The House met at 2 p.m.

Prayers.

SUPPLEMENTARY ESTIMATES

Hon. Mr. McCague: Mr. Speaker, I have a message from the Honourable the Administrator of the Province of Ontario signed by his own hand.

Mr. Speaker: The Honourable William G. Howland, the Administrator of the Province of Ontario, transmits supplementary estimates of certain additional sums required for the services of the province for the year ending March 31, 1979, and recommends them to the Legislative Assembly, Toronto, March 27, 1979.

Hon. Mr. McCague: Mr. Speaker, the honourable members will recall I tabled a set of supplementary estimates last December amounting to $6.4 million. At that time I was pleased to note that the increases had been fully offset by decreases elsewhere, and that the government remained committed to a total expenditure ceiling of $14.482 million as announced on April 25, 1978. The supplementary estimates which are being tabled today amount to $96.165 million. Again I am pleased to report that these expenditure increases will be fully offset in other areas so that the total expenditure limit of $14.482 million for 1978-79 will be maintained.

STATEMENTS BY THE MINISTRY

PUBLIC OFFICERS ACT

Hon. F. S. Miller: Mr. Speaker, the Public Officers Act requires that within the first 15 days of every session I advise this assembly of all securities furnished on behalf of public officers and of any changes made to such securities. Since my predecessor’s statement on February 28, 1978, there have been no changes in either category.

CLEANUP OF SPILLS

Hon. Mr. Parrott: Mr. Speaker, in December I introduced a bill to amend the Environmental Protection Act, 1971, with respect to spills of pollutants including toxic substances to the natural environment. The purpose of the bill is to impose clear responsibility to clean up and provide for more immediate and more effective action in these environmental emergencies and to provide a better mechanism for recovering costs and damages from the responsible parties. Early in January the bill was circulated to appropriate members of industry, to municipalities and to other concerned groups and I invited comments.

My request received considerable response and I am now introducing a revised bill that takes into account many constructive and practical suggestions I received. The compendium of background material on this bill is being updated and will be tabled shortly.

This revised bill is intended, among other objectives:

1. To impose a clear responsibility for control, cleanup and restoration on owners and those in charge of pollutants including those involved in their manufacture, handling, transportation and disposal;

2. To broaden the authority of the minister to order control and cleanup of spills and restoration of the natural environment by those responsible, and when necessary, by other persons;

3. To enable the ministry to take immediate remedial action in the event of a spill and to pursue the question of liability later;

4. To establish liability for compensation for damage resulting from a spill and for the cost of cleanup which clarifies and extends the right to compensation at common law;

5. To enable a person who has been ordered by the minister to clean up a spill, other than a person already responsible to do so, to recover his reasonable expense from the ministry. The minister subsequently will be able to recover the amount of such expenses from the owner and person in control. This amendment is meant to save the person ordered by the minister to carry out cleanup from having to collect from or sue the owner and person in control;

6. To authorize control and cleanup of spills and restoration of the natural environment by municipalities and designated persons and to provide them with the right to recover their reasonable expenses from the owner and the person in control.

In addition, among other things, the regulations to be developed will provide for the designation of certain types of discharges of pollutants as being abnormal, thereby clearly spelling out and avoiding delay and argument over what will be regarded as a spill and subject to the legislation.

Finally, the bill gives persons ordered to do cleanup and those authorized to do so, the right to enter on private land for the business of cleanup and immunity from prosecution.

As I informed the members previously, this legislation is unequalled in Canada. We hope it will lead to a decrease in the number of spills. We know it will speed cleanup, reduce potential damage and assist any injured party by placing initial responsibility on those who own and control pollutants.

Copies of the compendium required under the standing orders were of course made available during the last session when I first introduced this bill. However I must apologize to the honourable members that I do not at this time have a summary of the amendments that have been made since that date. The reason for this is that I wanted to give interested parties as much time as possible to suggest amendments and at the same time I wanted to reintroduce it at the earliest possible moment. We are currently working on a summary of the amendments made and I will be pleased to make those available as soon as they are ready.

In addition, there are three minor amendments of which I will advise the critics prior to second reading.

INTERFLOW SYSTEMS LIMITED

Hon. Mr. Parrott: Mr. Speaker, I have a second statement on another matter, if I may present it at this time.

On March 13 in this Legislature, I gave a commitment to produce a detailed account of the situation with Interflow Systems Limited and the Upper Ottawa Street landfill site in Hamilton. This statement has been difficult to prepare, due to the risk of prejudicing upcoming court proceedings and the possibility of interfering with the on-going investigations conducted by ministry staff, Hamilton-Wentworth police and the regional municipality, but the public concern and confusion which now exists makes it imperative that I speak in some detail about the situation.

We have said repeatedly that the day-to-day operation and responsibility for what goes into this landfill site belongs to the municipality. The responsibility for operating this site in accordance with ministry environmental requirements and for deciding what waste goes into it rests with the municipal level of government. It shall continue to do so. It is their site. They are responsible for minding the gate, so to speak, as are other municipalities in Ontario.

I am not criticizing the regional municipality of Hamilton-Wentworth. They have taken prompt action when the report of our waybill audit was finished. They immediately notified police and implemented tight controls on waste being allowed into this landfill site.

My office has been informed by Hamilton-Wentworth officials that municipal staff have since been reorganized; indeed, one person was dismissed and seven were disciplined for their part in the matter. I also understand that a new bylaw is being drafted to regulate more closely activities at the landfill sites. In other words, the municipality has accepted its responsibility.

The ministry has also taken action on this matter and on the entire problem of liquid waste disposal. I need not review my seven-point plan, but I will point out that our new waybill system is proving itself effective in dealing with this situation.

Much has been made of the “samples” supplied to the ministry’s regional office in Stoney Creek. I would like to make a few comments about this well-known scientific practice of pop-bottle testing.

In December 1976, two individuals dropped into our office with two pop bottles which they said contained samples from a load of waste delivered to Interflow and from another load hauled from Interflow to the landfill site. It was the understanding of the regional staff that these samples were given to them in strict confidence.

I would like to point out that the individuals were from a company operating in competition with Interflow; and it is not unusual for ministry staff to hear allegations from those in the waste disposal business against their competitors.

These samples had not been collected in an acceptable scientific manner. Since we had no way of determining whether they were representative of the loads they were taken from, no analysis was done in our laboratory.

Other than knowing what was in the bottles, an analysis would not have proved illegal activity. Disposal of liquid waste in this landfill site is not in itself illegal. The certificate of approval which we gave the municipality for the Upper Ottawa Street site allows licensed haulers to dispose of liquid waste there.

Mr. S. Smith: The fact that it came from outside Hamilton-Wentworth was illegal; that is against your certificate of approval.

Hon. Mr. Parrott: And who is running that site? Listen, please.

Mr. Nixon: No one is listening.

Hon. Mr. Parrott: It is the responsibility of the municipality; let that be very clear.

A Liberal researcher asked staff if they had had a meeting with three waste haulers. Staff said they did not recall such a meeting and asked for the date. A check of the files revealed that two persons had visited the office two years before. When reporters made inquiries, the visit was confirmed.

However, the ministry staff had suspected problems well before that visit. During 1976 and 1977, they conducted innumerable spot checks on Interflow, K-D Enterprises and the landfill site. Many visits were made incognito, as well as in the middle of the night, in an attempt to obtain evidence if illegal activities were going on. Both companies were also asked to supply additional information on the handling of their liquid waste. This they did. But no evidence of illegal activities was found.

The waybill system, with which we now keep tabs on what waste goes where, had only recently been introduced on an experimental and voluntary basis to give the ministry and industry time to become familiar with it. But it was not until April 1977 that this became a legal requirement.

During 1977, Interflow operations were closely monitored. On several occasions the ministry directed cleanups of minor spills on the company site. On November 29, 1977, Interflow was convicted on two charges for violation of the Environmental Protection Act and fined $2,500 and $500.

In December, staff supervised removal of contaminated soil and repairs to a leaking lagoon liner.

In the first eight months of 1978, staff conducted limited auditing of waybills, night-time investigations and indeed even tailed company trucks. But, again, no admissible evidence of illegal activities was found. Problems with linings of lagoons and improper piping were discovered. Requests for repairs were complied with.

It has been implied that trucks were illegally dumping waste at the site at night. We do not deny there is a lot of trucking activity there during the night. But most of it involves dumping of city street sweepings.

Mr. S. Smith: It was a foul-smelling liquid, my friend.

Hon. Mr. Parrott: Is the Leader of the Opposition saying most or all? Or what is he saying?

[2:15]

Mr. S. Smith: I have between six and 12 cases of foul-smelling liquid --

Mr. Speaker: Order. Questions and answers come later.

Hon. Mr. Parrott: It isn’t even a large portion. Most of it is city sweepings.

It is interesting to note that company officials complained of harassment by our regional staff -- a rather interesting note, I might add, that the company complained of our harassment.

In September 1978, more work on the waybill system made it possible to do a detailed audit of records. I cannot go into the details of that audit, nor would it be appropriate to discuss further the charges that have now been laid, but I would like to point out that the ministry lawyers, as well as staff from the ministry’s Stoney Creek office, have conducted countless interviews with truckers and officials from the municipality, Interflow and industries.

Statements have been made that people could die of cancer or suffer birth defects, as at Love Canal, because of this situation. Let me stress that public health is not in danger. Since the early 1960s we have regularly monitored Red Hill Creek which contains water that has seeped from the landfill site, called leachate. Monthly tests done at locations above and below the site have not found the presence of liquid industrial waste in the creek.

In the past two years we have stepped up the number of tests, and additional samples have been taken from leachate on the site itself. The results are the same. Most of the liquid waste that went into the landfill site consisted of water used to wash industrial tanks that held substances like oil, caustics and rust preventive material.

I am deeply concerned over the misleading and inaccurate information spread by the Leader of the Opposition.

Mr. S. Smith: Right on every time.

Hon. Mr. Parrott: He has asked for a judicial investigation. The ministry is investigating, the regional municipality is investigating --

Mr. S. Smith: Investigating itself. I am very impressed.

Hon. Mr. Parrott: -- and the police are investigating. His unfounded allegations have only served to deflect much of their efforts and have delayed a comprehensive and reasonable assessment of the facts of the case.

The leader of the Liberal Party has made statements about ministry staff looking the other way because of dereliction of duty or because they were paid off. He has talked of illegal dumping and threats to health. I realize a by-election is on, but surely some responsibility should be exercised. If the leader has evidence, he should bring it forward in the interest of justice.

Mr. S. Smith: You waited until the Christmas break before bringing forward the evidence.

Hon. Mr. Parrott: Let me repeat that: If the hon. member has evidence, let him bring it forward in the name of justice. And if he does not wish to present it to myself, then at least he can present it to the Attorney General (Mr. McMurtry) or the police.

Mr. Kerrio: Do you want them to do your job for you?

Hon. Mr. Parrott: On January 25 I asked the Leader of the Opposition in a letter, on a formal basis, to present that information.

I again asked him on March 13. Instead, he has chosen to drop those insinuations in the media.

Mr. S. Smith: You ignored the information you were given.

Hon. Mr. Parrott: If you had listened to what I have said in the last 10 minutes you would know that I have not --

Mr. Speaker: Order. Will the minister confine his remarks to his original statement? This is ministerial statements.

Hon. Mr. Parrott: I will be glad to, Mr. Speaker, if I don’t have to deal with any interjections.

The Leader of the Opposition has claimed it was his pursuit of this issue that produced action. His first question in the House was on October 31, 1978. As I have pointed out, ministry staff were well aware of the situation in 1976 and have pursued it with all means at their disposal.

The Liberal leader has asked that ministry staff should be dismissed for their handling of this situation. I do not agree. He knows that on another occasion here in this very House I criticized staff for actions they took that I did not agree with. In this case I find no reason to criticize staff; in fact, I would commend their efforts.

I feel his accusations are unfair, because staff cannot defend themselves. I regret he chose to cast doubt on the integrity of those people, with remarks that in our opinion border on slander. I wish him to know that the Hamilton-Wentworth police have told us that their investigation has cleared the ministry staff of any illegal activities or involvement in taking money; or “looking the other way,” as he has so often accused them of doing.

Many of the individuals working in the Stoney Creek office reside in the Hamilton region. They and their families have had to live with the embarrassment caused by the leader’s charges. I have spoken to them and I know the kind of insinuations that have been made to them. I feel a great deal of compassion for them.

Mr. Speaker, I would hope that the member for Hamilton West would have the courage to offer an immediate and public apology to my staff for the suffering he has subjected them to with his unfounded attacks on their professional reputations.

The ministry has certainly had its major concerns that all was not right. But the leader does not seem to realize that we must produce concrete evidence before actions can be taken. I hope he has now learned that the kind of allegations he made cannot be substituted for careful homework and investigation.

Interjections.

Hon. Mr. Parrott: Mr. Speaker, it is very difficult to ignore those interjections. In the last eight pages of this text I have put on the record what has been done. I had to be very careful in doing so because I do not wish to prejudice the trial.

In the future, I would like the leader to exercise greater care and I would welcome more co-operation from him in enforcing our laws. I intend to prosecute those who violate them, but I do not wish to try anyone in a kangaroo court conducted in the public media or in the Legislature by the Leader of the Opposition.

I have an obligation to do justice now and in the future. I wish that he shared it.

HOME RENEWAL PROGRAM

Hon. Mr. Bennett: Mr. Speaker, it gives me a great deal of pleasure to inform the honourable members that the very popular Ontario Home Renewal Program has been renewed for another year.

Recognizing OHRP’s value to municipalities and home owners throughout Ontario, my cabinet colleagues agreed to allocate $20 million for this year’s program.

Since 1974, some 22,000 home owners in some 615 municipalities have received more than $82.2 million in OHRP loans. In addition, another $4.2 million was approved for 811 loans to the residents of unorganized territories.

OHRP provides grants to municipalities to administer directly as loans of up to $7,500 to low and moderate-income home owner occupants for home improvements. A portion of the loan may be forgiven and interest rates vary from zero to eight per cent, depending upon the home owner’s income.

GRIEVANCE ARBITRATION

Hon. Mr. Elgie: Mr. Speaker, later today I wish to introduce a bill to amend the Labour Relations Act. The purpose of this bill is to reform the grievance arbitration procedure.

Members will recall that in July 1978 an industrial inquiry commissioner, the Honourable Arthur Kelly, reported to my predecessor on certain perceived problems relating to grievance arbitration under the Labour Relations Act. He made a number of recommendations as to how the existing system might be improved.

Mr. Cassidy: It’s taken so long, it’s shameful.

Hon. Mr. Elgie: I have now had an opportunity to consider the commissioner’s recommendations, as well as the comments of a number of employers, trade unions and arbitrators, to whom the report was sent for comment. In addition, I had the benefit of hearing the views of some members of this Legislature during consideration of my ministry’s estimates before the standing committee on resources development.

The bill I am introducing has three main purposes: first, to expedite the hearing of unresolved grievances; second, to provide third-party assistance to aid in the settlement of grievances, and third, to reduce the cost of arbitrating those disputes that cannot be settled.

The amendments proposed are simple in form but significant in impact. They enable either party to apply to the minister for the appointment of a single arbitrator 30 days after the grievance is filed, or following the completion of the grievance procedure, whichever occurs first. On receipt of such request, the minister must appoint an arbitrator who is able to commence the hearing of the dispute within 21 days of the receipt of the request for arbitration. Grievances involving termination of employment will be dealt with even more expeditiously.

The amendments further provide that upon receipt of a request for the appointment of an arbitrator, the minister may assign a grievance settlement officer to confer with the parties to assist him in arriving at a mediated settlement.

In addition, the amendments provide for the enactment of regulations fixing scales of remuneration for arbitrators and providing procedures for the review and resolution of disputed accounts.

Finally, the bill repeals the Labour-Management Arbitration Commission Act.

I believe the proposed amendments, while preserving the best features of the existing arbitration system, effectively and fairly address the problems of delay and of cost -- the two major issues which led to the establishment of the Kelly commission. With the passage of this bill, and with the co-operation of employers, trade unions and arbitrators, upon which I am confident we can rely, Ontario should have one of the finest grievance arbitration systems of any jurisdiction in North America.

ORAL QUESTIONS

DISPOSAL OF HAZARDOUS WASTES

Mr. S. Smith: A question of the Minister of the Environment: In view of the statements by members of his ministry that they are seeking those dumps that may have accepted hazardous liquid wastes in the past, and that they have no record of where these dumps are, can he explain such a statement from his ministry, when there exists this document from 1974, which I draw to his attention, called Land Drainage Reference Study, Task 2B?

This document -- which I may say was made up by a consultant from records in 1974, provided by the Ministry of the Environment itself -- contains maps and descriptions of 13 sites in the province that are listed as having accepted hazardous wastes. I would ask the minister if the ministry has lost this information, which it seemed to have for the consultant who drew up this report in 1974? Had the officials in his ministry simply not seen this report when they announced that they didn’t know where these hazardous locations might be found? Can he tell us how many of the sites referred to in this report are in fact still operating?

Hon. Mr. Parrott: On the very last portion, I would be prepared to get that information for the member. I think what we are saying with regard to the number of sites is that indeed there could be sites in Ontario that were in operation, were closed, that we would not be aware of; sites in the 1930s, the 1940s, the 1950s, the 1960s -- long before we, as a ministry, were formed -- that could have easily been opened and closed and no specific records known of them.

This summer we are making a further and complete search of all of those sites. We’ll have as complete an inventory as it is humanly possible to do of the sites throughout Ontario.

Had we or had any government had a ministry of the environment back in the 1920s and 1930s, it would be easy to have those records. But since neither we, nor any other jurisdiction, had those records, it’s now up to us to try to find as many of them as we can. It will be a difficult task, but we’re prepared to do it.

Mr. Breithaupt: I presume it all happened before 1943.

Hon. Mr. Davis: Certainly; you are right.

[2:30]

Mr. S. Smith: Supplementary: In view of the fact that in 1974 there were records, maps and descriptions of at least 13 sites listed as having accepted hazardous wastes, can the minister tell us whether that information, subsequently incorporated into this report, has since been lost by the ministry? I think that is a reasonable question.

While he is thinking about the answer to that question, may I also ask another question by way of supplementary? In view of his response to the resources development committee last fall, in which the minister was asked for a list of sites licensed to accept liquid wastes -- part of his information there noted eight sites which had accepted liquid wastes and now are closed, yet this report shows that as of 1974 as many as 15 sites were licensed to accept liquid wastes exclusively; interestingly, only three of the eight sites listed by the minister show up in the 15 here -- what about the other 12? Why were they not on his list?

Hon. Mr. Parrott: We will be more than pleased to identify those and to supply that information. The point I was trying to make, and I will try to make it again, was that we do not have full knowledge of all the sites that may have been opened and closed in the province prior to any particular date. Certainly we have not lost that information. If the member wants us to correlate it in, if you will, a more logical fashion for him, we are prepared to do so. I think that is easily done. If it will help, we will do it.

Mr. Cassidy: Supplementary, Mr. Speaker: In view of the fact that the ministry itself has estimated that there are more than 2,000 landfill sites that have been used across Ontario, and not just the 13 that have been referred to, can the minister undertake, in the first place, that his ministry will be seeking to establish how many of those more than 2,000 landfill sites received hazardous liquid industrial wastes; and, secondly, will there be a complete record made available to the public at the earliest opportunity so that the public will know which of these sites will be used for hazardous wastes and what is being done about it?

Hon. Mr. Parrott: There is no doubt that we will do that, Mr. Speaker, and we are pleased to do so. I draw to the attention of the leader of the third party, however, that finding these sites will not necessarily be easy, and certainly determining what went into those sites 30 years ago is not going to be easy either. We are flying over certain areas which we suspect likely would have sites, and we are doing a great deal.

Mr. Cassidy: You should do it if we’re not going to have any Love Canals in this province.

Hon. Mr. Parrott: Let is not extrapolate too far.

Mr. Cassidy: Let’s not extrapolate too little either.

Hon. Mr. Parrott: I can tell the member that in our judgement today there is absolutely no fear of a Love Canal in Ontario. Let us be very clear on that point. But I am not going to stand in this House and give that kind of assurance when there can be the tiniest fraction of doubt. We are going to search out as many sites as --

Mr. Cassidy: That’s right. Those words may come back to haunt you.

Hon. Mr. Parrott: If the member would permit me the full answer, I said that, having made that statement, it is my unconditional belief, and the belief of my ministry, that that is true. But because I have a great concern, and indeed this government has a great concern, for the health of the people, it does not give us a licence to make that statement and then to rest on our laurels. We are not going to do that. We will continue to search out as many areas as we possibly can.

I say to the member, if he has a spot he thinks should be investigated in detail, he should let us know; we will do it. Not only that, but that information will be as public as he wishes it to be. We have nothing to fear. We have nothing to hide. We will be better served if all of us know as much as we can about that problem.

Mr. S. Smith: Supplementary: Since the fact is that in 1974 the ministry apparently knew of 13 hazardous waste sites which now it apparently doesn’t know about, and since it knew of 12 liquid waste sites which the minister didn’t bother to mention in his report to the resources development committee, and which again I therefore assume the ministry doesn’t know about, I ask the minister if they have lost the information.

By way of answering that question, I will send the minister a list of the permit numbers of the 13 hazardous waste sites. Would the minister be kind enough to undertake in this House to send us copies of the certificates of approval for those sites, copies of any site inspection certificates and, while he is at it, copies of site inspection certificates for the Upper Ottawa Street site as well?

Hon. Mr. Parrott: I just can’t comprehend why the leader didn’t hear me say that I would correlate that information. We haven’t lost sight of what he has just said for the third time that we must have. I have rejected that statement three times. We will correlate it for him and will be glad to do it. That’s no problem at all. But please don’t ask me for the fourth time to say that I disagree that we have lost sight of it. We haven’t, for the last time, I hope.

Mr. S. Smith: Why didn’t you report it to the committee?

Ms. Bryden: Since I believe there are something like 900 fewer landfill sites now than there were in 1970, it seems to me the minister cannot say there are no potential Love Canals in Ontario until he knows what is in those 900 closed sites. I would like to ask him is he just taking an inventory of sites or is he actually digging into them and taking a test of what is underneath.

Mr. Havrot: All 900. Yes, he is digging into them all.

Mr. Wildman: That would be something for the member for Timiskaming to do.

Hon. Mr. Parrott: I said it was my un- conditional belief that there was no danger and I am very sure of that.

As we try to address this problem, one should perhaps look at our history a little bit. I think there is a lot of comfort in that. We have been basically an agricultural community. We haven’t been a highly industrialized society, a chemical society, nearly as much as have our neighbours to the south. They are now seeing some of the great side effects and unpleasant effects of a chemical industry. I think we are fortunate in that regard. It is a fact of our history.

Mr. Riddell: The farmers have saved your hide again.

Hon. Mr. Parrott: I am glad they have and I am glad that I too, am a farmer and can share in that heritage.

Mr. Breithaupt: You are certainly spreading it around right now.

Hon. Mr. Parrott: I think it gives us a far greater assurance that it isn’t likely to happen in Ontario. I will assure the member that we are now looking into those sites that we are aware of. We are digging into them. We are quite prepared to investigate them as thoroughly as she or I think it should be done. I want that done. I want it on the record that it has been done because I think we have a great obligation to the people of Ontario to guarantee the statement I just made. We will continue to work at that. We want to be very, very sure about safeguarding the health of the people of this province.

Mr. MacDonald: Tell the honourable member for Timiskaming. He laughed at it.

Hon. Mr. Parrott: I think the member might recognize that our greater concern is not so much what is happening here in Ontario, but in those jurisdictions which have not been so careful as Ontario. Because there is no way one can stop air circulation in North America or water entering into our Great Lakes, we have some concerns coming from other jurisdictions. But I think it is easily proved that we have done the best job of any jurisdiction in North America in many of these areas.

Mr. Martel: That’s taking it too far. The minister should have quit while he was ahead.

[Later (2:50):]

Mr. Speaker: Does the minister have a point of order?

Hon. Mr. Parrott: Yes. I am not quite sure whether it is order or privilege and I am certainly not trying to be provocative on this point. But I thought, regarding the point the Leader of the Opposition made to the effect that our ministry had supplied that information on the 13 sites, I note that it was from Environment Canada. We may have supplied it, but the information was from Environment Canada.

Mr. S. Smith: But the data were from the ministry.

Hon. Mr. Parrott: I thought it was inferred that we had given that report, and I think in fact -- well I read here: “Task 2B Report: Waste Disposal Site. Prepared for Canada Department of the Environment by two independent researchers.”

I am not trying to be provocative, I am simply saying I hope it is on the record that this was a Canadian report rather than --

Mr. Speaker: Talking on the point of clarification.

Mr. S. Smith: If I may respond on the clarification: Indeed, the report, of course, is from Environment Canada. It was provided to us by the provincial Ministry of Natural Resources. But the data used by the researchers, according to the researchers themselves, came from Ontario Ministry of the Environment records. That is where they got the data to draw up these maps and it is very questionable as to whether that data still exists within the ministry.

[Reverting (2:39:)]

PHYSICIANS OPTING OUT OF OHIP

Mr. S. Smith: I have a question for the Minister of Health. Now that the minister is aware that anaesthetists at Toronto Western Hospital, and for that matter at North York General, Scarborough General and Branson Hospital, have all opted out, and that consequently any patient who goes for surgery at those hospitals is then subjected to a means test administered by the physicians themselves, one would assume, could he tell us how he feels about that particular erosion of the universal health care system and whether he is prepared to accept the means test philosophy, a philosophy which is apparently well known and well liked by the Minister of Education (Miss Stephenson) of this province? Is the Minister of Health willing to accept that doctors will apply that kind of means test?

Hon. Mr. Timbrell: Let us perhaps deal with one example I asked my staff to look into and about which they reported. In the case of the Toronto Western Hospital, where the anaesthetists have apparently been opted out for a number of years, fully 70 per cent of the services provided are billed through the billing group on an opted-in basis.

Mr. S. Smith: A means test is what you call it.

Hon. Mr. Timbrell: I look at it this way, and I think this is a principle that certainly has stood the test of time though I will acknowledge that perhaps we need to look at ways to reaffirm it. The principle is that wherever possible the agreement of the patient should be obtained first.

Mr. S. Smith: Wherever possible.

Hon. Mr. Timbrell: I say “wherever possible” because there are cases --

Mr. S. Smith: Just before surgery.

Hon. Mr. Timbrell: -- where a person will be brought into hospital unconscious and wouldn’t have the opportunity to agree or not. In those cases, it is my view and it is my understanding that it is general practice that they should not be charged in excess of the OHIP rate.

Mr. Swart: The doctors wait until they come to and then ask for it.

Hon. Mr. Timbrell: As part of our --

Mr. Warner: You are an apologist for the OMA.

Mr. Speaker: Order.

Mr. S. Smith: They apply a means test; they don’t ask anybody.

Hon. Mr. Timbrell: I come at it from the other side. The Leader of the Opposition is coming at it in a different way.

Mr. Swart: You sure do, but not from the public side.

Mr. Warner: Go run a Mr. Submarine somewhere.

Hon. Mr. Timbrell: I say that the person should have the opportunity to review it and must agree before the provision of the service.

Mr. S. Smith: The minister knows they don’t.

Hon. Mr. Timbrell: I’m afraid that’s not the experience and it’s not the information I have; otherwise I think we’d have hard examples of people actually being deferred from necessary medical care.

As members know, we are reviewing with the medical association how we can revise the mechanism by which we negotiate their fee schedules. In fact, we are now talking about a specific document. We’re at the point where we are looking at a specific proposal. It seems to me that that principle, that an individual should have to agree beforehand, is one that has served us well. It may well be that we have to look at, and we will look at, possible ways of --

Mrs. Campbell: Opening the hospitals.

Hon. Mr. Timbrell: -- reaffirming that principle.

Mr. Warner: Try ways of protecting the patient. That would be a good way to start.

Mr. S. Smith: By way of supplementary, what is the minister saying? Is he not aware that certainly at the Toronto Western the chief anaesthetist is on record as saying that they don’t charge certain patients the extra because they feel the patients are too poor and that they make that judgement based on their own opinion about the patient’s working status and one thing and another?

Is the minister now saying that as long as a patient agrees to pay the extra, it’s quite all right for the doctor to charge it, even though these people are facing surgery, but if the patient doesn’t agree, then the doctor has no business charging it? Do I take it that what the minister is saying is any patient who simply says, “No, I do not want to pay the extra,” shall not be charged the extra by an opted-out doctor? Is that not what the minister is saying?

Hon. Mr. Timbrell: No. What we are saying is what is the strength of our system which has served the province well.

Mr. Swart: It’s breaking down now. Does the minister realize that?

Mr. Warner: You put it in the past tense. The system is being destroyed and you know it.

Hon. Mir. Timbrell: In fact, every province has in one means or another a variation. In Saskatchewan they have what’s called balanced billing where they can patient-stream anywhere at any time, in a physician’s office or elsewhere, on any account In other provinces, they have other variations. Every province is different in one way or another, although they all meet the principles of the Hospital Insurance and Diagnostic Services Act.

Mr. Swart: And this is the worst.

Hon. Mr. Timbrell: What I said was, to use a specific example of someone who perhaps comes into emergency unconscious, in that particular case it is my view -- and I understand it is general practice -- that that individual should not pay above the OHIP rate.

Mr. S. Smith: We’re not talking about that.

Mr. Cassidy: You have to be unconscious to avoid their surcharge.

Hon. Mr. Timbrell: What I’m saying is, that has been the principle that has been agreed to and supported by the medical profession --

Mr. Martel: You just knock them all out first.

Mr. McClellan: Medicare for the unconscious. If you are conscious you can’t have universal health care.

Hon. Mr. Timbrell: -- and by the health plan since the beginnings of the health plan. As part of our discussions with them, what I’m saying is we are looking at whether there is any need in some way to strengthen that and to reaffirm that principle.

Mr. Laughren: Supplementary: In view of the minister’s statement that opted-out physicians should not impose a hardship on people receiving health care in the province of Ontario and in view of the fact that the OMA has indicated the same, could the minister explain to me why it is that striking miners in Sudbury receiving $25 per week are receiving notices from opted-out physicians indicating that if they don’t pay up their bill will be sent to a collection agency? How does that fit with the minister’s indication that people in Ontario will have equal access to health care?

Hon. Mr. Timbrell: First of all, I have to go back and point out that in that particular area of the province the level of opting out is extremely low compared to the other parts of the province.

Mr. Swart: You don’t have to go back; you’re as far back as you can go.

Mr. Warner: Look at the bills.

Hon. Mr. Timbrell: Secondly, the basic philosophy of our system is that it is based on options for the patient and options for the physician. In that particular area, there are a great many options available with opted-in physicians as there are in all parts of the province.

[2:45]

Mr. Warner: The only one who should opt out is you.

Mr. S. Smith: Is the minister of the belief that in 1979 the public of Ontario is ready to turn back the clock and, when entering public hospitals, is now prepared once again to let doctors decide who shall pay and who shall not pay? Is he of the belief that that kind of doctor-administered means test is once again to be part of the health-care system here in Ontario in public hospitals or does he not see the necessity to have within the public hospital system those people who are prepared in fact to work within the insurance plan?

Hon. Mr. Timbrell: Mr. Speaker, I think again the last part of the question suggests exactly what we are talking about, that there be options, and to take the example of the west -- I don’t support or condone the principle of means test as you call it. What I am stating as the basic principle we have always worked upon, and which I acknowledge we may need to reaffirm in some tangible way, is that patients should have to agree and if they don’t agree they should not be billed.

Mr. S. Smith: With a knife over them.

Hon. Mr. Timbrell: Mr. Speaker, the member engages in hyperbole. It’s not a question of a knife over them. I already gave the member my views on the instance where the individual might be brought into emergency and not be in a position to agree, to even consider it.

Mr. Breaugh: Could I ask the minister whether I read correctly what he has just said. He has just said to the people of Ontario that if they don’t want to pay extra services, fees or over the approved rate, they simply don’t agree to it; the doctor must provide the service and the patient has the option then to agree or not to agree to pay that amount of money. Is that correct?

Hon. Mr. Timbrell: I am saying and I have said all along, Mr. Speaker, that it is the availability of options that is important. In fact in hospitals it is the billing groups that ensure the options are available. What I am saying is that the patient should agree first, and if they don’t then change the doctor --

Interjections.

Hon. Mr. Timbrell: Mr. Speaker, there are bound to be some cases where they are not in a position to consider it and in those cases they shouldn’t have to pay.

Mrs. Campbell: Mr. Speaker, I would like to address the question of the opportunities and alternatives. Is it not a fact that at North York General not only the anaesthetists opted out but so have the obstetricians? What is the function of the ministry in the funding of these so-called public hospitals where a whole staff would opt out? Has the minister given thought to his position vis-à-vis the open or closed hospitals?

Mr. Breithaupt: What are the patient’s options then?

Mr. S. Smith: You give the patient a choice.

Hon. Mr. Timbrell: Mr. Speaker, I don’t see the connection between the two but perhaps the member could make the point at a later date. Essentially, what we are saying is -- and this is since the beginnings of the plan -- the strength of the plan has been based on the options available. The evidence would indicate, from the inquiries we have had from the public over the last number of years and the investigations we have made to date, we found, for instance at the Western, even though the entire anaesthesia staff has opted out, fully 70 per cent of the claims have been on an opted-in basis.

Mr. S. Smith: On a means test.

Mr. Breithaupt: There is no option for the patient.

Hon. Mr. Timbrell: Mr. Speaker, I have already answered that point, I think. It would seem that in fact the public has been served well by the system that we have in this province.

Mrs. Campbell: In the past.

Hon. Mr. Timbrell: And currently. There’s absolutely no indication that the four principles of accessibility and universality of coverage and so forth of the plans, as embodied in the Health Insurance and Diagnostic Services Act, are being compromised.

Mr. Speaker: A new question; the member for Ottawa Centre.

Mr. Cassidy: Mr. Speaker, I want to pursue with the Minister of Health this question of the degree of opting out by surgeons and by other specialists in various hospitals around the province; and also ask about the kind of options that are in fact available to patients in situations where every practitioner in a particular specialty in a particular hospital has opted out of the plan.

If I can be specific, Mr. Speaker. In view of the fact that there are no anaesthetists providing services at the insured rates at Toronto Women’s College Hospital or at St. Joseph’s Hospital in west Toronto; in view of the fact that all seven obstetrician-gynecologists accredited to Scarborough General have opted out; in view of the fact that all the pediatricians at Northwestern Hospital have opted out; in view of the fact that seven of the nine psychiatrists at Toronto Women’s College Hospital have opted out; in view of the fact that many other hospitals we contacted in the past week would not, in fact, provide information on the number of opted-out specialists on their staff; will the minister now make available, for each specialty and for each community in the province, the number of doctors who opted out and the number who have remained in the plan?

Will he also say whether he really believes that the amount of opting out by specialists is not, in fact, a threat to the universality of health care in this province?

Hon. Mr. Timbrell: Mr. Speaker, I have to go back to this fact: If members look at the history of the health plan as we know it in Ontario, I would point out that every one of the 10 provinces has a slightly different plan one way or another --

Mr. Swart: Not quite as bad as this.

Hon. Mr. Davis: Oh Mel, you know better.

Mr. McClellan: What about Quebec?

Hon. Mr. Timbrell: -- a number of them involving additional billing options; including Saskatchewan, that allows patient streaming of any patient -- any patient on any service.

Mr. Martel: Three per cent.

Hon. Mr. Timbrell: Patient streaming and extra billing.

Mr. McClellan: Three per cent, and they are worried about it.

Hon. Mr. Davis: You are trying to have it both ways.

Mr. Warner: You don’t care about Quebec.

Mr. McClellan: You couldn’t care less.

Hon. Mr. Timbrell: Now I suspect, Mr. Speaker, if you look at any situation over the last number of years in any of the teaching hospitals, in those instances where we have groups of specialists opted out you will find an experience similar to the one we found when we inquired about Toronto Western. In that case a very high percentage of claims had, in fact, been billed on an opted-in basis. That is because for years they have had the right in the teaching hospitals to have billing groups. That right, as members know, was extended to all the clinical departments --

Mr. McClellan: Why don’t you just give us the information?

Hon. Mr. Timbrell: -- of the non-teaching hospitals earlier this year as a means of ensuring options for the patients.

I will take the member’s other question under advisement and give him an answer in a few days.

Mr. Cassidy: Supplementary, Mr. Speaker: Let me take a specific instance and then ask the minister if he can defend this.

At York-Finch Hospital all four dental surgeons on the staff have opted out of OHIP. Is the minister not aware of the particular case of a 76-year-old pensioner at that hospital, a man named Mr. Nick Laurella, of very modest means, who had a lung removed in June? He is now facing a bill for $167.50, in addition to the $433.50 paid by OHIP. His doctor has refused to listen to repeated protests by Mr. Laurella’s family that they cannot pay and could they please be excused? Does this kind of charge not constitute a deterrent to vitally needed health care; and how on earth can the minister tolerate a pensioner or any other citizen in the province of Ontario being put into this kind of situation?

Hon. Mr. Timbrell: First of all, Mr. Speaker, I have some difficulty in acknowledging that it is a deterrent when in fact the individual got the service. He got the service.

Interjections.

Mr. Warner: The system is crumbling around you and you’re doing nothing about it.

Hon. Mr. Timbrell: The second point is I would want to be sure that in fact it was discussed with the patient beforehand and that he agreed. What I am saying is I feel that it is a generally accepted principle --

Interjections.

Hon. Mr. Timbrell: I said I would want to know whether it was discussed with him beforehand, because it is a generally accepted principle, certainly by the government and by the profession, that it should be discussed with the patient beforehand except in those cases which we have discussed several times already today where you cannot discuss it with him, and that they should agree to it; that they then should have the option to find a doctor who will do it on an opted-in basis. That is the important point.

Interjections.

Mr. Roy: Supplementary: Trying to understand the ministry’s reasoning, and accepting the fact that as part of the opting out if the patient has a choice then the process can work -- if your general practitioner has opted out you can go down the street to somebody else, Mr. Speaker -- but can the minister explain, getting back to my leader’s question, what choice a patient has when he is sent to one of the hospitals mentioned and all the anaesthetists are opted out? When he is in bed in that hospital or wheeled over to the operating room, at what point is he given a choice? Can the minister explain to us here, does he feel that is a choice once the patient is in the hospital? And secondly, does he expect a patient in those circumstances to just get up, pack his bags, leave and go someplace else? Does the minister consider that to be accessibility and universality?

Hon. Mr. Timbrell: Mr. Speaker, in that particular case the evidence would seem to indicate that -- to continue that review -- 70 per cent of the claims are on an opted-in basis; the system has been working as it is supposed to work, in general. Maybe we will find specific ones where it hasn’t.

Mr. Roy: You have been given an example where it hasn’t.

Mr. Cassidy: You are hiding behind your averages.

Hon. Mr. Timbrell: The way we expect it to work is that it would be discussed with the patient beforehand and if the patient didn’t agree that he could then seek out another physician --

Mr. Martel: Yes, get out of his bed and find another doctor.

Hon. Mr. Timbrell: No, that is not what I am saying -- on staff to do it on an opted- in basis.

An hon. member: What about emergencies?

Mr. Makarchuk: He is put in there by another doctor.

Mr. Rotenberg: Why don’t you wait for the answer?

Mr. Warner: The system is crumbling and you know it. It is falling apart.

Hon. Mr. Timbrell: The evidence would seem to indicate that it is working that way.

Mr. Breaugh: I would like to ask the minister in this regard: In a telephone survey in recent days we called hospitals and the hospital would not tell us whether certain specialists had opted in or opted out. How is a patient supposed to know whether he can receive that service by an opted-in physician when the hospital doesn’t tell the patient whether they are in or out, and in some cases says they don’t know? How is the patient supposed to find out?

Mr. McClellan: Not from the Minister of Health, they won’t.

Interjections.

Hon. Mr. Timbrell: I think, first of all, it has been widely known -- and I will acknowledge that perhaps more needs to be done to make sure that it is even more widely known -- that the patient does have the option, that they can choose.

An hon. member: How can they choose when they don’t know?

Mr. Makarchuk: It is another doctor who sends him to the hospital.

Mr. Rotenberg: Why don’t you wait for the answer? Stop yelling over there. Just wait for the answer.

Mr. Makarchuk: He doesn’t have any answers.

Mr. Cassidy: Because it is outrageous, that’s why.

Mr. Speaker: Order.

Hon. Mr. Timbrell: Mr. Speaker, I can only point to the record of the health system these number of years. There is no evidence whatsoever -- none whatsoever -- that people have in fact been deterred from necessary medical care by our system.

Mr. Martel: Answer the question. They won’t give you the list.

Mr. Cassidy: The minister says there is no evidence. I just want to bring to his attention the fact --

Mr. Speaker: This is your second question.

Mr. Cassidy: This is my second question, Mr. Speaker -- that in the case I just brought to his attention, Mr. Laurella, this 76-year- old fellow was Italian-speaking, there was no advance notice given to him or his family. When the family, both verbally and then in writing, made the request to the physician to say, “Look, we can’t afford it” --

Mr. Rotenberg: What’s the question? Mr. Cassidy: -- the physician simply insisted on continuing with his demands for $167.50, despite the inability of either the patient or the family to pay.

[3:00]

Mr. Speaker: No question yet.

Mr. Cassidy: In view of the minister’s repeated insistence today that doctors should inform patients in advance if they are going to charge more than the OHIP rate, I would like to ask the minister whether he is aware that section 26 of regulation 577/75 of the Health Disciplines Act provides for disciplinary action against physicians who fail to notify patients in advance if they intend to charge more than the Ontario Medical Association fee schedule, but the regulation is in fact silent in insisting that a doctor tell a patient he intends to charge a surcharge over the OHIP fee, even though that surcharge is now averaging around 42 per cent?

I would like to ask the minister if he will undertake now, here in this House, to change the regulations in order to ensure that patients of opted-out physicians are, in fact, informed in advance if their doctor has opted out and intends to charge more than the OHIP fee, and how much more?

Mr. Swart: Give that commitment.

Hon. Mr. Timbrell: I can tell members that that is, in fact, what we have under consideration as part of the discussions with the OMA on the fee-negotiating process. That is the position we are taking.

Mr. Cassidy: Supplementary: Given the failure of the minister to give the commitment now -- if he is really committed to defending medicare he should have made that commitment here in this House, this has been an issue long enough for him to have made his mind up by now.

Interjections.

Mr. Cassidy: Since the minister says that the consumers of health should be informed, that an informed consumer is a good consumer, is he prepared to ensure that the consumers of health can at least find a physician who is practising under OHIP? Will he do that by publishing, on a regular basis, for each community in the province, a list of those physicians who are in and those who are out of OHIP?

Hon. Mr. Timbrell: It is my understanding that it would, in fact, be a violation of the Health Insurance Act --

Mr. Swart: Change it.

Hon. Mr. Timbrell: -- to publish physicians’ names. What is more, I think that, again based on the experience with the plan, ensuring the public’s knowledge of their rights, ensuring that this principle is upheld, will in fact serve the public interest best.

Mr. Warner: You are destroying this system we fought so hard for.

Mr. S. Smith: As the minister goes about permitting these little erosions of the principle of universality --

Mr. Swart: Little?

Mr. Warner: The system is being destroyed.

Mr. S. Smith: -- to the point of complete dismantling, is he also, in fact, prepared to countenance the matter we saw discussed in a newspaper today? That is the question of insurance companies being permitted to insure for the amounts above the OHIP rates? Does he not realize that if he permits this to happen, he could succeed in completely dismantling the system and turning back the clock to where he seems to want to go; that is to when doctors said who must pay and who must not pay?

Mr. Warner: That is the next step.

Hon. Mr. Timbrell: I should say I am surprised at the honourable member, but maybe I’m not. He is now engaging in the same kind of hyperbole we have been hearing from that other corner of the House, lo these many weeks. There is no evidence, there is no reason of any kind, to believe that our health plan is in any way being dismantled --

Mr. Swart: That is the biggest joke I have heard in the House.

Mr. Roy: How can you say that?

Mr. Warner: The system is being destroyed and you know it.

Mr. Cooke: You are living in a dream world, Dennis.

Hon. Mr. Timbrell: -- or that it is in any way in violation of the principles of the Health Insurance and Diagnostic Services Act. In fact, there is all kinds of evidence to suggest that it is very much in conformity. Any actions taken by this government have been to maintain the integrity of the health care system. And that includes, by the way, dealing openly and frankly with the medical profession; not trying to engage in doctor-bashing, not trying to use some kind of bludgeon; but rather to get at the real problem --

Mr. M. Davidson: Something you haven’t been doing.

Mr. Swart: What is the problem?

Hon. Mr. Timbrell: -- namely, the way we arrive at the fee schedules and the question of doctors’ concern about the bureaucratic procedures of the health insurance plan. That’s how you solve problems, by dealing openly with them.

Mr. S. Smith: Are you going to allow co-insurance?

Hon. Mr. Timbrell: No, we are not considering allowing co-insurance.

DISCRIMINATION BY POLICE

Mrs. Campbell: Mr. Speaker, my question is to the Solicitor General although I would be delighted to have the comments of the Attorney General at the same time.

In view of the recent statements by police officers concerning apparent discrimination against Jews, blacks and homosexuals in our society, has the Solicitor General any comments to make? Has he made any investigation of these facts as they have appeared?

Hon. Mr. McMurtry: I assume, Mr. Speaker, the member for St. George is referring to a recent publication of the Metropolitan Toronto Police Association called News and Views. I have discussed the article with the senior members of the Metropolitan Toronto police force and very recently with the president of the Metropolitan Toronto Police Association, who has indicated to me that he regrets very much that the article was published. As a matter of fact, I understand that the president of the police association will be having a press conference tomorrow to indicate his regret for the publication of the articles to which the honourable member refers.

I have also written a letter to the editor of that publication indicating my concern about the publication and I should be pleased to supply the honourable member with a copy of that letter.

Mrs. Campbell: Mr. Speaker, do I take it then that the Solicitor General views such statements by those who are engaged in the administration of the justice system of the province as being somewhat different from private statements of a similar nature made by private citizens?

Hon. Mr. McMurtry: Yes, I do, Mr. Speaker, and I pointed out to the editor of that publication that whether they necessarily always accept this fact or not, I think that the public regard the police as police officers 24 hours of the day. It is really impossible from a practical standpoint to separate their responsibilities as police officers and as private citizens, and although they may think that they are simply expressing their views as private citizens, invariably those views are going to be regarded as expressions of police officers and therefore I do regard them in a different position.

Mr. Bounsall: Will the minister, in his capacity as Solicitor General, suggest to the police forces across Ontario that in the annual education sessions which most of them undertake they include in that education session one of the very good courses run by the Human Rights Commission, whenever they are asked to do so, as a means of ensuring that these problems mentioned do not continue?

Hon. Mr. McMurtry: I am quite satisfied, Mr. Speaker, at the present time that the police forces across the province are aware of this problem and through education and through any other means available are attempting to avoid this type of incident, any expressions of bigotry or intolerance, and that is a problem about which all police forces are aware at the present time.

BRANTFORD HOSPITALS

Mr. Makarchuk: Mr. Speaker, I have a question of the Minister of Health.

Now the minister has had an opportunity to talk to the Brant County Health Council, has received a petition with 20,000 names on it -- I’m sure he has even had a suggestion from the Premier -- can the minister tell the House whether he is prepared to accept the idea that both hospitals in Brantford, the St. Joseph’s Hospital and Brantford General Hospital, will continue to be active treatment facilities?

Hon. Mr. Timbrell: Mr. Speaker, I want to first of all read to you a press release which came from the honourable member’s office this morning, and it is part of the answer to this. It said approximately 400 people will be demonstrating -- I think it was 120 -- in front of the Legislature to protest the attempt of the government to close St. Joseph’s Hospital in Brantford.

Mr. Speaker, with respect, that is totally misleading because in point of fact there is no intent, no desire at all --

Mr. Warner: You changed your mind.

Mr. Swart: You are going to leave it open.

Hon. Mr. Timbrell: -- to see St. Joseph’s Hospital in Brantford -- or any other hospital for that matter -- close.

Mr. M. Davidson: What are you going to do in Penetanguishene, Dennis?

Mr. Cooke: You are just going to starve them.

Hon. Mr. Timbrell: We had a very good meeting with representatives of the health council, and at a subsequent meeting we had a very good discussion with about 20 or 30 people, I would say, from Brantford and area, from the member’s constituency and that of the member for Brant-Oxford-Norfolk (Mr. Nixon).

The health council, by the way, has not officially received or considered any report yet from the rationalization committee which was struck about a year ago. The committee was under the former chairman of the health council, with representatives of the board, administration, and medical staff of each of the hospitals. They have not finished their work yet --

Mr. Swart: But you’ll close it anyway.

Hon. Mr. Timbrell: -- and therefore there’s no report before the health council to make a recommendation.

Mr. Makarchuk: Of course there’s a report.

Hon. Mr. Timbrell: No. With respect, Mr. Speaker, my information is that the rationalization committee has not finalized their work --

Mr. Makarchuk: It was presented two weeks ago on Wednesday.

Hon. Mr. Timbrell: What the honourable member is referring to, I believe, is the present state of the consideration of the rationalization committee, which they discussed with the public, which they have discussed at various meetings --

Mr. Swart: You call that a report?

Hon. Mr. Timbrell: -- but which they have not finalized, and which they have not recommended to the health council.

We do believe in decentralized planning, and we do believe the rationalization committee and the health council should have the time --

Mr. Swart: You believe in closing hospitals.

Mr. Cassidy: You have been using health councils as a smokescreen.

Hon. Mr. Timbrell: -- to hear the representations, to consider the alternatives, and to make some conclusions. The conclusions will be based on how to maintain the quality of health care within the standards that apply.

I indicated to the health council I am prepared to see, as we have done elsewhere, at the conclusion of their work the savings that will be generated from the rationalization applied against deficits that will be built up in the interim. What is more, I indicated in a letter I gave them when they left that we are prepared, at the point where the hospitals and the health council finalize an agreement on the rationalization, to reinstate up to $390,000 into the hospital budget for 1979-80, plus recovering -- which is consistent with our financial incentive policies -- any additional deficits from future savings generated by the rationalization.

Mr. Makarchuk: Supplementary, Mr. Speaker: The nurses say that in the past, sufficient material resources were available for sisters directing St. Joseph’s Hospital as a fully-accredited, active-treatment hospital, and the present economic climate will not permit the continuation of this fine service much longer. In effect, what they’re saying, contrary to what the minister has said, is that the hospital will stop being an active treatment facility.

The point of my supplementary is how much time does the Brant County Health Council have to come in with a new proposal? And is this proposal going to contain the decision to keep both hospitals open as active treatment facilities?

Hon. Mr. Timbrell: First of all, the health council has not made a recommendation. My information is they haven’t even had a recommendation from the rationalization committee. They will eventually make a recommendation to me, which will be based on two things: first of all, what is the most appropriate way for that community to arrive at the four active treatment beds per thousand population; and what is the most appropriate way to meet the chronic and rehabilitation bed needs of that community.

I have made no foregone conclusions --

Mr. Makarchuk: How much time will you give them?

Hon. Mr. Timbrell: I’ve made no foregone conclusions of what the recommendation will be. It will be a recommendation which is in the best interest of that community.

Mr. Makarchuk: How much time are you giving them?

Hon. Mr. Timbrell: I haven’t put a time on it. What I’ve indicated -- to repeat for the member’s benefit -- is that at the point of an agreement up to $390,000 will go back into the budget; and any additional deficit above that will be recovered, as would any capital costs associated with rationalization, from savings resulting from rationalization.

Mr. Nixon: Since the overall cut is estimated to be about $1.5 million, and the minister has indicated that close to $400,000 would be allocated --

Mr. McClellan: You are going down, Dennis, slowly but surely.

Mr. Nixon: -- to give the community more time to consider its alternatives, might we and the people of Brantford assume they have approximately three months to further consider the situation before the cuts announced by the minister in January will come into effect at the present stance?

[3:15]

Hon. Mr. Timbrell: I didn’t put a time limit on it, but I think everyone involved would want to do it in a timely fashion, so that the matter does not drag on indefinitely. I would hope it could be done in the next few months, so that we can get on with whatever is their ultimate recommendation, or set of recommendations, for the rationalization of services in that community, as we are doing throughout Ontario.

CHEST DISEASE CASES

Mr. Pope: Mr. Speaker, my question is to the Minister of Labour and Manpower. It arises from a letter addressed to myself from Dr. Vingilis of the industrial chest disease service of the Ministry of Labour. Dr. Vingilis has said: “There is no excess of lung cancers in Ontario gold miners in comparison with the population at large.”

Mr. Laughren: Really? He’s a Tory.

Mr. Pope: My question is how can Dr. Vingilis make that kind of an absolute statement in the light of a report prepared in December 1978 -- that’s approximately a month before this letter was sent to me -- which is entitled Cancer Mortality in Selected Northern Ontario Mining Communities, including Timmins, Kirkland Lake, Elliot Lake and Kapuskasing, and which establishes exactly that there is an excess of lung cancers in Ontario gold miners in comparison with the population at large?

Will the minister immediately engage on an urgent priority basis though his industrial diseases branch to determine whether this is a valid report and to determine whether or not there is additional information that can be made available? And will he act immediately to assure the miners of northern Ontario and their families that there is, in effect, no problem or take steps to remedy the problems?

Secondly, in the light of Dr. Vingilis’ statement --

Mr. Bradley: Cross the floor.

Mr. Ruston: Come on over here.

Mr. Pope: -- that diesel fumes in high concentrations are known to cause chronic bronchitis, will the minister review every decision the Ontario Workmen’s Compensation Board has made concerning railroad workers who are suffering from chronic bronchitis --

Mr. Germa: Speech.

Mr. Pope: -- and try to ascertain whether or not they have been fairly dealt with in light of this recent conclusion?

Mr. Breithaupt: You will be a parliamentary assistant next time.

Mr. Mackenzie: He’d make that kind of minister.

Hon. Mr. Elgie: Mr. Speaker, I was going to ask the member to repeat the question, but I think I won’t.

Mr. Bradley: No wonder you could upset that guy.

Hon. Mr. Elgie: I would be glad to have the report the member has referred to reviewed by the industrial chest disease service, and I will assure the member I will look into the other matter as well and report to the House.

Mr. Renwick: He’s the first Tory backbencher to express an interest in the topic.

Mr. Nixon: Some other people are going to look into it too.

Mr. Martel: Supplementary: While the minister is looking at the bronchial problem, could he look into a report a number of years ago which indicated that 22.5 per cent of the smelter workers in Sudbury suffered a bronchial problem? In view of the fact that we have been trying for about four years to get this government to recognize that as a compensable condition, would he make a decision as to whether those workers in the smelter are also entitled to benefits? This is far in excess of the provincial average.

Hon. Mr. Elgie: I’ll be glad to look into that matter as well.

NIAGARA RIVER POLLUTION

Mr. Kerrio: Mr. Speaker, I have a question of the Minister of the Environment. Is the minister aware of a statement made on water quality by the International Joint Commission that chemical dumps on both sides of the border must be found and clean-up must become a top priority by both countries? In view of that statement, I would also ask if he is aware of the fact the residents of Niagara-on-the-Lake, St. Catharines and Virgil have circulated a petition to be given to the New York state environment department protesting the dumping of additional chemical waste by a chemical dump company in the lower Niagara River? Is the minister leaving the responsibility up to the residents of the area, or is he, as the minister, going to assume a responsible position with the US authorities to make certain no more dumping of chemicals is going to go into the Niagara River until the residents on both sides of the border are guaranteed safe water?

Mr. Laughren: That’s free enterprise. I’m surprised the member would intervene.

Hon. Mr. Parrott: Mr. Speaker, I guess it was yesterday morning the member for -- I’d better check the location -- Lincoln, was it?

Mr. Martel: Yesterday afternoon.

Hon. Mr. Parrott: Brock. Sorry about that.

Mr. Martel: I knew you’d have trouble with that.

Mr. Breithaupt: You made a real impression.

Mr. S. Smith: There was a time you were considered important in the cabinet.

Hon. Mr. Parrott: The member for Brock gave me a call in the great riding of Oxford -- I don’t forget the name of that one -- and we had quite a long discussion on the very issue. It’s my understanding that the member -- and I support him fully on it -- is asking for a public hearing. I think he is doing so knowing that this is the approach that we in Ontario are now taking on these items. Having set the example for the United States in this regard, I think they would do well to follow our example and have public hearings on these items.

Yes, I am well aware of the statement by the International Joint Commission. Yes, I am well aware that at the moment by far the vast majority of those who are polluting our waters with chemical toxic wastes are from the other side of the border.

No, we will not sit idly by. We are very aggressively monitoring all of the water supplies. Let me be very, very positive about that.

Mr. Martel: You used to walk across the water, George.

Mr. Warner: You are watching vigorously.

Hon. Mr. Parrott: There is absolutely no danger to the present water supply of those municipalities.

I share the concern the member for Brock (Mr. Welch) expressed to me very forcibly about the future.

An hon. member: Does that mean you are going for a swim?

Hon. Mr. Parrott: We will remain concerned. But until it is proven otherwise -- and I think the only way you could prove it otherwise is to seek tests that would indicate there is a problem and at the moment there is not one -- there is no problem with the water supply in your riding, or indeed in Brock.

Mr. Warner: You will wait until we can have foot races across the river.

Hon. Mr. Parrott: We feel very confident that the water supply is in a very safe condition right now. We will monitor it. We have stepped up our monitoring of it and we will do everything possible. I hope the member for Niagara Falls will join the member for Brock and myself in saying we are sure today the water is all right. If there is any change in the tests the member will be the first to know -- the people will be the first to know.

Hon. Mr. Welch: Any time you want a public hearing.

Hon. Mr. Parrott: It is important that in the other jurisdiction over which we have no direct control we will not remain silent. I only hope they take the suggestion of the member for Brock and have a public hearing -- have it out in the open so we will all know.

Mr. Kerrio: I just want to bring something to the minister’s attention.

Mr. Speaker: By way of a question, hopefully.

Mr. Kerrie: Yes, thank you; I will bring the supplementary immediately.

I wonder if the minister is aware of the fact that both the Love Canal and the Bloody Run Creek are connected to that international waterway? Is he aware that one is in the upper Niagara River above the falls and the other is in the lower river? I hope he will not continue to make the statement that we will not have a Love Canal incident here, because it is connected with our waterways. I want to make that point very clear.

Also, I would ask if the minister is aware that if this dump site goes in in Lewiston, New York, they are contemplating moving some of the chemical waste over the Penn Central Railway in southern Ontario? I wonder if he would look into the matter to be certain that if any of these dangerous chemicals are going over the rails to that disposal site, he might be the first to know about it and therefore monitor it very diligently.

Mr. Martel: He is going to walk alongside the train.

Hon. Mr. Parrott: I think that the legislation I will be introducing in a matter of minutes has a great deal to say about the transportation of those dangerous chemicals. People from the industry have indicated to me it is pretty tough legislation because they will be held responsible. That kind of action on our part has alerted them.

Mr. S. Smith: The spiller must pay.

Hon. Mr. Parrott: Well, indeed they have. It is so difficult not to react to the interjections, Mr. Speaker, but the material that will be moved by the transporter and/or the industry that owns it is their responsibility. I know now from the reaction of both the transporter and the industry that they are very concerned on the safe transportation of the material.

Mr. Nixon: Shades of George Kerr.

Hon. Mr. Parrott: While I may not know in advance it is being moved, indeed, they know in advance it is their liability, their responsibility and that is very clear in this legislation the member will see today. I think that is a very important piece of legislation, to answer the question.

HEALTH INSURANCE

Mr. Renwick: I have a question for the Minister of Consumer and Commercial Relations. It relates to the private insurance industry and the Ontario Health Insurance Plan and the consequences of the doctors opting out.

As the continuance of the Ontario Health Insurance Plan as the sole insurance carrier under the Health Insurance Act, 1972, is the guts of our health care system, will the minister tell the House whether private insurers can now re-enter this field to insure the public against excess doctors’ fees over and above the fees permitted under the Ontario Health Insurance Plan, having regard to section 19(1) of that act, which reads in substance as follows: “Every contract of insurance for the payment of any part of the cost of any insured services performed in Ontario for any insured person under this act is void and of no effect” -- and these are the words that bother me -- “insofar as it makes provision for insuring against the costs payable by the plan, and no person shall enter into or renew such a contract”?

Hon. Mr. Drea: Just a few moments ago, my colleague, the Minister of Health, replied “No.” Since obviously for more than a decade there has been no co-insurance, I really fail to understand the concern of the member over those words.

Mr. Renwick: By way of a supplementary -- and this is precisely why I asked the question -- that subsection of the act states that there can be no insurance insofar as it makes provision for insuring against the costs payable by the plan. My supplementary question is: are those words not sufficient as at the present time to permit the private insurers to come in to insure the excess costs being incurred?

Mr. Breithaupt: Beyond that.

Mr. Renwick: If the answer to my question is that they are not an open gate for the private insurance industry to re-enter the field, will the minister consult with his colleague, the Minister of Health, and with the ubiquitous Attorney General of Ontario and let us have an opinion of the law officers of the crown as to whether or not that permits at this time private insurers to come in on the Ontario Health Insurance Plan and add to the destruction of that plan, which is taking place now?

Hon. Mr. Drea: First of all, I can answer the bulk of that supplementary question by saying, “No, not as long as I am the minister.” Secondly, if the member wants an opinion from the chief law officer of the crown, why didn’t he have the courtesy to ask the Attorney General? If the member wants me to get it for him I’ll be delighted to get it for him.

Mr. Martel: He didn’t have the courtesy to be here.

HOSPITAL BED ALLOCATIONS

Mr. Hennessy: My question is to the Minister of Health. In view of the repeated requests from the city of Thunder Bay, the local hospital boards and myself for a meeting with the Minister of Health to discuss the hospital bed situation in the city of Thunder Bay, has the minister set a date for such a meeting?

Hon. Mr. Timbrell: As I recall, there is a meeting being arranged for April 3, I believe, with a group representing the city, the health council and the various hospitals.

Mr. Speaker: The time for oral questions has expired.

MOTIONS

COMMITTEE OF SUPPLY

Hon. Mr. Welch moved that commencing Thursday, March 29, the House may resolve itself into a committee of supply.

Motion agreed to.

STANDING GENERAL GOVERNMENT COMMITTEE

Hon. Mr. Welch moved that the standing general government committee be authorized to meet this afternoon and this evening concurrently with the House, and on Wednesday, March 28.

Motion agreed to.

STANDING ADMINISTRATION OF JUSTICE COMMITTEE

Hon. Mr. Welch moved that the standing administration of justice committee be authorized to meet on the morning of Wednesday, March 28.

Motion agreed to.

[3:30]

STANDING STATUTORY INSTRUMENTS AND MEMBERS SERVICES COMMITTEES

Hon. Mr. Welch moved that the statutory instruments committee and the members’ services committee be authorized to meet on the morning of Thursday, March 29.

Motion agreed to.

STANDING SOCIAL DEVELOPMENT COMMITTEE

Hon. Mr. Welch moved that the standing social development committee be authorized to meet concurrently with the House this afternoon.

Motion agreed to.

ANSWERS TO QUESTIONS ON NOTICE PAPER

Hon. Mr. Welch: Mr. Speaker, might I use this opportunity to table the answers to questions 1, 3, 4, 5, 6, 7, 61, 62, 63, 64, 86, 89, 90 and 92, and the interim answers to questions 8 to 60 inclusive, 65 to 85 inclusive, 87, 88 and 91, standing on the Notice Paper.

MEMBER’S BOOK OF POETRY

Mr. Cassidy: Mr. Speaker, I regret that the member for Lakeshore (Mr. Lawlor) is not here in the House at this moment. It is very seldom that we have actual tangible evidence that one of the members of this chamber is literate; many people have had doubts on that particular question. I want to assure you, Mr. Speaker, and all members of the House that the member for Lakeshore is very literate and that today, in fact, he has published the outpourings of seven or eight years of poetic endeavour -- endeavour which I believe puts him in a class with such famous commentators, wits and reviewers of our time as Pope, Dryden and Ezra Pound.

The tome is known as The Psychotic Personality of Our Time. I wish to read one short introductory portion of it which I think sums up the thrust of the whole thing in reflecting this chamber. If I can quote Lawlor quoting Rilke’s Second Elegy: “Jeder Engel is Schrecklich” -- “Every angel is terrible.” And if I can quote Lawlor on this place, he begins his first canto in this tome: “The times are mad.”

I have had an offer from the member for Riverdale (Mr. Renwick), who was anxious to avoid any appearance of conflict of interest from having the member for Lakeshore peddling his own tome; therefore, the member for Riverdale will be happy to take orders for this particular work. At $10 a copy, the member for Lakeshore will be happy to sign them.

Hon. Mr. Davis: Mr. Speaker, having referred to the very distinguished member for Lakeshore as the poet laureate of this House on more than one occasion and having known him perhaps for more years than the present leader of the New Democratic Party, I would like to express my real congratulations to him. I guess it’s a more creative effort than one that I have been told about emanating from a former caucus member of his. When I say more creative, it probably will add more to the literary style of this province than Morton Shulman’s book will to the history of this province. I am not sure of that, but I am told that is the case.

I think it is only fair, as well, to point out to our very distinguished member that while I have no objection at all in paying $10 for access to this book -- and I am quite prepared to speak to the Minister of Education (Miss Stephenson) about having it on circulars 14, 15 and 16; I know that the school students of this province are avidly awaiting the introduction of this text in the compulsory English courses that may or may not exist -- I think it is only appropriate, in that he is of this very generous nature, that he look across the House -- and even to his right, if he can -- and come to the conclusion that he should sign copies for all members of the House at a nominal fee of zero. We would all be deeply appreciative of this gift. There would be no conflict. We would be delighted to have it. We would even promise to read it as bedtime reading, which would be much better than most of the things that the leader of the New Democratic Party reads in any event. But I would be quite prepared to accept a free copy.

Mr. Breithaupt: Mr. Speaker, if I also may be permitted a word of congratulation, I presume that a text with such a title as The Psychotic Personality of Our Time might be one of autobiography. Indeed, it might be one of dedication to his present or future leader. Of course, it could also be that it was written because of his caucus colleagues or in spite of them; I am not sure which.

In any event we welcome this literary outpouring. I presume that for those members who cannot obtain a copy in the next few months, no doubt when Dr. Shulman’s book receives greater prominence, perhaps in the future we could all get them as a pair at Coles for about $3.

Mr. Renwick: Mr. Speaker, as business agent, I just did not want any misunderstanding. The figure of $10 is for the paperback. For the hardback book, which is in limited edition, the price is -- well, it is almost going for auction now; of course, with the member’s signature on the flyleaf of the book, I doubt if any member of this House could afford to buy such a copy, but I am willing to accept any offers at all for his work.

Mr. Sargent: He’s trying to beat Maggie Trudeau.

Mr. Lawlor: Yes, there is a lot of competition abroad in the publishing field these days. I do not know how anyone reads anything; there is so much to do.

However, I would warn the Premier that, by heavens, before he says very much about it, he had better read it.

Hon. Mr. Davis: That’s why I am not paying for it first.

Mr. Lawlor: He will remember the famous colloquy of the critic who spoke to Robert Browning about these things. Robert said: “Oh, yes, there was a time when I and God understood what it was all about. Now only God knows.” I take that position almost from the time of its birth.

Writing poetry -- I suppose writing anything -- is a form of self-exposure; it may be indecent exposure, although I suppose it is not arrestable quite yet.

As far as my friend over here is concerned, he is included, let me assure him.

INTRODUCTION OF BILLS

ENVIRONMENTAL PROTECTION AMENDMENT ACT

Hon. Mr. Parrott moved first reading of Bill 24, An Act to amend the Environmental Protection Act, 1911.

Motion agreed to.

LABOUR RELATIONS AMENDMENT ACT

Hon. Mr. Elgie moved first reading of Bill 25, An Act to amend the Labour Relations Act.

Motion agreed to.

HURONIA DISTRICT HOSPITAL ACT

Mr. G. E. Smith moved first reading of Bill Pr4, An Act respecting the financing of the Huronia District Hospital.

Motion agreed to.

VILLAGE OF COOKSTOWN ACT

Mr. G. E. Smith, on behalf of Mr. G. Taylor, moved first reading of Bill Pr6, An Act respecting the Village of Cookstown.

Motion agreed to.

CONSUMER PROTECTION AMENDMENT ACT

Mr. B. Newman moved first reading of Bill 26, An Act to amend the Consumer Protection Act.

Motion agreed to.

Mr. B. Newman: Mr. Speaker, the purpose of this bill is to require that every product offered for sale by a retailer that is marked with the universal product code must also be clearly marked with its individual purchase price.

PORTABLE FIRE EXTINGUISHERS SAFETY ACT

Mr. Stong moved first reading of Bill 27, An Act to regulate the Manufacture, Sale and Servicing of Portable Fire Extinguishers.

Motion agreed to.

Mr. Stong: Mr. Speaker, the purpose of the bill is to protect the public from the fire hazard created by inadequately manufactured and serviced fire extinguishers.

INNOCENT PERSONS PROTECTION ACT

Mr. Stong moved first reading of Bill 28, An Act to protect the Reputation of Innocent Persons from Untimely Publicity.

Motion agreed to.

Mr. Stong: Mr. Speaker, the purpose of the bill is to prohibit publication of the name of or otherwise reveal the personal identity of persons charged with offences until such time as a court begins to hear evidence in the case or the person enters a plea of guilty to the offence.

MOTION TO SUSPEND NORMAL BUSINESS

Mr. Foulds moved under section 34 of the standing orders, that the ordinary business of the House be set aside to discuss a matter of urgent public importance, namely, the failure of the Minister of Health to provide adequate funding for hospitals throughout the province, as evidenced in northern Ontario by Thunder Bay, Kirkland Lake and other small communities; in Metropolitan Toronto by Lakeshore Psychiatric Hospital; and elsewhere in southern Ontario by Brantford and Windsor; so that the reduction in hospital facilities and services is causing severe hardships to citizens of this province and is seriously threatening the level of health care the people of Ontario have a right to expect.

[3:45]

Mr. Speaker: The honourable member, has up to five minutes to explain why he feels this is of urgent public importance.

Mr. Foulds: Thank you, Mr. Speaker. I believe the matter dealt with in the resolution is a matter of urgent public importance or the following reasons:

One, my attention was first focused on the issue by the effects of the active-treatment bed allocation method. It was devised by the Ministry of Health and sets the new and arbitrary bed ratios at 4.5 per 1,000 of population in northern Ontario and 4.0 in southern Ontario, to be reduced further to 4.0 in northern Ontario and 3.5 in southern Ontario by 1981. Although that came to my attention because of the devastating effects it was having in Thunder Bay and northwestern Ontario, I believe the evidence is mounting throughout the province in places such as Etobicoke, Windsor, Brantford and throughout northeastern Ontario that it is a province-wide phenomenon. It is just that we are now seeing the first evidence of it most strongly in the communities mentioned in the resolution.

Two: the first phase of the ministry’s plan goes into effect just four days from now, April 1, so the matter is urgent if we are as a Legislature to express our opinions and try to persuade the ministry they are set on a wrong course of action.

Three: we have no other avenue for discussing this most serious problem at the present time. The matter deserves debate and discussion, not merely questions that can be fobbed off by ministers during question period. For example, the Ministry of Health estimates will not come up for debate until after April 1; in fact, they are, in my understanding, slated to come somewhat down the road of legislative consideration.

Also, it is my understanding there is no opportunity for debate in the throne speech debate this week, and the throne debate itself does not focus sufficiently on an issue of this importance and magnitude throughout the province.

Four: this is the first opportunity since the House has resumed after the March break to discuss a matter of substance. Surely, the health of the populace must be one of our top priority considerations in this Legislature.

As I understand it, on the previous occasion when a matter of health was brought up for emergency debate -- the Chesley Hospital debate in November 1975 -- the Speaker ruled against such a motion that was confined to one situation. The House expressed its will otherwise so the debate proceeded because it was used as an example of the plan in 1975 which would decrease the effectiveness of the delivery of health care to the people of Ontario.

Five -- and I just want to use this as an example -- in my own area the matter has been brought to my attention very forcefully. I have received over 1,000 letters on the topic in the last 10 days to two weeks. There has literally been a news story every second day in the local media, which are being contacted by individuals. There has been concern expressed by city council and several representations to city council by McKellar General Hospital, St. Joseph’s General Hospital, the senior citizen groups, the district health council and many individuals.

I note the efforts of my friend, the member for Fort William (Mr. Hennessy), who has been trying to line up a meeting between responsible civic officials and the Minister of Health and/or some of his colleagues to discuss this urgent matter.

I am sure when this debate proceeds, my colleagues from Brantford, Oshawa, Windsor, and Algoma will be able to present ample evidence of the urgency of this motion as it affects many areas of the province.

To sum up, Mr. Speaker, the hospital bed cutbacks, the implementation of the bed ratio rates, is only four days away. This Legislative Assembly has the final authority and has not had an opportunity to discuss this urgent matter until now. The regular avenues of debate are not open to us.

Three, the House expressed its will with regard to the Chesley debate on November 20, 1975.

Finally, Mr. Speaker, I believe that the matter of health care is one that has been badly handled by the government. A government cannot cut back on active treatment beds the way it has until alternative services are in place and we shall make those arguments when the debate proceeds, Mr. Speaker.

Mr. Nixon: Mr. Speaker, my colleagues join me in urging you to accept the resolution and recognize that the matter put before us in the resolution is one of urgent and public importance. It has already been put to you, sir, that the effective date of April 1 is just two or three days away as far as the application of the budget cuts are concerned.

One matter that sometimes is forgotten is that in those areas where the budget cuts are going to persist -- I do not know whether there are any or not -- the layoffs, if they have not already been undertaken, are going to have to be paid for from some source. I would suggest to you, sir, it will be the responsibility of this Legislature to find those funds.

There will be an opportunity, I trust, sir, having a lot of confidence in your good judgement, to discuss the specific matters later this afternoon, but I should tell you that when my colleagues examined the resolution, notice of which was given to us, we wanted to indicate that other communities not listed in the resolution certainly should have their problems aired and discussed and put before the Minister of Health here. I refer to the hospital cutbacks which are going to cause a serious depreciation in health care facilities in Fort Frances, in Goderich, in Wingham, in the Four Counties Hospital at Newbury, and of course I, sir, want to bring your attention to the problems faced by the citizens in Brantford.

Frankly, I was a bit offended that the minister in a rather cavalier way indicated with some disparaging tone that only a handful of people appeared in front of the Legislature today to argue against his cutbacks of the services in our own community. I should tell you, sir, that in fact it was a very important delegation indeed, well versed in the problems that we have. As a further indication the policy seems to be still fluid, the minister in his comments in question period today indicated there was going to be the flexibility of about $400,000 in the situation in Brantford itself.

Unless we have a chance to put our arguments before the minister and to hear his responses in this connection, I would put to you, sir, that the citizens in our various communities, directly and deeply concerned with this matter, will otherwise not have an opportunity for the argument to be put by their elected representatives.

I end my comments, sir, by urging you once again to indicate that in your good judgement this matter would be properly before the House this afternoon for special debate.

Hon. Mr. Timbrell: Mr. Speaker, I would go along with the comments made earlier about the value of the discussion this afternoon of the various concerns with regard to hospitals. May I say, sir, in answer to the comments of my friend from Brant-Oxford-Norfolk, I certainly meant no disparaging tone or intent at all with regard to the group with whom I met. In fact, this morning when I got into the office -- I had been up to Panetang yesterday afternoon -- I got the notice that the group was coming and I bad been asked to meet with them. I readily agreed, although I couldn’t meet at the time they suggested and they were good enough to come at a time when I was free.

As I said earlier, it was a very good meeting. I think it was a constructive meeting for me and I hope for that group as well. We shared information and views.

Mr. Speaker, this subject is one that consumes a great deal of my time every working day in dealing with the district health councils and hospitals, and has as long as I have been in this portfolio, since the evolution, the transitional phase of our health care system is one that has been going on for quite some time and will go on for quite some time into the future. As the health care needs of the province have changed, are changing, and will change, so too will the means of addressing those needs be changed so as to maintain the quality of the health care system.

I will, therefore, be glad to participate. The time limits of such a debate are such that all the points can’t possibly be answered. Whenever my estimates do come on -- I don’t know when they’re going to be, whether it’s spring or fall, or whenever -- or during question period, or for that matter privately with members, I’ll be glad to discuss more than what can be covered in this limited time today.

I have arranged meetings with a number of members. My friend, the member for Huron-Bruce (Mr. Gaunt), was in touch with me recently about the possibility of a meeting With some hospitals in his area to pursue the question of planning for additional chronic needs in that area to be met out of surplus active treatment facilities. I certainly readily agreed to that. In fact, I think we’re meeting on April 6. I’m meeting on April 3 with a group from Thunder Bay, dealing with local people, to solve local problems. I’ll look forward to the debate.

Mr. Speaker: It is the responsibility of the chair only to decide whether or not the motion was in order. Proper notice was given. The main criterion is that it be of sufficient and urgent public importance. Given the comments I have heard I would rule that it is, so it does meet the criteria of standing order 34. The only thing that remains is that the Speaker ask should the debate proceed?

Motion agreed to.

HOSPITAL BED ALLOCATIONS

Mr. Foulds: In my remarks I’m going to focus on the problems as they have arisen in northwestern Ontario and Thunder Bay. Even in the 10 minutes allotted, I’m sure I cannot do that justice, as you will recognize. However, my colleagues will -- and perhaps you could -- describe the areas outside of Thunder Bay. I certainly feel inadequate to the task.

First of all, I want to say that my colleagues will be outlining situations in other areas of the province. I want to outline very briefly some of the facts, as I understand them, as they affect Thunder Bay and northwestern Ontario.

I think the big problem that has arisen is that the reductions that were announced by the minister and the ministry in January have put a crimp in service because we have not had in place ahead of time adequate alternative care -- adequate chronic care, adequate extended care. For all the will in the world, and for all the attempts, frankly -- I know what the minister is going to interject. I’ll let him use his time to do that -- adequate chronic care and extended care have not been provided first.

For example, in Thunder Bay we have lost 200 beds since 1974 and now must reduce by an additional 27 beds by April 1, 1979, and by 114 beds by April 1, 1981. In small areas of northwestern Ontario there are reductions that I’ll go into later on. There are over 100 chronic care patients and 100 extended care patients in Thunder Bay awaiting adequate placement. Until alternative facilities are in place, no active treatment beds should be cut.

We get to the question of how the ratio is established. I think we have to recognize that the ratio is largely an arbitrary one, that it is set up arbitrarily and can be changed arbitrarily. It is not dependent on any rationale.

For the remaining 77-bed reduction after April 1 that must be implemented in Thunder Bay by April 1981, we haven’t had details of that and there is no way of knowing at the present time if a four per thousand ratio is the final goal. We have not had a clear statement of that by the minister. As alternative services increase, hopefully, the minister may lower that ratio further, but because it is an arbitrary standard, it can be changed arbitrarily.

At the present time, my understanding is that McKellar General Hospital will be reduced by 16 beds, Port Arthur General Hospital by 12 beds, and St. Joseph’s General Hospital by nine beds.

[4:00]

In the last factor, the only real standard is how much the public will accept. Clearly, the provincial government believes we will accept it. I want to assure the House that until those alternative services are in place, we in the north will not accept it. It’s simply not acceptable. The conditions that exist are simply not acceptable.

I prefer not to use waiting lists as a criterion because they are not a full criterion for judging how crowded or overcrowded facilities are. But when you have occupancy rates of over 85 per cent, when you have patients staying overnight in emergency beds while they await admission to a regular bed, and when you have intensive care beds often full or nearly full and you have an increased number of patients being admitted as emergency cases rather than as routine admissions, then there is a widespread sense of chaos and pressure throughout the hospital. Those are the rules of thumb I would like to speak to.

The chronic care situation seems to me to be the crucial one to relieve the difficulty with active treatment beds. Although St. Joseph’s Heritage is slated to open before long with 100 nursing home beds, there is almost as much need for 100 chronic care beds. At the end of February I believe the waiting list was 102 for nursing home beds and 129 for chronic care beds. Even the recommendation by the district health council has not been approved that 24 of those beds -- just 24 of those beds that are in St. Joseph’s Heritage which the minister likes to talk about -- be designated chronic care. The minister cannot say the alternative services have been provided in Thunder Bay.

I just want to quote very quickly and briefly from one of the submissions made to the city council, I guess it was by St. Joseph’s hospital. They indicated that occupancy rates are 100 per cent in their medical and surgical units. They indicated that -- and I’m quoting -- “patients requiring in-patient medical care are subjected to staying in emergency for one or more nights. Emergency is not equipped or staffed to provide in-patient type of care and vital space is taken up to the detriment of bona fide emergency cases. This (the imposition of the present bed ratios) has resulted in a decline in the number of elective surgical bookings which can be made. Some patients are inconvenienced by multiple intrahospital transfers before they are appropriately accommodated. Physicians are coerced by the demand for beds into making decisions on discharge under pressure.

“We believe that some of these patients are justified in believing they have not experienced the quality of care they should have expected from what was thought to be one of the better health systems in the world. The impending sense of chaos was heightened recently when one night every intensive care unit bed in the city was filled. Each of these beds held a patient who genuinely required intensive care unit treatment. This apparently has never happened before.

“The precarious situations described are real and render impossible the systematic and orderly management of patient bookings and admissions. With our 100 per cent occupancy rate, the patient booked in the ‘urgent’ medical category has almost no chance of being admitted. They get better or are eventually admitted as emergencies. About 68 per cent of all patients are admitted as emergencies.”

As I understand the situation, that is serious. Those are not my words. They emphasize, too, the necessity for long-term care. They also emphasize the necessity, quite rightly, of the pilot project that has been suggested by the district health council, but that won’t provide for an immediate solution to the problem. What they suggest is a delay of the implementation of bed and financial cuts until the study is complete and long-term requirements are met.

The general hospital, 221 beds total: It has an 85 per cent to 95 per cent occupancy rate, and an elective waiting list of three months. Medical patients are being admitted on an urgent basis only. They have not yet determined where the cuts will come but it will probably be 12 beds.

St. Joseph’s hospital I have dealt with, but I wanted to add they have an elective waiting list of 206, urgent waiting list 55, five rheumatic, eight rehabilitation, 15 psychiatric, nine medical, 18 surgery; all admitting being done on an emergency basis first.

The McKellar hospital has 98 per cent occupancy rate for medical-surgical, 100 per cent in all other fields, patients staying overnight in emergency because of bed shortages. They will have to close 21 beds, even though they are slated to close 18, because they have to close one unit to make it economical.

I want to touch very briefly on the region because in Geraldton they are being reduced from 45 beds to 25, in Nipigon 33 to 20, in Red Lake 44 to 27. My colleagues will deal with some of those, but when the ultimate cut comes to 27 in Red Lake, the administrator there is being quoted that the occupancy rate at peak periods would be in excess of 117 per cent. That is just not possible.

I think we have to decide, for the regions outside, what is a hospital? When you are 190 miles away from your referral centre, no matter how small the community or given it is a reasonable size, surely there is need for the essentials of a hospital. You can’t cut physiotherapists or an x-ray technician when you have only one. So that those communities like Nipigon, Geraldton and Fort Frances are in danger of losing doctors.

La Verendrye Hospital and Geraldton Hospital, for example have had no increase at all.

Mr. Speaker: The honourable member’s time has expired.

Mr. Foulds: If I just might conclude with one or two sentences, Mr. Speaker, I think the present cutbacks in the northwest are just not reasonable. We are not asking for the moon. We are saying, “No. No more cutbacks until you provide the alternative chronic care and the extended care first.”

There is no lack of space in the north for those places. There is no lack of possibility of providing those under the present system.

Mr. Speaker: Order. Your time has expired.

Mr. Foulds: Thank you, Mr. Speaker. I just want to say, then, we in Thunder Bay and in northern Ontario do not --

Mr. Speaker: Order. The honourable member’s time has expired.

Mr. Nixon: I want to take this brief opportunity to convey to the minister how much the people of Brantford and Brant county resent the application of centralized power to the provision of their hospital services. They are all aware of our participation in the overall medical insurance program but the minister must surely understand how the area has been, I suppose, sensitized by the attempt by his predecessor, the present Treasurer (Mr. F. S. Miller), to move into a small community in the area, Paris, and simply unilaterally close the Willett Hospital.

The courts found that the government didn’t have the power to do that, Mr. Speaker, and the hospital still continues to give the excellent service for which it has established a well-earned and high reputation.

The minister, coming from his own more or less small community in the centre of Metropolitan Toronto, must surely realize the pride which people have in hospital facilities which they have, in fact, built themselves. With the initiative of the citizens of Brantford and more latterly the Sisters of St. Joseph, we have built there one of the finest hospital establishments probably anywhere in Canada, if not in the world. It has been done with our own initiative and, until about the last eight or 10 years, it has been done largely with our own money.

I see the minister is frowning and he may have a moment or two to tell us about it, but I simply recall to him, that at the time when the grants were coming from the Treasury of the province of Ontario and we were in an expansionary situation, there was no health council. The announcements of the grants were made by the Minister of Health’s predecessors, going back to Matthew Dymond and before and, of course, that assistance was very much accepted. There was all sorts of gratitude expressed to the ministers of the day.

Now that we are in a situation with the budgetary problems associated with the mismanagement of the government, the minister has set up a health council which has to do the minister’s dirty work in this connection. I tell you, Mr. Speaker, I resent this very much. The people in the community who serve on the health council are outstanding men and women. I feel that they have somehow been seduced by the minister into thinking that they are going to provide the views of the community regarding provision of the very best medical service.

Now, if they had been in operation a decade ago, when we were building these things, that would be fine. But, under these circumstances, these people have to make the tough decisions to apply the cutbacks which have been handed to them unilaterally by the minister. Perhaps they were handed to him unilaterally by the Treasurer or even the Premier. I’m not so sure that it happens quite as directly as it did when Darcy McKeough was holding the purse strings. But surely this is an area for real resentment as far as the people in our area are concerned. We have built these fine hospitals. We have two active treatment hospitals and I submit to you, Mr. Speaker -- and the Minister of Health, I think, would agree -- that we need them in the Brantford area.

Now the cutback of $1.5 million which goes into effect on April 1, a few days from now, is in the opinion of the medical authorities in Brant county going to degrade seriously the quality of the medical service in the community. There appears to be an attitude on the part of the ministerial officials that our doctors put too many people in the hospital and leave them there too long.

Now, I believe there is no evidence to indicate that the “cookie cutter” approach of the Minister of Health to the provision of hospital services should he applied to a community such as Brantford. That it is unfair and, I believe, it is bad judgement to apply this kind of uniformity to the communities right across the province.

As you know, we are not favoured with a university or community college campus in Brantford. But the statistics do show, and these are available to the minister as well, that the average age in the community is perhaps higher than in many other areas. We don’t have the hundreds and in fact thousands of young people going to university as they do, say, in Guelph, or in other communities, who, fortunately, don’t have to have hospital services. When they do, they normally return to their own home.

There are many factors which I’m sure the health council and the delegation from Brantford brought to the attention of the minister. I’ll say I applaud the fact that the minister did see fit to discuss the matter with both delegations. I’m glad he has at least relented to the extent that the final decision is postponed for some months -- three or four months in the Brantford area.

To tell you the truth, Mr. Speaker, I was not entirely clear as to the meaning of the minister’s comment when he said there would be a flexibility of approximately $400,000 with regard to our own hospital situation. But the only meaning I can give it is that in fact the immediacy of the decision has been withdrawn.

You know, the minister -- at least, spokesmen for the ministry have indicated that Brantford and Brant county had been warned that this cutback was coming. I suppose in some respect that was so. But we never believed either the minister or his officials. After all, they came and said that the Willett hospital was going to be closed, and the Willett is still functioning and it is functioning properly.

I would submit to the minister that, if this deleterious decision was going to be made in a hard and fast way, we should have had at least a year’s notice of a hard and fast decision. Then the delegations and the health council could have discussed it further with the minister and the administrative officials of the Health ministry. Then they could have made the rationalization required if the ministry of the day could not be persuaded that our needs were greater than indicated by the budgetary cuts.

Instead of that, the announcement was made, I believe on January 19, to come into effect April 1. It has simply not been practical or even possible for anything but the toughest sort of rationalization, involving removing active treatment from the St. Joseph’s hospital; centralizing it at the Brantford General Hospital; and removing the emergency service from St. Joseph’s hospital, which is closest to our large and we hope growing industrial area. These are the sorts of decisions that can only be reflected by the needs of the community itself.

[4:15]

My leader has spoken and will speak again perhaps later this afternoon. But in the question period today and also in speaking to the group in front of the parliament buildings this morning he indicated that for the officials to work with a computer, having something to do with the number of hospital beds per 1,000, without looking at the special needs of individual communities is really in our type of government simply unacceptable and that’s why I feel this debate is of such great importance.

I say again I am very glad indeed that the minister has softened his former inflexible approach. I have been somewhat critical of the health council of Brant county for not responding to the minister immediately with an indication that it feared the quality of our hospital services would be reduced to a point where it would endanger the good health of the community. I regret that their first response was to take the directive as if it had come from on high and simply determine how it was going to be implemented. This, if anything, is going to detract from the continuing value of a health council which must speak for the community first and not the Ministry of Health.

I feel that the members of the council individually feel that and I trust and hope that the Minister of Health feels the same way. I have a suspicion, however, that the health councils are, in the mind of the minister, designed simply to do his dirty work and leave him free to cut the ribbons. After all, he and his predecessors have not been too well favoured with the kind of brains that have seen the good allocation of public funds. You don’t have to go very far down University Avenue to find a major world-class hospital that had been sitting empty for eight years until it was more or less reprocessed as a chronic care hospital opening just a year ago. You know the one I mean, Mr. Speaker.

You don’t have to go very far away from here, just to McMaster University, I say with great respect to my colleague the leader, to find a $100 million facility that has been built and operating now for many years, and I don’t know what the percentage of utilization is but I believe that for all of these years it has been considerably less than half utilized. All of those millions of dollars, in fact, have been wasted in trying to persuade the community to use this facility. I believe that the planning of the Ministry of Health has been terrible and that this minister now is simply carrying the old ashcans that the former Treasurer had to set down when he found that his approach -- that is, going out and unilaterally closing the small hospitals in some of the Liberal areas of the province -- was unacceptable and that he could not proceed in that way.

Mr. Deputy Speaker: The honourable member’s time has expired.

Mr. Nixon: I appreciate that, Mr. Speaker. I am glad to have had the opportunity to at least put before the Minister of Health some of the very strong feelings felt by the citizens of Brantford and Brant county.

Hon. Mr. Timbrell: Mr. Speaker, I will try to deal with this situation in 10 minutes, but I ask your indulgence if I go over. Perhaps I could steal some time from my colleagues in this party.

Some hon. members: No.

Hon. Mr. Timbrell: In that case, Mr. Speaker, I won’t try to respond to the specific situations that have been described so far and will be described later in the debate. Those are dealt with regularly in this House as we consider questions and regularly on a daily basis as I deal with individual members and health councils and delegations from various parts of the province, some of which I discussed earlier today.

First of all, let me respond though to one point, that being the question suggested by the member for Brant-Oxford-Norfolk about giving a year’s notice. In point of fact, what the ministry has done is to give three years’ notice that we are moving in the health care system in the province towards the identification of and meeting of chronic care and extended care needs and the reduction of active treatment beds in recognition of that and in recognition of changing patterns in the provision of health care services. The standards that currently exist, of four beds per thousand in the south and four and a half in the north, are the standards which have applied in this province since 1972 and the goals of three and a half in the south and four in the north are for 1981, so, in effect, we are talking about moving over three years to achieve those levels.

I think our policies are well known in dealing with the hospital community. What concerns me -- and I think it’s worth putting on the record, though I don’t do it in a pejorative sense but as they have not put it on the record, I will -- is that certain of the policies of my friends in the third party are not referred to by them from time to time so that the people in a place like Brantford would know what the alternatives are.

I am concerned that if they ever sat on this side of the House it is their policy to abolish all hospital boards and establish social service and health boards. It is in their green paper and it is apparently stated as their policy. I think the people in Brantford, for instance, should know that at St. Joseph’s, the Willett and the General they would abolish all their boards.

Mr. Makarchuk: It is better to have them elected than appointed by the minister.

Hon. Mr. Timbrell: They should know that that party’s green paper in effect is prescribing for Ontario a prescription on their part very similar -- in fact, it is almost identical -- to that which is in place today in the United Kingdom. I think it is well known by any objective observer that the national health service of the United Kingdom is an unmitigated disaster. The policies of the third party, like those of the United Kingdom, would give effect to excessive bureaucracy and bureaucratic centralized control.

Mr. Makarchuk: That’s not true. What is the mortality rate?

Hon. Mr. Timbrell: In my time in the ministry I have spoken repeatedly -- literally hundreds of times -- in every corner of the province about the need to move our health care system through what is admittedly a difficult period of transition, a period of restraint in government spending, a period when the health needs of the province have clearly changed, are changing and will continue to change.

We have set standards for the province which compare well with any jurisdiction which one chooses to bring forward in Canada or North America or, for that matter, anywhere in the world.

Mr. Cassidy: That’s not true. It is the second lowest in the country, and the minister knows it.

Hon. Mr. Timbrell: Mr. Speaker, if you go back to the deliberations of the select committee in the summer and fall of 1978, they found that in terms of health spending for the provision of beds and on doctors or whatever Ontario tends to be pretty well on the national average. Some are higher. For instance, British Columbia spends more proportionately on doctors than we do, and proportionately less on hospitals than do we in this province.

It is interesting that this morning at the conference at the Constellation Hotel, which I believe my good friend from Renfrew North (Mr. Conway) was attending, apparently a gentleman, who is one of the principals in the firm of McKinsey and Company of the United Kingdom, made the observation that in the National Health Service, the Valhalla of the third party, they spend one-third as much on health care per capita as do we in Ontario. That is only one comparison. There are many and, in fact, people continue to come to this province to look at our health system as a model for other areas of the world.

Mr. M. Davidson: A lot of them are leaving because of it too.

Hon. Mr. Timbrell: We are encouraging rationalization. In my time as minister I have been pleased to see the initiatives taken by health councils and by hospitals. Let me just refer to two or three. In Windsor, when I came to the ministry, there was an ongoing holy war -- that’s the only way I can describe it -- between the ministry and the hospital community in Windsor. It revolved around one particular hospital.

There I said to the hospitals and to the health council that if they can find a way to rationalize services, to increase the numbers of chronic-care beds and to reduce duplication and overemphasis on active treatment, then the money would be ploughed back in for additional chronic beds --

Mr. Cooke: Tell us the whole story.

Hon. Mr. Timbrell: -- for chronic home care, for a CAT scanner and so forth. They grabbed the initiative. This wasn’t an imposition; this was working with the hospitals. The representatives of the boards, administrations and the medical staff --

Mr. Cooke: You tried to impose a lot of things, but we wouldn’t accept them.

Hon. Mr. Timbrell: -- arrived at an agreement which embraced all but one of the hospitals in that county and which will see, beginning April 1, albeit a reduction in the number of active treatment beds, an increase in the number of chronic and additional new programs throughout the county.

Mr. Cooke: Tell us the whole story.

Hon. Mr. Timbrell: The whole story is the ministry learned from its earlier experiences on how to work with a community like Windsor, how to work with a community like Brantford, how to work with Sarnia, how to work with Sault Ste. Marie and how to work with Cornwall.

This is the other point I wanted to respond to. My friend from Brant-Oxford-Norfolk says the people resent the application of centralized power. I would tend to go along with that. I live now and have for some years in a place called Don Mills, which we consider to be a small town within the bounds of a large metropolitan area, but I come from an even smaller area, so I think I understand that mentality as well as anyone here.

We cannot escape the fact this ministry does have a responsibility to set some standards, whether active-treatment-bed standards or of whatever kind, and we ultimately have to answer for the considerable amount of money we spend, which is running at about $11 million a day. As far as the planning is concerned, how to apply those standards and how to ensure the maintenance of the quality of health care, we do more and more rely on the health council. There are going to be good times and bad.

Mr. Nixon: There aren’t good, just bad. When are they going to get good?

Hon. Mr. Timbrell: There are going to be easy decisions and there are going to be tough decisions. I have to tell you, I am impressed beyond description with the way in which our health councils by and large have been working with their communities and advising them. I have to tell you too our batting record is about 95 per cent as far as the acceptance of the recommendations with which they come forward. So they are not just there to be a buffer, they are not just there to take the flak, they are there to work.

Mr. McClellan: Like Riverview?

Hon. Mr. Timbrell: Yes, like Riverview, exactly. That was a recommendation of the health council.

Mr. Nixon: So definitive and autocratic they never think of questioning them.

Hon. Mr. Timbrell: I want to talk about North Bay. in North Bay there isn’t a health council, so we are talking about other types of communities. There, the hospitals grab the initiative very early on. I have to tell you the day I got back from Windsor and a meeting with the health council to announce the agreement of all the hospitals but one, there was a phone message for me from Sister Margaret Smith, the administrator of the hospital in North Bay, St. Joseph’s. The message was very simple. We are going to make Windsor look like child’s play.

I was up there a few weeks ago to approve formally the proposal put forward by those two hospitals to move to the second phase of rationalization. The fact is that rationalization has been going on for the last four or five years in any number of areas and it has not meant a reduction in health care. It has meant a maintenance of the quality of health care. I would argue, where you are combining departments such as obstetrics where they have been run down in size, and putting them together and concentrating skills, that is actually an improvement.

I want to say one pejorative thing -- I will forewarn the House. I think if there is a problem in health care today it is the kind of things I see coming out regularly from that caucus at the end there, the kind of press releases that come out, the kind of statements that are made. If there is a threat to health care in this province it is the hyperbole and it is the distortion and it is the inaccuracies which regularly flow from that caucus in their public utterances.

Mr. Makarchuk: Twenty thousand people must be wrong.

Mr. Cassidy: I regret those last comments by the minister, I have to say, because I have been putting forward a great deal of accurate information about just what is happening in the health care field and in the hospital field. I have not yet seen a word from the minister to refute any of the facts which I used in the throne speech debate a week and a half ago. If the minister wants to refute any of that let him put it on the record.

Hon. Mr. Timbrell: On a point of privilege:

I fail to understand how the member can claim that, when he has been going around claiming the ministry is trying to close 17 or 18 hospitals which is blatantly untrue.

Mr. Cooke: They are starving.

Mr. Cassidy: I did not say that at any time. I said the number of beds which are being closed by the Ministry of Health is in fact equal to 17 or 18 major hospitals across the province. That is the scope of the cuts and I am putting it in those terms in order to illustrate just how savage the cutbacks being imposed by this ministry are in terms of health and hospital care across the province. I will put some figures on the record, Mr. Speaker. A cutback in two and a half years --

Mr. Deputy Speaker: Order.

Hon. Mr. Timbrell: Mr. Speaker, I take it then that the honourable member --

Mr. Cooke: This is not a point of privilege.

Hon. Mr. Timbrell: -- denies the statement attributed to him in the Canadian Press story of the eighth, wherein he claimed that the ministry’s policies are in fact going to result in a closure of more than 17 hospitals and a loss of 4,500 jobs, neither of which is true. Does he deny that?

Mr. Cassidy: Mr. Speaker, I would just say quite simply that I did not say they would result in the closure of 17 or 18 hospitals, and if that is what CP reported --

Mr. Turner: You were quoted.

Mr. Cassidy: -- then it is a misquote. I did say there would be a loss of around 4,500 jobs and I believe in fact that may well be an underestimate rather than an overestimate. We can calculate that with eight million and some people in the province, and something over a half a bed per thousand being cut, it is very easy to show how 4,500 beds are to be cut from the hospital system of this province according to the plans of the Minister of Health. The minister and his ministry have yet to come clean with communities across the province to say precisely how many beds are going to be cut in Hamilton, how many here in Toronto, how many up in Ottawa.

[4:30]

We have managed to learn of certain cases where there are going to be very substantial cuts. In my reply in the throne speech debate a few days ago I spoke about what was happening in Geraldton, where 20 of the 45 beds in their hospital are going to be cut. I read into the record a letter from the physician who practises in the area. He said, and I quote: “A viable hospital is an important factor in determining the scope of service a physician can provide. Competent doctors will be very difficult to attract or to keep here, should the hospital be reduced to the status of a first-aid post.” That is a small, isolated community 300 kilometres from Thunder Bay -- the problems of which my friend from Port Arthur was speaking about just before me.

Mr. Hennessy: How about your friend in Fort William?

Mr. Cassidy: We know, in other words, that about 25 beds are due to be cut in Geraldton. But I understand that several hundred beds have to be cut in Hamilton and very substantial numbers of beds have to be cut in Toronto and other parts of the province. All we have had is “one shoe dropped.” People don’t know when the other shoe is going to be dropped, in terms of how many more beds are going to be cut and what impact that is going to have on the quality of health service across the province.

I do want to suggest, though, that if this cut -- which is arbitrary and not being made on any medical basis that we can see -- if the minister is set in this pattern then we will get down to 3.5 beds per 1,000 in southern Ontario by 1981. We will be down to three beds by 1984; to 2.5 beds by 1987; to two beds by 1990; and by the turn of the century, there won’t be a hospital left open in the whole province.

Hon. Mr. Timbrell: That’s nonsense -- unmitigated nonsense.

Mr. Cassidy: The minister says “nonsense.” I presume that somewhere there is going to be a stopping point. But let it go on the record that from the statistics we have been able to gather from Statistics Canada, Ontario at the present time has the second lowest proportion of active-treatment hospital beds per thousand population of any province in Canada. Now, that’s already very low, and for the minister to say there are medical grounds for suddenly, sharply and arbitrarily going down even further suggests to me he is looking at his budget -- but not at the quality of health care in Ontario.

As far as the workers are concerned, I met yesterday with some health-care workers in Windsor. I haven’t the notes with me and I can’t reproduce specifics, but they were telling me of 30 and 40 per cent cutbacks in the work force in specific hospitals because of the effective budget squeezing by the ministry up until now -- before the further squeezing which is going to take place. I think the minister will accept there is at least one health-worker job for each hospital bed in Ontario; I believe the ratio tends to be a shade higher than that.

Not only that. When I met with the administrator and the medical director of the Welland General Hospital in Welland a few weeks ago they told me the minister had decreed that for this year their hospital, which is a very efficient one, is to have a cutback of 16 beds. The efficiency of the hospital and the fact that its per diem is far below some hospitals which may have conceivably a bit of fat to cut is not considered. They are finding that they have to cut a whole ward, or 29 beds. Even then, they will be $210,000 short of the overall cutbacks that the ministry wants to achieve.

If that holds true across the province -- and I have heard other hospitals tell the same story -- then what we will be seeing over the course of the next couple of years is not 4,500 beds being cut, not 12 per cent of the hospital beds in the province being cut, but a much higher proportion. How, I ask, can the quality of hospital care be maintained in that case: when we have never had a plan for health and hospital care in Ontario; when we have never had any rational ordering of priorities to ensure that services are available in the community before these savage cutbacks take place.

The health-care workers I met in Windsor told me a very troubling story. They said:

“Our hospital used to be a happy place.” Everybody understands that if you have a happy hospital it is a healing hospital as well, because if people are happy, that will be transmitted to the patients.

Mr. Wildman: Is that your solution?

Mr. Hennessy: It’s yours.

Mr. Cassidy: Half the art of medicine is psychological, not just medical. But now they say the tension and the pressure have transmitted themselves right down to the people who make the salads and do the work in the dietary facilities in their particular hospitals.

They told me stories about how workers are under such pressure now because of the cutbacks already in place, even before the latest round, that they are having to take sick days in order to get their act together, they are feeling such pressure. They tell me that when a worker is sick, that worker isn’t replaced, so the pressure on the colleagues who remain at work is increased. When workers go off for pregnancy or take a holiday they are not replaced, so other people have to cover up for that particular job.

They are telling me that among health-care workers in Windsor the number of compensation cases for people whose backs are injured from lifting without the aid of the second person who used to be there, is on the increase. They are telling me of head nurses in wards who are bursting into tears because of the difficulties they are having in order to try to provide adequate care.

They were telling me yesterday of older employees in the hospital who may have 10 or 12 more useful years ahead of them in providing care, dedicated conscientious people who have been working there for many years, who are now considering or, in fact, taking early retirement because they can’t hack it anymore because of the kinds of pressures that they are coming under. They are telling me of tensions which are transmitted from support workers to nurses, from nurses to doctors. You and I know, Mr. Speaker, that if people are under that kind of pressure it is going to be translated into pressure on the patients, and if the patients are feeling the pressure, there is no way those hospitals can be healthy healing places where people get better.

They were telling me that in the chronic-care facilities there seems to be an increase in the incidence of bedsores because there is not enough staff to ensure that the people in those facilities are getting turned frequently enough and are being looked after adequately.

Let me give the House another example. My colleague Mac Makarchuk will talk about Brantford. My colleague Jim Foulds has talked about Thunder Bay. In the throne speech debate I talked about the enormous number of hospitals, in the southwest and in northwestern and northeastern Ontario, which are registering not just zero increases this year but have to endure very sharp bed cutbacks in areas where there is absolutely no alternative available, where the options the minister says should be available to the people who are consumers of health care are clearly not going to be available.

My colleague the member for Lakeshore (Mr. Lawlor) will talk about the problems there where the minister didn’t consult any kind of a hospital planning council before he closed the Lakeshore Hospital, he just acted arbitrarily. A letter from the Goderich Medical Centre to the Minister of Health reads: “I would beg you to read this letter on my enclosed chief of staff’s report which has been appropriately underlined. The bed situation at Alexandra Marine and General Hospital is serious and if the bed cuts go through as proposed by the Ministry of Health we will be confronting a dangerous and potentially lethal situation.” Dangerous and potentially lethal.

Mr. Deputy Speaker: The honourable member’s time has expired.

Mr. Cassidy: I will just be 30 seconds more. The minister bridled the other day when my colleague from Windsor-Riverside (Mr. Cooke) raised the case of a 78-year-old patient who was sent away from hospital because there wasn’t room in the emergency facility and who subsequently died. The physician who did the autopsy put the blame on the cutbacks. He put the blame directly on the cutback policy of this minister. It is not just my colleague raising this, it’s doctors themselves.

Mr. Deputy Speaker: The honourable member’s time has expired.

Mr. Cassidy: People are consistently being backed up in the emergency ward --

Mr. Deputy Speaker: Order, order, order.

Mr. Riddell: Mr. Speaker, I am amazed at how quickly history repeats itself within this government and more particularly within the Ministry of Health. It seems to me that three years ago I, along with many of my colleagues, pleaded with the Minister of Health --

Hon. Mr. Timbrell: Mr. Speaker, I want to respond, if I may, on a point of privilege. I had hoped I would have been asked earlier in the day --

Mr. Deputy Speaker: What is the privilege? What is the point of privilege?

Hon. Mr. Timbrell: The privilege, sir, is the allegation that somebody knowingly let somebody go away and die because of some policy of a hospital or the ministry. The fact of the matter is my staff did investigate the matter for me and informed me it was a case where the attending physician felt the individual was well enough to go home and not requiring --

Mr. McClellan: We’ll see what the inquest says.

Mr. Cassidy: We’ll see what the inquest says.

Hon. Mr. Timbrell: We will, sir. But let’s let the inquest do that; let’s not have members prejudge it; shall we?

Mr. Cooke: Mr. Speaker, on that point of privilege?

Mr. Warner: He’s abusing the rules of the House.

Mr. Deputy Speaker: Order. I don’t believe you raised that question.

Mr. Cooke: I raised the question the other day. I originally raised it in this Legislature.

I would like to point out that this caucus is not prejudging that particular incident. Dr. Broadwell, the coroner in the city of Windsor, stated the following in the Windsor Star; referring to my comments that the policies of this ministry are causing people to die in this province, he said the following: “Dr. Broadwell, in a telephone interview, said: ‘Good for him, I think he’s right,’ when told of Cooke’s comment.” Those were Dr. Broadwell’s comments, not ours.

Hon. Mr. Timbrell: I was referring to the comments of the --

Mr. Deputy Speaker: Order.

Mr. Cassidy: On the point of privilege, Mr. Speaker, since I raised this just now and the minister was responding to it: I met yesterday with a patient whom I believe was at Hotel Dieu or Metropolitan General Hospital in Windsor on January 19. That night when she had to be taken into the emergency ward there were six people stacked up overnight in the out-patients and eight people stacked up in the emergency ward itself; and that, surely, prejudges a doctor’s decision about whether or not --

Mr. Deputy Speaker: Order. This is becoming a debate.

Mr. Roy: That’s right

Mr. Cassidy: That’s what we are here for.

Mr. Riddell: Before I was so rudely interrupted by the Minister of Health, I was alluding to how quickly history repeats itself in this government and within the ministry.

It seems to me that three years ago I, along with many of my colleagues, pleaded with the Minister of Health to find other ways of cutting the ministry’s expenditures without having to employ the heavy-handed tactics of closing hospitals. With the aid of the courts we were successful in keeping the hospitals open, with the exception of two psychiatric hospitals which were owned by the province. I would hope the minister and his officials have had an opportunity to assess the tremendous error they made in closing these facilities.

Whether it was due to sheer spite, knowing that the ministry had no authority to close the hospitals, or due to a determined effort to cut the budget at any cost, the minister now appears to be accomplishing the same mission by reducing the number of hospital beds to a point where the hospitals will find it very difficult to continue the provision of a much- needed high quality service, or even to operate.

I don’t think I need to tell you Mr. Speaker, the tremendous impact that the policy statement of the ministry has had in the riding I represent. I’m sure the minister has been deluged, as I have, with letters from Goderich and surrounding areas. They aren’t just ordinary letters from constituents. They are letters filled with fear and frustration. Many of these letters are from senior citizens who are terrified of becoming sick and immobile, with no place to go and no one to take care of them.

In their letters, some of them suggest that society, due to the actions of this government, is moving closer and closer to legislation that would permit euthanasia. Men and women growing old in Huron county after a life of struggle and care, are actually living in fear that they will be reduced to little more than bothersome burdens, without dignity or respect. Surely the most fitting word to describe this is sad.

Not only have there been large public meetings in both the Wingham and Goderich areas over the ministry’s proposals, but the member for Huron-Bruce (Mr. Gaunt) and I, along with our health critic, visited both the Wingham and Goderich hospitals over a week ago to talk to the grass roots of Ontario about the delivery of health-care services.

Let me tell you, Mr. Speaker, we got an earful. If the senior citizens in Goderich and area are frightened by the trends in health care across the province, the doctors in the community are even more afraid. They made it amply clear that the Ontario Ministry of Health, and the Minister of Health, along with his civil servants, are playing a numbers game that is purely political. The government is attempting to eat into the large deficit which it has accumulated over the years. The Minister of Health has decided to reduce hospital beds for no other reason than to meet a budget which was struck by his ministry officials.

The minister came up with a formula of 3.5 beds per 1,000 referral population. Let me tell you, Mr. Speaker, that the minister is making a serious mistake when endeavouring to base health care on a formula. You simply cannot formulate health care.

It is obvious that the government doesn’t care about who will suffer from the bed cuts; and I think that is a sad commentary indeed.

A number of my constituents have met with ministry officials, and the first question that was asked of them was, “What in the world is going on in Goderich? The only letters we seem to be getting are from the Goderich area.” It’s obvious from this debate today that this is simply not true. But if apathy does exist in certain areas of the province, it may be that so much has been happening on the health-care scene lately that people don’t really recognize the implication of the bed-cutting edict.

[4:45]

In Goderich’s Alexandra Marine and General Hospital, a community hospital providing nearly 90 per cent of all the required medical services for the people who live in the area, and a hospital that has just come through one of the most rigid and strenuous cost-cutting exercises anywhere in Ontario, the bed cuts are a hardship and a terrible hardship. What’s more, it is dangerous. Doctors at Alexandra Marine and General Hospital have become unbelievably scared, because they have been trying to mix patients inappropriately, breaking the rules of good medical practices and squeezing the situation so tightly as to invite disaster. The doctors using the facilities of the Alexandra Marine and General Hospital have looked at other ways of running the hospital, but they don’t really have any idea of what the costs will be.

For instance, day-care surgery has gone away up at AM and G recently, and probably will continue to climb. There is a whole list of surgical procedures which are approved for a day-care surgery unit. It means the patients are brought into the hospital in the morning, the operations are done, the operating and recovery room staff take care of them for the day, and in the evening the unit is cleared of staff and patients. Everyone goes home.

Doctors are looking more and more to home care for patients in Huron county, but the home-care program is limited to a very restrictive set of criteria. Not every patient qualifies for the program that gets people out of hospital and into their homes where the medical treatment continues under OHIP funds. The services of the Victorian Order of Nurses and the staff of the Huron county health unit are also possible alternatives to in-hospital care for some patients, but provincial funding for these services hasn’t increased sufficiently to expect them to accept any increased load.

There may indeed be other ways of coping with the reduced hospital bed situation, but many of the programs aren’t in place in Huron county, as they are in some other counties, and really don’t provide a viable alternative. The reason such programs are not in place is that the government has refused to fund such things as additional nursing homes in places like Goderich.

In all due respect, the ministry itself understands some of this conundrum and has provided small hospitals with a 10-bed float during the switch-over period, but this isn’t of much use to AM and G. This hospital has been on a tight money-saving regime for months, trying to make up a deficit, and will pay a fine of $60,000 for having more beds open than the ministry guidelines decree. AM and G can’t afford to run a 10-bed float. We in Goderich are really quite bitter about the penalties imposed by the ministry for being over-bedded.

We believe the penalties are not legal, and it would not surprise me if there was a move afoot to take the ministry to court on this matter. It might well be that the ministry has no right to penalize hospitals and withhold funds. It is very difficult for people to understand that on the one hand AM and G got an overwhelming vote of confidence when it received a three-year accreditation recently, and on the other hand the hospital gets hit for a $60,000 penalty. Somehow we have to maintain good care in spite of it all.

But there is even more to fear. No one knows what further penalties will be imposed by the ministry. Alexandra Marine and General Hospital simply cannot afford any more budget surprises this year, next year or any time. The ministry has decreed that for 1979 four beds per 1,000 referral population will be approved. That computes to 43 active treatment beds for AM and G. In 1980 that number will drop to 3.5 beds per 1,000 referral population, or 37 beds for AM and G. It is understood that the bed allocation will be approved annually by the ministry and that the only way to increase the hospital’s bed allocation will be to document an increase in the referral population. This we think we can do, and I am pleased that the minister has agreed to meet a delegation from the Goderich and Wingham area to discuss this very matter.

It is the referral population that is concerning all of us in the Goderich area, including the community doctors and the hospital boards. Board members have been in the ministry office time and time again to ask questions and to express concern. Until recently, board members and doctors felt they were not getting the number of beds to which they were actually entitled under the ministry’s own guidelines.

Just a short time ago it was explained to the board that the ministry accepted 10,032 as the referral population for AM and C, while the hospital board had assumed from its calculation that the referral population was 14,581. The administrator of AM and G Hospital said it was an honest mistake on the board’s part. He said the board was adding in 4,549 referral population for obstetrics based on cases discharged from the hospital, but for ministry purposes the obstetrics population was included in the 15-to-44 age group referral population, and the board isn’t quite satisfied that this is fair. The population allowed by the ministry for the 15-to-44 age group is 4,603; that is both men and women.

By the ministry’s own calculations, the referral population includes 4,549 for obstetrical services only, which shows that some women are using AM and C when they have their babies and other hospitals for all other medical procedures. The delegation which has spoken to ministry officials on a number of occasions finds it is futile to dispute the ministry statistics, but it still has some doubts about the referral population figures and doesn’t seem to be able to get satisfactory answers to that.

The doctors have even more doubts. The doctors say the referral population is based on 1977-78 referral patterns and there seems to be little argument these referral patterns have changed drastically within the last year or so.

Practically the entire medical staff in Goderich has changed since these referral patterns were established and the board agrees. Whereas doctors who formerly practised in Goderich often sent their patients out of town for medical care, doctors in Goderich now prefer to treat their patients themselves in the local hospitals. This creates a greater need for hospital beds at the Alexandra Marine and General Hospital.

In a question I posed in the Legislature, I expressed the concern that the ministry has not taken into account the fact that Goderich is a tourist town, and as such has an increased population in the summer months. I have seen figures which would substantiate a claim that the summer population in the area swells by 9,311 persons in the area including Goderich and surrounding townships and villages.

Mr. Acting Speaker: The member’s time has expired.

Mr. Riddell: I could go on for some time, and I intend to do so when I reply to the throne speech, but suffice to say at this time that the government, in my way of thinking, stands to be condemned for its policies reflecting its philosophy: the survival of the fittest.

Mr. Wildman: Then support our no-confidence motion.

Mr. Laughren: I am worried about the Liberals’ restraint package.

Mr. Acting Speaker: The member for Brantford.

Mr. Makarchuk: I would like to --

Mr. Acting Speaker: I am sorry, the member for Peterborough. I was looking on that side and didn’t see anybody standing. The member for Peterborough has priority.

Mr. Turner: I apologize for my diminutive size, Mr. Speaker.

Mr. McClellan: Tell us about Peterborough; tell us about health care in Peterborough.

Mr. Laughren: Tell us about how many doctors have opted out in Peterborough, John.

Mr. Turner: I can tell the member the figures are not what he is quoting.

An hon. member: They are only half as bad.

Mr. Turner: They are not even close. He knows that and he is deliberately distorting.

Mr. Cooke: We have seen your articles in the Peterborough paper.

Mr. McClellan: A point of privilege, Mr. Speaker. I would ask the honourable member to withdraw that remark. Mr. Speaker, you will ask the honourable member to withdraw that remark.

Mr. Eaton: He didn’t name anybody.

Mr. Turner: I didn’t name anybody.

Mr. Acting Speaker: You don’t tell the Speaker what he is going to do until he has a chance to consider it. What is the remark that you want withdrawn?

Mr. McClellan: He said we were deliberately distorting.

Mr. Eaton: He didn’t name anyone.

Mr. Wildman: Oh, so he can generally state it, is that it?

Mr. Acting Speaker: As I recall, he said the figures you were using were wrong, and I think that is a matter of opinion.

Mr. McClellan: And that we were deliberately distorting them, is what he said.

Mr. Acting Speaker: I don’t recall him saying deliberately distorting them.

Mr. Makarchuk: You had better withdraw, John.

Mr. Turner: Why? I am all the time. That is one of my problems, Mr. Speaker.

Mr. Laughren: Either withdraw or take off those glasses.

Mr. Turner: I can’t comply with the member’s request, Mr. Speaker, because I have lost my reading glasses and I must rely on these.

Mr. M. Davidson: We know you are the member for Peterborough now.

Mr. Turner: That is firmly established. It is interesting that the Ministry of Health is probably mentioned now in more headlines than I suppose any other ministry in government. The subject of health care has obviously become a matter of debate throughout the whole of our society, and I would suggest it is an interesting paradox.

On the one hand the people of Ontario are satisfied with the health care they are receiving. According to a survey, fully 84 per cent of people have indicated the level of health care they are receiving is acceptable or satisfactory to them. I would have to say, as a politician, there is some comfort in numbers of that kind.

We also have endorsements from other jurisdictions, particularly from our friends to the south of us who wish they had a health care system such as ours.

Mr. M. Davidson: You haven’t got anything; you are going to endorse something.

Mr. Turner: On the other side of the equation there are some interesting factors involved. Hospital administrators are upset that we are limiting their increases to a four-and-a-half per cent figure. The Ontario Medical Association is concerned about the level of income for their physicians, and the consumers have indicated very clearly that they are concerned about the rising cost of living, as we all are. It is the concern for money, I suppose, that has been focusing attention on health care on the front pages of our newspapers, and I would suggest that it is the cost, rather than the quality or the amount of service, that people are concerned about.

Basically, it is fair to say, the people within the health-care system want more money than has been budgeted for them. The ministry and the taxpayers want restraints. So obviously there is a difference of opinion. But some misconceptions are developing, and I think they should be clarified. I think there has been perhaps some exaggeration. We hear people talking about cutbacks and restraints -- and undoubtedly we are in a period of restraint -- however, it is interesting to note that the Ministry of Health figures this year will increase by 8.1 per cent.

Mr. Laughren: Did the member for Fort William (Mr. Hennessy) write this speech?

Mr. Turner: No. I would suggest that increase is considerably more than the increase that has been allowed for social services, education, government administration or support to local governments. Quite obviously, health has not ceased to be a priority of this government, and it will not.

What really lies behind the headlines and the debates about the cutbacks and the spending restraints is a fundamental shift in our approach to health. In its simplest terms -- and I do not want to be accused of oversimplifying it -- the strategy is to take money out of some of the traditional high-cost areas and to shift these resources to new priorities such as community health, home-care and chronic home-care programs.

Mr. Wildman: Where are the chronic-care beds then?

Mr. Laughren: A long silence.

Mr. Turner: Not really. That is one of the things that is happening: Beds are being re-designated and will be used for chronic care.

I would suggest that an analysis of health spending yields three important conclusions.

First, the general level of health in our province is not rising as quickly as our expenditures for it. We are experiencing diminishing returns on our health-care dollars, and this would indicate that perhaps we are spending our money in the wrong places.

Second, quite obviously society is changing; we are getting older. The health-care system is not oriented towards the treatment of degenerative and chronic illnesses which now are on the increase. Thus, quite clearly, we find patients in intensive-care facilities designed to treat acute illnesses who really need physiotherapy, counselling or housekeeping assistance.

Finally, we have to recognize that we have not made enough progress in prevention. Medical research increasingly points to the fact that many of our diseases are preventable or controllable if we can simply learn to lead more intelligent life styles. It makes no sense to continue spending more and more money to fix up the problem when we can prevent it in the first place and, I would suggest, without the pain and suffering created by unnecessary illness.

Thus, we are not exercising restraint simply because we want to cut spending; this is an important consideration, but it is not the whole story. And I would like to emphasize that it is not because we lack resources; there is enough money to go around. It is just that we believe now that spending mare on hospitals is not the best way to improve the system.

There is no question that building acute-care hospitals has had some real benefits. There’s no question that providing these health-care resources has been of great benefit to the various communities. But, as I mentioned before, the population is changing. We cannot continue to make progress if we continue our apparent love affair with high-technology hospitals and acute, in-patient hospital care.

[5:00]

I would emphasize that our target is not a healthy system but in fact a healthy population and that’s why we have developed a strategy to restructure the health system in Ontario. Quite obviously, we are de-emphasizing hospital care. I mentioned that earlier. We continue to budget more money for these institutions but we are also redirecting funds to develop less-intensive facilities and forms of care such as chronic-care facilities, as I mentioned before.

Mr. Laughren: Where are they? Where are they?

Mr. Turner: Floyd, you know as well as I do, they have been mentioned many times: day surgery clinics -- somebody mentioned that on that other side -- day hospitals and out-patient services.

Mr. Laughren: Ask the member from Timmins. Ask the member for Cochrane South (Mr. Pope). Boy oh boy, send them from Timmins to Peterborough; what a joke.

Mr. Turner: These developments, I would suggest, reflect the fact you don’t have to be a passive patient occupying an acute-care hospital bed having your every need attended to to receive effective treatment.

Mr. Wildman: You need a chronic-care bed if you are going to move.

Mr. Turner: The alternatives I mentioned are needed to treat degenerative disease, which is relatively unresponsive to high-care intensive hospital care.

Mr. Laughren: Quit while you are losing.

Mr. Turner: Secondly, disease prevention and community health programs are being expanded. We are moving towards creating a uniform province-wide standard for community health because we recognize this is the best and most cost effective way to improve the general level of health. Thirdly, we are promoting the concept of individual responsibility for health. We believe so-called self care holds enormous untapped potential for improving the health of the people in this province. The other day I read an interesting report by Dr. Robert Levy who is director of the National Heart, Lung and Blood Institute in the United States. He says if the rate of death in 1976 had been the same as it was in 1968, 164,000 more Americans would have died. His conclusion is based on the number of people who would have died from heart attacks and strokes had they not made significant changes in the lifestyles they had been leading in the past decade.

Mr. Acting Speaker: The honourable member’s time has expired.

Mr. Turner: Thank you very much, Mr. Speaker.

Mr. Acting Speaker: The member for Brantford.

Mr. Makarchuk: Thank you very much, Mr. Speaker. The member for Peterborough said the people of Ontario are satisfied with health care. Today, the people of Ontario from one community delivered to the minister a petition with 20,000 names which were collected in less than two weeks, saying they are not satisfied with the health care. I have a feeling the people who signed that petition are more accurate and know more about what it’s all about than the member for Peterborough.

I would like to get into this debate to point out to the Minister of Health and to the members here exactly how they go about implementing some of their decisions. In Brantford, the local health council called a meeting on a Wednesday night. The meeting went on for two and a half hours of steady droning by officials from the ministry. After the droning was over the message came across that they were going to close St. Joseph’s Hospital and make it into a chronic care facility. There were a lot of people who were upset. They wanted to ask questions. They wanted to find out. They were denied absolutely any opportunity to question the report, or question the officials.

That’s the way they operate. They ram it down the throats. We had a member before known as the great McKeough. Remember him? Every time he got up, the guys used to shudder. I think the feeling is developing. I notice when the Minister of Health was sitting over there, there seemed to be the cordon sanitaire around him that used to exist around McKeough when he brought in that OHIP budget.

Remember those days when the Attorney General said: “It’s not my budget, it’s his”? The Premier (Mr. Davis) had to get a solidarity group together there for a while. I think the same thing is going to happen with the Minister of Health. The Minister of Consumer and Commercial Relations (Mr. Drea) is saying right now that obviously Timbrell doesn’t know what he’s doing. I have a feeling the Premier is going to call the boys into the back shed and have another chat about sticking together on the situation.

The Minister of Health gets up in this House day in and day out and says all the beds are available, despite the fact doctors, people and everybody else cannot find beds for the people in hospitals at this time. He says there are beds. I will give you an example, Mr. Speaker, of how good the bed service isn’t in Ontario.

There was a mental patient in Brantford who had enough sense to realize he was suffering an acute attack and he needed to go into hospital. He contacted the hospitals or his doctor; they could not place him in the hospital because there were no beds. He contacted the hospital in Hamilton; there were no beds. He contacted the police; there were no beds. Finally, in desperation, this man got into his car, drove down to the local OPP station and demolished their fleet. After he had demolished their fleet, they found him a bed.

That is the health-care service of Ontario; there is an example of what the people opposite are doing.

Regarding the Brantford situation, something the minister and his group failed to realize is the fact that we have two hospitals, but one of them, St. Joseph’s, which the ministry plans to close, is situated next to an industrial area in which some 5,000 or 6,000 people are employed. It is convenient; it is adjacent to the industrial area. Having an emergency department close to an industrial area is very necessary. Everybody would agree to that, maybe even the minister.

Other factors are involved. The minister uses the population in the Brant county area of about 98,000 population. But he does not recognize the fact that the hospitals in Brantford receive patients from Norfolk, from Haldimand, from Oxford and from Wentworth. These people also come and feed into the Brantford system. But this is not taken into account in a decision when he goes about with his “cookie cutter,” as someone described it earlier, and chops off the beds and chops everything else.

It should also be recognized that there is a good deal of opinion and medical research available now pointing out that if you have a hospital with other services than chronic care -- it doesn’t necessarily have to have all the services, but it does have other services; it has an emergency; it has an operating theatre -- this kind of hospital operates better, provides better service for chronic-care people, provides better service generally all around. This is a factor that should receive great consideration from the minister and his officials when they try, as they have been attempting in Brantford, to close down the hospitals.

The assumption is that there are hundreds and hundreds of people in hospitals lolling about in the beds; just lying there. I challenge any member here in the House to name one. I challenge any member to name one patient he knows who is lying around in the hospital just because he or she likes to lie around.

Something the minister forgets to recognize is the fact that they have admission committees, they have discharge committees. In some cases, they may fall down on their jobs. In some cases, there may be some influence on the part of the doctor to ensure he has nine, 10 or 15 patients in the hospital so that when he comes through on his royal tour in the morning he can bill for nine, 10 or 15 patients for saying “Hello.” That is a well-paying business. But if you have a proper administration and if you have the committee set up, this should not be a problem.

No amount of computer input, or whoever uses a crystal ball in the back room, or something like that, can decide exactly or specifically how many beds should be there. The only way one could really decide on that is by knowing whether the beds are being used, used to capacity and the people in there need to be in there. Then, obviously, you have to keep that hospital open because you can’t play around with human lives. It was mentioned by my colleague the member for Oshawa (Mr. Breaugh): How high must the body count be before the minister changes his mind?

We have mentioned the one incident in Windsor. There was another incident in Brantford that involves a coroner’s inquest right now, a very similar situation. How many more do we have to go through before the minister starts looking at this thing from a human, sensible, point of view?

I want to conclude by pointing out to the minister that the doctors in Brant county disagree with him. In fact, one of the doctors on the health committee, who decided to express his views publicly, was chastized by the health committee: “You should not say these things.” The man was concerned that they are demolishing the health system here. He put a letter in the paper and the local health council immediately sent a letter to Timbrell dissociating itself and then sent a letter to the doctor criticizing him for speaking out for his community.

That brings into mind just what kind of people are on the health council. Mind you, a lot of them are old Tory hacks. I can understand they do have their political biases and they do have the intentions to protect the minister. But somewhere those of us who are not Tory hacks have some concern about the community, and sometimes we wish that some of the Tory hacks we have on some of these committees would show some concern for the communities.

I suggest in conclusion that doctors say the minister is wrong, the people have said the minister is wrong, and it is damned near time the minister started to listen.

Mr. Gaunt: Mr. Speaker, I wanted to make a few comments in this debate because Huron county, and particularly the Wingham hospital which I represent and which is in my constituency, are greatly concerned about this matter.

It has been mentioned this afternoon that the hospital bed-cutting program isn’t a program that is generating universal concern across the province and that is quite true. It is not doing so for a very good reason I suspect -- perhaps a number of reasons. One of the reasons was alluded to by my colleague the member for Huron-Middlesex (Mr. Riddell). The other reason I suspect is that a number of hospitals in Ontario are currently operating at the 3.5 beds per thousand level or below, and approximately 50 hospital centres are already at the 4.0 bed per thousand level which is the guideline applicable for 1979-80. So those hospitals that are already at the 3.5 or even at the 4.0 level certainly won’t be greatly concerned and raising any sort of a fuss at this time because they are really not being affected.

But I repeat that in my community there is a lot of concern, particularly as it relates to the Wingham hospital. There are concerns on the part of the workers who are afraid of losing their jobs -- a legitimate concern. There are concerns on the part of the medical staff. The medical staff feel that their ability to treat patients and their ability to deliver a first-class health-care system in the community are going to be somewhat limited and interfered with if they don’t have the active-treatment beds to which they can refer patients in need.

There are concerns expressed by senior citizens who fear that when they get sick there won’t be a bed in the hospital available for them. There are concerns expressed by the community generally -- legitimate concerns -- that once the ministry enacts its program of this particular bed cut three or four years down the road there will be another cut and eventually the small, rural hospitals will be reduced to a level that really won’t be economical in terms of operation.

I was at a hospital meeting last night in Goderich -- my colleague was there as well and he alluded to it -- where one of the medical staff said that in his view a hospital that doesn’t have at least 30 active-treatment beds cannot be operated efficiently. There is a great fear that the ministry will just gradually cut back and ultimately say to some of these smaller rural hospitals, “I’m sorry, you only have 20 or 25 active-treatment beds, you are no longer operating efficiently, you are too small.” And so the hospitals will go by the board in favour of a larger, centralized operation.

Mr. Riddell: That is what you call coming in the back door to close hospitals.

Mr. Gaunt: That’s right. I think my colleague is right. The government wasn’t able to do it via the hospital closure route and now it is attempting another measure in effect to accomplish the same thing. That is the fear that is being expressed.

Mr. Cooke: Closure by instalment.

[5:15]

Mr. Gaunt: Closure by instalment. I think there are some fears, particularly on the part of medical staff who have come from England and who have seen their system operate over there and fear that the same thing is happening here. The same sort of program evolved and eventually they got themselves into a real dilemma in terms of health care delivery, where even for a gall bladder operation a person has to wait for a year in some cases.

Let me cite some figures applicable to the Wingham hospital for the period April 1, 1978 to December 31, 1978 in respect to the use of active treatment beds. My colleague has dealt with the Goderich situation. Both of us are concerned about that as well, even though it isn’t in my riding, because there are people in my riding who are referred to the Goderich hospital. We really have major concerns with respect to both hospitals, but my colleague having dealt with the Goderich situation I will concentrate on Wingham for a moment, if I may.

First of all, those 65 years of age and over constituted 30.6 per cent of all the patients admitted during that period to which I made reference. There were 677 admitted for a total of 8,089 hospital days, which was 49.2 per cent of the total hospital days. The average length of stay was 11.9 days.

For those under 65, there were 1,536 patients admitted. They constituted 69.4 per cent of all patients and represented 8,343 hospital days out of a total of 16,432 active-treatment hospital days. In other words, of the total admissions for active treatment, 30 per cent were in the age bracket of 65 or over but constituted 50 per cent of the total hospital days.

At present, there are 33 long-term or chronic patients over 65 in the hospital, even though there are only 18 designated chronic beds in the Wingham hospital. In addition, there are six chronic patients under 65, for a total of 39 chronic patients but only 18 designated chronic beds.

The point I am making is that the hospital needs more chronic care beds than we presently have because the population makeup in Huron is well above the provincial average insofar as people 65 years of age and over are concerned. As a matter of fact, Huron is 50 per cent higher than the overall provincial average in that respect; 12.9 per cent of the people in Huron are 65 and over compared to the overall provincial average of 8.6 per cent.

There are only five counties in the entire province that have a higher percentage of aged population. In Bruce county, 13.3 per cent of the population are 65 years of age and over. There are only three counties in the province of Ontario that have a higher percentage of aged people. These figures, incidentally, are taken from the March 25, 1977 figures supplied by TEIGA.

Further, I should point out what is happening at Huronview, the county home for the aged. At the moment, there are 292 beds being occupied out of a total of 310. There are 148 patients who require extended bed care, which means that those who occupy those beds require at least one and a half hours of nursing care per day. 78 out of the 292 require some nursing care and only 66 are able to totally look after themselves. There are 27 on the waiting list. Of those, 14 will require bed or extended care while 11 can partially take care of themselves.

The point in all of this is that the home for the aged for practical purposes has now been turned into a chronic hospital. There should be more chronic hospital beds designated in the county and more nursing home beds approved to return the county home to its original purpose. The Ministry of Health has continually refused to grant any more nursing home beds in the county. We have made a plea on numerous occasions, year after year, but consistently the ministry turns the applications down. The need is there and can be shown, and I hope the ministry responds accordingly.

Surely in an area as important as health care the ministry has to be sensitive and alert to the needs of every community across the province. Obviously there is difficulty in applying a policy uniformly and universally across the province because there are differences in communities, there are differences in population makeup, there are differences in the degrees of hospital efficiency across this province, and those matters should be taken into account.

I say to you, Mr. Speaker, that those matters, up until now, have not been taken into account. The Wingham hospital, for instance, has come in under budget on three successive occasions, the latest of which is this year.

Mr. Acting Speaker: The honourable member’s time has expired.

Mr. Gaunt: Thank you, Mr. Speaker. May I just conclude by saying that the minister has indicated to me in a letter dated March 16 this year that reclassification of surplus active beds to chronic care will be considered in those areas where there is a demonstrated need. In my view we can demonstrate that need and I hope the ministry responds accordingly. Not only do we need to maintain our active treatment beds, but we need more designation of chronic beds as well.

Mr. Hennessy: I rise concerning the district of Thunder Bay. I am greatly concerned about the cutting of hospital beds. I have not before had as many calls, as many people who were concerned about an issue as they are about this one. If you live in a remote area far from major places of medical attention, if you happen to live up in northwestern Ontario and realize the long distance between various towns and municipalities, you then come to appreciate what it is to be a northwestern Ontario resident. It is very, very difficult to reach one area from another, especially if medical attention is seriously needed. You have difficulty maybe with air transportation -- because of the weather it might not be feasible. At various times the weather changes within 50 miles’ radius with a large snowstorm between different towns.

I can’t buy the idea of cutting back beds. In all sincerity I cannot buy it. Even being a member of the government, I just cannot buy it as a human being.

Mr. Riddell: Come on over, Mickey.

Mr. Hennessy: No, this side is still better. With all due respect, we all have our own thinking. I feel that I would not be fair to myself if I was just to agree it’s right financially; in a humanitarian way it’s not right. When you have somebody in a hospital, Mr. Speaker, whether it be a mother, father, sister, brother, a relative, whoever it might be, there is nothing that leaves a more lasting impression than the medical care and attention they receive. You also consider in your mind whether you got in there soon enough, or were you too late, or did you do the right thing. I think the members know what I am talking about when I talk in this vein.

When you have to go to a hospital and be put in a hallway to wait overnight to receive a bed, it does make the person wonder -- it does make the people, the parents, whoever it may be, wonder -- about the welfare of the people who are there. I guess it is very nerve-racking, because when you are sick you do a lot of thinking, you have a lot of time to think.

I am concerned about the possible loss of jobs. The economic condition is not that good. There are many people who are working in hospitals who could possibly lose their jobs after 15 or 20 years of employment, people who maybe do not have much of a bankroll stashed away, if you want to put it that way; or who don’t have many benefits in regard to a pension fund and therefore would be more or less destitute and perhaps spend their remaining years in poverty, to some extent.

I am greatly concerned and, as I mentioned to you before, there is the problem of the long distances involved. I think that the lack of chronic-care hospitals or beds in Thunder Bay is like putting the cart before the horse.

We mentioned the other day at a hospital meeting I was at with my colleague the member for Port Arthur (Mr. Foulds) and the members of the hospital board, and I’m very pleased to say this, that a meeting has been arranged for this coming Tuesday with the mayor and council, the hospital boards and the Thunder Bay District Health Council, along with the local representatives. The Minister of Health and his colleagues no doubt will be there. I hope that something satisfactory can be arranged through sensible dialogue between all parties concerned. I don’t think any ranting, or any yelling and shouting, is going to solve the problem. I think if we sit down with people who know something about the medical situation in Thunder Bay perhaps we can come to a suitable arrangement. I sincerely hope so.

Knowing the long waiting period, one can understand the anxiety that is experienced by people in Thunder Bay who have somebody who is sick and are worried about whether they can get to a hospital to receive medical attention -- particularly when you realize that Winnipeg is 450 miles from Thunder Bay and in between, from Kenora on, you have to go either to Winnipeg in the province of Manitoba, or to Thunder Bay, for major surgery. Even when you look to Manitouwadge and White River, you’re still talking about 200 miles or 300 miles which you have to travel. It’s very difficult.

Before I became an esteemed politician -- if you want to call it that -- I was a liquor salesman.

Mr. Ruston: Oh you are very esteemed, Mickey; sure you are.

Mr. Hennessy: I’m talking about you fellows too.

I was a liquor salesman and I had to travel those routes in the wintertime. Even at the best of times, coming from Red Lake was no prize. I almost got killed a few times. I still think to this day that it was the Liberals who were trying to kill me, with all due respect to Bob Nixon.

To get back to the subject --

Mr. Kerrio: That’s why you were a Liberal, eh Mickey?

Mr. Hennessy: That’s right, a black one.

Mr. Wildman: Black and blue.

Mr. Hennessy: I would hope that this situation can be rectified to some extent.

I hope that money for maybe a sewer or a road is not as important as the life of a person who depends on the medical attention they may receive -- whether it’s a woman or a man or a child, a boy or girl. That’s the last stage in life, when you’re going to a hospital and everything depends on whether you will have the right attention and whether the facilities will be available for you.

I think that medical facilities should be made available. After all, you’re dead a long time. There’s lots of sorrow left behind when a person departs from this world, perhaps though no proper facilities being available or the right precautions taken. As far as I’m concerned, I would very much like this meeting on Tuesday to produce more chronic-bed care so perhaps we can make more beds available in the hospitals in the city of Thunder Bay.

Mr. Wildman: I rise to participate in this debate because of a concern for the problems we have in northern Ontario in terms of hospital beds. I appreciate the comments of the previous speaker because we know the feeling he has and I understand the difficult position he finds himself in.

We have today a very serious situation in northern Ontario, and even the government is aware of it. When you consider studies that have been done by this government -- for instance the health policy evaluation study, in part of the review for the “Design for Development in Northwestern Ontario” two or three years ago, where the government was told the death rates, particularly violent deaths and infant mortality, are much higher in northwestern Ontario than they are throughout the rest of the province. When you consider that, one has to wonder why we are cutting services. It seems to me we should be increasing services, not cutting them.

Members might argue that hospital services won’t deal with these major problems, but until we have more community-based services in place it doesn’t make sense to cut the active-treatment care facilities we have now. As the previous speaker said, we seem to be putting the cart before the horse.

[5:30]

If one argues, as the parliamentary assistant did, that we need more chronic care, we had better provide that before we cut the active-treatment beds. We can’t do it the other way around.

The study I referred to a moment ago pointed out that in northwestern Ontario we have a shortage of chronic-care and nursing-home beds, as well as psychiatric-care beds. When you consider that we have the shortage already, and the distances that are involved in my own riding, in the northern part of Algoma, we are having a terrible time attracting doctors. This is a problem throughout the province. Unless we can provide adequate services, we are going to have an even more difficult time. Even when you have those facilities, it is sometimes difficult to attract doctors; if you do not have them, it is even more difficult.

We have to take into account the geographic factors in northern Ontario. If the government cuts hospital beds in Thunder Bay or in the small hospitals throughout the northwest, with the result that there just are not beds available, people are going to have to travel much greater distances if they need care. We cannot accept that.

The government might argue that the 10-bed cushion it has given to small northern rural hospitals this year is dealing with that kind of flexibility. Frankly, I do not think it is good enough, because we do not know what is going to happen next year. Are these hospitals to continue having a 10-bed cushion or is it going to be denied next year? If it is going to be denied next year, are we going to be able to maintain viable hospital services?

The problem that a small hospital has, unlike a larger one, is that it cannot cut a ward, because it has only one ward. How do you cut a ward? You cannot lay off a technician, because you have only one technician. You cannot lay off nurses, because you only have enough to provide the one service now.

If I feel emotional about this, it is because I have dealt with small hospitals which have difficult times now in attracting doctors and in providing the services necessary. And what do we have? The government is cutting budgets to them.

Just look at some of the things we see in northwestern Ontario. Look at Kenora, Rainy River and Fort Frances. For La Verendrye Hospital, there is no budget increase this year. For Red Lake, there is an increase of only 0.87 per cent in money this year. When you consider that, you wonder what happened to the Ministry of Health’s commitment that hospitals with fewer than 50 beds would receive at least a 5.3 per cent increase. Those hospitals do not have more than 50 beds. Red Lake, for instance, has only 44 beds now, and yet it is getting a 0.87 per cent increase. Why is it not getting the 5.3 per cent? That is true also in Geraldton District Hospital, Manitouwadge General Hospital and Nipigon District Memorial Hospital. The first two are not receiving any increase this year, and Nipigon is getting 3.6 per cent. Well, 3.6 per cent is not 5.3 per cent. I would like an explanation from somebody on that side as to the reason for this.

Altogether, these six rural hospitals from Geraldton to Terrace Bay are receiving only a 2.8 per cent overall increase in funding this year. I know the Speaker is interested in this. I would like to hear an explanation. How does the government justify it?

Throughout the north we have this problem, of course. Cochrane is being hit particularly hard. If you consider Bingham Memorial Hospital in Matheson or Anson General Hospital in Iroquois Falls, they also qualify for a 5.3 per cent increase, and yet they are receiving a zero increase.

The eight hospitals in Cochrane district have been the hardest hit: 71 beds are to go next year, or 141 altogether, if the small-hospital allowance of 10 beds is not taken into account; and we do not know that it will not be next year.

I would like to have some explanation from the people on that side. When they started off with a 4.5-bed-per-1,000 ratio a few years ago, that was completely arbitrary. They could not justify it at that time; now they are cutting it, and they do not give any justification.

Overall, we are getting a 3.6 per cent increase in funding for this year in northern Ontario. That is a long way from the eight per cent that was mentioned by the parliamentary assistant. It is not enough to have a general bed formula where you say 4.5, 4, 3.5 or whatever number of beds per 1,000 for a geographic area, because when you talk about the districts in northern Ontario you are talking about a lot bigger area than the counties that were mentioned by our colleagues from southwestern Ontario; and they’ve got problems. If you don’t have the beds in Hornpayne and you don’t have beds in White River or Wawa or Geraldton, it’s a hell of a long way to Thunder Bay or Sault Ste. Marie.

I would like some explanation from over there.

Mr. McGuigan: Mr. Speaker, I would like to join this debate and to express the concerns of Four Counties Hospital at Newbury. This hospital is not in my riding. It is about four miles outside in the riding of the honourable member for Middlesex (Mr Eaton). It serves four counties. About 50 per cent of the patients; I believe, come from the two townships in Elgin that I represent, approximately 40 per cent from the county of Middlesex and approximately 10 per cent from Lambton.

A total of 15,950 days of care were given from January 1, 1977 to March 31, 1978. This is one of a group of seven small hospitals in southwestern Ontario coming under group nine in the hospital statistics. These are hospitals with from one to 49 beds.

I note that only two of this group of seven have no chronic beds. I visited the hospital last Friday and talked with the administrator and with the nurse administrator. They tell me they have not sought chronic beds in the past because the area is well served with nursing homes.

In this hospital they do carry out a very extensive out-patient commitment. Their people go to the various nursing homes and assist them in their care of chronic patients so that they prevent bed sores and debilitating diseases such as those that result in rehabilitation care within the hospitals. So this hospital is going to the people.

While they do not require these chronic beds, or they have not in the past, they do require the finances to carry out this program. Now with the reduction of five beds, starting April 1 their budget is reduced by $60,000. By 1981 they are supposed to go down to 19 beds so they would have only a total of 26. This brings up the point the honourable member for Huron-Bruce (Mr. Gaunt) brought up: when they reach that figure of 26, how economic will the hospital be? It will have lost economy of scale and will probably cease to exist; or at least the people certainly feel that.

This hospital has a somewhat different problem than those mentioned by other speakers. Their problem is not so much in active-treatment beds; their problem is a matter of having the finances to carry out their outpatient work.

I would mention that a number of years ago this hospital attracted a specialist from London who over the course of years attracted other specialists. Today we have people visiting the hospital on a daily basis -- an eye man today, internist tomorrow, a bone specialist the next day and so on. These people come out from the city of London and do a great deal of their diagnostic work in that hospital, a hospital that operates on a cheaper per-bed item, than say in the city of London where some of these patients are eventually sent for very serious treatment. They receive the diagnostic evaluation in the smaller hospital because of these specialists coming out there. So they have a very active in-patient and out-patient program that is somewhat unique in the hospitals, so they tell me, in Ontario. This is carrying out, I believe, some of the aims of the ministry in that they talk of shifting from active-treatment beds to preventive medicine. This hospital has been carrying this out to a very high and excellent degree but the people find now that their finances are being threatened and they’re very concerned.

Their occupancy rate is not as high as others that have been mentioned. It’s about 80 per cent. They can possibly survive the five beds that they are going to lose on April 1, but they cannot survive the loss of money. I would point out, as others have pointed out, that the people are proud of the hospital and they regard the assaults on their hospital as an assault on a small community. They ask, if the hospital is reduced to only 26 beds, if the hospital will survive.

I understand that the board has asked the ministry for a team of officials to visit and examine the total operation of the hospital. They have told me that the honourable member for Middlesex has indicated that such a team exists and we would certainly urge that if this is so that work go forward.

Mr. McClellan: Send one up to Cochrane too.

Mr. Eaton: All you have to do is work on it.

Mr. Kerrio: Just think, we’ve got a champion looking after your hospital, Bob.

Mr. McGuigan: Mr. Speaker, I’ve been sent a petition from just over 50 local people and I received many letters, which I have in my hand. I’d like to read you one letter which I think eloquently expresses the --

Mr. McClellan: How many people?

Mr. McGuigan: About 50; just over 50. I’d like to read a letter that eloquently expresses the feelings of the local people.

It says: “As your constituent, I am respectfully submitting the following concerns for your action. As you are aware, the budget for the Ministry of Health has included the cutback of services of various hospitals, including that of Four Counties, Newbury, which serves your constituents. As a previous patient of that hospital, as a present volunteer member of the auxiliary of that hospital” -- and this person goes on to list many activities within the community -- “I urge you to use all the political clout you possess to halt the present cutbacks of hospital services especially in the area you represent.”

The writer asks: “Have you personally noted the list of consultants” -- I did this last Friday -- “outside the door of the emergency room at Four Counties? Have you noted the varieties of disciplines from which they come? Have you computed the miles of travel and hours of heartaches of your constituents that have been saved by these services? Do you know that surgeons from London, the best, who have performed operations at this hospital also return the next day to check on their patients? Do you know what the daughters of many of your constituents have served and are now serving as candy stripers daily in that hospital? Do you know that as of April 1, 1979, five beds will be unavailable to your constituents and that in future months many more will be unavailable?” It just asks for acknowledgement of the letter, which I have done.

I would point out in closing that this hospital is somewhat different in its situation than others that have been mentioned but the people there have a very real concern for the quality of care that they can offer to their patients both in and without the hospital, and they have urged me, and I through you, Mr. Speaker, that the government seriously consider measures to maintain the very excellent services which this hospital has been able to perform.

Mr. Lawlor: Mr. Speaker, I’m trying to leave some time for another colleague of nine --

Mr. Eaton: Mr. Speaker, the rotation is going this way. We should be next.

Mr. Riddell: You really don’t want to speak on Newbury, Bob, do you?

[5:45]

Mr. Eaton: Oh, yes, I do. I would like to continue and add a few remarks to what the member for Kent-Elgin has said in regard to Four Counties General Hospital because it is a very fine hospital and performs an excellent service in the community and will continue to perform that service.

Mr. Kerrio: Even if they have no beds.

Mr. Eaton: I suppose I reacted rather hastily, as I usually can when something like that comes up, and I expressed a few strong feelings to my friend, the Minister of Health, as I can. When someone reads in the paper that a hospital is going to be cut from 45 beds to 26, he naturally gets pretty damned concerned pretty quick --

Mr. McClellan: Doesn’t the minister talk to you?

Mr. Eaton: -- and gets a little hot over it. We went into the matter a bit and, as members know, they weren’t cut that much in the first cut that was made. In fact, the budget worked out for this year not as $60,000 less, as the member for Kent-Elgin has stated, but they have a one per cent increase in their budget. With inflation, that’s pretty hard to take. But I sat with the board and we discussed that and the board said: “We can live with that. We can do it.” That’s the attitude of the people in that community in regard to their hospital. They know they want to operate it. They know they can do it that way.

Mr. McClellan: Despite the government.

Mr. Eaton: The member for Kent-Elgin mentioned the chronic-care situation. It was indicated to them a number of years ago that they should be applying for chronic-care beds and the board did that at their last meeting. They have now applied for the chronic-care beds that will be necessary in that area. I understand from the ministry that they are going to be approved and that they will be supplied with those chronic-care beds, which will almost take up the number of beds that is being cut from active-care treatment. It just stands to reason if that’s the kind of service that is being provided, a chronic-care situation, then that’s the kind of beds they should be classified as.

In some instances in large hospitals, where a whole ward could be converted to that, it would probably mean fewer dollars in the budget because they can operate a complete ward for less money when it comes to chronic-care services. In the case of a small hospital, they are probably going to get the same dollars for the chronic-care bed as they are getting for the active-treatment bed, so they are still going to end up with the same budget. In fact, if there’s an increase coming next year, they will be eligible for the same increase as other hospitals are based on their active-treatment beds and based on their chronic-care beds.

Mr. Bradley: That ought to make them happy.

Mr. Eaton: That’s right. It should. The member can be sarcastic but when we sat down and examined the situation and worked out with the ministry what was really happening, we are going to have as many dollars for that hospital. We are going to have the increases that are going to be necessary each year to operate that hospital and we can continue to provide the services that are being provided there now. They are fine services and the people have a very great right to be proud of what they have developed in that area.

Mr. Sterling: And proud of their member.

Mr. Eaton: One can go a little farther. I think one of the members over there referred to the fact that there are many people coming from Brantford to his hospital and they weren’t considering the people that came from outside there. When I saw the first figures for our hospital down there in Newbury, I reacted the same way. I said, “Jesus, there are more people in that area than that.”

We sat down and examined it. The ministry has the exact figures of how many people came out of Wardsville and went to that hospital, how many people came out of Wardsville and went to London, how many went to Chatham. It is the same thing for the townships in the area of the member for Kent-Elgin. They know exactly how many are involved in the particular area and have worked it out very well.

When we sit down calmly and work at this, when we work with the boards, then the situations can be worked out. I think if some of the other members who have reacted in the same way as I probably did in the first instance would sit down and work their way through these, we can find that the hospitals can still continue to provide the services. I don’t think that anyone on this side or that side wants to see any health services cut in any way. What we are interested in is seeing that health care is delivered efficiently in those areas. It can be done and it will be done --

Mr. Foulds: And humanely. It is a humane thing. Didn’t you hear the member for Fort William? Humanitarian.

Mr. Eaton: -- with the administration of our Minister of Health and this government. Thank you.

Mr. Speaker: The member for Windsor- Riverside? The member for Lakeshore -- finally.

Mr. Lawlor: Thank you. I shall try to be brief and allow time for my colleague.

May I just put it rather bluntly to the minister in the empty spot he is occupying over there -- I mean the blankness that I received from him this day is just about equal to the hiatus that exists as I look across the floor. You get about as much response in one circumstance as in another, so it doesn’t really matter very much whether he is here or not, does it, Mr. Speaker?

Mr. Hennessy: He is, Pat, you can’t see him.

Mr. Lawlor: The minister is making a very bad mistake in closing Lakeshore. He only has three psychiatric hospitals in this greater Toronto region serving as far out as Halton, including south Halton. He just won’t have the capacity in a very short time, certainly in two or three years, to -- I find it much more palatable talking to him this way than I have to do normally.

Mr. Breaugh: He is much more intelligent.

Mr. Roy: Well, he is doing just as well there as he did in the question period this afternoon.

Mr. Lawlor: I have to do this quickly. So I say the minister hasn’t got the capacity. The figures are all set out for him in a brief submitted to his office, and which I trust he has looked at, by the union involved.

Mr. M. Davidson: I wonder where he is.

Mr. Bradley: He is here in person.

Mr. Lawlor: At page two, they say -- indeed, this is a quotation from your own McKinsey report -- ah, here he is. Now, I may as well sit down.

According to the McKinsey report -- indeed at least as measured by in-patient beds, by international standards -- both Ontario and greater Toronto have already reached a minimal level of psychiatric hospital resources. I quote: “We believe it would be unwise to plan on a reduction on the rate of admissions to cut the growth in beds needed at any of the psychiatric hospitals, especially Lakeshore.”

Then, if the minister would peruse what is contained on page 24 of this brief: “It is seriously questionable whether Queen Street will be able to cope with the physical transfer of 296 patients and 286 staff to its facilities. Despite all official claims of excess capacity at Queen Street, the government’s own study indicates that there are only 125 to 150 beds realistically available to accommodate the transfer.

“Originally built for 700 beds, Queen Street has 416 beds currently set up and staffed, leaving 284 beds theoretically available. However, of these 284 beds, 68 are dedicated already to Metro court referrals for assessments and cannot be used.

“The use of another 138 beds would require the physical relocation of several programs and interfere with the utilization of the psycho-geriatrics unit in the 1956 building and, therefore, only one third to two thirds of these could be used and only with difficulty. Only 78 of the beds could be used without disruption. That brings the number of beds that could realistically be available to 125 to 150.” This was borne out in further figures contained later on.

I recommend to the minister and have recommended and will continue to recommend to the minister that, first of all, he cannot place human lives over against a balanced budget and that is precisely what he is doing. The impersonality and the arbitrariness of the whole thing --

Mr. Riddell: That’s right.

Mr. Lawlor: -- and the impact on mental health care -- which is what I am concerned with today -- is just too great in terms of human suffering and the minister is responsible for that.

What I recommend he does is not move in with new facilities immediately. But he says there will be no capital expenditures throughout the 1980s. That is totally absurd. There must be fairly substantial capital expenditure on hospital construction, renovation and whatnot throughout the 1980s. So, don’t move in on Lakeshore immediately; use a phasing or a planning concept. If the minister wants to take down one of the older buildings, let him place a smaller hospital or some portion of a smaller hospital on those very extensive grounds. It doesn’t have to use all the grounds by any means. In 10 years’ time. -- or, trusting that the economic conditions will improve, in lesser time -- the minister would have a 150-bed hospital there; he would take down the other buildings gradually and phase it in.

That would save the minister all his difficulties with respect to this out-patient scare. In my opinion, he is just not going to find the facilities in Lakeshore to accommodate the Alcoholics Anonymous unit, the utilization of the vocational and therapeutic training that people presently get on the grounds -- and, incidentally, in fairly new buildings too, which the minister is going to have to raze to the ground.

Why does the minister not work it in a far more intelligent and long-sighted fashion? Unless he has a peculiar animus against Lakeshore, or even possibly against me, he would reconsider his position in that light. He would give further thought to how this could be worked out with retention of the present facilities without the disruption he is going to cause and leaving his own hand short, because he is going to spend five times as much money in capital expenditures by 1985 on a location somewhere else. We are going to have to buy new land because he will find that he is going to be dreadfully short of hospital beds and the dearth will come home. He may not be the minister at the time but he must look forward. It is his responsibility now.

Mr. Bradley: Mr. Speaker, in the last few minutes available to us, I join this debate and express the concern that many of the members of the Legislature have expressed this afternoon, whether it be on matters that directly affect their own constituency as they relate to the closing down and cutback of certain areas of hospitals, or whether it be on a province-wide basis.

I had the opportunity to sit for a number of years on a hospital board in the city of St. Catharines and saw evolving the financial problems which hospitals are running into. The member for Middlesex (Mr. Eaton) mentioned that the members of hospital boards had the opportunity to analyse what the province was doing over the years, and that to a certain extent they were prepared to live within the confines. Few of us would deny the fact that there was a need for a rationalization of services, that there was a need to move towards efficiency.

At the same time, I think we recognize, certainly from the input of our own constituents, that the public by and large supports extensive expenditures in the field of health, for the purposes of health care and specifically for hospital facilities within communities. This is something I think we have to keep in mind, because the public, while it may not tolerate expenditures in other areas -- and I heard the member for Fort William mention that people can do without certain other services -- I think we would have to recognize that the public sees as at least within the top three essential services being provided through the auspices of the provincial government, indirectly or directly, the provision of health care services.

I think we see frustration at these cutbacks in those who are involved directly in delivery of medical care services, because the potential is very great. We have evolved and developed in this province an excellent health care system. Many from other jurisdictions in North America and certainly across this world look upon us with a good deal of envy. We have the potential to further develop this to a great extent, except that we have the possibility of losing good medical people to other areas When they see extensive cutbacks, when they become frustrated by the fact that the equipment may not be available, the facilities are not available, and that the potential exists in other areas to a greater extent than in our own.

We also look at the fact that research in this particular province has a lot of potential and that if there were funds available for the facilities for this research we would attract even more people to the province of Ontario and to our country to provide services that would be excellent for those of us who live in the province.

So I urge the Minister of Health to re-examine very carefully the program of cutbacks that he has announced from time to time and that he take into consideration the feelings of the people of Ontario as expressed through their members in this assembly that we want to see a high level of service continue in this province. It can continue if we are prepared to fund it efficiently, yes, and rationally, yes, but fund it also in a humane manner so that the cuts that are made are not made at the front line. They are becoming very noticeable particularly to those at the nursing level, the actual care level When the minister is looking at cutbacks, and he must, of course, look over the shoulders of local authorities, he can ensure that some of the administration shares those cuts which are forced.

So I plead with the minister, and with the members opposite to put the pressure on the minister, to maintain an excellent health care system in this province, one which is supported by the people and certainly by the opposition in this House.

Mr. Speaker: The time allocated for this debate has expired.

The House recessed at 6 p.m.