me.

Mr. S. Smith: And none in your cabinet, Frank.

Hon. F. S. Miller: They’re thinking about it now, he says. That’s because I’m minister. Let me get on to the next issue, the mercury issue.

This is one of the ones which is so hard to talk about without the political implications coming in. I try to be unbiased. Between closing at 6 p.m. tonight and reopening at 8 p.m. I spent time visiting the eight or 19 people who are going to Japan on our behalf this Saturday: the neurologist, the ophthalmologist; fisheries biologist and so forth; people with some fairly high skills who are going over with the Japanese government’s assistance to learn more about the problem.

The pledges made in Kenora were that we would provide alternate protein sources as long as the need existed. We set no time limit on it. For the last six or eight months, approximately 400 pounds of fish a day, give or take, have been available for the Indians on the two reserves from normal sources. All fish contain some mercury that we know of but all of these are below the 0.5 parts per million guideline that we have. We said that the epidemiological and clinical studies would go on with whatever intensity was needed on the reserves; using, if possible, some of the natives themselves to help us, because we recognize communications as an essential part of the programme we’re trying to effect. We are conscious of the great distrust that really does exist between the white man and the Indian, or vice versa. I guess the case is that they have had a lack of confidence in what we have said. We hoped it would be overcome partly by having some trained people from the reserves working with us. I can’t tell you how intensive that needs to be until some of these people return from Japan and give us the benefit of what they learned there -- and in Iraq by the way, they are going to Iraq for two weeks too.

The question of compensation and a number of other matters have been left, because they are well beyond my responsibility or knowledge. We have, in Ontario, held to the belief that a polluter is responsible for damage caused through pollution.

With mercury poisoning, we haven’t as vet diagnosed a case. I know it’s said that the Japanese doctor did. I haven’t seen the final translation of his papers yet, but I understand even that has been watered down in his papers.

Mr. Sargent: That wouldn’t matter. You’d still have Dow Chemical to deal with.

Hon. F. S. Miller: One of the things that has been suggested, and I talked to the neurologist about it tonight, was that we should try to get the co-operation of the people in that area to permit autopsies on any of the Indians in the area who die, naturally or through accidental death; we should examine their brains to allow us to assess whether there is any damage to the brains of people who have been eating fish in that area. That, to the best of our knowledge is the only way we can predetermine whether these people are starting to show internal symptoms of mercury poisoning.

I have never at any time tried to say I don’t expect to see trouble. I hope I don’t, but I certainly am not going in prepared to try to prove there isn’t a problem, nor do I need the proof that there is a problem to take the actions we think necessary to protect the people from a potential hazard. That’s why the food sources are being established and that’s why the testing programme will go on as intensively as necessary.

We do need to educate people. We think that the chiefs are doing a pretty I good job on our behalf and on their behalf now. As you know, the federal government financed, partially anyway, their trips to Japan, and I think that most certainly opened the eyes of the chiefs and a few people who went with them as to the real potential of the dangers their people face.

Mr. S. Smith: Just a question, through you, Mr. Chairman, to the minister, regarding this particular vote, which in my understanding is item 3, health services, just to remind the House at this point. Under supplies and equipment, I notice in comparing the estimates with those of the previous year that the amount seems to have been increased quite markedly, by approximately $1.8 million. I am certain there is a good explanation but I would be grateful to the minister for the explanation.

Hon. F. S. Miller: Can we have a moment while we cheek?

Mr. S. Smith: Thank you.

Hon. F. S. Miller: Supplies and services, is that the one you mean?

Mr. S. Smith: Supplies and equipment, under health services. You are presently requesting $2.9 million and last year it was $1.041 million. Would I be of assistance to bring this over?

Hon. F. S. Miller: it wouldn’t do any harm. I have the answer, even though I can’t find the figure. Somebody dee knows more about these figures than I do. It says we moved the ambulance purchase costs from transfer payments to direct operating expenses; an accounting move, in other words.

[9:45]

Mr. S. Smith: Sorry about that, but I’m afraid I am no more enlightened because transfer payments last year amounted to only $550,000 and were entirely under district health councils, unless you are speaking of a different vote. This time, as I said, there is a rather large increase. Why don’t I send the figures over to you?

Hon. F. S. Miller: There are transfer payments in other votes which are reflected in this item but are not under this vote. We have combined a number of our bookkeeping functions on a different basis this year, partly because the ministry reorganized.

Mr. Chairman: Does the hon. member have any more comments on this item?

Hon. F. S. Miller: Incidentally, if we haven’t satisfied you, I can turn you over at any time to our audit people to search the matter in detail.

Mr. S. Smith: No, I appreciate it. It is just that one doesn’t want to let a large item pass without some comment. In general, I am sure all the opposition members would feel the way I do -- that when there are large changes from year to year in the estimates an explanatory note of accounting changes would probably save the time of the House and a lot of research time.

Mr. Godfrey: A supplementary, Mr. Chairman: Further to that, I note under general hospitals and related activities, it states payments for ambulances and related emergency services $31 million, which represents a very sizable increase from the previous year. I do not wish to confuse your mathematics but just to tie down the change in the ambulances. This is under the general hospitals and related activities situation, where it mentions transfer payments; payments for ambulances and related emergencies services $31 million, which shows a 66 per cent increase from the previous year.

Hon. F. S. Miller: I was looking at something else when you started to talk, so just --

Mr. Chairman: Does the hon. member for Hamilton West have further remarks on this while they are looking up the information he seeks?

Mr. S. Smith: No, although I must say I join with the hon. member for Durham West because he did find the other item and that did increase vastly as well. I’m still mystified by this accounting increase and what it’s about. It’s probably nothing important. I’ll gladly yield the floor to other members.

Mr. Chairman: Will the hon. minister commit himself to getting that information?

Hon. F. S. Miller: I have to get the right page. You were on 565, if I’m not wrong, when you were asking that question? Part of it is inflation; part of it was the transfer of some provincial operations to private operators during the course of the year. In other words, it wasn’t a total increase in spending. It was a total increase in the payments which were transferred.

Mr. Godfrey: I am sure that is satisfactory, sir. I didn’t understand it, but thank you.

Mr. Burr: Mr. Chairman, the member for Wentworth has asked some questions about a hospital and the member for Grey-Bruce was asking questions about a hospital. Am I out of order if I ask a similar question?

Mr. Chairman: Yes, I would prefer that you raise it under 2903, item 2.

Mr. Burr: Do you mean you are really on item 3 here now?

Mr. Chairman: We are on item 3, vote 2901, health services.

Mr. Burr: I will pick a different category, drugs and therapeutics. I would like to ask the minister about one item, it won’t take very long; that is the Aspirin tablet. Shouldn’t there be labels on Aspirin tablets? You can push this off to the federal government, of course, but if you agree with me, perhaps you could give some assistance. For example, as far as pregnant women are concerned, there are several hazards in consumption of Aspirin. For example, Aspirin consumption during early human pregnancy has been associated with malformation of the central nervous system in babies. Aspirin is a powerful inhibitor of the synthetics of prostaglandins, substances vital to the body in reproduction. Pregnant women using Aspirin run the risk of anemia; pregnant women using Aspirin run the risk of haemorrhaging; they run the risk of prolonged gestation; and they run the risk of complicated deliveries. Taken during the last two weeks of pregnancy, Aspirin has caused blood disturbances in infants. All of these and other side effects can be found in the New England Journal of Medicine, July 4, 1974.

My question to the minister is: Why isn’t Aspirin labelled with a warning for pregnant women and why isn’t it treated as a prescription drug because of its many side effects?

The minister will recall that recently we had some discussions about the idea that vitamins should be sold in pharmacies because the druggist would be available for consultation. It seems to me it would make far Fetter sense for a pharmacist to be present for consultation when selling Aspirin to People, especially pregnant women, than it would be to try to consult with people when one wanted to buy some harmless vitamins. I would just appreciate the minister’s comments on Aspirin.

Hon. F. S. Miller: I have learned to appreciate this member’s comments, too; because if I have learned anything in the short time I have been Minister of Health, it is that no knowledge is total. Things we consider safe today are found to have risks tomorrow, and vice versa. I know that you have taken perhaps more time than any other member of this House to look into some of the health wonder drugs -- like fluorides and things of that nature -- that are currently in vogue.

I also think back to a few years ago when I read the medical journal called Reader’s Digest that said that the safest drug in the world was Aspirin and that almost any amount of Aspirin could be taken without any known harmful effect upon the human being. That’s not too many years ago -- it may be 15 years ago -- but it just shows us how our appreciation of a given material changes with time and experience.

I would be the first to agree that Aspirin has evidenced these risks. If you haven’t seen the pamphlet that our ministry produced describing the risks of Aspirin -- because one has been produced on that basis -- then perhaps you would like a copy.

You are quite right when you said the question of labelling or restricting the sale of Aspirin is not provincial, it is federal. I would see no harm in endorsing the comment that perhaps risks be mentioned. I don’t think you would find it would qualify as a prescription drug, because we have just got opposite positions, almost, on this and the other issue you referred to, the megavitamins or high potency vitamins. We suspect some risks there, therefore we were trying to protect the public from something they didn’t wish to think about as a potential risk.

Mr. Burr: But we know them here.

Hon. F. S. Miller: That is what I say. I say the positions are almost reversed. We think we know some of the ones in the other field; at least sonic people feel they do. Some people put papers out that don’t just say: “We think.” Their attitude is: “We know.” I don’t think in either case that the risks justify the total freezing of the sale by the prescription process, but I do believe in both cases they justify some kind of a warning.

Mr. Burr: Would the minister get in touch with Ottawa and talk about it?

Hon. F. S. Miller: We do that fairly regularly, so I will make a point of it.

Mr. Sargent: Continuing the saga of the closing of hospitals in my area --

Mr. Chairman: I wish the hon. member would hang that up under item 2 of vote 2903.

Mr. Sargent: Okay, I’ll just speak about ambulances for a second. You’ll find this hard to believe of this minister, who purports to look after the needs of our people. We have an area of 4,000 square miles in my riding where, as of two weeks ago, we did not have any ambulance service between midnight and 8 o’clock in the morning. The most dangerous hours are between midnight and 8 o’clock, yet there is no ambulance service in that 4,000-square-mile area because of budget cutbacks. Now what do you plan to do about that one?

Hon. F. S. Miller: The answer I’ve been given by my staff -- I was just checking, because I can’t tell you whether your ambulance staff are on 24 hours a day --

Mr. Sargent: I can’t hear you. Say it again.

Hon. F. S. Miller: I have the same trouble. Your ambulance staff are on what they call immediate call-back at night. In other words, they’re available to come in on the basis of a call, but they’re not sitting in the ambulance station.

Mr. Sargent: If a man lives 10 miles out of town, by the time --

Hon. F. S. Miller: I hardly think that would be called immediate call-back; in fact, I’d like to know if such a problem exists. Surely, you’re not suggesting that we wait for somebody to drive 10 miles to town?

Mr. Sargent: It’s a fact that one of them lives nine miles out of town; he lives in the beach area. If there’s a snowstorm, he has to get dug out to drive into town and get the ambulance to go to the call, no matter where it is.

Hon. F. S. Miller: My director says under those conditions, if a person lives out of town, normally he makes arrangements to be in town at night when he’s on duty.

Mr. Sargent: But what kind of a system is it? We pay the same hospital rates as the rest of Ontario, yet we have an area of 4,000 square miles where there’s no ambulance from midnight to 8 o’clock in the morning? What kind of democracy or equality is that?

Hon. F. S. Miller: That’s not quite fair. There is an ambulance service during those hours of the night, but the drivers aren’t sitting waiting by the vehicle.

Mr. Sargent: But they’re on call.

Hon. F. S. Miller: They’re on call.

Mr. Sargent: Volunteers.

Hon. F. S. Miller: Lots of towns, like mine, have a volunteer fire department at night for the same reason. If the number of calls being placed during the hours between midnight and 8 in the morning fall below a certain number, you can’t justify people sitting there night after night. I can probably get you the exact number of calls made between those hours if you want them, and I’d be glad to give them to you. Would you like that information?

Mr. Sargent: Come on. You can doctor anything you want to; I’m talking about intelligence. Consider the amount of money we pay you, and you ask questions like that:

Do I want the figures? What the hell good are the figures? If a man is lying dying on the highway and you’ve got to phone in for a guy to get out of bed and get into an ambulance to come down and find out where the call is -- what kind of nonsense is that?

Hon. F. S. Miller: What you’re saying is figures won’t influence you.

Mr. Warner: Don’t confuse him with the facts.

Mr. Ziemba: Don’t confuse him with the facts.

Mr. Sargent: What the hell --

Hon. F. S. Miller: I’ll get the information for you anyway.

Mr. Sargent: Who needs it? We want an ambulance service around the clock. That’s what we want. We don’t want your figures.

Mr. Bain: Mr. Chairman, I was a little mystified when the minister responded to a comment by the member for Carleton East (Mrs. Gigantes) by saying that he attempted to always listen to what the community wanted. I am afraid that in my riding he has failed to listen to the community.

In the south end of my riding, in the Tri-town area, the community would like nothing better than to express its wishes on the site of a new hospital, and indeed whether a new hospital is wanted by the community. I would appreciate the minister’s comments as to whether he feels that the people in the local community are entitled -- I believe they are entitled, but does he believe they are entitled -- to voice their opinion as to whether they wish one new hospital or whether they wish to upgrade the existing facilities?

[10:00]

Mr. Chairman: I would prefer if the hon. member would bring this up under vote 2903, item 2. You were distributed a supplementary sheet showing health services, item 3; which covers drugs and therapeutics, inspection branch, direct services division, psychiatric hospital branch administration only, ambulance services and clinic services branch. So I’d prefer that you keep your remarks to those areas, otherwise we’re going to be bogged on this vote all might.

Mr. Bain: I was prefacing my remarks to general item No. 3.

Mr. Chairman: But if you want to get into the specifics there’s no money here for general hospitals per se, it’s under vote 2903, item 2.

Mr. Rain: We will try another one and see where this one fits. The other question I would like to raise with the minister has to do with chronic and extended care.

As I’m sure he is aware, in all parts of this province there’s a great lack of chronic and extended care facilities. In my riding in particular, in the north end of the riding, in the Kirkland Lake area, in the Teck Pioneer Residence for senior citizens, fully 50 to 60 per cent --

Mr. Chairman: Again, the specific item that you speak of is covered under vote 2903, item 2, general hospitals and related activities. Item 3, if you’ll notice, deals with extended care and rehabilitation services.

Mr. Bain: We will try and make ourselves available when that’s raised.

Mr. Chairman: The hon. member for Nipissing.

Mr. R. S. Smith: Mr. Chairman, I have three questions on regional health councils, and perhaps the minister could clear up in my mind just what’s happened over the past year and a half or so. As I recall, I think I and other members of the Legislature received maps some time ago indicating what areas of the province were covered by the regional health councils. Of course there were craps here and there where they hadn’t been set up. Then I hear there are really only five in operation, while somebody else says well there are 21 on the go. Just what is the situation? Could I preface my remarks by asking that question?

Hon. F. S. Miller: When we talk about the ones that are formed, I was just trying to find out what state Nipissing was in right now.

Mr. R. S. Smith: Not a very good state as far as that is concerned.

Hon. F. S. Miller: May I explain the process of the formation of one in general, rather than specifically for your riding or the area that you’re representing?

Mr. R. S. Smith: No, no. I am not yet asking specifically about my riding. What I’m asking is bow many are in actual operation across this province and how many are in the process of being formed? I mean actually being formed, I don’t mean where they’re just talking about it.

Hon. F. S. Miller: The formation rate is going along quite quickly. I’m told 21 are in the steering committee stages, which is in the formation stage. The other stage is the discussion stage. I can’t tell you how quickly these are coming on stream, but I can tell no that for a while we’ve been strained to go through the recommendations of the groups that have been giving us lists of names. From our staff point of view, we’ve been handling them as fast as we could and not quite keeping up with the inflow of requests.

Mr. R. S. Smith: How many are anticipated to cover the whole province?

Hon. F. S. Miller: I’m I guessing 35 or 36, somewhere in that range.

Mr. R. S. Smith: So you’re talking about perhaps two-thirds of the areas where they’re either in place or they’re moving toward --

Hon. F. S. Miller: Yes, right.

Mr. R. S. Smith: There is the steering committee and then there is the actual formation of the council itself.

Hon. F. S. Miller: Yes.

Mr. R. S. Smith: Okay. Some time ago a map was sent around to the members showing where they were in place. I suppose the map must have included those 21 that had entered or were approaching the steering committee position. I looked at that map and I said: “God bless us. Are we going to be left with what’s left between Parry Sound and Sudbury, or between Muskoka and Sudbury? That’s can’t be possible. Nobody could do that.”

Sure enough that’s what happened. There’s been a request now from the ministry, I suppose though the branch that’s looking after this, that a district health council be established that would include the district of Nipissing basically, and most of the district of Parry Sound down to the northern boundaries of your riding, or perhaps a little above that.

I can accept the fact that the district of Nipissing, and the northern part of the district of Parry Sound, as well as the corridor down Highway 11, would naturally come under the same health council. But for the life of me, I can’t understand what input the town of Parry Sound and that area down there would have to any health council, or would have in any connection, geographically or otherwise. By otherwise I mean in the provision of health services to the rest of the area that’s outlying.

I’ve expressed my views on this matter publicly to the group that is trying to formulate the council in the area. It’s not yet ta the steering committee stage. I think it’s prior to that stage; they are moving towards the steering committee stage with some difficulties.

One of the difficulties, I believe, is the areas that have been outlined by the ministry without consultation. I would like the hon. minister to explain how the people in the town of Parry Sound are going to be served by a health council that also includes the northern part of Parry Sound and the district of Nipissing, rather than be in the Sudbury minister to explain how the people in the district where they go for the services that are rendered to them outside of what can be rendered to them at the hospital situated in Parry Sound itself.

Hon. F. S. Miller: Mr. Chairman, I don’t know that the hon. member should jump to the conclusion that they are heading in this direction. The boundaries that were shown on any of the maps that were circulated, and I think at one point Gordon Walker probably sent the hon. member the one he has because he was letting members know some proposed boundaries, were sent out as discussion pieces. He got quite a few reactions back from hon. members saying they disagreed, on the kind of basis the hon. member is talking about, with the boundary drawn.

Parry Sound has been actively trying to get a health planning council going. At one point they wanted to form, in a sense the nucleus of one there, even if they didn’t have anybody to which they could attach for the time being. Frankly, Parry Sound does have problems relating to even the balance of the district of Parry Sound, as you know.

Mr. R. S. Smith: Right, that is what I am saying.

Hon. F. S. Miller: It is because of the two corridors, east and west, in that particular area. They even ran two Conservative candidates at one time, which indicates a problem.

Mr. R. S. Smith: That seems to be the biggest problem.

Mr. B. Newman: You asked for it.

Hon. F. S. Miller: We would think there could be a good argument for Parry Sound being included, as it is in the health unit, with Muskoka.

Mr. R. S. Smith: Well okay.

Hon. F. S. Miller: Muskoka as yet hasn’t reached any definitive stages. It is talking about Simcoe. One of the problems we are going to run into is the fact that I think there’s an economic region boundary going across between the district of Parry Sound and the district of Muskoka, set by Treasury, Economics and Intergovernmental Affairs. Generally speaking, the economic boundary limits in the province have been considered inviolable. You just couldn’t lump parts on either side of them into one plan for any of the community and social services; it didn’t matter what.

We argued in Muskoka, and I’m sure you’d argue in your area, that these boundaries, as drawn, aren’t necessarily in the best place for certain services.

All I can tell you is that our ministry right now has a relatively open mind on where boundaries would go in the Muskoka, Parry Sound, Nipissing and Simcoe regions. We haven’t negotiated any. Steering committees usually look at that as their first problem; what boundaries should we draw, and then how do we organize to serve them.

Mr. R. S. Smith: I beg to disagree with the minister on this, because that’s not the impression your ministry is leaving with those people who are trying to tackle the problem. They are given to understand that these are the boundaries that they are to work with and that’s it. Part of the problem in setting up the regional units is the fact that the people feel as a result of these maps that were circulated that they’re having boundaries put onto them. It hasn’t been explained that after they come to the steering committee stage they will then choose their own boundaries. If that is what the minister is trying to say, I wish he would make it very clear, because I think this makes all the difference in the world to many areas.

I’m not saying that Parry Sound should be left out in the cold, or anything else; they have to fit in somewhere, but logically. They certainly don’t fit into an area where they don’t go for their services. I feel there is an impediment being placed in the formation of a regional health council in Nipissing by this artificial setting of boundaries. I know your government always has a problem in setting boundaries because they have no type of regional planning across the province that’s really in place. Everyone of your ministries has a different regional boundary.

Hon. F. S. Miller: No it doesn’t.

Mr. R. S. Smith: A few of them have the same, that’s a haphazard mistake. They’re bound to come up on the same boundaries twice the odd time. But I would ask you, are you going to make it clear to these steering committees that they have the right to set their own boundaries?

Hon. F. S. Miller: Not quite. In speaking to steering committees myself a few times and to groups contemplating the formation of a steering committee, I made it perfectly clear that it was one of their first duties. I’m told by my staff that they understand we are dealing through the area planning coordinators with potential steering committees, saying the structuring of boundaries is flexible. One must admit, though, that as more and more boundaries are defined the choices for those who are beginning become more and more restricted, don’t they? So the first few people virtually had an open field. Now we’re getting to the point where Sudbury on your west, being the district of Sudbury plus Manitoulin Island, obviously gives you an absolute western limit.

Mr. Martel: Is that where you want the council?

Hon. F. S. Miller: That’s right.

Mr. Martel: Is that where you want to have the council?

Hon. F. S. Miller: Just a second. You’ll have your time in a minute.

Mr. Martel: We will talk about that in a few minutes.

Mr. Chairman: Order, please.

Hon. F. S. Miller: I was afraid we would. In any case, that’s one boundary now chosen. Obviously, on the other side you’ve got the boundary between Ontario and Quebec. What the northern boundary is going to be, I’m not so sure; and what the southern boundary is going to be, I’m not so sure. Those are part of the negotiable areas right now.

Mr. R. S. Smith: I should think that you would have some input into what the southern boundary is going to be since it is your northern boundary.

Hon. F. S. Miller: We were going to include you.

Mr. R. S. Smith: Thank God you changed that one. But obviously if you want to get that cue off the ground you’ll have to tell them that they do have the right to make that decision, because they don’t know.

Mr. Chairman: The hon. member for Algoma.

[10:15]

Mr. Wildman: Mr. Chairman, I have a question regarding area planning coordination. What is the ministry doing to coordinate the development of area health centres to ensure they are adequately funded? Some areas of the province have very few facilities of this type, while others seem to be beginning to proliferate. A part of the problem in the north, in trying to attract professionals, has been the development of area and community health centres. The ministry seems to be wanting to attract professionals by encouraging the development of these centres. But unfortunately many small communities cannot afford to build them. I would like to know what direction the ministry is giving these small communities to prevent the uncontrolled proliferation of centres in small areas where they may not be able really, to afford the facilities. If small centres are encouraged to build centres by the ministry, they surely should be given the financial aid which is necessary to build them. At this particular point, as the minister knows, and as he has stated a number of times, the ministry does not give grants for this sort of thing.

In other words, it seems to me you are encouraging a development of centres but you are not willing to finance them. The Bruce Mine situation is a situation like that. I would like to know what role the area planning coordinators have in. the direction of local communities and local officials in the development of such centres? What input do they have in the development stage of these centres? I would hope that the minister could clarify that situation.

Hon. F. S. Miller: Mr. Chairman, that was 2901-1, but the hon. member wasn’t here when that vote passed so if you don’t mind I will answer him. The funding of health service organizations, at least of community clinics, the kind of thing you are talking about in Bruce Mines --

Mr. Wildman: The thrust of my question really wasn’t on funding but on the role of coordinators in the development; and I believe that is under this vote, Mr. Chairman.

Hon. F. S. Miller: The coordinator, in a sense, wasn’t the man you dealt with. The person you dealt with is in charge of our underserviced area programme, Dr. Copeman.

Mr. Wildman: Right. I understand that.

Hon. F. S. Miller: He is not an area planning coordinator. Now if, in fact, we had an area health council in place, I think we wouldn’t have had the kind of problem yon have in your area where three communities within not too many miles of each other, on what is a very understandable local competitive basis, all did the same thing at the same time and made it difficult for any of them to survive properly. I think you understand that problem.

It is very difficult, as you will discover, to discourage any community that makes up its mind to build something that the neighbours have. That is exactly what I think happened in Bruce Mines, in Richard’s Landing, wasn’t it? It hasn’t built one vet and it has the doctors there in Thessalon.

In the beginning, when Dr. Copeman started talking about them, one place was to be built. We do not control the building of them anymore than we control the building of a doctor’s office by a private individual. Once they are built by a community, they are faced, as your communities have been, with trying to pay off the debt; and this, then, requires occupancy by practising people. There is where we get in trouble.

We are, as I explained in the House a couple of times, only able to finance the numbers needed or available. Now we have both problems in Bruce Mines. We need a dentist and they aren’t available; and we can’t afford another doctor. It may well be that the practice changes in your town one of these days, let’s say the fee-for-service doctor leaves, and we are immediately able to justify a second doctor in the community. I think that is the only thing.

It is one of the risks a community takes in trying to bring to it people it feels it needs. It is a risk, I think, they took in the beginning, knowingly; but the facts of trying to pay off the debt have been tougher than they really hoped they would be.

Mr. Wildman: Mr. Chairmen, am I to understand from the hon. minister that without an area health council there isn’t this kind of co-ordination among communities in the development of such facilities at all? There is no direction from the ministry?

Hon. F. S. Miller: No, there is none.

Mr. Wildman: None at all?

Hon. F. S. Miller: One thing we could have done, and I guess maybe should have done -- hindsight being better than foresight -- would be to have refused funding to one of those communities, and said, look, we will not designate your town as an underserviced area. I suspect we would have done that, though, after the building was built, looking back at the scene, and that would have compounded the trouble. Unfortunately we went ahead and did support them once they built the community.

Mr. Cunningham: Unlike the member for Grey-Bruce I can’t complain about the improvements we need to make in hospitals in my riding inasmuch as we don’t have a hospital in my riding. It is a similar situation to that of the member for Grey-Bruce in that it is a large riding and that makes a very good ambulance service integral to the safety of the citizens of my community.

The question I would raise with you -- and I have before -- relates to the ambulance service we do have which, in my view, is a good ambulance service but is run on a private basis. As I have mentioned to you in the past, the lady who happens to be running this service is experiencing a great deal of difficulty and I am told in recent days that her difficulties have been increased somewhat.

She is in the position where she has to run her service to provide a nightly service in an area where I understand there are a great number of accidents. She subsidizes that cost and the people who operate this service more or less on a voluntary basis are paid the sum of $1 per hour which certainly contravenes our labour standards.

The question I would raise with you is what can we do to help keep this woman in business so that we do not lose the only ambulance service we have in this rather large riding? I would like to say at this time I would be very concerned if this service wont down the drain and we were forced to rely on the services of ambulances from either Burlington or Hamilton. They tend to get lost in the regional areas, on the Treasurer’s regional roads, and they have a great deal of difficulty finding locations within the area. Specifically, I would like to know what can be done to assist this woman and others like her who are carrying on in good faith on a private enterprise basis. Possibly, you might indicate to me the attitude of your government at this present time to other people who are involved in health services on a private enterprise basis.

Hon. F. S. Miller: I have had the opportunity to meet both your operator and your township councils -- the township of Flamborough, if I am not wrong -- and the reeve, at least twice and perhaps more often, on this issue over the past few years and we have discussed the matter quite a bit. We’ve had a number of problems, I guess, in dealing with the operator. They are probably mutual; I am not placing blame. I am just saying there have been disagreements.

To begin with, I think we had trouble getting the staff trained through the ambulance training course at Borden. Then we had troubles with her accepting the central dispatch. We feel that is essential because we don’t want ambulances tearing off in all directions duplicating calls and taking direct calls. I believe she still does this, though we have ordered her not to.

We have central dispatch in that area and it is there specifically to make the best use of the ambulances on duty. She is supposed to be on a call-back basis at night but at her election, keeps staff on duty. This is one of the other areas of argument.

She is an individualist and I admire her for it. I can only say that some of the troubles in that area are not of our making. We have done our best to meet her requirements and our requirements for a reasonable cost operation when they are well trained. We continue to discuss these with her and I think we will solve most of them.

Mr. Cunningham: The point I would make is that there is general consensus -- I think tremendous consensus -- within my constituency that she is providing an excellent service notwithstanding, I think, disagreements from a few people whose motivations I won’t question at this particular time.

If there is a reason or basis for her concern, as it relates to a central dispatching system, it is that once she opts into this system it would appear she is not going to get the calls she has had heretofore. The habit has been for Hamilton ambulances and Burlington ambulances to be dispatched to the Flamboroughs particularly and they have a tendency to get lost. Of course, I don’t have to elaborate on this point as it relates to public safety.

I would say that my own view, having met with this woman at considerable length, is that in fact she is doing a good job and she is quite sincere in her efforts. She tells me that her remuneration in the last year has been somewhere in the area of $5,000 to $6,000, which I don’t think is particularly appropriate for somebody who puts herself at the disposal of the community 24 hours a day.

Again, I wonder if I could get from the minister, so that I could convey his views to her, some form of encouragement as it would relate to the future of her operation and the future of the service in my particular constituency.

Hon. F. S. Miller: I have assured your council the service will be there. It does require co-operation with central dispatch. We won’t get well-integrated ambulance services until central dispatches are properly used. She is not on a fee-for-service basis. In other words, it is not a question of her earning extra money because we are directing calls her way. It’s a question of utilizing her properly and effectively.

We code all our calls; we know whether they are urgent or not urgent. I would like you to take the time, if you would, to look at the organizational end of that. Some day when you have got some time I would be delighted to have you do just that. I am quite willing to accept advice from you if you think it’s unfair. At the same time, I would like you to know the reasons behind some of our operating decisions.

This is a spill-off from the old days when ambulance operators were almost like the old lawyers, literally chasing business. We can’t afford that kind of ambulance service anymore. It has to be tied together. In Toronto, when we had two or three different services competing with each other and two dispatch systems, we had cases from time to time of somebody dying because an ambulance that was 20 minutes away was called although there was one three or four minutes away. We can’t afford that kind of overlap when people try to provide the service without reference to the availability of vehicles in the area.

Mr. Germa: Mr. Chairman, I note the hour. I only have about 2½ minutes, so I am going to save any berating I have of the minister’s incompetence for a later date --

Hon. F. S. Miller: You can get all that into 30 seconds.

Mr. Germa: No, I could berate you for half an hour and I would still have lots left, because I think you run a terrible ministry as far as occupational health is concerned. I refer to the Elliot Lake disaster, and sinter plant disaster and the present cover-up. But I am going to ask you three specific questions.

I think you have received a plea from the hospital administrators in Sudbury regarding some co-ordinating services in the integration of the new hospital which is coming on seam. Even as late as 5 o clock this evening I was talking to an administrator of a hospital in Sudbury, who told me that when Laurentian Hospital was phased in to take paediatrics, let’s say on Oct. 15, they were supposed to come on stream with a certain number of beds. Lo and behold, the Sudbury Memorial Hospital phased out its paediatrics and we find now that only 15 beds are available because of restrictions by this ministry in allowing only 140 beds to come on stream at Laurentian.

Mr. Chairman: I have to call the hon. member to order. That’s not under this vote.

Mr. Germa: I am talking about area planning coordinators. I am trying to get some coordination in the city of Sudbury as far as hospital services are concerned.

Mr. Martel: We might even get a health council if we are lucky -- if the minister will let us.

Mr. Chairman: If you want to confine your remarks to area health coordinators, you are in order. If you want to talk about hospitals, that’s under vote 2903.

Mr. Germa: I had a request at 5 o’clock this afternoon for the minister to send a coordinator to the city of Sudbury; it was an earnest plea for this ministry to intervene and to try to co-ordinate the phasing-in of the new Laurentian Hospital.

Hon. F. S. Miller: In the short time remaining, would you tell me who called you, because to the best of my knowledge I haven’t been called?

Mr. Germa: The administrator at the Sudbury Memorial Hospital told me he is thinking of reopening the paediatric section but he hasn’t got the specialized staff because they have all been transferred or laid off as of Oct. 15th. They are about 35 beds short in the city in terms of paediatrics alone. I can say the same thing about the phasing-in and phasing-out of the chronic wards; there is no coordination there at all. It’s probably because you refuse to appoint an area health council board. Why don’t you appoint it? The names were submitted to you months and months ago.

Hon. F. S. Miller: They have never been submitted.

Mr. Martel: They have been; on Aug. 15.

Mr. Germa: On Aug. 15 names were submitted to you from a vote of the symposium on health care and social services. The symposium didn’t go along with the minister’s request that they only submit a multitude of names so you could pick the area health council. Your statement of 15 or 20 minutes ago flies in the face of when you said you wanted to get input from the community.

These were people elected from a symposium of probably 500 people, and chosen to represent the city of Sudbury. They detailed who they wanted on the area health council, and you refused to appoint them because you wanted about 50 names to pick out your Tory hacks in order to appoint them to the health council.

Mr. Chairman: Order, please.

Mr. Germa: And that’s precisely what you are doing.

Hon. F. S. Miller: I don’t do that, and you know it.

Mr. Martel: All right; take the 17 names that have been submitted to you.

Mr. Germa: Yes, why don’t you appoint the 17 names that were submitted?

Mr. Chairman: Order, please.

Mr. Martel: The names have been submitted to you and you know it. Now you are asking for something else.

Mr. Chairman: Order, please. The time for adjournment has arrived.

Hon. Mr. Welch moved that the committee rise and report.

Motion agreed to.

The House resumed; Mr. Speaker in the chair.

Mr. Chairman: Mr. Speaker, the committee of supply begs to report progress and asks for leave to sit again.

Report agreed to.

Hon. Mr. Welch: Mr. Speaker, before moving the adjournment of the House, may I indicate that tomorrow we will deal with legislation. We will carry on with the consideration of Bill 8. There will be order Nos. 6, 4, 5, 7, 8, 9 and 10. Then, if we have time, we will then go into committee of the whole and consider the bills that are in committee of the whole House. Friday, we will resume the debate on the Throne speech.

Hon. Mr. Welch moved the adjournment of the House.

Motion agreed to.

The House adjourned at 10:30 p.m.