Assemblée législative de l'Ontario

The House resumed at 8 p.m.

SUPPLEMENTARY ESTIMATES, MINISTRY OF HEALTH

On vote 2903: (continued)

Mr. Chairman: When we last discussed these estimates, I believe the hon. member for Welland had the floor.

Mr. Swart: Mr. Chairman, I guess it’s one of the penalties of not timing your remarks to conclude at the adjournment time that you must restart part way through the speech and make it rather disconnected. However, perhaps it is an advantage that you get the opportunity to repeat some of the things that you have said before. However, I had nearly concluded my remarks, Mr. Chairman, and I hope to do so very shortly.

On Friday I had pointed out, in speaking to the estimates on OHIP, that it was my considered opinion, and I think I can say the considered opinion of those of us who sit in this part of the House, that the dominant motives in the cutback programme, which were demonstrated better than anything else by the cutback in the public labs, were twofold on the part of the government.

One, it was posturing on restraint and, number two, it was an attempt -- and I think a deliberate attempt -- to destroy efficient public institutions for which the government of this province holds no brief. In support of those statements, I submitted some evidence to point out it was impossible to get detailed information from the ministry in support of closing of the public labs; that what was supplied was inconsistent and grossly inaccurate. I pointed out in the case of the closing of the public lab in St. Catharines, which operates on a total annual cost in this year of $106,000, that they say they could save $56,000 by closing that lab. That was a quote in a letter from the minister.

That means they intend to provide those services -- you intend to provide those services, Mr. Minister -- for the sum of $50,000. I pointed out that the courier costs were going to be $14,000 alone and that the tests which would be farmed out to the private labs or perhaps elsewhere to be paid by OHIP would amount to another $26,000. That is $40,000 of the $50,000 cost for these tests under the new system that is already spent before 90 per cent of the tests, or 75 per cent of the work load were provided for.

In other words, it leaves $10,000 in the budget to do 75 per cent of the work load and 90 per cent of the tests. Even then we didn’t account for the cost of moving the people who were employees in the lab to various parts of Ontario.

Of course, it is preposterous that this kind of saving can be made. It’s preposterous that any saving could be made in the closing of the public lab in St. Catharines. I think, the other day we documented that. It is, in fact, going to cost substantially more to the citizens of the province to have the tests provided in the future than it has in the past because of the closing down of the public lab.

I didn’t mention the human dimension in the closing down of that lab. Of course, it is a small lab, but there is a very real human dimension. There were seven employees in that lab. Of those, four have elected to go elsewhere in the province. One is going to Hamilton; one is going to Thunder Bay -- as a matter of fact, she is already there and, with all due respect to my colleague from Thunder Bay, she is terribly dissatisfied and thinking of quitting already and returning to the Niagara region. Of course, if you live in the Niagara region for some period of time you would realize how difficult it was to get used to living in any other place in the province, Mr. Chairman --

Mr. Chairman: That may be subject to some question.

Mr. Swart: -- another one has gone to Kingston; another one of the employees is being transferred to Toronto.

And I say to you that the human dimension, apart from economics -- and I talk mostly about the economics because that is supposed to be what the people on the other side understand, I don’t think they really understand the human dimension. I don’t think in the environment that they are in they know what it is to have close relatives out of work or threatened with being out of work. I say to you that is every bit as serious as the economic implications, and the economic implications are sad.

There has been of course, as we know, a tremendous increase in payments by OHIP to the private labs -- and that is going to get greater with the closing down of these public labs -- and they have been ripping off the public right and left. Perhaps that terminology is not correct; they are probably just ripping off from the right. It’s not the left, in this case, but they have been ripping off the public. While I suggest that it all adds up to posturing about restraint when you can’t prove -- and I think my leader documented this very well this afternoon that it is not really a saving. The net result is going to be greater cost to the people of this province. And at the same time, we are destroying some very efficient and needed public institutions.

I say to you, Mr. Minister, far from operating the ministry and the government on an efficient, businesslike operation, there is fiscal mismanagement to a colossal degree. I have almost come to the conclusion that the group on that side couldn’t even run a good used car lot.

Hon. F. S. Miller: I can; I have already proved it.

Mr. Swart: They stock the cars that operate the poorest and cost the most. Maybe, as you say, Mr. Minister, you are a good used car salesman, because I suppose a good used car salesman is the kind of a person who can sell the poorest product for the highest price. I think maybe you’d be successful in that one; use a little body cement, slap on a bit of paint and wax it -- lots of wax, that helps when you try to sell a product -- and try to sell it off as a good cut-back vehicle. I suggest to you that it is a pile of junk and the rust spots are already showing through.

Let me tell you, finally, it will never get off the lot; and if it doesn’t get off the lot and it is not going to do what you thought it was going to do, it is not going to carry you through the next election.

Mr. Chairman: The hon. member for Nipissing (Mr. R. S. Smith).

Hon. F. S. Miller: Am I not allowed to answer all that, Mr. Chairman?

Mr. Chairman: All right.

Hon. F. S. Miller: You know, I am rather flattered with the attention I am getting from the opposition these days.

Mr. Nixon: Getting several billion dollars too.

Hon. F. S. Miller: I understand there are 20 more speakers waiting to tell me what a great guy I am.

An hon. member: That’s just tonight.

Mr. Nixon: But there’s not a soul on your side, Frank, not one.

Hon. F. S. Miller: No, that’s true. It has always been my observation that the opposition lets a person who is making a mistake bury himself. It would seem that the attention I am getting indicates some apprehension on your part that perhaps the opposite is true and that the people of this province want us to save their tax dollars by better management of those resources that are left to us to run.

Mr. Swart: We don’t want to bury you -- just your party.

Hon. F. S. Miller: We’ll keep on finding the ways, and in fact all the ways haven’t been tapped yet. There is no indication they aren’t going to be. I would point out that there have been some inconsistencies in the relationship when you talk about the lab at St. Catharines. The information I have says 90.4 per cent of the total number of specimens -- not DBS units but specimens and there is a difference; units and specimens are not the same thing. In the total workload 90.4 per cent of the work is, in fact, environmental bacteriology or serology. The relative percentages in fact are 53.4 per cent for bacteriology with 37 per cent of total specimens environmental bacteriology, leaving 9.4 per cent the only possible part that could be done anywhere but at a government operated and owned laboratory.

Now, of that 9.4 per cent, not all of it, if any of it, necessarily moves into the private labs. In fact, we are taking measures to see that whatever percentage we can will move to those institutions already funded by public money and which have spare capacity.

Mr. Swart: Is that 9.4 per cent, may I ask?

Hon. F. S. Miller: I can give you the complete breakdown: 5,366 specimens were bacteriology; three specimens were mycology; 126 were parasitology; 21,195 in the months of April to March -- this is about a period of a year.

Mr. Swart: Do you have the workload and the number of tests?

Hon. F. S. Miller: And 30,572 were serology, for a total of 57,626.

Mr. Renwick: How many patients?

Hon. F. S. Miller: The great bulk of this has nothing to do with the patient load. Certainly serology results from tests done when doctors suspect venereal disease and send them on for testing. These are not done by anyone else. We have a corner on the market so, in fact, we transfer them to another location. The budget of the lab is not $106,000 as you said. It is $128,900.

The present budget of the lab is $128,900 and it would have gone up probably 10 or 11 per cent this year. The savings of the five staff at $11,000 per staff member is an extremely low figure to allow for a salary saving. I think if one checked the salaries of the staff members, four of whom have been transferred to openings elsewhere, it would indicate they are earning probably more than that, plus the fact we pay a considerable package in addition to the basic salary.

The $11,000 that was paid in rent to the hospital, while it is a transfer to another government agency, would not be made up in their budget and therefore, in fact, it is a saving. It is a saving because there is that much less money flowing to that hospital in the coming year.

Now, you must have some information about the courier service I don’t have. The tenders weren’t even opened the day you mentioned. They were opened that day. Although I haven’t seen the tender results, I am informed the first one opened was $12,000, not $14,000 -- the lowest as you quoted.

Not only that, a great percentage of the material flows to it by existing services as you know. For example, specimens; of the 47 users of one of our labs, 41 are already using courier service. When one attempts to take the statistics apart some other facts must be kept in mind.

The destruction of viable institutions is utter rot. We are not trying to destroy viable institutions just to prove we can win an election. They were carefully and painfully thought out and done because we felt we had to and done in spite of what your leader said this afternoon because the alternatives were in place, not in spite of the alternatives being in place.

Now, in reference to the human dimension -- year after year I hear the speakers from your party talk as if only you have a corner on the human dimensions of this world. That is not so. It is just utter rot again.

Mr. Swart: You just don’t understand that.

Hon. F. S. Miller: I do understand it. I do understand unemployment. Listen, I understand unemployment very well from a personal basis. I understand it from a family basis.

Mr. Ferrier: Knowing your background, I don’t know how you can take the guff that Jim Taylor gives out.

[8:15]

Hon. F. S. Miller: I’m going to limit my comments to my ministry, okay? I have enough trouble in that area.

Mr. Foulds: The people in Ontario have enough trouble with your ministry.

Hon. F. S. Miller: Yes, and they’d have a lot more if you were running it. Mr. Chairman, I was told to ignore interjections; I shall.

Mr. R. S. Smith: I have a few remarks to make on this vote, in regard specifically, again, to laboratory closures, as well to the whole area of the use of laboratories across the province. I think there has to be a rationalization of the laboratory services that are being provided. I don’t think you can only look at the two areas that have been mentioned in this House so far; and that’s the question of the private laboratories, and also the public laboratories that are situated in the hospitals, where most of the expenditure is. Of course, there has been no mention of that whatsoever. I believe OHIP payments made in that area are perhaps much greater than those made in the area of private laboratories. Of course the cost of the provincial laboratories is much less again.

Mr. Renwick: Have you any figures on that?

Mr. R. S. Smith: The hospitals in my area --

Mr. Renwick: I said did you have any figures?

Mr. R. S. Smith: No, I’m not saying I have. But if you go to a hospital where there’s a laboratory -- where it’s above 150 beds -- the payments in that hospital are well over $1 million to the lab.

Mr. Renwick: I wanted to know whether you had any facts, that was all.

Mr. Nixon: Whose side are you on? Aren’t you supporting the little man; the small community?

Mr. R. S. Smith: He’s supporting the pathologist, whom I’m just going to talk about. They sometimes make $150,000 to $175,000 a year.

Mr. Nixon: He supports the corporation lawyers.

Mr. Chairman: Order please.

Mr. Renwick: That is what this debate is about, the facts.

Mr. Chairman: Order, please.

Mr. R. S. Smith: I guess that is why you are not taking part.

Mr. Renwick: Neither are you.

Mr. Nixon: You want that laboratory closed in North Bay.

Mr. R. S. Smith: Is that right?

Mr. Chairman: Order, please.

Mr. Renwick: I just asked for some facts.

Mr. Nixon: He is interrupting, Mr. Chairman. The hon. member for Nipissing has the floor, I thought.

Mr. R. S. Smith: The hon. member for Riverdale is a little upset, I don’t know why.

Mr. Chairman: Just ignore the hon. member for Riverdale.

Mr. Nixon: He is very difficult to ignore when he asks for facts.

Mr. R. S. Smith: The minister will provide him with the facts; that the payments are much greater to the labs in the hospitals than they are to the private labs. Anybody could see that without even looking; even you could see it, if you looked.

The fact is that among the pathologists who run the labs in the hospitals across this province there’s no equality at all. There are some on salaries who are making as low as $35,000 to $40,000 a year. Now I don’t consider that a low amount, but there are others who have different types of arrangements with the hospital laboratories and who are making as high as $150,000 to $160,000 per year.

Mr. Reed: That is factual.

Mr. R. S. Smith: And that is factual, if the member for Riverdale doesn’t buy it.

Mr. Nixon: Surpassed only by certain corporation lawyers.

Mr. Renwick: Why don’t you name some names?

Mr. Nixon: They are all listed in the monthly returns. They are there for you to see if you read, for those who have eyes.

Mr. R. S. Smith: What I’m saying is that if you’re looking at one you’ve got to look at them all. There’s no question there is a situation in the private laboratories that has to be investigated; but I also say that you have to look at what’s happening in the hospital laboratories. We have to get to the point in those laboratories where the people who are running them, those people who have some type of a hold on that laboratory, are paid equally across this province and are put on salary. I believe that that’s the only equitable way that situation can be cleared up.

It’s very odd to me, as a lay person, that one pathologist who is running a lab in an area is on salary for $35,000 or $40,000; and another is on a percentage of the OHIP payments to that lab and sometimes making in excess, at some locations, of over $150,000.

I believe that area has to be looked at, as well as the private labs, because I think there are differentials there which are costly to this government, as are the difficulties which have been brought forward in regard to the private labs.

Of course, there are the other labs, the public provincial labs which have been closed in this province. Perhaps the member for Riverdale is supporting the minister on these, I don’t know, but if he’d listen to his leader to his right I’m sure he wouldn’t.

Mr. Renwick: We don’t want our case destroyed

Mr. Eakins: Put your name on the list.

Mr. Renwick: -- by the arguments put forward by members of the Liberal Party in support of their stand. We’d like to have your support, but we’d like to --

Mr. Chairman: Will the member for Riverdale come to order, please?

Mr. R. S. Smith: Yes, will you do something with him? He’s out of hand, really.

Mr. Nixon: It certainly is difficult to have a coherent debate.

Mr. R. S. Smith: I would just like to quote from the minister -- perhaps I’ll go back to Dec. 18 when I had a phone call from the minister to tell me that the lab in North Bay would be closed and that decision would be announced on the following day, the day after the House was to adjourn. The minister gave me no reason other than the fact that it was to save money. I asked him a number of questions in regard to the lab but there was no real answer forthcoming.

On Jan. 19 I spoke to him again in the House. At that time there was still no answer forthcoming so I went to see -- he set up a meeting for me with his assistant deputy minister at that time, so that I could obtain some of the facts in regard to the closure of that lab.

I went over to see the assistant deputy minister and he provided me with some facts in regard to what the savings would be -- what the total cost was and this type of thing -- which had not been made available to the people concerned with the laboratory itself -- the employees -- nor had it been made available to the people in the general area who were going to be affected by the closure of the lab.

The assistant deputy minister said that the total cost of operation of the lab was $254,000 and to close the lab there would be a sawing of $208,000. He indicated to me at that time that the environmental bacteriology that was being done would be done in Orillia. He also indicated to me that the other laboratory work, which represented 44.8 per cent -- is that factual enough for the member for Riverdale? -- would be done partially in Sudbury and partially in Toronto. That left 3.6 per cent, for hematology, which was to be done in the lab of the North Bay Civic Hospital.

That was the position and those were the facts -- the only facts -- that I could obtain from the ministry, except the breakdown on a percentage basis of where the work came from that went into that lab. Those facts are not important at this point; however, the total volume was 50 per cent environmental bacteriology and 50 per cent serology and other types of chemical analysis which couldn’t be done in the same type of process as is used for environmental bacteriology.

What I learned on that day was that the saving would be $208,000 on a total cost of operation of $254,000, and on these facts the lab was to be closed. At a later date the minister made a statement. He said the decision to close the North Bay public health laboratory was reached only after thorough studies had been made. I don’t know what these thorough studies were but the facts he now comes forward with, in his statement about a month after I had met with the assistant deputy minister, are altogether different.

Mr. Miller says we are going to save $167,000 instead of $208,000. This indicates a discrepancy of at least 25 per cent between the assistant deputy minister’s figures and his figures. There were supposed to be things that were all done prior to the announcement that he was going to close the labs. lit indicates to me that there had been no figure arrived at when the announcement was made, that in fact there was no thorough study done whatsoever. He must have just picked the four labs out of the air, because obviously the facts conflict depending on who you talk to within the ministry.

Mr. Miller also said, in the same statement, that the work load had diminished by eight point some per cent. That is tree, but in the interim during which the work load diminished in that lab, they had opened a subsidiary lab in Sudbury. This had taken a good percentage of that work load, and if they had not opened that subsidiary lab there would have been an increase in the work load.

In his statement he said that integrating laboratory services between St. Joseph’s Hospital and the Civic Hospital was going to provide an alternative and that 34 per cent of the work which was coming to Toronto would then be going to that hospital lab. When this statement was made, and up until last Monday at least, there had been no arrangement made between this ministry and the Civic Hospital as to whether that work would be done there or not. So there couldn’t be any value put on what that 34 per cent of the work was going to cost, because there had been no arrangements made between the hospital and the provincial laboratory services.

The $167,000 he has come up with was not based on any factual information, because there had been no agreements made, almost anywhere along the line, to provide the services.

It becomes apparent that saying “after thorough study” was a really misleading statement. Thorough studies still haven’t been done, because now I understand that environmental bacteriology is not going to be done in Orillia at all. It is going to be sent to the lab in Sudbury.

Those 10 people or so who are employed in North Bay have all obtained other employment, except for one. Some of them have been moved to increase the complement of other labs in the area. Two people have been moved to Orillia. One of them is the director; that won’t increase the complement but the other person will, as I understand it. One of them has been moved to Sudbury; and there will be another person added to the staff of that lab, so there are two more people there. One of them has been moved to Hamilton. One of them has been moved to Thunder Bay to increase the complement of that lab.

So we are talking about four people who are going to increase complements of other labs. Yet the minister has just finished saying that $11,000 does not nearly cover the costs of a person working within the laboratory services, if I understood him correctly. Now there are four there. One moved out of the province; one moved out of the laboratory service; one was moved to the psychiatric hospital next door; and there was one without a job.

There has also been an announcement that the mobile lab will be brought into the area for a five-month period this year, with two full time employees. So there again we have a cost that I am sure will exceed $35,000 to $40,000 when you consider the equipment that is being used, as well as the two salaries that have to be maintained for that period of time.

So it’s very difficult to find out how the minister has arrived at his saving of $167,000 and his assistant deputy has arrived at an amount of $208,000. Now, to put those two figures together is really impossible and shows just how much thorough study was done prior to Dec. 18, when these figures were made available, on Jan. 19 and again in late February and early March when your full statement came out in regard to all the lab and hospital closures. Within that one-month period they dropped $40,000 someplace. I just can’t figure that out.

[8:30]

Beyond that, though, there is the whole question of the service to the area. I’m sure that the laboratory service that’s going to be brought in on a temporary basis this summer will provide what is required for the lakes and rivers in the area insofar as water sampling is concerned, and the many areas that are unorganized and have no water supply other than that taken out of the ground must use these facilities from time to tune in order to cheek on their drinking water.

I’m sure that service will be fine for that five-month period. But it also leaves another seven-month period where there will be no service that will be as quick as, and perhaps no more efficient than, the service that is now provided in the area.

I do not know what the costs are for the courier service that is to be developed, as well as the other types of transportation that are to be used in order to get these samples to the labs in Sudbury, Orillia and some up to Timmins. In fact, no one knows what kind of an arrangement has been made with the local hospital in connection with that 34 per cent of the work -- nobody knows where it’s going, either to Toronto or to the local hospital, and what kind of a cost figure can be placed on that.

Since the minister and those within his department came out with different figures long after Dec. 19, when the original announcement was made, it becomes apparent that there was really no study done concerning the decision. Also there was no consultation whatsoever with the local people involved or with the staff at that lab.

For the first month there was nobody on the scene to deal with the staff and to explain to them what was happening. It was not until well after Jan. 17 or Jan. 18 that anybody appeared to explain to the staff what would happen. In fact, when they did appear, they were told that if they did obtain employment in a laboratory service someplace else in the province, they wouldn’t even be provided with the cost of moving and so on. And this is what Dr. Willoughby informed them. The week following that, of course, they had somebody from the -- I’m sorry, I just can’t remember the part of the ministry that looks after that type of thing -- they were up there and they explained to them how they would be moved if, in fact, there was employment elsewhere.

But there was never a list provided, until two months after, of what jobs would$ be available in other laboratories or in other sectors of the ministry. So these people were left to hang in the air for a period of two months. Eventually there were six who did obtain employment within the government, not particularly within the laboratory staff.

I’d just like to make the point that, first of all, the whole matter could have been done with fewer problems at the local level if, in fact, there had been consultation beforehand and if, in fact, there had been some type of study done as to what would happen with the work that was to be done and what the cost would be.

To this day I don’t believe there are any hard and fast figures available to show what the actual cost and the actual savings will be. On this basis, the people in my area feel they have no alternative but to oppose the removal of the lab until they have at least been provided with a set of figures that add up and they are given the opportunity to discuss the matter with the ministry based on those figures. So I would ask the minister if, in fact, he does have a final set of figures on which the costs can be placed; and if he does have that final set of figures if we are in a position now where the people in the area can discuss it with the ministry, and the laboratory staff can also be given the opportunity to show where the need in the community still exists in so far as the lab itself servicing the area is concerned?

Beyond that, there are a number of organizations -- and the minister alluded to one in his statement on Friday in regard to some of the testing that is being done in the schools, a programme that was started some three years ago -- which have put private financing into that testing and do not feel that it has been totally explained to them, other than what you said on Friday last, that in fact the processes that will take place will be sufficiently fast to give the results that are required.

Perhaps with these remarks I would close, except to ask the minister, when he is considering laboratories, that he look at all three kinds of laboratories and not just two, because I think the savings that could be brought about within the hospital laboratories would be much more than what he is going to save by closing four provincial laboratories. I know that this ministry and this government have not wanted to interfere with that very sacrosanct place that the pathologists might have across this province, or might not have. I believe it is time we looked at that and we looked at it very closely; and that they were placed on some kind of a schedule of salary that is commensurate with the work they do.

Hon. F. S. Miller: I’ll be very brief, Mr. Chairman. Hospitals don’t get a fee-for-service for lab services. They get a budget.

Mr. R. S. Smith: No, but the pathologists do.

Hon. F. S. Miller: The pathologists do, providing they don’t have a contract with the hospital for salary or for some other method. The hospital doesn’t have to pay them the amount of money that it gets from OHIP for their salary if it wishes to pay them a lower amount. On the other side, some hospitals have paid more. They have paid a salary that exceeded the gross professional component of the pathologist’s fees because it was difficult to get pathologists on a salary basis in the past. That problem is easing as time goes on.

One of the reasons for the expansion of the private lab sector, the sector that has received so much criticism of late, has been the ceiling on the budget for hospital lab services. Hospitals -- and one was quoted to me today and it will be on the press tonight I am sure -- have had a tendency to sublet work into private labs if they were feeling budgetary strains within the hospital in general.

I don’t like that. I can understand why they do it. It has not been illegal or immoral. It has been an easy way to save certain moneys within their budget and transfer them to my budget in another division. It is not easy to plug that, but that is one of the loopholes we intend to try to plug within the next few months.

The criticism I’ve got quite often from people is that we have made no attempts to help the staff become relocated, and yet both yourself and the previous speaker have documented that our displaced employees at these labs have been helped to find open positions in other labs where they existed, and there was a small complement change in some of the labs to compensate for the amalgamation of services.

As for the last thing, we think very highly of the programme run by the Kidney Foundation in North Bay. In fact, as you may know, between November of last year and February of this year students from three schools were tested; 1,036 of them between the ages of 12 and 15. Six per cent of them showed test results that indicated a need for a doctor to follow up with them. We believe the programme should be continued if the local people want it to be, and there is absolutely no reason in the world why it wouldn’t be as effective now as it was when the lab was in North Bay.

Witness the fact that many other communities could do the same thing, although to begin with they wouldn’t have had a local lab. We simply say the programme was not of an urgent nature in terms of getting results within minutes or hours of the tests being done. The speed with which the response was made had nothing to do with the value of the programme. We commend the programme and hope it carries on.

Mr. R. S. Smith: I would like to say to the minister that he hasn’t really touched on my main remarks. I don’t really think a thorough study was done prior to Dec. 18; and if it was done, why could your ministry not provide at that point definite cost savings, and why has there been a differential in the cost saving from month to month as I have made inquiries? Obviously there wasn’t a thorough study or you could have given those statements.

Why, at this point, are you now saying there was a thorough study done when you are still looking around to find places to get some of this work done? Obviously there have been no arrangements made with the local hospital, unless they have been made within the last week, which was well after the time of your statement?

Hon. F. S. Miller: I obviously can’t from personal experience, tell the member whether or not arrangements were made with the local hospital.

Mr. R. S. Smith: You said there was.

Hon. F. S. Miller: No, just a second; I said I can’t say from personal experience because I didn’t talk to them. I can only tell you I was told they were. I was told this would happen and you say it hasn’t. I am quite willing to have our facts checked out to see which of us is correct. I simply have to depend upon people giving me information at times. I haven’t had any reason to doubt the correctness of the gentleman who told me that.

As for the change in the dollars, the dollars we showed in my original estimate and the dollars we showed in my press release are both the same. If Gary, in working it up with you in his office, trying to show you an illustration, had some variation in it, I would wonder if he made some error talking to you that day as compared with the figures he gave us. He spent some time with you. I don’t think he tried to rush through it.

Interjections.

Hon. F. S. Miller: I think he tried sincerely to offer that information. I met with a delegation from North Bay in Sudbury, as I am sure you know. I understand representatives of the ministry returned to North Bay, we sent people up to talk to a public meeting on the matter, did we not? Well we said we were available if we were asked and I was told that Mr. Chatfield in fact visited North Bay to do it.

M. R. S. Smith: No, he has been asked but he has not come.

Hon. F. S. Miller: He had made arrangements to go on a specific date, that much I know.

Mr. R. S. Smith: Well he hasn’t been there.

I just have one more question, Mr. Chairman. The minister made a statement in Sudbury that there would be an additional 45 jobs at the psychiatric hospital in North Bay. He was using this to soften the blow of the closing of the labs. These jobs at the psychiatric hospital were supposed to be created because of the movement to North Bay of patients from Northeastern or the one up in the Porcupine. But of course this never did come about.

Hon. F. S. Miller: Oh, oh, oh!

Mr. R. S. Smith: The movement of the patients came about but the creation of the jobs never did come about.

Hon. F. S. Miller: Mr. Chairman, he’s wrong and I will get the data for him, although I may not have it tonight. You are wrong.

Mr. Ferrier: Mr. Chairman, one bright note that seemed to be sounded in the midst of the crisis that we went through in our community after the announced closing of Northeastern was the fact that at least the lab would be left. The minister had given us a commitment that new facilities would be made available for the provincial lab in the city of Timmins and we had put up quite a case before him and his ministry. I believe that those new facilities are under way and probably in eight or nine months’ time the lab in Timmins will be in decent facilities and the staff will have a reasonable working environment in which to carry out their work.

[8:45]

I am wondering if the minister feels that there are economies to be realized in the lab field in an area such as my own, the district of Cochrane, by amalgamating some of the services under perhaps one or more of the general hospitals. I know there is a private lab, MDS, operating out of the 101 Mall in Timmins, which serves some of the doctors, while other doctors use the lab at St. Mary’s Hospital. I believe the lab in St. Mary’s Hospital also serves some of the surrounding doctors but not all, whereas the private lab serves some of the doctors from other places. It seems to me that there is duplication of services and facilities there.

I have heard statements made that the most expensive type of service that the public gets is through these private labs, and I wonder how speedily the study is really progressing that I understand is supposed to be under way at the district health council of the labs in the area. I think you could very well have the whole situation of the lab services for the district studied by that health council and some pretty definite recommendations made.

I would like to know why you permit duplication of services if, in fact, there is duplication of services between a private lab and those in the hospitals. Do you not have any say about private labs springing up in an area to carry out their services? You have got pretty close control over nursing home beds, chronic care beds and that type of thing, and it would seem to me, when there is a public outlay of money to the labs, that you could have just as strong a say there.

I wonder if you have thought of having the health council go into this matter in some depth as part of the study it was looking at and whether it would be possible to remove some of the duplication of services and, if necessary, expand the public health lab that is there to get the new facility. I think that maybe this is the kind of approach you could take.

If you are going to close some of the public labs and get the kind of resentment in the communities that there has been in those four communities, why can’t you close some of the private labs by refusing to provide OHIP money for them?

Hon. F. S. Miller: Mr. Chairman, savings by amalgamation of laboratory facilities certainly are very real. This does not limit itself to any specific type. We are just as anxious to amalgamate laboratory services between hospitals where duplication exists as we are between the private and public sectors. I haven’t heard of the Health Council’s wish to make this study but I’m sure it’s certainly one we would encourage if it wanted to look at the duplication of services.

Duplication, though, by another name, is competition. Under some circumstances that’s good; under some it isn’t good. If, in effect, there’s a limited market, then the competition is good. The one problem I have is that where we have already bought and paid for publicly-owned laboratory facilities I feel they should be utilized to the fullest rather than have them run at a low percentage of capacity and still farm business out to the private sector.

We do have complete control over the licensing of private labs. Very few have received licences since they were required to have them in 1972.

Not only do we license them for location but for the type of tests. One of the things we will probably do in the next few months is start restricting some of the existing licences when there is fair capacity in a publicly-owned facility for that type of test.

Mr. Makarchuk: You should have been doing that two years ago.

Hon. F. S. Miller: The fact remains, though, that your party and ours will disagree upon what the lowest net cost is starting from scratch. In other words, if in a community today we had to create more laboratory facilities to meet the demand -- a legitimate demand -- I would suggest to you that they will be done more cheaply by the private labs than they will by the public labs -- not what I pay for them right now but in terms of the net cost per test done.

Let’s not confuse that with what I’m paying, because I think valid arguments can be proposed that an LMS unit which is not related to the volume of tests done on one location can, in fact, become very profitable as volume goes up.

Woods Gordon, I understand, did a lung test study for us in Hamilton. Their conclusions were that there was little if any difference between the two sectors, although there were so many variables they really qualified their answers very carefully in saying that the private labs were or were not cheaper, or more expensive, than the public labs operating in the Hamilton area alone. They also recommended that I not try to transpose a decision based on a study in Hamilton to any other part of the province because of the lack of validity in so doing. So, in effect, that conclusion has been left unmade.

The one thing I can say to you is if, in fact, the private sector’s true costs for running a lab are lower than the public sector’s, it’s the first time private enterprise has not beaten government in terms of cost.

Mr. Makarchuk: Come off it.

Mr. Ferrier: If I could just pursue that for a minute: You talk about the private labs being able to do it cheaper. I think you’re talking about efficiency. Surely when there’s no profit involved and the right kind of management and administration is being given, it stands to reason that it could be done a good deal more cheaply in the public sector?

Mr. Dukszta: Not only could be but it is cheaper.

Mr. Ferrier: The computer work for this government is done under the Ministry of Government Services, but it is handled in such a way that it’s competitive and even lower than the private sector. If it can be done in computer work why can it not be done in some of the other areas? Why can’t you get the same productivity? That says something for your management ability over there on that side of the House.

Hon. F. S. Miller: The one big difference between our party and your party is we recognize that the moment government tries to run things they aren’t run efficiently. Your party keeps on believing that the public sector can always be run more efficiently.

Interjections.

Hon. F. S. Miller: Mr. Chairman, can you hit that gavel for me?

Mr. Chairman: Order.

Mr. Dukszta: Mr. Chairman, he is being very provocative.

Mr. Chairman: The hon. minister has the floor.

Hon. F. S. Miller: I think we’re into the kind of argument that will forever separate your side of the House from my side. British Coal, British Steel, British Airways, British Rail all were formed on that basis. Every one of them has the lowest productivity of anything in the European Common Market.

Interjection.

Hon. F. S. Miller: They were based on the assumption profit was something taken from people.

Mr. Martel: You Tories kept giving it back.

Hon. F. S. Miller: I will tell you, when government takes over it is an added cost to the people.

Mr. Martel: The Tories kept giving it back. Don’t distort the facts. You kept giving it back every time. The Tories gave it back. The Tories gave it away.

Interjections.

Mr. Makarchuk: The difference between our party and their party is the fact that if we put --

Hon. F. S. Miller: Mr. Chairman, on a point of order. Is he speaking? Is he the next speaker?

Mr. Chairman: There is nobody from the Liberal Party who wants to participate.

An hon. member: They gave it up.

Mr. Riddell: We are waiting for the next vote.

Hon. F. S. Miller: What a pleasure.

Mr. Ferrier: That’s a change, isn’t it?

Mr. Makarchuk: Mr. Chairman, one of the things we would like to get across to the minister --

Mr. Nixon: If you think listening to Makarchuk is a pleasure you need help.

Mr. Makarchuk: -- is that if we were running the government, or if we were running the labs or some of these things, we would put people in charge of those institutions who believed in the institutions.

What the ministry has is institutions that are public and people in charge who do not believe in the public enterprise. It is very easy to go around and say it doesn’t function, particularly if you have a hand in screwing it up.

Mr. Martel: Right on, right on.

Mr. Makarchuk: In getting into the debate I am reminded of an ad that used to run on TV, generally just before the national news, extolling the virtues of the post office. Somebody sent tests to a lab somewhere in the distance. Eventually some reply arrived and of course a frantic person came screaming out of the door, “It’s okay, it’s okay!”

We know the virtues of the post office. After the ministry goes into the lab business I have a feeling the same situation is going to exist in Ontario.

I was at the meeting at Woodstock, Mr. Chairman. There were a lot of people out there. Somehow they came out on their own and they were people who lived in Woodstock. They have a stake in the community. They are not dumb people. They are not ignorant people. They are people who know what is going on in that community.

They are people who are members of the municipalities; they are people from the hospitals; they are people representing the defined groups -- the educational groups and so on -- in the community. These are the sort of people who make Ontario run. Each and every one of them got up and said what the minister was doing was wrong.

Obviously, when we come down to it, Mr. Chairman, it’s a fact that this ministry, the computers and minions at Queen’s Park know exactly what’s going on and what’s happening with the lab in Woodstock. The people in Woodstock obviously don’t know anything.

Let me tell you, Mr. Minister, you are dead wrong. That’s something the people in Woodstock and a lot of other places in Ontario are not going to forget. One of the lessons the minister should have learned in the last election was that it is important to listen to the people of Ontario. They have something to tell and the ministry should listen to them. Obviously, the lesson did not sink in. The ministry has gone ahead without taking into consideration any of the local wishes of the people and proceeded to chop and cut without any reason.

Let me suggest something to you, Mr. Minister. At this time there are some unusual operations going on in the private labs; hopefully the minister is going to investigate some of things that have been brought out in this House. Hopefully there will be some changes made.

Until such time, Mr. Minister, I would suggest the public labs be left alone because, as was pointed out earlier here by the leader of our party, there are a lot of savings that can be made. The ministry may have to do a lot of relocations and may have to bring about changes in the private labs operation of the province.

Until the minister has resolved this problem, investigated the expenditures, do not touch the public labs. We can stand here and argue back and forth about the figures; you have your figures and I have my figures. You are no expert on it and neither am I, but I have seen the figures that were provided by the people who work with these labs. I have seen the figures of the people who operate these labs and their figures do not agree with your figures. In fact, in the Woodstock operation they say the extra cost to the ministry will be something like $127,000. It would cost more if the lab were closed and some of the work fanned out to London and private labs, the drivers hired -- which you are advertising for, incidentally, in your papers -- and to buy the cars, buy the insurance, pay for the gas, run these things, run them by bus or anything else.

[9:00]

Mr. Martel: No wonder it’s more costly.

Mr. Makarchuk: And you expect to save money that way. I really can’t understand ft and the people out there can’t understand it. The message I want to leave with you is the fact that there are a lot of people in the community who I think know something about what is going on there. It was unfortunate that the member for the area at that time was unable to attend, but I’m sure he’s got the message since then. What they’re trying to tell you now is, for gosh sakes, you are making a mistake and this time, with everything else happening in regard to the private labs, you could leave those labs open.

Hon. F. S. Miller: Obviously the speaker has not paid any attention to the fact that the great bulk of the work in those labs is not done in the private labs under any circumstances, and had to be transferred to other government labs.

Mr. Chairman: Shall item 1 carry? The member for Windsor-Riverside.

Mr. Burr: Mr. Chairman, realizing that there are time restraints on these supplementary health estimates, a typical Tory restraint resulting from typical Tory lack of planning, I shall be as brief as I can. We should have been called back here two or three weeks ago so that both the supplementary estimates and the Throne debate could have had the adequate discussion they deserve.

If the hospital and social service cutbacks are not part of Tory strategy to pander to the redneck Conservatives out there amongst the voters, and if our Minister of Health has simply been told to make a $40 million or $50 million OHIP saving as his share of reducing the anticipated debt, then the issue we are debating in these estimates is simply whether the minister’s method is the best method.

My colleague from High Park-Swansea (Mr. Ziemba) has already indicated that there could be a saving of some $40 million or $50 million if the elaborate tests that have become routinely ordered by some physicians were controlled or, in government jargon, restrained. In 1971 OHIP paid less than $18 million to the private labs. By 1975 it was over $66 million, and the projection for 1976 seems to be in the order of $88 million.

Mr. Chairman, I say to the minister make your $40 million saving by controlling the indiscriminate and unrestrained acquiescence by many doctors in prescribing unnecessarily numerous medical lab tests. A better auditing system is obviously required. Apparently significant savings could result from a better system.

But the great weakness in OHIP has been, ever since its inception, the open-ended nature of the government’s arrangement with the Ontario Medical Association.

I have spoken more than once on this subject during the Health estimates in past years. Should the minister care to look up one of these occasions, I refer him to the year 1974, Oct. 81, page 4740. The minister’s usual reply to my suggestion has been that it has been considered and rejected. So I was encouraged on Friday morning to hear the hon. member for Hamilton West (Mr. S. Smith) come up with the same proposal that I had been making for several years. And I was interested in the minister’s usual, quite inadequate reasons for rejecting a closed-ended arrangement.

Hon. F. S. Miller: You have undergone a change.

Mr. Burr: Oh, I hadn’t noticed. For the last time, Mr. Chairman, I am going to attempt to persuade the minister to adopt a closed-ended system for OHIP as far as each kind of medical service is concerned. My recommendation is based not on some abstract theory but on actual practice and experience, not in some remote corner of the earth but right here in Ontario. This closed-ended system existed for many years and worked successfully in Windsor and Essex county, probably for 15 or 20 years, before OHIP was established. It was run by the doctors of the Windsor and Essex county area. I think eventually it even extended into Kent county. Briefly and simply, the system worked as follows -- and I have never been able to get the minister to listen to this carefully so I was hoping on this final appeal that he would really bear down and think about it for the first time.

This is the system simply stated and briefly stated: Monthly fees were contributed and collected from subscribers throughout the area, mostly through employee groups and by payroll deduction. At the end of each month, administration costs were deducted and the balance was divided among the participating doctors, of whom I think there were 98 per cent in the Windsor area, on a prorated basis according to the value of the services for which each doctor sent in bills.

If administration expenses amounted to 10 per cent then the remaining 90 per cent of the premium was divided among the doctors. If the number of services was above average in any particular month, then each doctor presenting a bill for a $5 service might get only $4.80 or $4.85. If the number of services billed was below average, each doctor would receive the full amount allowed by the fee schedule and the surplus was put into a reserve fund.

When the system ended, incidentally, there was a reserve fund of about $1 million which was divided among the participating doctors. This system never went into the red. By its very nature, it couldn’t go into the red because the system never over-spent. It served the public by guaranteeing whatever medical services were required. It served the doctors by ensuring that 100 per cent of their bills were collectable instead of only 50 per cent as had been the case with most physicians for generations.

There is no reason this system could not be adapted to the medical part of OHIP. There is one advantage of course that Windsor Medical had and that is in the fact that the participating physicians were sufficiently few in number to allow every member to be known to at least one member of the doctors’ managing committee. In Windsor, I understand that one doctor always sent in an excessive number of bills and he was routinely paid for half of them. He never complained and the committee never commented.

The group was small enough to deal with and discipline its members on a personal and informal basis. OHIP, on the other hand, because of its magnitude, becomes impersonal requiring spot-checking, supervisory personnel, and computer devices, all of which adds to the expense and the overhead. Through an open-ended system, the ministry can form fairly accurate projections of the coming year’s expenditures but this is a projection based on all the numerous disincentives to economize that have been outlined already in this House.

There have been no restraints in the OHIP medical system and there will be no restraints in 1976. The ministry should eliminate from OHIP all the incentives to provide unnecessary uses of doctors’ services whether for surgery or for weekly or monthly routine checkups. The ministry might allot a specific sum each month, to be shared by whatever groups are appropriate, either geographically or perhaps according to specialized interests. For example, the surgeons, the anaesthetists, the general practitioners, the chiropractors, the obstetricians -- this is purely a suggested variation -- might be regarded as groups and allotted a monthly amount to share. It might be better to decentralize so that Windsor Medical would essentially be revived, the only difference being that the collection of money would remain provincial, the payment to participating doctors would be administered locally.

Replicas of Windsor Medical could be organized in all the other regions or districts or counties as deemed appropriate. Incidentally, Mr. Chairman, another possibility for closing the open-endedness of medical fees might be to use the same restraint that has always been used for the chiropractors. Chiropractic services can be given to a patient only up to an annual maximum amount of $100 and $25 for x-ray services. The chiropractors have been restrained, in this sense, ever since they were admitted to OHIP.

If general practitioners, for example, were restricted to a $100 a year fee for certain kinds of patients -- those who visit regularly for reassurance, the hypochondriac perhaps -- the minister might find that the number of visits scheduled by some doctors would drop surprisingly.

This system that I have mentioned would probably help to solve the minister’s problem about the apparently excessive number of certain surgical operations. In local areas, peer pressure, to use an educational term, would become a factor. If a certain surgeon was performing three times as many tonsillectomies as his local colleagues, questions would certainly be asked that are not now being asked. If the local surgeons were sharing a limited, finite, closed-ended monthly allowance or salary from OHIP, the performing of questionable operations by some surgeons would be more easily detected and would in all likelihood be restrained. At the present time, if one doctor is doing far too many operations, visits, tests, or what have you, the other doctors aren’t particularly concerned; first, because they don’t know about it, and, secondly, it’s because ifs the provincial taxpayer who is being ripped off.

When you have a local system, however, where everyone is acquainted, if one doctor got out of line and if the salary allowance of the whole group was being ripped off then, as I said, the peer pressure would certainly be there and this would help the minister, I’m sure, get restraint enforced locally.

Although it is probably not an alternative method of saving as much as $40 million or $50 million, I should like to suggest that the fees for hospital visiting of patients be revised. If a doctor has to drive several miles to visit one patient in his home and if he spends an hour of his time doing so he certainly earns whatever the fee schedule allows. If, however, another doctor visits a dozen patients all in the same hospital and spends only an hour doing so he does not deserve to be paid 12 times as much as the first doctor. Couldn’t fees for hospital visiting be put on some other basis, perhaps on an hourly basis? This is a matter, of course, that would require consultation with the OMA, but it is a part of the present fee schedule that is suspect in the eyes of a great many members of the public.

Let me conclude by summarizing: First, make the required $40 million or $50 million saving by controlling or restraining the amount of testing performed by the private labs. Second, establish a ceiling on the amount of money allotted by OHIJP to the various health services provided by the various groups of practitioners. The $40- or $50-million saving could easily be achieved in this way. Instead of doing this, of course, the minister is going to cancel the benefits of the $40 million or $50 million saved by disemploying, to coin a verb, 5,000 hospital staff members by giving the doctors an estimated $56.7 million increase.

[9:15]

This is only an estimated amount because he has an open-ended system of paying doctors, a system totally lacking in restraint, in fact, a system that discourages restraint. This estimated $56.7 million may end up at the end of the calendar year as $70-million.

Finally, point three: For reasons that are obvious and compelling to all those affected, don’t close the 10 small hospitals, please.

Hon. F. S. Miller: Mr. Chairman, in spite of the perhaps provocative and almost acerbic comments to begin with, the rest of the hon. member’s talk was thoughtful as it almost always is from this particular member, and very constructive I must say. I don’t really disagree with the objectives you’ve stated in your comments at all. In fact, I think you will find that the Maxwell Henderson report said that open-ended programmes in government should be closed whenever possible. OHIP is an open-ended programme. We recognize the difficulties of closing it. You have to realize, of course, that we are looking at ways and means and the suggestions you made relating to the Windsor area would be valid if, in fact, all the funds were raised in easily identified ways as they used to be on a premium basis. They are not now, as you know. Perhaps one-fifth to one-sixth or something thereabouts are.

If I were just philosophizing and dreaming as to how one eventually would have district health councils function, they would take over some of the duties you are talking about once they passed their first X years of getting used to planning. They may well solve, in the long run, some of the very things you are talking about.

Dr. Mustard in his report suggested some of the ways you are talking about of closing the open-endedness of the system. For example, they are open-ended to a degree because people can move in without restrictions. The problem with the chiropractic analogy to medicine is, of course, that we really need our medical aid in large dollars tinder crisis conditions. Chiropractic has seldom had that overtone to it. We simply have said that a life has seldom been saved by chiropractic. I am sure some chiropractors would argue with that. It is more often a treatment seldom required in, let’s say, high dollar values for any one person.

Mr. Burr: Well, that is why I compared it to this weekly or monthly checkup.

Hon. F. S. Miller: Yes. I don’t mean to give you the impression that we aren’t prepared to look at ways of closing the open-endedness of OHIP, we are. I have to be satisfied that they will work. Capitation is one of them. The systems of capitation that are being experimented with in some of our health service organizations will have finite budgets for the physician per person served and in effect that is a closed system. They do have, unlike the British system I am told, a charge-back if the patient goes elsewhere for service,

That is, I think, a vital freedom of a patient. The patient should have the right to get service elsewhere if they are not satisfied with the treatment of the doctor to whom they have been attached for bookkeeping purposes, albeit a choice made by them in many instances. Not always, but in many instances.

I don’t want to give you the idea that I am not looking at closed systems. I simply say first we’ll evolve into them. Secondly, they are not as fool-proof as they appear to be at first glance. We will be carrying out pretty intensive examinations of the validity of the other than total fee-for-service system over the next two, three, four, five years, whatever time it takes. All the while, more and more doctors are electing, when they enter practice, to go some other route. This is fine. I don’t feel that any one system has the corner on the market.

It may well be that the system we evolve in time will bear little resemblance to the one currently in practice. I suspect we have to learn more about what motivates people, what gives good quality of service and at the same time controls costs, than we currently know.

Item 1 agreed to.

Mr. Chairman: Item 2, general hospitals and related activities.

Mr. di Santo: Mr. Chairman, perhaps it’s redundant at this point to speak again about the closing of hospitals, in particular Doctors Hospital, after the superb speech given by the leader of my party this afternoon. He has illustrated the aspects of the decision made by the Minister of Health in closing the hospitals, how irrational it is and how destructive the consequences are for the small communities across Ontario and for a special consideration in Toronto, the immigrant groups which are hurt by the closing of Doctors Hospital.

But I think that it is my duty to reemphasize the position already expressed by the leader of my party and by several members in the past week. We are concerned about the closing of hospitals in general and I’m concerned about the closing of Doctors Hospital. I don’t think only the member for St. Andrew-St. Patrick (Mr. Grossman) has to be concerned for the closing of Doctors Hospital, because this hospital is not his private preserve. As a representative of a riding with a large ethnic community, at this point I think that I have to express the feelings which have been conveyed to me by many people who live in Downsview, many people who have been served by the Doctors Hospital and who are preoccupied by its closing.

The government restraint in health services is part of a political game, orchestrated by the government with the purpose of creating a psychological climate of uncertainty and fear among the public which will allow the government to emerge as the one able to remedy the present situation.

The fact is that the Conservative government of Ontario is the only one responsible for the colossal mismanagement of the economy and its finances as it has been expressed by the leader of my party this afternoon. This is even more true if we consider that the savings announced by the government with the closing of hospitals are not real as it has been proved by the leader of my party again.

The Minister of Health himself, last Thursday, in reference to the closing of Doctors Hospital, said that: “The cost associated with the closure will minimize total savings.” In perspective, this proves now how inaccurate the figure of $50 million we-announced by the minister on Dec. 19, 1975, was.

As a result of closing hospitals and reducing their size by up to 3,000 beds, the government will save money, if any, only through laying off 5,000 employees. That shows how much you are concerned about unemployment, Mr. Minister. But this is not a real saving. I think on the contrary the government decision, while aggravating the already serious situation by creating more unemployment, will add a heavier burden on the community in social terms and in human terms.

I think, though, it is hard for the government to conceive different ways and means to fight the present economic crisis. They cannot even conceive, in their stone age approach, the potential of growth of our economy and the possibilities of broadening the potential of our economic system so that more jobs can be created and no one would be sacrificed and penalized. The government, through the reduction of transfer payments to the municipalities, cutbacks of social services and closing of hospitals, is attacking the weakest and the most defenceless groups in our society because they know that from these groups they will get the least resistance. They are concerned with the powerful groups in our province, whether they be the mining companies or the doctors.

The Health Minister knows that the doctors’ incomes increased by 124 per cent between 1962 and 1972 -- the highest in the province. The minister knows that even the subversive Ontario Economic Council recognizes, in his recent report, that the fee for service system is unworkable and represents one of the most uncontrolled cost increasing factors in the health care system.

The minister knows the rip-off by the private labs. The minister knows the incredible amount of money wasted in unnecessary surgery as, again, has been illustrated by the leader of my party this afternoon. The minister knows also that wage costs represent 80 per cent of hospital operating costs, as it has been stated as recently as March 11 in a memorandum of the Hospital Council of Metro Toronto. But he does not touch the doctors. He does not touch the private labs because, as the free enterprise wants, they have to make profit. He does not scrutinize the amount of money involved in unnecessary surgery. He deprives communities of their health services and fires personnel, both medical and non-medical, because this is the easiest way to operate in this free enterprise province.

The closing of Doctors Hospital proves, to an even greater extent, what I am saying. The justification for the closing, as well as the other health cuts, is cost saving and the criterion is to have a ratio of four beds for 1,000 people. It is legitimate to ask why the Minister of Health closed Doctors Hospital among those to be closed in Toronto, and not other hospitals, like Mount Sinai for instance.

Doctors Hospital is one of the most efficient in Metro Toronto since the occupancy rate is 84 per cent compared with 78 per cent in other Metro hospitals. The length of stay at Doctors Hospital is 7.7 compared to 9.8 days for other hospitals. The cost per patient is $98 compared to $205 in 1975.

Since 1969, the province has spent $1 million in improvements plus $350,000 in the last three months for a new air-conditioning system. But that is not all. What statistics cannot show is the social value of this unique health care centre and the importance it has for those who mostly use it, namely immigrants. Three-quarters of the general practitioners, one quarter of the specialists, the majority of the nurses and maintenance staff are immigrants. This hospital, with a unique philosophy and concept of treatment and care, has gathered together a multi-cultural staff able to speak all the languages of the patients. Of 225 doctors, 150 speak three or more languages. That does not bother the Conservative government and the Minister of Health, since ethnic groups have never been a priority for them. The government does not care about the fate of the ethnic population of Toronto and their problems once deprived of the unique opportunity to be treated in a health centre such as Doctors Hospital.

[9:30]

The government of Ontario has never cared much about ethnic groups. We know the paternalistic approach you have taken in the past years. We remember Heritage Ontario and the parade of self-styled ethnic leaders, the power brokers you have used in order to exercise your power -- leaders with no following as the last Sept. 18 election demonstrated.

The Conservative government and the Minister of Health are not concerned with the fate of the doctors and the staff of Doctors Hospital, the 600 employees. They know that most of them will not find an opportunity to practice in another hospital. They know that 18 interns will lose their year of training. They know that many will be unemployed. But they are an easy prey to be sacrificed.

Doctors Hospital was approaching a model of a community health centre; a model proposed and supported by the New Democratic Party, a model accepted in the past 20 years by the Ministry of Health.

Twelve thousand, four hundred patients have been cared for in hospital emergency and outpatient departments in Doctors Hospital, usually seen principally by interns and only supervised by the general practitioners and specialists. Now the minister is reneging his own policy and aggravating the large immigrant community without offering any alternative.

These are the reasons we are concerned. We are fighting for Doctors Hospital, not because we want votes. We know that the ethnic communities of Ontario will never support your government because you have done nothing for them. Because they know that whenever you cut down with your axe you hurt them, as is proved not only in this episode of Doctors Hospital but as has been proved by the Treasurer of Ontario (Mr. McKeough) when he has reduced transfer payments to municipalities and the boards of education. The very first programme which has been cut by the Toronto Board of Education is English as a second language; and what is more ironic, from now on the children of immigrants and immigrant children cannot have English as a second language as they have been saying in Ontario for more than two years, This means that those children who sneak their mother tongue at home will never have an opportunity to learn English, which means you are condemning large groups of people, only for the fact that they are immigrants, to be second class citizens became they won’t make real contact with other pupils within the school system.

Mr. Chairman: Are on speaking to the principle of the general hospital item?

Mr. di Santo: Yes, Mr. Chairman, I was mentioning this aspect of the policy of the Conservative government because it is consistent with what the government is doing in closing Doctors Hospital.

As I said before, we ask you to reconsider the destiny of Doctors Hospital because you are hitting very hard a constituency which seems to be defenceless. But we will fight because we know -- and you should know, actually, Mr. Minister -- that your decision is perceived by the ethnic groups as discriminatory and, perhaps with some exaggeration, with some racist connotations.

I hope that with the appeal that Doctors Hospital will make to the Premier (Mr. Davis), you will consider the specific nature of this particular group in this city of Toronto and you will change your decision. As far as we are concerned, we will keep fighting against your decision because it is unjust, because it is irrational and because it is discriminatory.

Hon. F. S. Miller: Mr. Chairman, it is quite fair for any member here to attack me on my calculations or my choices. I don’t really appreciate an attack based upon the ethnic situation. This is not a question of taking an action because it was an ethnic group. I’m sure you and many people like you who came to Canada were welcomed here.

I’m sure that 52 per cent, I’m told, of the people emigrating to Canada -- the thousands we welcomed, the thousands who have enriched our country in many, many ways -- still come to Toronto and still find an opportunity in this country which far exceeds that which they left behind. They’ll find that this city and this province allows them to do the things they didn’t have the right to do at home -- to get an education; to have welfare schemes that are far better than they ever knew in their past; to have things like free drugs long before they’re qualified for federal pensions -- and you know that.

Ontario made this available to people who couldn’t qualify for federal pensions. We tried quite sincerely to bring some of these things to people who wouldn’t have had the time to live in our country long enough to get federal old age pensions. GAINS is given to these people too.

I feel very badly when a person like you, who is a very important interpreter to this community of what goes on in our government; a person who has won the right to sit here and represent not only Canadians but those people who are new to Canada, feels so badly about the country he has chosen to come to that he attacks us in that way. I find it discouraging because our decision was not, in any sense at all, based upon that.

The whole downtown city of Toronto health care scheme, in one way or another, serves the ethnic community and I believe it serves it very well. It’s going to keep on doing that. Hospitals like Toronto General, Mount Sinai, Western, Central, St. Michael’s and St. Joseph’s, you name them, not only have very high percentages of people who come to Canada from abroad on their staff but offer services to the people who have come to Canada as their patients.

I’m proud of those services. There will be no differentiation by this government on that basis. I’m sorry to see you have to stoop that low.

Mr. McClellan: That’s a lot of nonsense; downtown Toronto is invisible to you.

Mr. Lewis: He didn’t say you closed it because it was ethnic.

Mr. Chairman: Order, please.

Mr. Lewis: For so many years you had John Yaremko tramping around this province playing the ethnic community like some kind of instrument and now you suddenly worry about the whole matter.

Mr. Grossman: That was playing it and what we just heard wasn’t playing it?

Mr. Chairman: The hon. member for Downsview has the floor.

Mr. Lewis: Such solicitude.

Mr. Chairman: Order, please.

Mr. di Santo: Mr. Chairman, what I tried to get across to the minister is the fact that Doctors Hospital is a unique institution in the city which serves almost exclusively ethnic populations. I know the patients will be transferred to other hospitals, but will they find the same kind of services, the same kind of interpreters, the same kind of nurses? Will the doctors be accommodated in other hospitals, because as you know, as of today, there are no vacancies for them? This is the problem.

At the Doctors Hospital, as I said before, most of the doctors are of ethnic origin. I think that’s something you should take into account, because when the patients go to Doctors Hospital they find an atmosphere in which they feel comfortable. Of course they will be accommodated in another hospital, but what you miss is the fact that you are destroying something that is now serving a population and with which that population is satisfied.

Mr. McKessock: I’m not going to holler and shout at you tonight. I’m not even going to throw any snowballs. I’m happy to represent the Durham hospital, which I’m sure is going to get special consideration when all the facts are out and he kept open. Myself and the Liberal Party certainly agree with saving money in the Health budget, and in the rural areas we are quite willing to take our share of budget cuts, such as 2.3 per cent of the hospital budget across Ontario, to save the projected $40 million.

I believe in good government and I do not like the way the present government is using the rural community. I decided to try to get into government so I could have a chance, with advice from my constituents, to make some input on the decision-making in our area. The Minister of Health called me the night before he came to Durham and told me what he was going to do the next day.

Mr. Riddell: The usual procedure.

Mr. McKessock: To me that’s not having a chance. The people in government cannot make such important decisions for us without first consulting with us. I spent three-quarters of an hour talking with the minister in his office on the Tuesday following the Friday announcement of the closing in Durham.

He’s kind of a nice fellow, even though he isn’t listening to me, and he seems like a reasonable guy. If he had contacted us three months ago and said: “This is what we have in mind for Durham; what complications will it bring to your area?” we could have worked it out better.

The minister told me the day he was in Durham that they tried talking it over with people in some localities but it didn’t work. I said to him that in a democratic society you must consult with the people involved whether you think it works or not.

I would like to make it clear to the members of the Legislature the conditions that exist in the Durham hospital situation which clearly point to the injustices being implemented there.

The weather and road conditions in the winter do not allow normal travel between towns. Durham hospital has an 88.7 per cent occupancy. Durham hospital in 1975 supplied 2,439 meals-on-wheels from its kitchen to senior citizens in the town. There are ambulance services attached to the hospital, with volunteer drivers. A doctors’ clinic is next door to the hospital. It’s on a main highway from Owen Sound and each week doctors from Owen Sound do dental surgery and other surgery in the Durham hospital because no beds are available in Owen Sound. With the close to $500,000 cut in Owen Sound’s budget this past week it is going to be imperative that the Durham hospital remain open.

[9:45]

Durham hospital was new in 1962, with a new addition in 1972. Average length of stay in the hospital is only 7.8 days. The Durham hospital is one of the few accredited hospitals in the area. Durham hospital is in a tourist area and the hospital services many tourists both summer and winter.

Community efforts resulted in contributions of up to $4,000 a year toward the hospital. Examples are the hospital auxiliary, junior hospital aids and the community fair. In addition estates also leave money to furnish rooms in the community hospital.

The Durham hospital handled 4,062 emergency cases in 1975. We want something better from the Minister of Health than a statement saying they are going to close our hospital and save $550,000; that is not good enough. We want the facts and figures as to why Durham is closing.

We would like him to try and answer these questions. Are we not efficient? Are we keeping the patients too long? Is the cost per day too high? Marie Cooper, the Durham hospital administrator, has all the figures. She could have helped the minister make this decision.

I thought the Davis government would have learned its lesson last September, but it hasn’t changed a bit. There is still no involvement with the people. In a democratic society, they have no right to make decisions for us, behind a desk in Toronto, without first having full consultation and input from the community and area involved.

I am not mentioning just to be critical the fact that the Health Minister has a new $7 million hospital going up in his riding. Maybe he needs it. That’s his area, we will let him decide. Or the fact that the ministry has just set aside 14 acres in Toronto for a new 700-bed hospital. That is in Toronto’s area, we will let them decide; just as long as he will let us help decide what we need in Durham.

It is a well-known fact that the hospitality and bedside manner you receive in a small community hospital cannot be equalled in any other. Friends and neighbours can drop in and see you, which helps brighten your day and speed your recovery.

After spending some time with the Minister of Health, I am convinced that the Conservative government is not interested in decentralizing large cities, but rather in making them larger. They are not interested in the rural communities growing. The minister said to me: “What makes you think that Durham will grow? There are no highways going up there.”

An hon. member: They are going into Muskoka.

Mr. McKessock: I was glad to bear him admit that the bits of asphalt that pushed their way up into our area are not called highways -- but the Minister of Transportation and Communications (Mr. Snow) calls them really good highways. I said to him that our tourist industry will build up the highways someday, if nothing else. For this reason, we would like at least to hold our own for the time being. But if you keep kicking the props out from under us, we will deteriorate instead of growing.

Mr. Lewis: He has just about closed the town down; not much left.

Mr. McKessock: There are some alternatives to produce savings; there are a few things that should be changed. If a nursing home patient stays in a hospital it costs them nothing; if they stay in a nursing home it costs them $6.15 a day. This encourages the patient to try and stay in the hospital. This must be changed.

Leo Kell, a dairy farmer who lives in Melanchthon township, has given me the idea that our OHM cards should be similar to credit cards. They should be put through a machine in the doctor’s office before the doctor can receive payment. I think this is a very good idea. Some of the doctors have been caught making bills up when they didn’t have the patients. This would put a stop to this and save money.

There are many alternative ways to save money and the Minister of Health does not have to set up a commission to study it. He only has to move into each riding that has had a hospital closing announcement and he can get the answers. I think he is overlooking dollars to pick up pennies in Durham.

I would like just to mention something likely to happen if the hospital closes. Regional government will move in, because local governments will become discouraged. Business will drop in the town. Approximately $600,000 worth of wages will be taken away in Durham. I was talking to one businessman in Durham who was thinking of expanding. He is now changing his mind and thinks maybe he is too big.

Over 50 per cent of the people in town are senior citizens who are living in nursing homes, senior citizen apartments and private homes. There are plans for a new $2.5 million home for the aged complex to be built in Durham this year. This ratio of old to young should be considered. How would these people get to a hospital or doctor if the doctors leave, which they eventually will? Now it is quite easy and inexpensive with a town taxi available. Taxes will rise for the people left if the hospital goes and removes 55 people from the town.

If Durham hospital is closed the 4,600 emergency cases that were treated there last year will have to be treated somewhere else. Some of them, no doubt, will not make it to another hospital. There is a great difference between closing a hospital in a rural area compared with a closure in a city where there is another one readily available with good road conditions.

Durham hospital saved the Ministry of Health $181,983 in the last five years by running their hospital this much below the allotted budget. I would like to know how many other hospitals run at below-budget allotments and by how much.

The hon. minister has suggested that if we could come up with similar savings in the area he would consider leaving the hospital open. Why do we have to come up with alternatives? The Minister of Health has made the alternatives for the other 230 hospitals.

I guess the alternative should be further hospital budget cuts of one half of one per cent right across Ontario, which is very little for each hospital and which would give the same $10 million saving you are looking for. If everybody accepts then everybody would have to learn to save. The way that it is proposed, if you shut us down we learn nothing, and the hospital beds that aren’t cut will continue to run wild with the spendings.

Hon. F. S. Miller: Very quickly, I have two or three quick comments. Eighty per cent of the bed cuts in dollars were in cities, not in rural Ontario.

Credit cards are being considered and have been for some time. There are a number of other problems involved.

Three, across-the-board cuts have generally been acknowledged as unfair to those hospitals that have growth situations. There is no use trying to rationalize the system by across-the-board cuts when, in fact, some areas need more because they are growing.

Mr. Riddell: Frank, there is a big difference between bed cuts and closing of hospitals.

Hon. F. S. Miller: The last thing I would point out concerns your comment on something you and I said in my office. Sure I said those very words. I never have had a habit of denying when I say something to somebody. There are other things I’ve said and there are other things that people have said to me. I have always felt that when I was talking privately to a member I could count on him not quoting me in the House and vice versa. There are some people in this room I could embarrass profoundly with the things they said to me privately in my office about their own particular constituency matters. I think that is a matter to keep in mind.

Mr. McKessock: Mr. Chairman, I don’t feel I said anything that would embarrass the minister.

Hon. F. S. Miller: You started questioning the growth of your area and my comments about roads, that kind of thing.

Mr. Riddell: You are very sensitive, Frank.

Hon. F. S. Miller: Well you are one of the ones who must remember some of the things you have said.

Interjections.

Hon. F. S. Miller: I can’t answer them.

Mr. Grande: Mr. Chairman, I wonder if it is in order that I ask the minister a few questions before I proceed with my remarks?

I understand, Mr. Chairman, that in 1971 a role study for Doctors Hospital was done by the consulting firm of Peat Marwick and that it spelled out the change that the hospital was going to undergo. Can the minister tell me who commissioned that study; and to whom did Peat Marwick present the study? Were you in basic disagreement with the change of Doctors Hospital and who was the author of that study? If I may have the answers to those questions, Mr. Chairman, then I will proceed, if it is in order.

Hon. F. S. Miller: I can’t answer them.

Mr. Grande: Yes, there was a study in 1971, but I will come to that later.

Mr. Chairman, I want to protest as strongly as I possibly can the closing of Doctors Hospital. I know, and 80,000 people in Metropolitan Toronto know, that the Minister of Health is wrong on this issue. I refuse to get involved in the game of name-calling, even though such names as “The Executioner” and “The Angel of Death” perhaps suit the minister well.

Hon. F. S. Miller: What did you just do? What did you just do?

Mr. Grande: I have no snowballs hidden in my desk and I have no solidified hydrogen sulphide to throw in your direction. I only have some facts and some evidence, which I hope will prove to the minister that closing Doctors Hospital is not only sheer folly but complete madness.

The decision was not arrived at after careful planning but out of political expediency. Efficiency was not the criterion used to arrive at the decision to close the Doctors Hospital.

The minister admitted that the other day, on Wednesday. He said, “Of course the Doctors Hospital is an efficient institution.”

Before I focus on the Doctors Hospital, let me assure the Minister of Health, the member for St. Andrew-St. Patrick, and the Liberal Party, that I and my party are not interested in playing the political game of making a case as to why a particular hospital should be closed or should remain open and agree with the closings of all the rest.

The New Democratic Party has taken a stand, as enunciated by my leader today, against all the closings of the community hospitals and the public laboratories. We know that the closings in Paris, Virgil, Kemptville, Bobcaygeon, Durham, Copper Cliff, Clinton and Toronto, are wrong. The people in those communities have paid dearly for those services, and now they are told that those services must be cut off.

The Minister of Health on March 10, in response to one of the questions from behind his back, said he had two reasons that determined the closing of Doctors Hospital. You said -- and I quote:

“Its size; it happened to be lower than the total number of beds we required. Somewhere in the order of 400 within the city had to be closed: it had 319.”

Aside from the fact that those particular remarks were off the cuff, I understand the incoherency. The second reason was:

“The fact that it [the Doctors Hospital] had made proposals to me ... saying it needed to be rebuilt at a cost of $15 million.”

The minister avoids mentioning that Doctors Hospital was closed down because of inefficiency. He knows that he cannot win that argument.

Mr. Grossman: That was a good question that day.

Mr. Grande: Let me give you some facts on the efficiency of Doctors Hospital -- and this is not information that only I have; I think everybody has this information. For the year ended Dec. 31, 1974, the cost per patient-day at the Doctors Hospital was $86. At an average similar hospital, doing the same type of work, the cost was $92, and at Mount Sinai the cost was $165. I am not making these comparisons, Mr. Chairman, to indicate that Mount Sinai ought to close leaving Doctors Hospital open. I hope that I have made that point clear at the beginning.

[10:00]

The cost-per-patient at Doctors Hospital was $664. At an average similar hospital it was $760, and at Mount Sinai, $1,619. The average length of stay at Doctors was 7.7 days, at an average similar hospital, 8.4 days, and at Mount Sinai, 9.8 days. The proven costs, therefore, for the whole year’s operation at Doctors Hospital would be $8,406,240, at an average similar hospital, $9,621,000, and at Mount Sinai, $20,496,540.

As of June, 1975, the Ontario Hospital Association has some very interesting figures, which say that the cost per patient-day at Mount Sinai is $171.57, while at the Doctors it was $102.30, and the cost per patient at Mount Sinai was $1,697.25 and at Doctors it was $780.17. Doctors Hospital in 1975 consistently came under budget. As a matter of fact, the figure, in 1975, they say is approximately $160,000.

These facts prove beyond any doubt that Doctors Hospital is the most efficient institution when compared with any other hospital of its size doing a similar type of work. The Doctors, if allowed to continue its operation, would save the province money immediately and will continue to save the province money in the future.

Another very important factor which the Health Minister has not taken into account, is the fact that Doctors Hospital serves as a major community health resource centre. The staff of that hospital speaks at least 34 different languages, and that can respond to the needs of the patients who go to that hospital.

Provincial hospitals do not have it in their budget and do not provide salaries for medical translators, so all hospitals depend on regular staff to act on call as interpreters. At Doctors, with a high ratio of new Canadians among the professional and technical staff, the immigrant patient can be made to feel more secure about what is going to happen to him. The patient will be able to understand the difference between a benign tumor and a cancer, between corrective surgery and the amputation of a limb. The bilingual staff can go over the details of proposed treatment in the patient’s native language, so that the patient really receives the best possible care available.

Now, a note here about the multicultural atmosphere in Doctors Hospital. I have been one who has been very active within the educational system to try to make those institutions represent the needs of a particular community in which that institution lies. That, to me, is going toward the development of the multicultural society, whether the people on the other side of this House believe in the multicultural society or not. I suspect that all they are doing is paying lip service to it like their federal counterparts in Ottawa.

Mr. Chairman, no one can really understand why the Minister of Health has decided to descend upon the Doctors Hospital and single out that institution in all of Metro, and I hope that the minister is going to be giving us the details which allowed him to make that decision.

One particular day in this House he said: “Don’t worry, there are not going to be any cutbacks, any changes in the monster hospitals.” To stay for a few more minutes on the fact that the Doctors Hospital represented, truly, the multicultural society that we have in the city of Toronto, what happens when a patient does not understand what his doctor or his nurse do or say to him?; The shouting match begins. This shouting technique is tried, and the rationale behind it is that if you scream a little louder somehow the immigrant will understand you, if he happens to be speaking a little English or no English. When this does not work, untrained nursing aides and clerical workers are called in and they often -- not because they want to -- do not translate exactly what the doctor or the nurse said. The reason for that is because they do not have the technical vocabulary, not only in the English language but in their own language, with which to make that translation effective.

Mr. Chairman, who suffers in all of this? It’s got to be no one else but the patients, because the patients do not get the proper care that they require and that they expect from an institution.

One very important point that the ministry has not taken up -- as a matter of fact, I really don’t think that the minister or the ministry understands it -- is that hospitals are sources of primary medical care. My colleague from Parkdale (Mr. Dukszta) has talked about this particular point. He has talked about it incessantly. He has been speaking about it for years. The Doctors Hospital is typical of a community hospital in that it sees as many patients on an outpatient basis as it does in-patients; thus the hospital’s doctors, through the clinics, act very much as the source of primary medical care to people in the neighbourhood. In closing Doctors Hospital the ministry is cutting people in their neighbourhood off from the major source of their primary medical care. Who suffers, Mr. Chairman? The patients.

Another point which I would like to make, and it needs to be made, is that if and when Doctors Hospital is boarded up, where are the 210 doctors of the hospital going to have privileges? The minister is trying to assure us; “Don’t worry, the doctors will get privileges in other hospitals. The nurses will also get positions in other hospitals.” What is going to happen, I suspect, is that the doctors will continue to take care of their patients when they are not seriously ill. They will continue to see them in their clinics, but when these patients require hospitalization then what has to happen is that the doctor has to turn over the particular patient to a complete stranger, to a doctor with whom the patient has no relationship whatsoever. The closing of Doctors Hospital will mean sending a largely ethnic population into hospital care at unfamiliar institutions because many of the people -- and the leader of my party mentioned this today -- in the particular area where the Doctors Hospital is situated do not know these great big monsters. They are not sent to these great big monsters by their doctors. Once again, the people who suffer are the patients who need the care.

The minister would have us believe that if Doctors Hospital had 500 beds instead of 319, all of them would be filled. We know that this would probably be true. The doctors are interested in bringing patients into hospital and performing operations. The more operations they perform, the more money they earn. The more patients they have in the hospital, the more visits they can make to these patients in one day and thus bill OHIP for a lot more.

Does the minister realize that this attempt to curb the greed of the medical profession and his attempts to change the patterns or establish patterns in attitudes of doctors are hurting the patient? The patient will not be able to get into some of these other institutions which he claims can fill the vacuum.

The patients will not be able to get into these other institutions, at least not the patients who require medical work to be done. It is the patient who has to wait not two or three weeks only in order to get into hospital but he has to wait a period of one or two months perhaps. Why is it that in all this futile exercise the minister has been indulging himself while the patients must suffer?

There is another group of people which is hurting and suffering as a result of the minister’s futile exercise. I am referring to the hospital workers and the nurses. The minister somehow shows no concern whatsoever for those particular workers. All he is concerned with is to be seen out there in the public as making tough decisions. All he is concerned with is that his health budget increase is maintained at 10 per cent or 11 per cent. If people are hurt in the process -- well, that’s rough justice.

The minister is not concerned about the 554 employees of Doctors Hospital, especially at this particular time when we have 6.1 per cent unemployment in the Province of Ontario. All he is doing is throwing more people on the unemployment rolls.

Of course, if they cannot find jobs, and the likelihood is that they will not be finding jobs, these people will be going on unemployment insurance, thereby getting money from the federal coffers. The province doesn’t have to worry about that.

He is not concerned that these people will not be able to find work in other hospitals; he is not concerned that these people will not be able to find work -- period -- in any other place. He is not concerned about the fact that as the Ontario Hospital Association shows, hospital jobs in Ontario are hard to come by these days.

I would like to return briefly to two reasons for closing Doctors Hospital. The very first reason is that the minister said, “I looked around in the city of Toronto and Metro Toronto. I needed to close over 300 beds and there it is.” Doctors Hospital is a ready-made place for the minister to close.

He had no other concern whatsoever. He made no other concessions whatsoever. All he was interested in doing was closing the beds. And all the other factors that he should have considered -- I believe he did not.

[10:15]

Really, that particular reason I call political expediency. He says, “There is a hospital. It has more than the number of beds I require to close. All right, let’s close it.” The Premier (Mr. Davis) said of the Leader of the Opposition (Mr. Lewis) and the leader of the third party (Mr. S. Smith) that they were zooming in like vultures and if they were ready to call an election on this issue, to go right ahead. Well, I suspect it was the Minister of Health (Mr. F. S. Miller) who zoomed in like a vulture on the Doctors Hospital and decided that it must close.

The second reason that the Doctors Hospital got the axe, the minister said, was because this particular institution was going to be rebuilt in the next two years, with extensive work going to be done. He thereby gave the public the idea that somehow this particular hospital was a shambles: The ceilings were ready to crack; the patients were not safe in that hospital. Mr. Chairman, that is not the case, because I understand and I have been given assurances -- and the Toronto Star published a little article last Saturday, which was headed, “‘Hospital is too good to die,’ doctors claim,” and they suggest that the Doctors Hospital can continue in its present condition for at least another 10 to 15 years.

I want to talk a little bit about this second point, because I did a little digging and I got hold of a couple of letters which showed exactly why the Doctors Hospital was going to be changing from the present structure into a community health service.

I asked the minister, at the beginning of my comments, whether he had any information about the role study that was done in 1971. The minister replied in the negative. I understand that Peat, Marwick, the consulting firm, was commissioned in 1971 -- I don’t know exactly, and I wanted to find out from the minister, whether it was the minister who commissioned this consulting firm or whether it was the Doctors Hospital that commissioned this firm to do this particular role study related to the changeover. As I said, it was back in 1971. The person responsible, the author of this particular book, was none other than the present Deputy Minister of Health, Mr. Backley.

Mr. Lewis: I wish I had known that. Backley wrote the report?

Mr. Grande: Right.

Mr. Lewis: Boy, oh, boy, are you surrounded by crackerjacks. I understand he is an able fellow. He certainly changes his mind.

Mr. Grande: Mr. Chairman, when the present deputy minister wrote that report in 1971 he was not then with the ministry, and I don’t want to suggest that there is any kind of bad faith in all this process.

Hon. F. S. Miller: Go ahead and do it anyway.

Mr. Grande: No, I really don’t. I have no indication whatsoever to do that. All I am pointing out is the fact that he did write that particular role study. He was the author of that changeover. I have two letters which I want to put on the record, Mr. Chairman. One is a letter written by the Minister of Health to none other than the Hon. Allan Grossman, Provincial Secretary for Resources Development, on Dec. 20, 1974. This is what the letter states:

“Dear Allan:

“Re: Doctors Hospital, Toronto.

“The Ministry of Health is prepared in the near future to authorize Doctors Hospital to proceed to plan a new 200-bed hospital on the present site, designed with a strong emphasis on the ambulatory and outpatient care.”

Mr. Lewis: That’s what I was talking about this afternoon.

Mr. Grande: It goes on:

“However, at this time it is not possible to offer a firm construction date. I understand the role study for Doctors Hospital, carried out in 1971 by Peat, Marwick, could, with minor updating in light of the reduced number of beds we now contemplate and demographic changes, be used for the hospital as a basis for future planning.

“I would suggest, therefore, on the clear understanding there would be no determination as to the year in which we might look forward to the construction of the new facility, but early in 1975 Doctors Hospital approached the minister to request permission to proceed with planning.

“Yours sincerely, Frank S. Miller.”

Again, on Aug. 11, 1975, the Hon. Allan Grossman, wrote to Mr. Frank Herbert, president, board of directors, Doctors Hospital. It says:

“Dear Mr. Herbert:

“I was delighted in discussion with the Honourable Frank Miller, Minister of Health, to be advised that approval has been given for Doctors Hospital to proceed to develop a master plan.”

Mr. Lewis: I don’t believe it.

Hon. F. S. Miller: I never denied it.

Mr. Lewis: Aug. 1, 1975, and you closed it down in February, 1976. The whole ministry is involved with that whole thing.

Mr. Chairman: Order, please. The hon. member for Oakwood will continue.

Mr. Mackenzie: That’s private enterprise efficiency.

Mr. Grande: It continues:

“Subsequent to our discussion I was provided with a copy of a letter from William Bain, Director, Institutional Planning Branch, Ministry of Health, to Stan Johnston which outlines in some detail steps to be taken.

“I particularly noted in Mr. Bain’s letter, that while you are requested to reduce by 50 the number of active treatment beds, it is appreciated that it may not be feasible until such time as the self-care unit and day surgery unit are in full operation. This, of course, has been a matter which I have brought to Mr. Miller’s attention some time ago.

“I join with you, the board of governors and your administrator, in the anticipation of the fulfilment of a long-awaited dream, the development of Doctors Hospital as outlined in the master programme prepared by Kates, Peat, Marwick in 1971.

“With kind regards, Allan Grossman, Minister.”

Mr. Lewis: Boy oh boy, no wonder he retired.

Mr. Grande: Mr. Chairman, again I am not going to suggest that all of these -- the role study done by the now deputy minister, the encouragement which Doctors Hospital received from the Hon. Allan Grossman in the years 1973, 1974 and proceeded into 1975 -- were any reason whatsoever in the decision to close down Doctors Hospital. All I am saying is that certainly this encouragement that the Doctors Hospital received from this particular ministry at this particular time emerges as one of the major reasons why Doctors Hospital is being closed. It seems to me ironical, to say the least, all the encouragement that it received. As a matter of fact, I know that the Doctors Hospital had proceeded in December of last year, knowing full well that this changeover was going to take place, to go down into the United States and hire an administrator, and as a matter of fact, as of January, 1976, the administrator took office at Doctors Hospital.

I am not going to make any interpretation of all these things. I want to leave them here and all I want to say, Mr. Chairman, is that if Doctors Hospital is going to be closing it certainly must be interpreted that the Ministry of Health has encouraged it to move in that direction of doom. I think that the ministry and the ministers who were responsible for this kind of development ought to take responsibility for that.

So to summarize, the Doctors Hospital will remain one of the most efficient institutions, at least in Metro Toronto, if not in the whole province. The Doctors Hospital reflected the multicultural needs of that particular community. Therefore, if the ministry, or if the government, thinks that this particular factor is important, and is not simply paying lip-service through the Ministry of Culture and Recreation and through the umpteen different kinds of reports that they write on this particular issue, then I think that they’d better look twice before they dismantle what happens, at present, to be a multicultural institution at its best.

If the minister would please try to get that information, I would like to get a copy of that 1971 role study, and there are also a few more questions which I really would love to know the answers to, if the ministry has any answers to them:

One, if and when the hospital closes, where will the patients go? Two, how many interpreters are there in St. Joseph’s and in Western and Toronto General? Three, what is the minister doing about the interns of Doctors Hospital? Is he intending to make sure that they don’t lose their year? Four, what is the ministry going to be doing about the doctors at the Doctors Hospital and about the nurses? And the last one is: Where will the 1,800 babies be delivered?

Thank you, Mr. Chairman.

Mr. Nixon: Mr. Chairman, there are only about three minutes remaining, and I would like to put it to the minister, having to do with the situation in Paris at the Willett hospital, that he has had the position from our chairman of the board, the mayor and others, put very strongly and clearly. From my point of view I want simply to say to him in this forum that I do believe it would be a serious mistake if, in fact, that facility were boarded up.

Now, his instructions are that the Willett Hospital will be closed as of April 1 or as soon after as possible. The minister knows that there are proper and clear alternatives to that, that fit into the constraints that he is applying as far as the reduction of costs are concerned. I sat with the minister in a meeting of, I believe, the Brantford General Hospital board in which it was clearly pointed out to him the need for chronic facilities in the Brantford-Brant community.

In the question period a couple of days ago the minister said the Willett Hospital board does not want the hospital continued as a chronic facility. He is correct in that statement. Because they, very properly, believe that if the Willett becomes only a chronic hospital in fact, we have no hospital at all.

I would suggest to the minister, however, that if this is the only alternative available then obviously we want the facility kept functioning. And I would urge as well that at least some out-patient facilities continue to be associated with the hospital.

The minister knows the arguments, of course, about the fact that the hospital was built originally with local funds. He knows the argument that all of the expansions and extensions in that hospital and those nearby were approved and certified by his predecessors. He is surely aware that the taxpayers in Paris are still paying off a debenture for the last expansion of the Willett Hospital. I believe it amounts to over $40,000.

I simply put it to him, with all of the strength that I can command, that to close up the facility and board it up so that it is of no further function to the community would be a serious and irreparable mistake. It’s not a question of heart. I suggest it is a question of clear and simple judgement.

The minister is going to be making a final decision in this connection in the very near future, perhaps in the next few hours. I would simply put to him, in the strongest opinion I can express, a call for a continuation of the Willett facility, if necessary just as a chronic facility, hopefully with out-patient responsibilities as well. I hope he is going to be able to say to the chairman of the board, and the mayor, and the other representatives of the community, that lie is giving that some further consideration.

I wish there were an opportunity, and perhaps there will be when we return to this item sometime later in the week, to continue the discussion. With that in mind, Mr. Chairman, with your permission, I move the adjournment of this debate.

Hon. F. S. Miller 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. F. S. Miller: Mr. Speaker, before moving the adjournment of the House I would like to act in the place of the House leader and point out that tomorrow afternoon the debate on the Speech from the Throne will be carried on by the leader of the Liberal Party (Mr. S. Smith). Following that, the supplementary estimates for the Health Ministry will continue in committee of supply.

Hon. F. S. Miller moved the adjournment of the House.

Motion agreed to.

The House adjourned at 10:30 p.m.