L061 - Thu 5 Dec 1985 / Jeu 5 déc 1985
The House resumed at 8 p.m.
ORDERS OF THE DAY
ONTARIO DRUG BENEFIT ACT
Hon. Mr. Elston moved second reading of Bill 54, An Act to Authorize and Regulate the Payment by the Minister to Specified Persons on Behalf of Specified Classes of Persons for the Dispensing of Specified Drugs.
Hon. Mr. Elston: On November 7, I introduced two bills in the Legislature concerning prescription drug pricing and consumer protection. The Ontario Drug Benefit Act will for the first time give the government legislative authority to manage the Ontario drug benefit plan. Specifically, it will empower the government to determine what drugs are to be included in the Ontario drug benefit plan, the prices the government will pay for drugs listed in the Ontario Drug Benefit Formulary and who is eligible to receive drug benefits.
This new act will end price spread, which has caused the government of Ontario to pay greatly inflated prices for drugs, a situation that has placed an unjust burden on the Ontario taxpayers and consumers. In addition, the new act provides flexibility so that no pharmacy operator will be reimbursed for drugs dispensed under ODB at a level lower than what pharmacies pay for the drugs. This flexibility is an important feature of the act, ensuring the continued economic viability of small, independent pharmacies.
The second bill I introduced is the Prescription Drug Cost Regulation Act. It will govern all drug purchases in Ontario-cash purchases and purchases under private drug plans as well as those under ODB.
The effect of this act will be to ensure that high-quality, low-cost drugs are available to all Ontario consumers. Under this act, the government will be able to decide which drugs are interchangeable on the basis of the recommendations of the drug quality and therapeutics committee, an expert committee of professionals that advises the Minister of Health.
The act will protect consumers in several ways. Pharmacists will be required to inform customers of their right to request a less expensive interchangeable drug, except where physicians' prescriptions specifically state no substitution. For all interchangeable drugs dispensed to cash customers, pharmacists will be free to set their own dispensing fee, but they will be required to post this fee prominently and to inform customers about it. They will also be required to register the fee with the Ontario College of Pharmacists. All these features are designed to ensure realistic prescription costs and to protect Ontario consumers from unnecessarily high costs for prescription drugs.
The two bills and the draft regulations I introduced on November 7 were widely circulated to groups that represent consumer interests, drug manufacturers, drug wholesalers, third-party insurers, pharmacists and other professionals, such as physicians and dentists. We actively solicited informed comments and suggestions from interested individuals and groups, so that the final form of the legislation would protect the legitimate interests of all concerned.
During the last few weeks, I have received numerous letters concerning the proposed legislation. My officials and I have met with many groups and individuals to discuss the bills. I have been impressed with the many positive and constructive suggestions I have received. I want to assure the members of this House that these suggestions have been given careful and serious consideration. As a result of some of the concerns expressed to me, I intend to propose several changes to the legislation when it is presented for discussion in committee.
Further, authority for enforcing the Prescription Drug Cost Regulation Act may be assigned by regulation to either a minister of the crown or the Ontario College of Pharmacists. After discussions with the college, I have decided to recommend that enforcement of this act should be delegated to the college. This is compatible with the concept that pharmacy should continue to operate as a self-regulating profession.
Enforcement of the Ontario Drug Benefit Act will be the government's responsibility, reflecting the fact that ODB is a government program. I will outline the specifics of proposals for additional changes to both acts when the committee meets to discuss the two bills.
I wish to impress upon the members of the Legislature that we all have a responsibility to deal with these two bills on an urgent basis, so that we can proceed with the publication of a new ODB formulary. The formulary which is currently in use was published last January. It is now seriously outdated and its continued use is causing hardship to taxpayers and consumers.
Taxpayers are suffering because many prices for drugs listed in the current formulary reflect price spread, which means the government continues to pay greatly inflated prices for some drugs.
As regards consumers, many of them elderly people with restricted incomes, they too are being inconvenienced because physicians have prescribed certain new drugs that could be included as benefits in the new formulary, but which are not now listed in the current one. This also has implications for the manufacturers of those products.
Furthermore, the delay in publishing a new formulary means the increase in the federal excise tax levied last July 1 on nonprescription drugs, and the additional one per cent increase in that tax which is to become effective January 1, cannot be reflected in prices paid by the government under the ODB program.
Many representatives of Ontario senior citizens, as well as groups representing other consumers, have expressed their solid support for these two bills. They welcome this legislation and they have indicated they would be extremely disappointed if it was not enacted as quickly as possible.
I urge all members of this House to remember the legitimate concerns of Ontario's consumers and seniors. It will be these groups that suffer most if we do not act speedily to move from second reading and into committee.
I am pleased to have this bill in front of the House for second reading and I look forward to the comments of my colleagues and the support of the members of this Legislature, so that we can get on with the committee discussion and the work that remains to be done there.
Mr. Pope: I too look forward to the discussion of this bill in the Legislature. I want to comment briefly on the statement given by the Minister of Health and on the proposed amendments on the eve of introduction of this bill for second reading, combined with a request that all honourable members co-operate in ensuring its quick passage. It is one-way co-operation.
I want to comment on a couple of points raised in the statement. First, there is a statement on page 3, which says:
"The two bills and draft regulations that I introduced on November 7 were widely circulated to groups that represent consumer interests, drug manufacturers, drug wholesalers, third-party insurers, pharmacists and other professionals, such as physicians and dentists. We actively solicited informed comments and suggestions from interested individuals and groups, so that the final form of the legislation will protect the legitimate interests of all concerned."
I would also draw the attention of the House to the statement on page 5, where the minister indicates his only option with respect to consumer interests is not to add to the existing formulary but to pass this piece of legislation. He said:
"As regards consumers, many of them elderly people with restricted incomes, they too are being inconvenienced because physicians have prescribed certain new drugs that could be included as benefits in the new formulary, but which are not now listed in the current one. This also has implications for the manufacturers of those products."
8:10 p.m.
I would like to talk about some of the background to Bill 54 and the related legislation in Bill 55. Tonight we are addressing Bill 54. On November 7, when the minister rose in this Legislature to announce these new initiatives, he said, and I am quoting from page 3 of Instant Hansard: "Unrealistic drug prices are a major contributing factor to the rising costs of the ODB plan and the problem is not a new one. It would appear the previous administration became aware of it shortly after the plan was introduced in 1974."
I want to come back to that a little later. I want to link that comment with the minister's statement just now on page 3 of his statement that said this piece of legislation, Bill 55, and the accompanying regulations were widely circulated.
Then we get to the estimates committee. Specifically, I refer the members to page 7 of the proceedings of Wednesday, November 20, 1985, the afternoon sitting. In comparison to the minister's statement, which said, "It would appear that the previous administration became aware of it shortly after the plan was introduced in 1974," we see in the statements in the estimates by those responsible for the administration of the plan something more resembling the truth.
I quote from Mr. Burrows on page 7 of Instant Hansard for the afternoon sitting of November 20: "A price war developed -- I am sorry I cannot remember -- either early 1982 or 1983" -- not 1974 -- "where suddenly generics came on the market and started competing head on in price, and the real price in the market dropped to the order of $12 to $13. The listed price for the generics in the book was about $20. They had a very significant price spread.
"Couple that with the volume of drugs that was used in drug benefit, the magnitude of the individual problem related to an individual drug was far out of proportion to what it had been even one or two years earlier. With the advent of more and more competition for increasingly higher-priced drugs, there was a fairly rapid acceleration in the growth of this spread between 1982 and 1984."
Hon. Mr. Elston: Check back and take a look at the Bailey report.
Mr. Pope: These are the minister's own employees. They are his own words. It is in the estimates of his own ministry, and it is in direct variation with his comments that this was a large and well-known problem in 1974 that we did not address.
Hon. Mr. Elston: Take a look at the number of reports. Several were done before 1982.
Mr. Pope: I am continuing with my quote from page 7 of November 20, 1985: "In fact, it went from a situation of being in the hundreds of thousands of dollars range to being in the several millions of dollars range very quickly. In 1983, the government took action with respect to cimetidine, the drug I mentioned, by fixing the price at a more realistic level in the July 1983 formulary.
"I would like to point out, too, if I can backtrack a second, one significant point to understand this manipulation of the listed price based on quotas from the manufacturers. It has two effects. First, if the manufacturer who profits by the price spread by selling the drug on the basis of how much can be obtained in the price marketplace because of the way the system was set up, that would have an immediate impact on the consumer.
"By not wanting to be the lowest price, in other words, wanting to compete with the other manufacturer on the basis of spread, this had a somewhat delayed effect on the drug benefit because the bottom line would start spiralling upward as no one wanted to be that lowest price." That is in 1982 and 1983. "So you had an immediate disadvantage for the cash-paying customer, which is not fulfilling the intent of the original legislation. Then coming back six months later when it was time to plan a new formulary, quotations coming in were ensuring that the bottom line was rising, which had a direct effect on government expenditure. That spiral has continued.
"In July 1983, cimetidine action was taken. At the same time the cimetidine problem became apparent through our research and market statistics, we started to do a retroactive analysis of other drugs in the market to see if there was anything we could learn from that. We went out and got data that we had never seen before.
"It became evident from that research, which took several months, that the problem was big and it was growing, with the result that in the fall of 1983 the ministry entered into intensive discussions with the profession of pharmacies, represented by the Ontario Pharmacists Association, and representatives of the drug manufacturing industry, the Pharmaceutical Manufacturing Association of Canada and the Canadian Drug Manufacturers' Association, representing the generic drugs.
"Suffice it to say that after many attempts at resolving the problem, lengthy discussions at many meetings and proposals for changing the way the formulary is listed and proposals for listing the product selection, legislation on which all this hinged, there was no consensus. The problem was not resolved. However, there was an agreement in February 1984, whereby there were agreements to do certain things to deal with this problem. One thing that was common at that time was the opinion of all parties concerned that this was an issue that had to be addressed and we had to find some way to resolve the problem.
"There was a three-part agreement at that time. The first part was that 30 new high-volume drugs would have their prices reduced to realistic levels. Because the ministry had been unable to get some of the manufacturers involved to quote realistic prices, there was an arrangement agreed to whereby the pharmacists association went out and sought pricing information, brought that information back to the" --
Mr. Breaugh: On a point of order, Mr. Speaker: I would like to refer you to standing order 19(d)(4), which deals with the matter of reading unnecessarily. While I am entertained by the honourable member's ability to read, I believe it is against the standing orders.
The Deputy Speaker: That is a valid point of order. Perhaps the member would cut it down.
Mr. Pope: I have half a page left.
The Deputy Speaker: Perhaps you would cut short or paraphrase.
Mr. Pope: No, I am going to read the next half page, Mr. Speaker, because it indicates that what this minister said on November 7 about this problem being in an existing form in 1974 was what his own officials did not say in the estimates of the Ministry of Health on November 20. I think he owes the members of this party an explanation for that kind of comment, which is becoming all too common in his statements in the Legislature.
The Deputy Speaker: The Speaker has asked the member for Cochrane South to make the balance of this quotation very short from this particular article.
Mr. Pope: I will just complete this paragraph. Then I will say a few words and refer to other material.
Mr. Breaugh: That is reading unnecessarily.
Mr. Pope: Yes, according to your definition.
Interjections.
Mr. Pope: "The pharmacists association went out and sought pricing information, brought that information back to the ministry and between those data sources there was an agreement on price. So 30 high-volume drugs had their prices reduced. The net impact of that was in the order of a $14-million reduction in drug cost expenditures."
This is what is going on in 1984 after the government became aware in the fall of 1983 of the consequences of the rapidly accelerating price spread. The fact, as Mr. Burrows said, was that it was no longer becoming a problem of hundreds of thousands of dollars, but of millions of dollars. Faced with that reality in 1983, there was an attempt by the previous government to solve the problems, and we used the assistance of the pharmacists association to deal with 30 specific drugs that were causing a major concern in the Ministry of Health.
That was the action that was taken in 1984, which is a far cry from the statement that this problem existed since 1974 and that there was a lack of will to do anything about it. This comes from the statements made by this minister's own officials in the estimates of the Ministry of Health.
I draw members' attention to the comparison of those statements with the statements of the minister on November 7 in this House. Members can draw their own conclusions from that comparison.
Also we indicate --
8:20 p.m.
Mr. Stevenson: Now for a further quote.
Mr. Pope: No. I will just summarize the next point.
The next point is again on page 9 of the transcript of November 20, 1985. It says that in addition to rolling back the costs on those 30 specific drug items, there is also an agreement to adjust the fee temporarily from $4.65 to $5, and the fee stands at that point today. That again was part of the negotiations and discussion that went on with the Ontario Pharmacists' Association in 1984.
The third part of the settlement was that a commission was established under John Gordon, dean of the school of business at Queen's University. Through most of 1983 he deliberated and gathered input from all the interested parties. He presented his report in the fall of 1984, and a very comprehensive report it was. It was widely publicized and commented upon by those involved in the profession and in the operation of pharmacies across the province, by those who have some concern about drug prices and the quality of drug dispensing across the province.
That was the situation as it stood, with negotiations in the spring of 1985 with the OPA and the college under the previous administration.
I also want to comment on the statement the minister just made with respect to extensive negotiations. I refer members to the Hansard transcript of the standing committee on general government when it was dealing with the estimates of the Ministry of Health on Wednesday, November 20, 1985, at its morning and afternoon sittings, and to the transcript of the proceedings on Wednesday, November 27, 1985. I refer members to page 12, where there is a rather interesting exchange:
"Mr. Pope: I understand everything you said. Now, getting back to the question I asked, how many times -- and if you said this last week, and if that is the complete answer, okay, that is fine -- have you met with the OPA with respect to the legislation now before the House?
"Hon. Mr. Elston: We briefed them on November 7, and we have had several meetings with pharmacists. Now, the OPA itself -- Mr. Belitz, if you would like, is president -- I cannot tell you how many times I met with him on this specific legislation. Probably, in terms of the entire draft, I did not meet with Mr. Belitz before it was introduced.
"Mr. Pope: Do you think in retrospect that is one of the problems you are facing right now?
"Hon. Mr. Elston: I do not think it one of the problems I am facing right now.
"Mr. Pope: Do you have any plans to meet with the OPA before we proceed further with the legislation?
"Hon. Mr. Elston: Well, I met with Mr. Belitz, for instance, on Friday, and he probably told you.
"Mr. Pope: I have not talked to him.
"Hon. Mr. Elston: No, but we met with him last Friday. He wanted 15 minutes to come in to chat with me. He made it very clear it was not negotiations. I could not understand why, but he said: `Do not call this negotiations. Do not say it is anything more than an information exchange;' and so I said, `That is fine.'
"Instead of 15 minutes, we spent half an hour or so talking about things with respect to the ad campaign generated by the pharmacists. I had anticipated receiving some input from the OPA, but he advised that the OPA would be forwarding their comments on the legislation to the ministry yesterday, and I have not seen them, but I understand they did arrive. I am not certain of that, but I understand they were supposed to have arrived yesterday."
Then on page 14:
"Mr. Wiseman: To clarify what was said last Wednesday when we were discussing this and I had asked, after meeting with my pharmacists, about how many meetings you had prior to the legislation going out; I do not have a copy of Hansard last Wednesday afternoon, but from what you gave my colleague Mr. Pope, it would appear you met with them once but you never showed them the draft legislation before it went out, so that what my pharmacists were saying is in fact true.
"I took all those dates that you gave me last week at face value. I do not have Hansard here but I am going to read it and check." I will delete the next sentence from the transcript --
Mr. Breaugh: Why?
Mr. Pope: Okay. "I felt I was maybe misled a little on the number of meetings and with whom. It seems you had them with private individuals and not with an individual who speaks on behalf of anyone."
Then on the next page: "...when you had a meeting November 7 with the OPA, my understanding is you had the draft legislation in your hands when you met with them.
"Hon. Mr. Elston: But before that there were meetings as well between staff and OPA as well.\
"Mr. Pope: Not on draft legislation, though.
"Hon. Mr. Elston: With respect to parts of the draft legislation --
"Mr. Pope: Did your staff -- I do not think there was legislation in front of them.
"Hon. Mr. Elston: I do not think there was. I was not at those meetings but I suspect there were not pieces of draft legislation at those meetings."
We heard the statement tonight that, "The two bills and draft regulations I introduced on November 7 were widely circulated to groups that represent consumer interests, drug manufacturers, drug wholesalers, third-party insurers, pharmacists and other professionals, such as physicians and dentists." However, in reality what we have is draft legislation that was waved at the OPA and perhaps the college on the day it was introduced. There were no discussions with the OPA and the college with respect to this draft legislation before it was introduced.
If there was circulation, it was after introduction; that is a very important difference, and it lies at the root of this minister's current problems in his relationships with a number of people in the various health disciplines of this province. He proceeded to draft legislation on this very fundamental change, which has such a dramatic impact on the profession of pharmacy in this province, without consultation. There was no discussion of the draft legislation. There was no open meeting where the proposals were on the table for examination and discussion.
On November 7, the day of the grand announcement in the Legislature, people were summoned to the minister's office and told, "This is what you are going to get later today." That is vastly different from the wording contained in this statement tonight and from the wording we heard in estimates of the Ministry of Health in mid-November, and that lies at the root of the reaction of the pharmacists of this province to this legislation.
What I want to do, as spokesman on behalf of my party, is to talk a bit about this reaction and about how it involves all of us in the Legislature as members. We have all heard from pharmacists. We have all received letters. We have received deputations. We have talked to them on the phone. We all understand their concerns. We all understand at the root of the concern was a statement being made by every single pharmacist across the province that this minister did not consult on the legislation and regulations before they were introduced in the Legislature. That was a dramatic departure from their normal relationship with the government, and they had the right to expect better from this minister and this government.
Yes, as a party, we do understand that there have to be changes to the Ontario drug benefit plan. We do understand the conclusions and recommendations of the Gordon report. We do understand how tough an issue it is for the Minister of Health (Mr. Elston) to address. We do understand the concern of all the interest groups in Ontario society that this matter be resolved to the satisfaction of everyone, including the consumers. As a party, we understand that, and we understand how tough it is for the Minister of Health to deal with this issue. However, our party has grave difficulties with this legislation, the way it was handled and what it represents.
8:30 p.m.
As I said, we are aware of the problems of the functioning of the Ontario drug benefit plan; they are apparent. We recognized them, and in 1984 we made our own attempt to take action with respect to 30 specific drugs. We commissioned the Gordon report to identify and analyse the problem and to recommend some solutions. The recommendations of the Gordon commission formed the framework of our negotiations with the OPA to change the Ontario drug benefit plan to ensure lower drug prices, and those negotiations were under way in the spring of 1985.
As well, we introduced the substitution of generic drugs for name-brand drugs if the generic product is interchangeable and cheaper. As it stands now, the pharmacist can substitute in these situations. We also encouraged doctors to prescribe generic products when they are suitable. This has proved to be very successful, and the number of prescriptions written for generic products has increased by at least 35 per cent over last year alone.
We do not think the bills being presented by the current government accomplish the goals we worked so hard to achieve and which the current government is genuinely working to achieve. We are concerned that the bills will do exactly the opposite. The legislation could drive the cost of prescription drugs higher because under the legislation, only one drug product, the cheapest, will be listed for sale in the Ontario drug benefit plan formulary. The other manufacturers of that product could be shut out of the Ontario drug benefit plan market, and their products will be available only to cash-paying customers, who will now have to pay more for this drug.
A company must recover the costs of producing a product and make a profit from its sales revenues. Even the New Democratic Party admits this. For example, if a company needed to make $100 from sales to recover its costs and make a profit, and it sold 100 units of the product, it would charge $1 per unit. If it sold only 50 units, it would have to charge $2 per unit. Customers in the cash market may have to pay more because of the impact on some of the drug manufacturers in Ontario. Fewer units could be sold, and the cost of those units would have to be higher.
We share the concern of the Minister of Health with respect to senior citizens and welfare recipients, but we are also concerned about their right to choose the most appropriate medication for them as individuals, in consultation with their doctors and their pharmacists. They will have to take the medication listed in the formulary. Other members of society will retain the right to choose the drugs based on advice and information from doctors and pharmacists, but not those under the Ontario drug benefit plan.
We are concerned, as is the Minister of Health -- and this has been said across this province by many more than the members of this party -- that one of the potential impacts could be that many independent pharmacies will be driven out of business and many rural communities in all regions of the province will be left without a pharmacy.
We are concerned -- and the minister has attempted to address this at the last minute tonight, without discussion -- that policy can be established under these bills by setting regulations in cabinet. There will be no checks or balances on the policies that could be created by regulation. We are not talking about the law now; we are talking about policies that can be set by regulation, which will not be responsible to the Legislature and which will not allow interested parties the opportunity to have any input.
One of the potential side-effects of this combined legislation will be that it will allow third parties to make therapeutic decisions for others. Anyone who walks into the pharmacy to pick up prescriptions -- relatives, children, taxicab drivers -- could be asked to decide which medication should be dispensed.
We also have long-term concerns about employment as a result of these two pieces of legislation, in pharmacies, in drug manufacturing industries in the province and in the suppliers to the pharmacists in this province.
All these concerns are not being talked about just by members of this party; they are also being talked about by members of the third party, in every constituency across this province, by pharmacists and by others who are concerned not only with this legislation but also with the way in which it is being handled.
I reiterate that our party is not opposed to change in the Ontario drug benefit plan, but we do voice our concern about these two pieces of legislation, the way they have been handled and their potential effects, which obviously had not been contemplated by the officials of the Ministry of Health before they were introduced in this Legislature on November 7. That is our concern.
We do know about the growth of the Ontario drug benefit plan, both in terms of the total number of claims and in terms of total cost to the government of Ontario. We are aware of the Ontario-Saskatchewan cost variances per 100 tablets for a number of specific drug products. We are aware of the status of the 33 high-volume drugs that are being dispensed in Ontario. However, far from resolving the difficulties of the Ontario drug benefit plan and the issues of the relationships between the government and the Ontario Pharmacists' Association and the college, this legislation creates more problems than it solves. Why?
I heard the minister's response in the Legislature to the question of the member for Grey-Bruce (Mr. Sargent) a couple of weeks ago. The minister could not understand what all the dispute was about; the thing was going to committee. Almost every pharmacist in the province was wrong and the minister was right. The ads that appeared in all the newspapers were ill-conceived and uninformed. However, the volume of mail we have all been getting on this issue speaks to the fact that there has not been the fullest of communication between the Minister of Health and the pharmacists of this province.
We look at the ad by the Ontario Pharmacists' Association, headed "Prescription for Trouble." The minister has commented on it. He has commented on it in press conferences, saying, "Confrontation has escalated since November 7," and he has indicated his concerns about the ad. However, the Ontario Pharmacists' Association is correct when it says: "We have one of the best health care systems in North America, if not the world. It is based on communication. It is based on respect for professionalism. It is based on co-operation." That is the formula for building the health care system that we are all proud of and that we all want to improve.
This minister has thrown that co-operation out. He has thrown the communications out. He started communicating on these bills on November 7, and in doing so, he has left an unfair perception that he does not respect the professionalism of the pharmacists of this province.
I tried to talk to him about this in the estimates of the ministry on November 27. As usual, I got nowhere. I tried to draw from him a statement about how he saw the professionalism of the pharmacists of this province and the role of the college and the OPA coming into play. Instead of seizing the opportunity to put on the record his point of view on their professionalism and what they could do to make the system work better, his comment was that the Ontario drug benefit plan was a government-run plan, and the government was going to run it. That is not the kind of response we need if we are going to work out a solution with respect to Bill 54 and Bill 55 with the OPA and the college.
Ads are going into the newspapers that are causing concern, and no doubt the minister has launched a counter-campaign. We are headed towards complete confrontation. There will be more ads. There will be open-line shows. The minister will do his share and go on open-line shows, and the pharmacists will go on open-line shows themselves. Everyone will dig in, and we will have a full-scale confrontation from one end of this province to the other with respect to Bill 54 and Bill 55. I simply have to ask why. Why?
It all started on November 7, when the two pieces of draft legislation were waved under the noses of the pharmacists and the OPA, and that was the answer of the government.
Mr. Stevenson: Trudeau-style confrontational government. Split the country apart, and then go in and be the hero and try to solve it. Trudeau-style confrontational government.
8:40 p.m.
Mr. Speaker: Order.
Mr. Pope: I would refer the members of this Legislature to the correspondence between the Ontario Pharmacists' Association negotiating committee and this minister and the ministry with respect to the legislation and draft regulations. I just want to read the first line from a letter where we are talking about negotiation as opposed to confrontation.
"The written submission which you requested from our negotiating committee last Monday, November 18, was completed over the weekend by members of the committee and is now enclosed for your consideration. Please note that we found it very difficult to do such an important presentation in such a limited period of time.
"We would also ask you to note that this submission at this date officially represents the views of the negotiating committee members only. Some members of the executive committee have been involved in its preparation and we also have had the benefit of the input during last two weeks of a large number of our members both directly and through their elected council members.
"The negotiating committee accordingly feels comfortable in suggesting that its positron paper will undoubtedly be endorsed by council as soon as council is able to vet it. In the meantime, the committee members are available for discussions with you and trust that OPA will be given an opportunity to appear before an appropriate committee of the Legislature to express our concerns in that forum as well.
"These matters, you will appreciate, are extremely important to every pharmacist in Ontario, and we have no hesitation in saying that all pharmacists will agree, if a choice becomes necessary, that a much higher priority should be given to the legislation being put into appropriate form and substance before it is enacted than to simply having something in place by the date which the minister has selected as his target date, January 1 next, for a new formulary.
"We look forward to your early response." On Monday, November 18, the Minister of Health asked the OPA negotiating committee for a detailed reply to Bills 54, 55 and the draft regulations there under. That was on November 18, and we are talking about two major pieces of legislation that will have a dramatic impact on pharmacists in this province, according to the Ontario Pharmacists' Association.
The paper the negotiating committee prepared for the minister puts a number of questions. First of all, concerns -- and I am not going to read the entire document --
[Applause]
Mr. Pope: Although I may.
"(1) While the goal of the government to reduce the cost of prescription drugs is commendable and has always been embraced by OPA, the plan being put forward by the government is ill-conceived and destined to failure."
The very first point of the negotiating committee of the OPA is that the proposal of the minister will not work, that it will not reduce the cost of prescription drugs, which is the fundamental reason that the minister introduced the legislation. From the very goal of the legislation we have a direct conflict of interpretation of result between the OPA and the minister and his staff.
On page 7: "(2) The proposed legislative package discriminates against pharmacists."
This is a very serious charge by the OPA that the legislation discriminates against pharmacists.
"(3) The government's proposals, while adopting some of the Gordon commission's recommendations, negate the fundamental principle of drug pricing adopted by the commission."
In other words, this government, according to the OPA, has not followed the recommendations of the Gordon commission.
"(4) `Dispense as written' has long been a point of controversy in the continuing ODB contract negotiations, and while Bill 55 appears to adopt this concept it is apparent that the government intends to invoke it only in certain cases, notwithstanding the wording of the bills." In other words, they are not sure of the intentions of the government and it obviously has not been cleared up in discussions with the Ontario Pharmacists' Association, this minister and his staff.
"5. Actual acquisition costs: if adopted, will it mean the death of existing brand-name interchangeable drugs in Ontario, and with it a formidable deterrent against drug innovation in Ontario?" That is a very serious allegation about the future of the drug industry in this province.
Then they go on to list a number of unanswered questions with respect to the legislation. Again, this was delivered on November 25, 1985, a week after it was requested by the Minister of Health. They have already challenged most of the basic principles and goals of the minister as not being met in Bills 54 and 55. They proceed to list issues they do not think have been addressed properly in Bills 54 and 55.
"1. Under Bill 54, does the definition of `drug' include such items as milk of magnesia and mineral oil, which are currently benefits under the ODB plan?
"2. Under the same bill, does the definition of `prescription' mean that a prescription issued by a podiatrist for an eligible drug for an eligible person can be billed to the ministry?
"3. What fee will be payable to a dispensing physician compared to the fee payable to pharmacies?
"4. Why have the words `the minister may make this act apply' been used in section 6(1) of Bill 54?
"5. Because the bills refer to an operator of a pharmacy, does it follow that an employed pharmacist who does not fall within that definition is not covered by the provisions of the bills?
"6. In the same vein, is an employed pharmacist excluded from the protection of section 6, subsection 2 of Bill 54?
"7. Is there any situation, other than charging a patient for a prescription, where the drug is not a listed drug and it subsequently turns out that the drug has been authorized by the minister, to which section 6, subsection 2 of Bill 54 applies?
"8. If section 7 of Bill 54 is intended to cover situations where listed substances are to be provided by persons not qualifying as operators of pharmacies, should the section not make it clear that this will only occur where an operator of a pharmacy is not available to provide the service?
"9. Shouldn't the words `reasonable dispatch' in the inspection sections of the two bills be replaced by words such as `immediately' or `forthwith'?
"10. Why isn't OPA, in its customary role as a spokesman for pharmacy, mentioned in the appropriate subsections of the enabling section dealing with the regulations that can be made?
"11. Why is there to be a change in the provisions of section 7 of Bill 54 at some later date?
"12. Why is Bill 54 silent as to who will be responsible for administering it?
"13. Do you agree with our interpretation of the definition of `interchangeable product' in Bill 55 as excluding single-source drug entities?
"14. Do you consider the definition of `interchangeable product' broad enough to permit similar products, such as amoxicillin and penicillin V to be treated as interchangeable?
"15. Section 2 of Bill 55 seems to require the steps of subsection 3 to be taken even if a pharmacist has opted for product substitution under subsection 1 or the patient has requested product selection under subsection 2. Why is this?
"16. Why is the term `dispenser' introduced in Bill 55, yet not defined?
"17. We interpret subsection 3 of section 2 2(3) of Bill 55 not to be applicable to verbal prescriptions. Do you agree with this?
8:50 p.m.
"18. The concept of `single maximum dispensing fee' under section 4 of Bill 55 is unrealistic in view of the multiplicity of fees that have to exist for different products and situations unless the fee to be selected is simply one large enough to encompass all situations. Is this the intention of the draftsman?
"19. Why is there no provision for the single maximum dispensing fee to be altered from time to time? This appears to be an oversight.
"20. The requirement to post a fee, as distinct from filing it with the registrar of college, presents even greater problems. Has any thought been given to the details that will have to be incorporated in the regulation? The draft presented is inadequate in this regard.
"21. As long as different drug costs must be identified for the same product depending upon the payer for the prescription and whether it is interchangeable or not, the effect of section 8 of Bill 55 will be to cause confusion to the public and to pharmacists as well as unfair competition among pharmacies. The proposed regulations do not do anything to avoid this. Has any further consideration been given to this very serious problem?
"22. Why are different standards applicable to inspections under the two bills?
"23. Subsection 12(3) of Bill 55 seems to suggest a hidden agenda that has not been carried forward as yet in the draft regulations. Is this true, and if so, what is contemplated?
"24. Why does subclause 6(a)(iii) of Bill 55 draft regulation exist? It seems to be redundant."
Mr. Speaker: Perhaps the member would return to Bill 54.
Mr. Pope: Do not worry, Mr. Speaker. Finally:
" 25. The provisions in the ministry's proposal seem to give the government unlimited authority to require pharmacies to prepare and file purchase and sales information whenever requested to do so. This could be abused and be very costly to pharmacies. What protection is intended? Or alternatively, what compensation will be offered to pharmacies for this reporting service?"
All of these 25 questions, as well as basic challenges to the laudable goals and to the effect of this proposed legislation, were proposed to the minister by the Ontario Pharmacists' Association by delivery of a letter on November 25.
Lest the members think the final point in that list is not important, we then have a document issued by the Ministry of Health, drug programs and policy branch, 6th floor, 7 Overlea Boulevard, Toronto, dated November 27, 1985. That is two days after the OPA put on record its concerns and its questions with respect to these two pieces of legislation. It is entitled, "Re: Urgently Needed Pricing Information for the Ontario Drug Benefit Formulary, January 1986.
"This is further to a letter dated November 7, 1985, sent to all drug manufacturers by the Honourable Murray Elston, Minister of Health. Included with that letter was an information package concerning two new pieces of legislation, the Ontario Drug Benefit Act, 1985, and the Prescription Drug Cost Regulation Act, 1985, which were introduced in the Legislature on November 7, 1985. You were also informed that the government of Ontario plans to have the legislation in place by January 1986."
They did not discuss it with the House leaders, but they announced it would be in place in January 1986.
"In order to compile listings of drug products under the new acts and a price listing for Ontario's drug benefit, and in order to have this in place by January of 1986, the ministry requires the urgent co-operation of your company."
One-way co-operation again.
"Pricing information for the ODB Formulary plus sales data on average selling prices for all drug products, listed or proposed for listing, are required. Listing as a benefit in the formulary is contingent upon the manufacturer providing the required sales data."
In other words, they have to do it right away or they are not in. It is going to be in by January, and the cutoff date is Monday, December 9, 1985. In other words, on November 27 a letter is sent out to all the drug manufacturers saying, "Have all the information in by December 9 or you are not going to be in the formulary for 1986." It is underlined, just so they do not misunderstand this one-way co-operation that is being proposed.
"The ministry reserves the right to delist drug products or to establish alternative reimbursement amounts for drug products considered to be essential therapeutic benefits. To facilitate your submission," -- and this is really good -- "your submission of realistic and accurate drug sales information, the following brief description of the format of the drug listings originally provided to you in the minister's November 7 letter is repeated:
"(a) The schedule of interchangeable products under the Prescription Drug Cost Regulation Act, 1985, will set out interchangeable products in a format similar to that utilized in the current January 1985 Parcost Comparative Drug Index, except there will be no product amounts, i.e. prices." That is underlined as well.
"The schedule of ODB benefits from the Ontario Drug Benefit Act, 1985, will list those drugs that are benefits, along with the amounts that the government will pay for those drugs. Note, multiple-source drugs will have only one product amount or price listed, regardless of the number of drug products or brands listed, and single source products will have a product amount or a price listed.
"The amount listed will reflect the average unit price for which the drug is available to pharmacies. The schedule will also provide that pharmacies will be reimbursed for actual acquisition costs under specified circumstances. This letter includes some formulary price quotation information with which you may be familiar from previous ODB formularies, plus new material. Please read carefully,"
They enclose three forms for existing listings, new and additional listings, and form 3, sales data information. Again:
"These forms must be completed and returned before 4:30 p.m., Monday, December 9, 1985. It should be addressed to: The Ontario Drug Benefit Formulary, January 1986, and be mailed to Kingston, Ontario."
There is an explanation attached as to what the pharmacists and manufacturers are required to produce in these three forms. The first, with respect to existing listings, is quite simply,
"A list of the products listed in the current formulary, January 1985. You are not required to complete form 1, as all necessary information is now required on form 3.
"Form 2, new and additional listings. On this form list a description and DIN for (a) new drugs, and (b) additional strengths and dosage forms of drugs now listed as benefits for which a listing is requested in the next edition of the formulary proposed for January 1986, i.e. listings in addition to those in the January 1985 formulary. For all those products listed on form 2, please include sales data for each package size on form 3." This is by December 9. "Completion of this form provides information only and does not constitute an application for a listing in the formulary. Such application should be made directly to the executive secretary, drug quality and therapeutics Committee."
"Form 3, the sales data information." Mr. Speaker, this is very important to the pharmacists and drug manufacturers of the province. "Using your sales data for the most recent consecutive three-month period available since July 1, 1985, and your sales projections for the six-month period commencing January 1, 1986, list all data requested on this form to show the actual and projected average price per unit for all package sizes of each drug product listed on forms 1 and 2. Please specify the three-month period used for the 1985 data. N.B. Data for this time period is essential in order for the ministry to appropriately take into account 1985 increases in the federal sales tax.
9 p.m.
"For all package sizes enter the price under the direct price to pharmacists per unit column for those products distributed direct to retail pharmacies in Ontario, or enter the price under the indirect price for wholesaler per unit to wholesaler per unit column under those parts distributed through indirect distribution channels to retail pharmacies in the province of Ontario. Please indicate with a single asterisk where the unit price includes 11 per cent sales tax and with a double asterisk where the unit price is subject to 11 per cent federal sales tax to be added at the wholesale level. Please enter in the spaces marked" -- whatever -- "the percentage of units of each product listed which is sold direct or indirect to retail pharmacies in Ontario."
There is nothing here that guarantees confidentiality of the sales information, that indicates what is going to happen to this information once it is provided, that gives any protection at all to anyone who deals with or provides this information to the Ministry of Health. It is a new requirement, a six-month projection of sales figures for both form 1 and form 2 drugs, a six-month projection of sales broken down into various units.
The industry was told on November 27: "Thank you very much. Have it all available in 12 days or you are not going to be listed." That is the extent of co-operation.
Mr. Stevenson: That is open, consultative government.
Mr. Pope: That is open government.
What has the effect of all this been? What is the effect of the events since November 7? We have all seen it in our constituency offices. One of the primary effects has been that we now have the OPA holding press conferences to outline their concerns with respect to Bill 54 and Bill 55, obviously because they are not satisfied with the state of communication with the minister, the ministry or this government. This is a concern, by the way, that is echoed by a number of other professions in the health care field in this province about a lack of co-operation and consultation in advance of introduction of measures.
There is a press release today, December 5, 1985, which says, "New drug prescription law will increase costs, pharmacists say." That is the title of it. I will not read it all into the record. It is indicative of how this matter has started to cause a deterioration in the relationship of this government, the OPA, the college and individual pharmacists across the province. It is not just the OPA; it is druggists from one end of the province to the other. Every member of this Legislature has heard from them.
I have a letter here, dated October 14, from 35 Lysanda Avenue, London, Ontario. It is a letter to the Honourable David Peterson from Mr. Rob Campbell. It says:
"The past several months have seen a minister of your government try to change public opinion by using misleading information in his dealings with the press. The Honourable Mr. Elston has tried to tar and feather pharmacists with facts that are being used out of context.
"You will find enclosed a copy of a letter I sent to Mr. Elston that outlines the full story. A minister of any government should never disclose facts to the public that do not outline the full story if the public is to have faith in its government.
"The Ontario drug benefit system needs to be reviewed, as I pointed out in our last meeting. I feel that unilateral action by any government is not good government. If Mr. Elston stopped using pharmacy as a political football, I am sure you could open discussions with the Ontario Pharmacists' Association that would greatly benefit the system and the people of Ontario.
"I look forward to your comments on the issues outlined in my letter to Mr. Elston and why your minister has misled the public.
"Yours truly, Rob Campbell."
Attached to that is a very interesting exchange of opinions with the member for London North (Mr. Van Horne), dated October 12, 1985. I will not quote some of the repetitious allegations about the minister in the letter to the member for London North, which no doubt have been transmitted by the honourable member to the Minister of Health.
It outlines a number of drugs, their specific cost, the payment by consumers and the gross profit margin. He takes issue with the statements that have been made by this minister over a period of time in dealing with this issue.
There is also a rather interesting attachment to it. It is a copy of a letter dated February 11, 1985, to myself. It says:
"Please find attached a copy of the Ontario Pharmacists' Association paper on ODB negotiations. Mr. Steinberg and other pharmacists in London...have expressed their concern over this problem on more than one occasion. The essence of their concern is fairness. You and your advisers can talk all day long about the Gordon report and government policies, but you have no credibility with me or the pharmacists as long as you talk doubletalk and fail to keep your communication open, honest and fair with everyone. Please let me know your response to the pharmacists."
That scathing a letter addressed to me as Minister of Health was signed by Ron Van Horne, MPP, London North. Do members know what he is saying? He is saying, "communication open, honest and fair with everyone. "The allegation he now makes, that this minister has failed to address this in his dealings with the pharmacists, the OPA and the college. That is the allegation against this minister. His own colleague in cabinet predicted it so accurately on February 11, 1985, that this would be the position of the pharmacists with respect to this government and this Minister of Health.
Mr. Callahan: You did nothing.
Mr. Pope: The member must have missed the earlier part of the discussion. That is selective hearing as usual over there.
Mr. Ward: It is selective reading.
Mr. Pope: Selective reading? The parliamentary assistant has accused me of selective reading, so I will not do that any more. I shall read the entire thing.
The covering letter says:
"Dear Mr. Pope:
"As the Minister of Health in the previous government, you were involved with discussions with the Ontario Pharmacists' Association that resulted in our lobbying campaign of last February. I feel that you have probably been approached by pharmacists recently concerning the actions of the Honourable Murray Elston, so I will not bother outlining the pharmacists' position. I have enclosed copies of letters I have sent to the Honourable David Peterson, the Honourable Murray Elston and the Honourable Ron Van Horne. Also enclosed is a copy of a letter the Honourable Ron Van Horne seat to you when you were minister of health.
"I find this situation very frustrating when a member of the provincial government" -- this is the Minister without Portfolio (Mr. Van Horne) -- "can change his stance very abruptly by crossing the floor. I look forward to your input."
That is his position. Again, he encloses all the documentation or correspondence with the Minister without Portfolio on October 12, 1985; February 11, 1985, to myself; October 13, directly to the Minister of Health, in which he reiterates the allegations he makes in the letter to the Premier and to the Minister without Portfolio, and he attaches documents, Geriatrics and Gerontology, edited by Peter P. Lamé; Potential Medication-Related Problems in Noninstitutionalized Elderly. Those are all the documents attached.
If the member cannot get a copy from his own Minister of Health, who is so open and communicative, I will be glad to send him a copy at any time.
Then we have a letter, dated November 14, 1985. As the minister said in the Legislature 10 days ago, he does not understand all the uproar around the province. It is going to committee; everything is fine; progress is being made; do not worry about it; he will handle the pharmacists. In the meantime, we are all getting letters, such as a letter from the Brant County Pharmacists' Association in Brantford. I know the member from Brant-Oxford-Norfolk (Mr. Nixon) will be very interested in these statements. He is listening intently as I read them into the record.
9:10 p.m.
The Treasurer (Mr. Nixon) remembers the Brant County Pharmacists' Association. They used to be his friends and supporters. They say: "As members of the Brant County Pharmacists' Association, we are appealing to you on our members' behalf. If the Liberal government goes ahead and acts unilaterally, as they have indicated, setting drug prices, eliminating the one-month supply, posting of fees, setting up different fees to different individuals and changing pharmacy practice in general, the result will be devastating to pharmacies financially, to the practice of pharmacy itself and to the public in terms of the services that will be provided.
"Historically, the problem of price spreading, a major concern for the Liberal government, is a problem between the government and the drug manufacturers. Yet most parts of the new legislation is aimed at cutbacks to the pharmacy. Is that fair? Pharmacies have had to be hopeful of successful negotiations, many of which never took place, tolerant of formularies months out of date and unjust compensation of pharmaceutical products. Is that fair?
"Application of subsection 155(c) of the Health Disciplines Act, which was a law introduced by the Conservative government and supposed to be in review ever since, is only now, for apparently political reasons, being enforced. Should we as professionals doing our job be the object of political football? Much of the increased costs to the ODB, the Ontario drug benefit program, were due to increased usage of the ODB plan by more eligible persons. Yet the pharmacist is faced with the blame and is the victim of the proposed legislation. Is this fair?
"Since 1983, negotiations for a fairer and equitable dispensing fee have been futile. Is there any hope now that all rules are to be changed? Should the rules be changed with no assurances of a new dispensing fee? This is what the Liberal government is proposing. Surely this will save the government money, since without successful negotiations proper remunerations to pharmacists will be thwarted and the government's best interests will be had. Is this just?
"Pharmacy has always wanted a fair fee for its reasonable acquisition costs. Unfortunately, over the years price spreading allowances have taken the place of reasonable dispensing fee increases. This should not have been allowed to happen. That is the government's fault, not pharmacy's. Pharmacy, under protest, has just played by the government's rules. Should we be punished for that? With the proposed legislation, the Ontario Drug Benefit Act and the Prescription Drug Cost Regulation Act, we object to the following proposals, as they adversely affect the practice of pharmacy:
"The elimination of the 34-day supply: this was the cornerstone of the drug benefit program upon which our dispensing fee was based. With this eliminated, pharmacy loses its assurance of proper financial remuneration from our patient population. Imposing this upon pharmacy without a newly negotiated dispensing fee is absolutely unjust. Professionally we are concerned that increased quantities of medications dispensed to individuals will lead to increased waste, increased drug diversion, increased opportunities of poisoning and overdoses. Pharmacists will also lose their opportunity to effectively monitor patient compliance, the ability of the patient to follow the doctor's directions correctly. This is a primary function of a professional pharmacist.
"Second, posting of fees: unless dispensing fees are set the same for all pharmacies, for all patients and for any medication dispensed, this proposal will lead to patients shopping simply for the best price rather than for the best prescription service and care. This will lead to a poorer quality of service from pharmacies, as cost cutting will result.
"At present, for a fair dispensing fee, patients receive their medication. Their medication profile is kept on file and reviewed for errors, drug interactions and for easy access. They receive patient counselling, verbally and written. Delivery is often offered sometimes free of charge, and the stores often have long hours of operation into the nights and weekends for the public's convenience.
"If competition leads to price cutting, the only service the patient may receive is the medication. If the government really wants to save money and this is the way they want to do it, the fee charged could be a whole lot less if they replaced pharmacists with vending machines.
"Third, tiering of dispensing fees: the legislation proposes to permit different fees for generically substituted medication, name brand medication, patients with ODB coverage and those without. Is this right when the service provided to dispense any of those medications is the same? Not only is this unfair to the consumer, this will be cumbersome and perhaps unmanageable for pharmacists to carry out and the government to enforce and, most definitely, this selection of fees will be confusing to the public. This proposal, along with fee posting, will lead to more time being spent by the pharmacist explaining and justifying this complex fee structure and, as a result, less time will be spent on professional counselling.
Constructively, we suggest the following -- "
The Acting Speaker (Mr. Morin): Order. I have given you three minutes and 19 seconds so far to read your text. I suggest you go on with the bill.
Mr. Pope: I intend to show to this Legislature that this issue has virtually every pharmacist in every region of the province concerned and feeling that this government is acting against pharmacists and does not want to listen to them. I am prepared to take as long as it takes to put on the record the fact that these pharmacists have expressed their concerns. This minister has not listened to them. Every single member of the Legislature has been meeting with the pharmacists over the past three weeks because this government will not.
Mr. D. R. Cooke: Throw the member out.
Hon. Ms. Caplan: It is absolute junk.
Mr. Pope: It is, is it? Every pharmacist in the province is wrong and the government is right.
With respect to tiering of dispensing fees, they suggest an alternative for lowering the cost to the taxpayer.
"ODB patients should pay the extra cost of `no-substitution' prescriptions. This should be considered an extra service. Limits could be made on the selection of medications covered by the ODB plan, especially some nonprescription items. The introduction of a surcharge would also decrease the overutilization of medication. A $1 deductible would be quite reasonable. We suggest an amendment to the proposed legislation that a fair dispensing fee be negotiated, to be applicable to all prescriptions and to all pharmacies. Fee posting may be allowed if the above is carried out so that patients can recognize the value of the prescription service in the cost of their medication. The fee should be based on the reasonable supply of medication and that should remain in the pharmacist's control for the public's sake."
I will not read the concluding paragraphs, though I may.
Mr. Stevenson: Let us have it.
Mr. Pope: I will read just one last sentence then.
Mr. Ward: No selective reading here.
Mr. Pope: No selective reading, the parliamentary assistant demanded.
Mr. Ward: That is right.
Mr. Pope: I will read one last sentence: "Please do not allow this legislation to be passed through the House as is. The livelihoods of the pharmacists and their staff are at risk, and the service to the public is at jeopardy." It is signed by Norm Corriveau, Tom Smiley, Dave Glass and Ron Silver, all executive members of the Brant County Pharmacist's Association.
I know the member for Brant-Oxford-Norfolk has been paying careful attention.
It has not just been confined to letters to myself and to the minister, we have had telegrams. A telegram to the Minister of Health on November 14 --
Mr. McClellan: I hope it is a singing telegram.
Mr. Pope: The member for Bellwoods would not want that. That is cruel and unusual punishment. That is worse than my speaking.
I will read one sentence. "We request that before you proceed with legislating bills by the January 1, 1986, date that would seriously affect the practice and profession of pharmacy, you negotiate further with the OPA." It is signed Henry's Pharmacy Ltd. from Timmins.
We also had correspondence to the Honourable Murray J. Elston from Janeway Pharmacy Ltd, in Massey, Ontario. It is dated November 15, 1985. This was barely a week after the legislation was introduced. The writer thanks the minister for the copies of the proposed legislation which were just received and then says:
"From the outset, the proposed legislation has merit and goes some considerable way towards resolving long-outstanding issues, particularly the problem of spread-pricing by drug manufacturers. I must point out, however, that legislation such as this has very serious consequences for the drug manufacturing industry, pharmacy, the Ontario College of Pharmacists, doctors, your ministry and, most of all, consumers and taxpayers alike.
"I am frankly mad as hell that you, your ministry and the government would even consider it proper that legislation affecting virtually every person in every part of society in this province should be brought before the House and given passage with a suggested date of implementation less than 60 days hence. It is clear that if your government railroads this bill through the House, without all affected parties and interested groups having had the opportunity to provide input, some questions answered and the opportunity to have changes made, democracy is indeed dead in Ontario.
9:20 p.m.
"You claim that you are concerned that community pharmacy receive a fair dispensing fee under the ODB program; however, there is no indication whatsoever what a fair dispensing fee might be or the standards by which it might be judged.
"Further, there is no provision in the proposed legislation regarding the negotiating process, frequency of adjustment or for the provision of a process for the resolution of disputes arising out of the operation of the program, as is the case with our current agreement with yourself. One has no choice, therefore, but to assume that you have no intention of negotiating but rather intend to proceed arbitrarily as you have done in presenting without consultation this proposed legislation.
"This implicit mandatory participation in the drug benefit program is without question the single greatest alienation of individual rights and freedoms ever perpetrated by a Liberal government. The `refusal to dispense' clause places an unfair burden upon pharmacists to defend themselves when a decision has been properly made not to dispense a prescription for any number of valid reasons. Clearly, provisions for fines up to $50,000 without any provision for review or appeal is illegal by any standard.
"Further, the proposed prescription drug act writes into law that the only form of remuneration for pharmacy in the cash marketplace is `a single dispensing fee.' I have grave doubts as to the legality, much less the fairness, to either the consumer or the pharmacist of this requirement.
"Indeed, by copy of this letter, I will request the Ontario College of Pharmacists and the Ontario Pharmacists' Association to pursue relief from these above repugnant, unjust and illegal aspects of this legislation in the appropriate courts, should it be passed as written.
"There has never been any great degree of unanimity either amongst pharmacists or the consumers that a single fee for service is necessarily either fair or equitable. Indeed, there is mounting evidence that such a fee is, indeed, unfair to those persons under treatment with relatively inexpensive `maintenance drugs.' They are improperly being forced to subsidize those persons receiving expensive drugs.
"The point is that these are relatively complex issues and deserve to be treated as such, including due consultation with all interested and concerned parties, certainly not arbitrarily and without any consultation.
"Until these and many other questions left unanswered in the proposed legislation are resolved, there is a very real risk they will create more problems and inequities than are resolved. I have grave doubts that small community pharmacists, typical of rural and northern Ontario, who have historically placed a high level of importance on consultation, education and personal service, will be able to survive, particularly where a disproportionate part of the population are drug benefit recipients, a marketplace where the Minister of Health has historically placed the greatest importance on price alone.
"At the very least, there will be a serious reduction in the level of service to those people who most need service, as well as much patience and understanding. I would, therefore, urge you, and by copy all concerned parties, to delay the passage of this legislation until such time as it has been given the proper study, revision and consultation that it deserves by its very magnitude, to say nothing of the legitimate concerns about the consumer, the taxpayer and the pharmacist."
That is signed by Gail I. Janeway, pharmacist.
Mr Stevenson: Has the member got anything there from pharmacists in Niagara Falls or Mount Brydges or some of these other places?
Mr. Pope: There must be. There is also correspondence, dated November 18, from H. M. Sparrow of 167 Campbell Avenue in North Bay:
"The writers, Tina and Herb Sparrow, feel that these bills, if passed, would adversely affect the drug retail services: (a) cause some pharmacists to leave the industry because of the heavy fines that are now proposed; (b) lower the quality of service; (c) cause bankruptcies in the industry; (d) cause unemployment in the industry.
"These pharmacies will be unable to stock vital drugs that are sometimes expensive if they have to sell at cost. The waiting period for payment on these drugs from the province is also an added cost. We respectfully request that you vote to have these bills sent to the standing committee.
"Respectfully submitted, Tina Sparrow and Herb Sparrow of North Bay."
My colleague the member for York Mills (Miss Stephenson) received a number of telegrams from across the province regarding the proposed Ontario Drug Benefit Act, and there are basically two or three different requests in all of them. I will just read their names and summarize what they are asking of the members of this Legislature. I do not want to quote selectively, though; so I am hoping I will not be misunderstood.
Alan Pizel, president of Economy Prescription Services Ltd., indicates that the two acts would seem to violate the pharmacists' constitutional right of free choice, i.e., clause 4(1), and that further serious study and consultation is required.
The same request is made by Gill Rolbein of Downsview: "The proposals affect all aspects of pharmacy. Serious public study required. Bill should not be railroaded through Legislature to meet arbitrary January 1 date," which the minister has now embarked on.
B. Steinberg of Shoppers Drug Mart: "Urgent that bills not be rammed through Legislature but must be placed in committee for further study and input." I am not quoting from the entire telegram.
J. W. Spence, Wishing Well Pharmacy in Scarborough: "Do not push through legislation without further study and input by public and pharmacy."
H. Mazurkiewich of Streetsville: "Proposed changes affect all aspects of pharmacy. Serious public study required."
Charles Nekler, Newmarket Drugs: "Please refer the second reading of the health act to a full House committee, since we as pharmacists and voters find that the proposed act will drastically lower our income."
Wallace Drugstore, R. M. Konopelky and T. A. Calaiezzi: "Proposals affect all aspects of drug distribution, retail and manufacturing. Serious public study required. Please consider further study and input in lieu of railroading legislation through to meet arbitrary January 1 date. We must approach this problem logically, with consideration for the impact and hardships that will ensue. We urge you not to proceed at this time."
A. Jelski: "Pharmacy legislation cannot proceed as written. Major flaws. Massive study and consultation needed. Halt passage of this ill-conceived injustice to all concerned." That is from Richmond Hill.
Mr. Janeway, whose letter I quoted from earlier, also sent a telegram in which he reiterated that community pharmacy could not survive in northern Ontario under these bills.
We also got correspondence from the Village Pharmacy in Petawawa, addressed to all members; therefore, all members got it.
An hon. member: The member should read --
Mr. Pope: It is a very brief letter:
"I am writing to solicit your support" --
Ms. Fish: The member is not reading selectively, is he?
Mr. Pope: No, I am not reading selectively.
"I am writing to solicit your support and indeed your positive action in stopping the process through the House of two bills introduced by the Minister of Health, namely, the Ontario Drug Benefit Act, 1985, and the Prescription Drug Cost Regulation Act, 1985, and their regulations, until such time as they have been properly studied by a committee of the Legislature to which pharmacists and/or their representatives have had an opportunity for input.
9:30 p.m.
"Although the minister in press conferences and in correspondence to pharmacists has stated his commitment to providing fair compensation for pharmacists, the provisions found in the bills indicate otherwise. The legislation has been rigged to give the minister absolute control over the financial benefits of providing medication to the public, and even goes so far as to prohibit a practising pharmacist from refusing to fill a prescription even when such filling would be to his economic detriment.
"The proposed legislation is extremely regressive and might be expected in Russia under their type of government but surely not in Ontario where there should remain some freedom for pharmacists to earn a reasonable living, reasonable in terms of an expected professional earnings level and not as compared to the poverty line.
"The remuneration system which has existed is a finely tuned balance of restrictions and latitudes which has been adjusted over the years to provide fair compensation to the pharmacists, fair value to the taxpayer and consumer and enough leeway to enable the pharmacist to be competitive. The new legislation proposes to keep the old restrictions, throw out the compensating devices and permits the minister to set prescription fees without negotiation.
"With this kind of power, the minister could, for political gain, regulate pharmacists right out of any compensation at all. In the current situation vis-à-vis prescription pricing, the minister has shown the extent of his power over the destiny of pharmacists by unilaterally refusing to discuss increasing dispensing fees which have been frozen for two years, by refusing to adjust the cost of drugs payable by the drug benefit program so the pharmacists are now being reimbursed at less than their costs in many instances, and by stonewalling efforts by the Ontario Pharmacists' Association to meet with the ministry in order to conduct meaningful discussions on the subject.
"In fact, the ministry seems to have acted in bad faith on this issue and has adopted a Hitleristic stance, possibly in revenge for the shenanigans of some generic drug companies, a matter over which the community pharmacists have no control.
"As you can see, the subject of prescription pricing has many ramifications and should not be hastily or unilaterally imposed by the Minister of Health, nor should legislation be put in place to allow him to do so. Pharmacists are not in this world to score political points. Rather, we have chosen this profession because of our desire to help our fellow man in one of his areas of need. In return, all we ask is the opportunity to determine our own future within the constraints of today's society, and the right to earn a reasonable living. I therefore appeal to you to do your part to make sure it is not railroaded...." etc.
Signed: "Edwin Chow, community pharmacist; Lorne Wilson, community pharmacist; Raymond Oswald, community pharmacist."
Again, I am just quoting. This is from another letter, dated November 26, from the Family Drug Mart of Kingston, Ontario.
"We urge you to vote against the Ontario Drug Benefit Act and the Prescriptions Drug Cost Regulation Act presently before the house of parliament. These bills are socialistic to an extreme not before seen in the province of Ontario. They strip away the professional rights of the pharmacists and remove the powers of the Ontario College of Pharmacy to regulate the profession.
"The bills are the result of unilateral action by the Liberal government without any input from the profession of pharmacy. This is especially evident in some of the clauses which make the act unworkable in its present form, i.e., the determination of actual cost, which is not really known until the end of the business year, and in some other clauses which the Ministry of Health itself admits it cannot explain.
"The intent is to control prescription costs under the Ontario drug benefit plan and the result of the legislation will be the very opposite. The net result will be higher costs to the retail pharmacist and a loss of professional image due to the posting of fees and the emphasis on price this will create. The minister himself has admitted that the smaller pharmacists will suffer directly."
I do not know whether the minister admitted that, but he may want to reply to that comment. "We the pharmacists of Ontario urge you strongly to vote against this piece of legislation. It is poorly written and will provide only a lower quality of overall pharmacy service and more cost escalations."
It is signed by Bruce Wheeler, pharmacist.
On November 28, the Ontario branch of the Canadian Society of Hospital Pharmacists wrote to the minister and set forward its position. This is from Albert E. Chaiet, president:
"The Ontario branch of the Canadian Society of Hospital Pharmacists has recently reviewed draft copies of the proposed Ontario Drug Benefit Act...." etc.
"In reviewing this proposed legislative package, the members of the Ontario branch, a professional association representing over 700 practising hospital pharmacists in the province, have identified a number of serious concerns regarding the manner in which the legislation has been introduced as well as the contents of the legislation itself.
"In terms of the introduction of the legislation, the branch, as one of the participants in the health professions legislation review process that has been in process for the past two years, is extremely concerned about the short time frame associated with the introduction of this legislation, i.e., first reading, November 7, 1985; proposed implementation, January 1, 1986.
"The speed with which this proposed legislation has been introduced is not consistent with the spirit of consultation and consensus that has been the hallmark of the health professions legislation review process. The proposed legislation therefore appears to be proceeding on a separate course from the overall review process, which apparently will culminate in the introduction of new legislation during 1986. The branch feels that any new health-related legislation introduced at this time should only be undertaken within the context of the health legislation review process.
"The proposed legislation raises a serious question regarding the principle of self regulation. According to the legislation, the minister may appoint inspectors to examine a pharmacy's records and, indeed, remove these records. This provision raises questions regarding the jurisdiction under which" --
Mr. Stevenson: A great speech by a great Canadian.
Mr. Pope: Do not go that far.
"The proposed legislation raises a serious question regarding the principle of self-regulation. According to the legislation, the minister may appoint inspectors to examine a pharmacy's records and, indeed, remove these records. This provision raises questions regarding the jurisdiction under which the profession falls and, indeed, the accountability of the profession, which, under the provision of the Health Disciplines Act, establishes the Ontario College of Pharmacists as a regulating body for the profession.
"The branch strongly feels that any inspection of the pharmacy records should only be carried out under the auspices of the college. The only exception, of course, is the inspection of narcotic and controlled drug documentation, which falls under the jurisdiction of the federal Narcotic Control Act and its regulations.
"It is disturbing to note that the proposed legislation makes absolutely no reference to the term `pharmacist,' only to `operator of a pharmacy.' According to the Health Disciplines Act, only a pharmacist or a physician can dispense a prescription. The omission of the pharmacist in this legislation is a serious oversight. It must be emphasized that the role of the pharmacist goes beyond the mechanics of dispensing and prescription pricing. The professional responsibilities of the pharmacist include patient counselling and assessment of the appropriateness of the drugs prescribed as well as patient profiles maintained in the pharmacy.
"No person other than a pharmacist or a physician is legally authorized to carry out these responsibilities under the current provisions of the Health Disciplines Act. The proposed legislation prohibits the `operator of a pharmacy' from refusing to supply the listed drugs for an eligible person in order to avoid the operation of a provision of the act. A person contravening this section is `guilty of an offence' and on conviction is liable to a penalty of up to $10,000, $50,000 for a corporation.
"It must be emphasized that there are instances where a pharmacist may choose not to fill a prescription for professional reasons, a professional responsibility that must be maintained in the interests of optimal patient safety.
9:40 p.m.
"In a similar vein, the provision requiring the dispensing of the entire quantity of the drug prescribed may not be in the patient's interest. Indeed, there are specific instances where such a practice could be hazardous -- for example, prescriptions for narcotics -- from both a patient care and poison control perspective.
"These are but some of the concerns raised by the Ontario branch. We have not addressed issues related to the potential financial impact of the proposed legislation on the operation of community pharmacies. We are, however, concerned with the implication for the self-regulatory status of the profession, as well as the potential erosion of the professional responsibility of the pharmacist, undesirable outcomes which would not be in the best interests of the public."
It is signed by the president of the Ontario branch, Canadian Society of Hospital Pharmacists.
From eastern Ontario, we have had correspondence from the Eastcourt Pharmacy in Cornwall addressed to me, and from Watson's Village Pharmacy in Westport addressed to my colleague the member for Leeds (Mr. Runciman).
This is from Cornwall: "I know you have a lot of demands on your time, but please take a moment to read this plea for help. The Honourable Murray Elston, the Minister of Health, has managed to create the impression that the pharmacists of Ontario are solely responsible for the cost increases of the past two years. To correct this problem, he has introduced some of the most creative legislation since the Spanish Inquisition."
The Deputy Speaker: Order. Is the member starting another letter?
Mr. Pope: No. I am just referring to it.
The Deputy Speaker: I remind you it is not in order to read from any document; that is, needless, repetitious reading verbatim from any document.
Mr. Pope: I am entitled to refer to letters that have been sent to members of the Legislature.
The Deputy Speaker: It is one question to refer to letters; it is another to read verbatim from those letters.
Mr. Pope: I was just told by the parliamentary assistant that I should not quote selectively.
Mr. Ward: I take it back.
Mr. Pope: The member takes it back. All right; I will not quote from it directly. I guarantee you, Mr. Speaker, that I will not quote directly from the letter.
It goes on to say in general terms that they feel the statements the minister has been making to the press -- can I quote one word? Is it unparliamentary to say the word if I say it directly?
The Deputy Speaker: It is not out of order to quote, but it is out of order to read the letter verbatim.
Mr. Pope: This is just one sentence out of one paragraph: "If the ministry carefully selects its examples for the norm, pharmacies should be" --
Mr. Callahan: Mr. Speaker, on a point of order: Section 20(a) off the standing orders says, "If a member on being called to order for an offence against any standing order persists in the offence, the Speaker may direct him to discontinue his speech, and if such member refuses to resume his seat, the Speaker shall name him to the House."
You have done it three times, Mr. Speaker, and he continues to read from the letters ad infinitum.
The Deputy Speaker: Your interpretation of the order is quite correct. However, he has stated he will not read verbatim in the future
Mr. Callahan: If we catch him reading again, he is out of order,
Mr. Pope: I am glad the member is an expert already. It is great to see.
It goes on to say that if all the minister's facts quoted to the press were true, pharmacy would be the most profitable operation in Ontario. That is from a small independent pharmacist in Cornwall.
Ms. Fish: I did not quite catch that. How did he say that?
Mr. Pope: I cannot read it. I have to give the member my summary of it.
Ms. Fish: Perhaps the member can paraphrase. I did not quite catch that. Perhaps he can try it again.
Mr. Pope: Can I paraphrase?
Mr. Callahan: We have the copy.
Mr. Pope: The member has the copy? Then why did he not read it and talk to his minister about it?
The letter from the Eastcourt Pharmacy in Cornwall goes on to outline a number of specific examples of the quantity prescribed of different drugs.
Ms. Fish: What sorts of examples?
Mr. Pope: All right. The examples were Adalat, Visken, Megace, Calcimar and Nolvadex. The letter goes on to specify the quantity, the ODB permitted price, the actual cost minus the rental factor and the margin. In three out of the five drugs --
Mr. Stevenson: This is just like a Conway speech, is it not? Does the member remember speeches like that?
Mr. Pope: Yes, I remember that. I remember it very well; about a year ago.
Ms. Fish: It rings a bell, does it not? I am sure Mr. Speaker recalls these.
Mr. Pope: It rings a bill. About a year ago at this time.
I will not quote from the letter, but it goes on to say that in three out of the five drugs on this list, which I presume the minister has looked at, which are listed on the Ontario drug benefit plan, the pharmacist loses money. In three out of the five there is a negative margin.
If the minister disagrees with those numbers, I presume he has probably communicated with this pharmacy in Cornwall and told the people their numbers are incorrect. If he agrees with the numbers, I presume he is going to do something and not ram legislation through the House without any discussion of these issues with the small pharmacists from one end of the province to the other.
The same thing applies with respect to Watson's Village Pharmacy in Westport. I will not read from the letter, but to paraphrase, it says that the Minister of Health does not listen to or talk with the Ontario Pharmacists' Association. He acts unilaterally and calls the media when he has something to say. He communicates through the media.
Mr. Callahan: He is reading it.
Mr. Pope: I am not reading it. The pharmacist also indicates that there has been no adjustment of the $5 dispensing fee since 1983.
Mr. Cousens: On a point of order, Mr. Speaker: If the honourable member is not being allowed to take quotations verbatim from certain correspondence and important documents, that is a new ruling this chair has made. I object to that, and on this point of order I would say that this member should be allowed to make such references verbatim.
Mr. Harris: On the same point of order, Mr. Speaker: Can you indicate to this Legislature what the new ruling is that precludes a member from quoting from material he feels is pertinent to his speech? Can you tell us that?
The Deputy Speaker: There is no new ruling. I said the member can use quotations, but he cannot read unnecessarily verbatim. What he has been doing is reading an entire letter verbatim.
Mr. Harris: On the point of order, Mr. Speaker: I assume you are referring to page 4 of the standing orders and rule 19(d)4, "in the opinion of the Speaker, refers at length to debates of the current session, or reads unnecessarily from verbatim reports of the legislative debates or any other document."
I remind you that in calling a speaker to order on that you are determining that the speaker is unnecessarily referring to documents. You might want to be very careful in your ruling about whether it is necessary to the speech to refer to some of the documents the member for Cochrane South has been referring to in the debate tonight.
Most of the documents I have heard the member referring to are documents the minister either will not read, refuses to listen to or refuses to allow access to. It is necessary when we are dealing with legislation such as this that these items get on the record and are there for the public to see. The pharmacists and the public are telling us they have no other vehicle to get them there, so I ask you to consider that.
Mr. Callahan: Why does he not table them?
9:50 p.m.
The Deputy Speaker: Order. In answer to the House leader of the official opposition, in my opinion it is not necessary to read the whole document to carry out his part in the debate and to bring the attention of the minister to the matter set forth in the letters and to the letters themselves.
Mr. Harris: On the same point of order, Mr. Speaker: I can understand if you feel that a particular document, after it is quoted at some length, may not be there. But are you telling me you are ruling that it is not necessary to read from any document any time now or in the future?
The Deputy Speaker: No. Under these circumstances in this debate tonight, that is my ruling.
Ms. Fish: On a point of order, Mr. Speaker: Are you saying you will determine which items of correspondence are to be entered into the debate and appropriately referred to by the member?
Mr. Lupusella: On a point of order, Mr. Speaker: With the greatest respect, the House leader of the Conservative Party spoke on behalf of all of his members in relation to this particular issue, and I think that recognizing other people from the same party addressing the same point that has been raised is a waste of the precious time of this Legislature.
Mr. Pope: I want to get on with wrapping up this presentation.
Le député de Cochrane Nord (M. Fontaine) a indiqué que c'était une perte du temps de tous les membres de l'Assemblée législative de l'Ontario de lire toutes ces lettres de tous les pharmaciens de la province, pharmaciens qui ont indiqué leurs problèmes --
The Deputy Speaker: Order. The member for Brampton with a point of order.
Mr. Callahan: On a point of order, Mr. Speaker: "A member called to order shall sit down, but may afterwards explain. The House, if appealed to, shall decide on the case, but without debate. If there be no appeal, the decision of the Speaker shall be final."
Your decision is final on the issue of the question of whether he can refer to letters, and unless it is appealed --
The Deputy Speaker: No. I did not say at any point that he could not refer to letters or use excerpts, but he cannot read entire letters verbatim.
M. Pope: C'est très important pour tous ces professionnels en Ontario d'avoir l'occasion de discuter de ces choses devant les membres de l'Assemblée. Il faut que chaque pharmacie, dans chaque comté de l'Ontario, ait l'occasion de le faire. C'est pour cette raison que j'ai décidé de lire quelques-uns de ces documents aux membres de la Législature. C'est très important pour l'avenir de ces pharmacies-là.
For the honourable member from Magna Carta to say it is a filibuster when we are dealing with important concerns of the pharmacists and the consumers across this province is something I cannot accept. These are issues that people have been writing to us about, that members in that party have from time to time in this Legislature, over a number of years, read into the record.
Now he says it is not important enough, that the Ontario branch of the Canadian Society of Hospital Pharmacists is not important enough to be heard by this assembly; that Family Drug Mart in Kingston is not important enough to be heard by the members of this Legislature; that the Village Pharmacy Petawawa Ltd. is not important enough to be heard by this assembly; that Janeway Pharmacy Ltd. in Massey is not important enough; that Mr. Jelski in Richmond Hill is not important enough; that Wallace John Drug Store Ltd. in Cochrane is not important enough; that Newmarket Drugs is not important enough to be heard from by the members of this Legislature; that the druggist Mazurkiewich in Streetsville is not important enough; that the Wishing Well Pharmacy is not important enough; that Shopper's Drug Mart is not important enough to be heard; that Mr. Rolbein in Downsview is not important enough to be heard from; that Economy Prescription Services Ltd. is not important enough to be heard from; that the Sparrows from North Bay are not important enough to be heard from, and most important, that Henry's Pharmacy in Timmins is not important enough.
They all are important.
Mr. Callahan: Where are the letters from the consumers?
Mr. Pope: We are going to get to that. Do not worry. I will get to that. If you challenge me to get to that I will. Do not worry.
Mr. Callahan: Right at the bottom. The big interests first, and then down at the bottom are the little guys.
Mr. McFadden: In the fullness of time.
Mr. Jackson: Be patient. No doors, no walls, just open government.
The Deputy Speaker: Order.
An hon. member: We are going to be spending more time on the consumer, do not worry. Far more than we have spent so far.
Mr. Pope: Mr. Worrall, of Eastcourt Pharmacy, indicated the pharmacist's problems with respect to the Ontario drug benefit plan. He indicated that he is losing money on a number of these drug items, given the current formulary process. He indicated that. He has had no reply from this government. He has no reply from the Minister of Health.
The parliamentary assistant, who so wants to travel around different parts of the province, has not even been to see him in his Eastcourt Pharmacy in Cornwall. He should go to the Eastcourt Pharmacy in Cornwall, talk to them, see what their concerns are. If he does not believe their numbers, he should go and check it out himself. He is going to have inspectors do it this time next year, anyway. He should go and do it himself and talk to the pharmacists. This independent pharmacist who is facing some financial hardship -- he should go and talk to him. Maybe he will change his mind on a few things.
Mr. Stevenson: What about Kingsville? Are the pharmacists happy in Kingsville?
Mr. Pope: Watson's Village Pharmacy in Westport contacted my colleague, the member for Leeds, with respect to their concerns. They asked that there be realistic pricing under the Ontario drug benefit plan. They also indicate their concern over the lifting of the fee per month on maintenance drugs.
Mr. Callahan: That is right. Realistic prices, that is the whole thing.
Mr. Pope: Does the member want the prices? Okay, I will read them into the record.
Ms. Fish: Mr. Speaker, on a point of order: Is he permitted to read that into the record?
Mr. Pope: Can I read that into the record?
Ms. Fish: Is the speaker permitted to read such things as prices from correspondence into the record? Is he permitted to make a selective, possibly out-of-context, reading?
The Deputy Speaker: Certainly he is.
Ms. Fish: Is the Speaker then saying, further on the point of order, that it is permissible for a member to read excerpts out of context into the record of the assembly?
The Deputy Speaker: Out of context would depend upon the interpretation.
Ms. Fish: Does the Speaker then agree that the context is best understood when the whole of the matter is read into the record so we can be assured that nothing will be put in improperly out of context?
The Deputy Speaker: The member can refer to documents as part of his speech, but not read entire documents verbatim and lengthy excerpts from documents.
Ms. Fish: But surely, Mr. Speaker, you would not want to have those excerpts out of context. You would surely encourage all members to read sufficiently to have the full context on the record.
Mr. Callahan: On a point of order, Mr. Speaker: There is not to be debate on your decision. That is exactly what this member is doing. She is debating it. She is out of order, with the greatest of respect.
The Deputy Speaker: She did not have a valid point of order.
Mr. Pope: Thank you, Mr. Speaker, it was the prices that the member wanted read into the record, as I understood the comment.
Ms. Fish: Mr. Speaker thinks it is appropriate to read them in.
Mr. Pope: Can I get a copy of the formulary. I will read the whole thing in.
I will read the formulary into the record for the member if that will make her happier.
Ms. Fish: Just so we could compare that on the prices.
Mr. Pope: Okay, we will just go back to Eastcourt Pharmacy. We will just read five into the record. I do not want to delay proceedings.
Ms. Fish: The member must be sure it is in context.
Mr. Pope: These were the five that I named earlier. I gave the final one, but I now want to go through the detail because the member for Brampton (Mr. Callahan) is not convinced.
The margin on the first item is $3.20. The margin on the second item is $2.38.
Hon. Mr. Kerrio: He did not do it. He cheated somehow. He had notes somewhere.
Mr. Pope: What does he mean, "cheated"?
The Deputy Speaker: Order.
10 p.m.
Mr. Pope: The second item was $2.38 margin. The third item was a $7.73 loss as a margin on this drug. The fourth one was a $4.01 loss on that item and the fifth item, Nolvadex, was a $3.36 loss under the existing plan.
Nolvadex is also referred to in a letter to my colleague the member for Simcoe East (Mr. McLean), otherwise known as Coldwater. That letter is from Larry Wilson, a new pharmacist, who has just opened a pharmacy in Washago in the new Lions Medical Centre. I will read one sentence and I will not read it out of context.
Hon. Mr. Kerrio: Go ahead and read it.
Mr. Pope: Okay. "The publicity and misinformation appearing in the Globe and Mail concerning pharmacy is of great concern to me. The new Liberal government's handling of pharmacy fee negotiations is also worrisome."
I will not read the rest of it, but it goes on on page 3 to say the following: "Here is one example. Drugs are sold on a basis of cost plus fees. On Nolvadex, the 10-milligram cost to me is $1.45 per tab for 60-tab size, which is $87. The Ontario drug benefit plan pays $1.342 per tab for $80.52 and a dispensing fee of $5, which is $85.52."
Even adding in the dispensing fee, this druggist loses $1.48 on every prescription for 60 tabs of 10-milligram Nolvadex that he fills out as a pharmacist in this province. He raises the very important point that he is stocking $87 worth of these drugs in his store at his cost.
Mr. Callahan: Is he operating out of a truck? He is selling peanuts, razors, cigarettes.
The Deputy Speaker: Order,
Mr. Pope: I hope the member is not on the Liberal team that is going to sit down with the pharmacists to discuss this matter.
He also talks about his problems with respect to Feldene, 20-milligram size, and his loss of $29.99 with respect to that prescription. Again, I presume the Minister of Health is answering his concerns.
My colleague the member for Northumberland (Mr. Sheppard) received a letter from a pharmacist in Cobourg, Catherine Barren-White, who indicates her concern.
Hon. Mr. Kerrio: What does it say? Read it.
Mr. Pope: I will read just a couple of sentences. "The number of persons covered by the program increases each year, as does the number of drugs included as benefits under the program. Special authorizations, which may be granted by the Ministry of Health at the request of a physician, permit payment for drugs that would not normally be covered under the Ontario drug benefit formulary. The number of special authorizations is also on the increase. The Ontario drug benefit program could reduce expenditures by altering the formulary to eliminate drugs that do not normally require a prescription and by being more selective about special authorizations."
This pharmacist has raised a new issue for the attention of the Minister of Health, again without response.
The letter goes on to say: "I would like to state my objection to the proposal that Ontario drug benefit recipients be supplied with a three-month supply of medication rather than the one-month supply that they now normally receive. Many patients become confused with the medications. They may take more or less than the recommended dose.
"It is also quite possible that the dose may be changed in a three-month period. Compliance will be more difficult to monitor. This problem would be most intense where drugs of abuse are prescribed. It would also be a problem when potentially suicidal patients were prescribed antidepressants. One month's supply could be lethal if taken at once; three months' supply is a greater lethality. The risk of accidental poisoning may also be increased.
"Thank you for your assistance in the past and for your consideration in this matter once again."
That was to my colleague the member for Northumberland. My colleague the member for Burlington South (Mr. Jackson) has indicated his concern. He has been contacted by several pharmacists in his constituency. He indicated that he wanted to ensure there was some consultation and negotiation with the Ontario Pharmacists' Association, and that view is expressed by the three pharmacists who have written to him.
Mr. Jackson: That is 43 now. It is rising every day.
Mr. Pope: Then there is a letter from W. G. Walker, president of B and B Pharmacies Ltd. I will quote just the worst sentence: "This letter is in response to the unprecedented and unjustified attack on pharmacy, which is being led by the Honourable Murray Elston. I would like to point out the following."
Then he talks about the traditional use of the price spread by government and pharmacy as part of reimbursement in conjunction with the dispensing fee. He challenges the minister's estimate of "a windfall of $6,000 per pharmacy per annum through price spreading." He says, "This represents a very small purchasing advantage of approximately two per cent, based on average prescription inventory purchases of $300,000 per annum.
"The average pharmacist earns approximately $32,000 per annum under very unattractive working conditions," such as shift work, weekends and holidays. This pharmacist has "personally invested $60,000 for a computer system primarily to handle ODB billing and rebilling" and has never been reimbursed for that. In fact, his "cash-paying customers have always paid a higher market fee to subsidize ODB patients."
As a result of legislation, this pharmacist claims he will have to restrict his staff to 10, restrict consultation time and cut back the free delivery service he is now providing. He indicates he has been providing prescription and related services in a cost-effective manner. He goes on:
"Our impulsive and short-sighted minister has drastically changed my objectives with respect to pharmacy as well as my respect for the Liberal Party, Although I will be reducing staff and service, I will not be run out of business. The upcoming legislation will force me to redirect my efforts from service to financial survival. I will work within the system, but not for its betterment.
"With respect to the legislation re fee posting, how can a dispensary with 95 per cent of its revenue derived from prescription-related products maintain present services in competition with a discount drug mart with 95 per cent of revenue from non-prescription-related products?"
My friend the member for Brampton failed to recognize the differences between those two types of pharmacists in his ill-informed comments of a few minutes ago.
"Obviously, the drug marts owned by large corporations will offer loss-leader prescription services to increase front-shop traffic. Discounting prescriptions and related services are not in the public's best health interests. But then neither is the Honourable Mossy Elston. The sudden and thoughtless action of Mr. Elston will not only hurt pharmacy but all those served by pharmacy."
Here is another letter. I will just indicate that four pharmacists -- Asif Kahn of Straders Drug Mart, Harold Dike of Straders Drug Mart, Dipika Patel of Huntingdale Drug Mart and Elizabeth Chau of Peoples Drug Mart -- all feel the relationship between the minister and the Ontario College of Pharmacists, this whole issue, has got out of proportion. They feel the matter should be negotiated again and serious public study should be carried out before any further decisions are made.
The pharmacist from Peters Drugs (1982) Ltd. in Kingston indicates his concerns over the attack on the retail pharmacists who are not responsible for the Ontario drug benefit plan.
10:10 p.m.
There is a letter from Matthews Pharmacy, Pine Plaza, Timmins:
"We are writing in response to the introduction in the Legislature of the Ontario Drug Benefit Act, 1985, and the Prescription Drug Cost Regulation Act, 1985
"We are hoping you may have some influence in stopping or delaying passage of the two ill-conceived acts, If they are examined closely, they will benefit no one ... it will only encourage long and very costly legal battles in the courts between the Ministry of Health and the Ontario Pharmacists' Association. It will also mean the closure of numerous smaller pharmacies in the province with a large proportion of them coming from your very own riding of Cochrane South."
It is signed by Gordon Matthews, secretary-treasurer of Porcupine Pharmacists' Association."
Also, John Worrall from Avonmore indicated to the member for Stormont, Dundas and Glengarry (Mr. Villeneuve) that he communicated with the Minister of Health and indicated his concern about increasing costs of pharmacy operations, including increasing municipal and government taxes and the need for some consideration by this Minister of Health.
He outlined a list of 14 different products, which I will not list, and indicated a loss in each of them, ranging from three cents to $11.22 for prescriptions dispensed under the Ontario drug benefit plan. This is a letter to the Minister of Health. Since this letter was sent on September 7, I presume the minister has responded to that pharmacist.
All these people, and many more who are pharmacists across the province, have been talking to all members of this Legislature about their concerns. They have been writing to the minister all fall and expressing universally their opposition to the way in which this minister has handled the introduction of legislation. They are expressing universal opposition to the fact that he is proceeding unilaterally with respect to the legislation and the regulations and has yet to sit down and negotiate.
The pharmacists, the Ontario Pharmacists' Association and the Ontario College of Pharmacists have been asked on virtually no notice to develop comprehensive responses to the minister. They have been asked to analyse within 10 days their concerns with respect to this legislation, not having had notice of it before its introduction on November 7. They have had no opportunity to sit down and negotiate meaningfully with the officials of this ministry or with the minister directly.
They have been frustrated in their attempts to talk to the Premier (Mr. Peterson). They cannot get anywhere with him. They see all this lack of co-operation and consultation in a government that promised them in the summer of 1985 that it would be a new, open government and that the sun would shine into the corridors of power in Queen's Park. Since that time we have seen the failure of co-operation and the failure of consultation.
We have seen confrontation spread from the Ontario Medical Association to the OPA, to the college, to individual pharmacists and to doctors' organizations. We have all seen the concerns of the Ontario Dental Association with respect to the proposals for denticare.
We have seen the concerns of the nursing home operators. We have seen all this confrontation over the fall months with a government that said there would be a new era of consultation and co-operation. It has not happened, particularly with respect to this Minister of Health.
That is why the Ontario Pharmacists' Association is reduced to issuing press releases to indicate its opposition to the principles of the bill and its genuine concern about service to the public, to the people who qualify for the Ontario drug benefit plan, to the senior citizens and to those who are welfare recipients, and to indicate its concerns about the quality of the plan of the pharmaceutical services to be provided to them across this province.
They have been reduced to going to the media and fighting the minister in the media because that is their only avenue left. That is not appropriate. That was not the way to introduce this legislation, never mind sliding through committee and indicating there had been all sorts of consultations on all sorts of issues found in the bill.
Finally, we got the minister to acknowledge on November 27 that he had met with the OPA with respect to both pieces of legislation on the day they were announced. That was not negotiation. That was not what he tried to say to the members of the committee when the estimates originally started. The member for Lanark (Mr. Wiseman) indicated on the record what he thought about the statements of so-called fact that were made at the beginning of the estimates of the Ministry of Health about the consultations.
All sorts of people across this province -- not just those who are operating individual pharmacies, but drug manufacturers of generic drug products, innovators and inventors -- have indicated their concern to this minister, seemingly without results. They have indicated their concerns to individual members on the government side, but it has had no impact. They have seen all of these problems. That fits in with the entire attitude of confrontation or lack of consultation that has taken place since this minister became Minister of Health. There are all sorts of issues.
On September 3, 1985, the Minister of Health in a press release said, "For the past several weeks, representatives of my ministry have been meeting with the Ontario pharmacists and drug manufacturers in an effort to resolve certain drug pricing practices in this province." The response of the Ontario Pharmacists' Association was that there was only one meeting, on August 14, 1985, between the OPA and ministry negotiators since the Liberal government took office on June 26, 1985, although the OPA constantly requested other meetings.
The statement made on September 23 said, "For the past several weeks, representatives have been meeting with the OPA." The reality is that there was one meeting on August 14. That is the kind of thing that turns sour the whole negotiation and consultation process, the attitude of co-operation that is needed to make the ODB plan work. Those are the kinds of statements that are made by this minister in press releases, which everyone challenges with respect to what actually happened. I will put it that way.
The same press release stated, "Ministry officials will be instructed to meet with pharmacy representatives immediately to negotiate with them an equitable dispensing fee." That is on September 3. Where is the equitable dispensing fee? We are now told it is not going to be negotiated. I just read into the record all sorts of comments from pharmacists across this province -- not verbatim, but the substance of them. They say there has been no negotiation of an adequate dispensing fee, in spite of the statement on September 3, 1985. There has been no progress on that.
Here is what the OPA says: "The OPA was contacted by telephone on September 6" -- that was three days after this press release -- "by the ministry to indicate it was ready to meet with the OPA. Before a meeting could be arranged, the minister made another announcement on September 12, 1985, and cancelled his instructions for negotiating meetings to be held." Now we know what really happened. The minister cancelled the negotiations on the dispensing fees.
Why did he do it? Because of the court challenge by a producer. That is his justification. In the meantime, he did not seize the opportunity during the fall to start negotiations on a proper dispensing fee that would entirely change the atmosphere surrounding this bill and the administration of the Ontario drug benefit plan.
On September 13, 1985, the OPA placed a call to the ministry to ascertain the minister's comments on September 12, 1985. In fact, that meant no negotiations could take place. The ministry confirmed that this would be a fact. There would be no negotiations on dispensing fees while the court case was taking place. There is some linkage that is obscure to everybody in this province except for the Minister of Health.
On September 17, 1985, in his letter to the pharmacists, the minister said: "We are unable to publish a new formulary. Neither will we be able to negotiate a new dispensing fee." The OPA has repeatedly indicated to this minister that it cannot understand why a dispensing fee cannot be negotiated, even though there is a court challenge going on with respect to the formulary, but again without success.
10:20 p.m.
A meeting was finally arranged for October 10, but that call to have a meeting on October 10 was made on October 7. That happened to have been after the minister told the Globe and Mail that his assistant had asked the OPA to say what it considered a fair fee to be, but he had not heard back. They are claiming that on October 6 they asked the OPA to say what it considered to be a fair fee. The next day, to justify the story in the Globe and Mail, they called the OPA and asked if they would meet on October 10. There were no meetings before then. The minister cancelled the meeting.
What is going on? Negotiations through the media. There is no direct contact. The only contact that has been made is to justify the minister's statements in the Globe and Mail. That has been the kind of negotiations carried on by this government. It is shocking.
The same Globe and Mail article on October 6 says: "We are looking at perhaps a two-tier fee structure that would allow small-volume pharmacies to have more flexibility. Now the ones who make the most money are the high-volume pharmacists."
The OPA's response: "The minister has stated to OPA that he does not want to negotiate in the press, nor does he want to see the OPA do this." Yet the minister makes these statements, taking a negotiating position in the Globe and Mail on October 6, 1985. That is the state of negotiations: through the Globe and Mail. He should have invited all the reporters; they could have negotiated on both sides of the issue. A hall could have been hired.
Hon. Mr. Nixon: More.
Mr. Pope: There is more, lots more. I am very happy to accommodate my friend.
Ms. Fish: Accommodate the member for Brant-Oxford-Norfolk.
Mr. Pope: Yes. He did not want to listen to the Brant County Pharmacists' Association letter that was read into the record. He distinctly did not listen to it. That is terrible.
In a Globe and Mail article of September 5, 1985, the minister said, "Drug prices and the dispensing fee are separate issues."
The response from the OPA, again to an article in the Globe and Mail and not to direct negotiations:
"Drug costs and fees cannot be dealt with as separate issues unless and until drug costs, his actual acquisition costs and dispensing fee are adjusted to take into account all elements of remuneration due a pharmacy. The government has never been prepared to go to these concepts and has always recognized purchasing advantage as a legitimate element of remuneration due a pharmacy. OPA remains willing to negotiate actual acquisition costs and a reasonable dispensing fee incorporating all elements of remuneration, but it has been unsuccessful in getting the ministry to do so."
From the minister's press release -- a press release again; he is negotiating through the press -- of August 15, 1985: "The prices of many multiple-source drugs listed in the formulary were higher, in some cases much higher, than the prices at which drug manufacturers were actually selling to pharmacies."
I will not read the entire response into the record, but again the minister is negotiating with the OPA directly through the press. That has been his stance all along on these issues. It has not worked.
Mr. Davis: Confrontational politics.
Mr. Pope: Confrontational politics; the member is right. The minister is negotiating through the Globe and Mail and through press statements. It goes on and on all through the fall. The consequence is that the minister has forced the Ontario Pharmacists' Association to get involved in press releases and press conferences. Pretty soon the whole thing is going to escalate.
Is that the logical result the government wants, escalating confrontation through the media and no direct negotiation? If it does not want it, why did it allow the minister to proceed along this course from the very beginning on these issues?
Everyone knows there have to be some changes in the Ontario drug benefit plan. Everyone knows that the issues that concerned the Conservative government and led us to appoint the Gordon commission have to be addressed; but they have to be addressed in the way they have traditionally been addressed, through negotiation, consultation and co-operation. We have seen the consequences of not doing it that way.
I do not want to quote selectively. I do not want to read everything into the record --
Hon. Mr. Kerrio: Go ahead and read; we're listening.
Mr. Pope: The government has an 18-page brief from the Ontario Pharmacists' Association that I did not refer to. I did not read it into the record. It details the specific problems found in Bill 54 and Bill 55. The problems of Bill 54 and Bill 55 have been issued to the media and to every member of this assembly. The member for Northumberland has received the mail, as has every other member on this side of the House.
I suspect everyone on the other side of the House also has received this mail. When they were in opposition, the members on the other side were ready to introduce all this documentation and read extensively from it into the record so their constituents' views could be put on the record, but now they will not stand in their places and quote from that same correspondence so their constituents' concerns can be addressed by this assembly.
No, they will not do it any more as they did when they were over here. Instead, they are going to proceed with legislation, knowing, if they review their own constituency files, the concerns that have been created across this province by this legislation, not only in terms of the process but also in terms of the principles of the legislation and its detailed wording.
Having addressed the process, I now want to get into the contents of the legislation itself.
Hon. Mr. Kerrio: Clause by clause.
Mr. Pope: No, not clause by clause. I am just addressing the principles of the bill; I am afraid I am not going to be able to address them all tonight, but I shall do my best just to indicate --
Interjection.
Mr. Pope: I shall be able to continue tomorrow, I know, but I just want to indicate --
Mr. Callahan: Did Bill write your speech? He wrote all the letters.
Mr. Pope: Who wrote all the letters? The honourable member is saying that Henry's Pharmacy in Timmins, which sent a telegram to the Minister of Health and this member, did not compose its own telegram. He is saying that Henry Giallonardo does not have the capacity to speak for himself. He is saying that to a respected pharmacist who has provided service to the people of our community for the past 40 years, and he is saying this respected pharmacist in our community does not have the ability to speak for himself. He is saying that Matthews Pharmacy in Timmins and all these other pharmacists from one end of the province to the other do not have the ability to speak for themselves.
I have read into the record -- not quoting -- the essence of these letters, and there are different concerns in different parts of the province. Pharmacists are writing at the same time expressing different concerns over the way this Minister of Health has handled his relationships with the pharmacists of Ontario, the Ontario Pharmacists' Association and the Ontario College of Pharmacists, indicating in very great detail their concerns with respect to the principles of the bill and the impact of this bill on their operations in communities from Cornwall right through to Windsor and from Niagara Falls right through to Moosonee.
In every part of this province, pharmacists are concerned and consumers are concerned. I am going to get into that as well. Consumers are concerned about the potential impact of these two pieces of legislation and the effect of increasing drug prices across the province in terms of increasing the costs of the system to the taxpayers of Ontario. They have all taken the time to write to members opposite, and to us as the official opposition, to ask us clearly for full and extensive consultation and to think hard before we adopt Bill 54 and Bill 55 because of the problems they create for them in carrying out their professional responsibilities.
All these demands I referred to tonight obviously have not moved the member for Brampton one bit. He does not believe they even wrote them themselves. He does not believe they have any right in this province to express their concerns. He says that what they really do is dispense peanuts and chocolates. He did not listen to the documentation I was reading out. I read it out because I knew he would not listen. I want him to reflect upon the words that are in the transcript of Hansard tonight and upon the genuine concerns of pharmacists from across this province.
I want him to reflect upon all those things, and I want him to talk to the Minister of Health, because he obviously has not done it before, and to express on behalf of the pharmacists in his riding and on behalf of the Ontario drug benefit plan recipients in his riding, his genuine concern about the consequences of these two pieces of legislation.
On motion by Mr. Pope, the debate was adjourned.
10:30 p.m.
TRANSPORTATION PROGRAMS
Mr. Speaker: Pursuant to standing order 28, the question that this House do now adjourn is deemed to have been made.
The member for Rainy River (Mr. Pierce) has given notice of his dissatisfaction with the answer to his question given by the Minister of Northern Development and Mines (Mr. Fontaine) concerning air transportation in northern Ontario. The member has up to five minutes, and the minister has up to five minutes to respond.
Mr. Pierce: I rise in regard to standing order 28(a) to express my dissatisfaction with the answer I received from the Minister of Northern Development and Mines earlier today in question period.
My question to the minister was clear and specific. I asked about the report of the previous member for Lake Nipigon, a respected member of this House and the former Speaker, Jack Stokes, and his task force, examining the utilization of a second Dash-8 aircraft for norOntair, this aircraft to be used exclusively in the northwest.
This is not a frivolous question. Transportation, especially air transportation, is very important to the northwest. Isolation is a serious problem in the communities of the area. With the Speaker's indulgence, let me refer to comments from the town of Dryden, a community of about 6,500 and a service area of approximately 20,000.
Representation made to the Stokes task force in Dryden emphasized that as far as that community is concerned, air transportation is a necessity, not a luxury. Dryden is deeply concerned about this issue. The community believes additional Dash-8 service is necessary. The tourist industry in the area has not been well served, and norOntair has a responsibility to develop an air system to satisfy this need.
If the Dash-8 service is to be introduced, it must be introduced wisely. Introduction of the Dash-8 could jeopardize existing air service provided by the private carriers. In Dryden's case, therefore, the question of the Dash-8 service is an essential one. Additional Dash-8 service could strengthen the local economy or, if introduced unwisely, damage existing transportation services and return air service to this community to the level that existed prior to 1972. No one would like to see that happen. All members, certainly on this side of the House, are committed to seeing northern communities given every support and incentive to develop services in the north that are equal to those available in the south.
Dryden's concerns about additional Dash-8 service are shared by other northern communities. My riding, the great riding of Rainy River, and two communities, Fort Frances and Atikokan, have come to a consensus with the town of Kenos on the need for an additional Dash-8 service. Those three communities see Dash-8 service connecting Thunder Bay, Atikokan, Fort Frances, Kenora and Winnipeg and return twice daily, seven days a week. That kind of service would allow the luxury of one-day return trips to major centres to become possible. That kind of service would be a great boost, not just for tourism but for all businesses and commerce.
I am sure the minister is aware that the tourist operators in northern Ontario spend a lot of money and most of their winters attending sports shows in the United States to promote tourism in northern Ontario. Part of recommendation 2(a) of the task force was based on the service of the Dash-8 to interconnect with US flights, allowing the American visitor better access to northern Ontario tourist facilities.
The Stokes task force recommends that norOntair service be strengthened so that its mandate to reduce isolation, to improve on the service provided by private carriers and to encourage industrial and commercial development be continued. The task force recommends that norOntair get in contact with private carriers such as Republic Airlines and Nordair to ensure that schedules of flights work to benefit business travellers and tourists throughout the northwest.
The setting of schedules is a key concern, as I pointed out with the example of Dryden. A poorly set schedule could turn the clock back a decade as far as air service in the north is concerned.
That is why northern communities are anxious to know what the provincial government will do in response to this report. These communities want the time to study the government's reaction in depth. They want to have time to respond to Queen's Park and to make suggestions based on local needs and experience. They want to make sure their communities, their businesses and their industries are ready to take advantage of the expanded Dash-8 service.
That is why I asked my question in the House today. The northwest deserves to know what the government intends to do in response to the task force recommendation. It deserves an honest answer, not a one-word answer or even a one-sentence answer. It wants to know the facts and not to hear a jumble of rhetoric and innuendo.
Our system runs on the accountability of government in the Legislature, on question period being an open and honest forum for --
Mr. Speaker: The member's time has expired.
Hon. Mr. Fontaine: First of all, I want to remind the member for Rainy River that I can read too. I read this report a few months ago. I do not have to take anything from him, because I will decide in due course when there will be a service. I want to remind him too that I come from northern Ontario, and I know what it is not to have any airplanes, because I just got our norOntair service a week or two weeks ago in Hearst.
The member asked me today, "Is the minister ready to tell the people of northern Ontario that he is prepared to accept the recommendations of the task force and the ONTC so the people can gear up their operations?" I said no. Ma réponse est non, je ne suis pas préparé à ce temps-ci à le faire. I am not prepared to say that at this time. Then, in response to the member for Lake Nipigon (Mr. Pouliot), I gave the reason why we will not do it at this time.
I will be making a report to the cabinet first. I do not have to report over here. My first task is to try to get a schedule on line, and I will report to cabinet at that time. Then I will be back here in the House.
First of all, I want to remind my honourable friend that we are committed to the future operation of norOntair in a fiscally responsible manner. This was a major part of our government's task force. Concerning the Stokes report, which the member said we had not read: I read it, and we will be back. It is only one input, and I have to get other input from other people, because it was only a few months ago, or a month at least, that the decision was made to purchase Dash-8s.
More specifically, the private sector involvement has increased in that area. They are providing more service with faster, more comfortable aircraft. My staff are receiving options that will balance the needs of northern Ontario residents against the costs of providing a service and the desires of the private sector. I expect my staff to report these findings to me in the near future. After that, I will discuss my position with my cabinet colleagues. That is my first duty.
Concerning the rumours from my friend the member for Kenora (Mr. Bernier), who got his rumours from his friend who sits on the board of the Ontario Northland Transportation Commission, I can assure him the Dash-8 will not be flying in Nova Scotia. I can assure him this is only a rumour from his friend who is sitting on the ONTC. I can assure him it is not our intention to do so. I do not know where he got this. I know it was discussed at the ONTC meeting last week, and his friend was there. He is the one who told the member for Kenora about this.
Mr. Davis: Answer this question. The member for Kenora is not asking this question.
Hon. Mr. Fontaine: If it is true that the member was a minister, he should be a good Christian and listen a little bit.
While the decision is made on a route, the licences must be obtained. That process can take up to six to eight months. I can assure the member that any recommendation will recognize the importance this government places on high-quality air service in northern Ontario, with due regard for the taxpayer. In short, northern Ontario residents will end up being better served when this is all over.
10:40 p.m.
INSURANCE RATES
Mr. Speaker: Pursuant to standing order 28(b), the member for Welland-Thorold (Mr. Swart) has given notice of his dissatisfaction with the answer given by the Minister of Consumer and Commercial Relations (Mr. Kwinter) to a question concerning an increase in insurance rates. The member has up to five minutes; the minister also has up to five minutes to respond.
Mr. Swart: This debate is taking place this evening not just because of the inadequacy of the replies of the Minister of Consumer and Commercial Relations today and last Friday, but more because the minister proposes no substantive measure to deal with the worst crisis in insurance coverage during this century. In fact, he does not even seem to recognize the degree of the crisis that exists.
Very briefly, the facts are that the increases in the rates that are being applied in 1985 and early in 1986 will take at least $1 billion, and more likely about $1.5 billion, out of the Ontario economy. The impact is simply horrendous for the businesses and motorists of this province.
Auto insurance is going to go up by 30 per cent, or probably more than as reported by the Insurers' Advisory Organization. Taxis are facing increases, or many have had them, of 100 per cent. Municipalities have had increases of 200 to 300 per cent. We read in the paper just yesterday or the day before that the 110 or so hospitals that insure through the Ontario Hospital Association had increases in their rates from $2 million in 1984 to $9 million in 1985. Truck firms are reporting increases of two to five times, motor coach operators are reporting increases of two to 10 times and licensed establishments can hardly get insurance at any price.
The increases in those rates are not the whole problem; there is also the inability to get adequate insurance. The Ontario Truckers' Association wrote to Barbara McDougall, Minister of State for Finance, about this problem. She sent them 10 names. When they examined them, only two of those companies would provide insurance and they would only provide it on a selective basis to the best risks.
Mr. Bob Dowd of Carleton Bus Lines said he was notified on November 13 that Royal Insurance would not renew his insurance when it expired on November 30. Incidentally, his company had won safety awards. On November 29, after spending 250 hours, he finally got insurance for his tour coaches, but the price went up from $1,800 per year to $15,000 per year.
Rose City Wholesale Inc. in my municipality, Welland, could not get its insurance renewed. It went to the Facility Association and found that what it had paid $3,600 for last year, it would have to pay $10,000 to $12,000 this year. Where did they go for insurance? They went to the United States to buy their insurance, and they got it cheaper.
The minister says, "Leave all this to the marketplace." I have to tell him, there is no marketplace; they cannot get insurance. I have letters here from numerous trucking and bus companies that could not get any other quotes except from where they were getting their insurance. I will send copies of these letters to the minister, because he does not seem to be aware of it.
Another real problem that exists is a likelihood that insurance coverage will be dropped. I have been informed that insurance coverage has been dropped by many licensed establishments because it is not worth the price for them to carry it. If there is a large claim against them and they cannot pay it, they will just go bankrupt. The public is going to suffer from that.
I wonder whether the minister knows all this. He should know it, because this has been taking place for months. In fact, I wrote to him on August 26, pointing out all these problems to him. I asked the minister today whether he had done any investigation of the justification for the refusal to insure and for the massive increases in the rates. Because he evaded that question, the answer obviously is no.
I admit to the minister, and everyone knows, that settlements and court awards, particularly for liability, are increasing and that some adjustments on rates are necessary. However, if the insurance companies were forced to justify them, we might get by with half of the increases they are applying at present.
I know from the minister's philosophy that he is not prepared to introduce the kind of legislation they have in Saskatchewan, Manitoba and British Columbia, but surely even he would be willing to adopt the kind of plan they have in Alberta, where the insurance companies have to justify all the rate increases. I ask the minister to do that here, with the kinds of horrendous increases that are taking place this year and the inability of businesses and motorists to get insurance.
Hon. Mr. Kwinter: The member for Welland-Thorold has made a very strong case for having me try to justify the rates of insurance companies. I take exception to a couple of statements he made about my not being aware of the problem. On December 2, I made a ministerial statement in which I expressed my great concern for the problem and outlined the steps I was taking to try to resolve it.
He touched on various issues and implied that if Ontario would only go the route of Manitoba, Saskatchewan and British Columbia, we would solve all our problems. I would like to quote from the New York Times of October 20:
"With premiums for business liability insurance soaring and coverage almost impossible to obtain for such high-risk areas as day care centres, obstetrics and long-haul trucking, the commercial insurance industry is, by common agreement, in crisis. Insolvencies among state-regulated insurance companies are running at the highest rate since 1969, when the Insurance Services Office, a trade group, started keeping such records."
We are not operating in isolation in this province. We are part of a global system of insurance where we have re-insurers, most of them offshore, who have a direct and profound effect on this market.
I met with my counterpart in Ottawa to address these problems. I set up a task force to take a look at these problems, because I am very aware of the problem. I live with it every day. I have newspaper headings such as, "Insurance Rise May End Local Bus Charters in London." I know about greenhouses in Leamington that cannot get insurance and about professionals, such as engineers and doctors, who are complaining, as well as municipalities and hospitals. Without doubt, it is a problem that is of great concern not only to this government, but also to everybody who is doing business.
Wringing one's hands and saying it is a problem does not resolve it. We have to address it and try to find alternatives. One of the things we are doing is trying to set up a Canadian insurance exchange so that we will not be at the mercy of the offshore insurance exchanges, which take a look at the global market, shift their money around, note that the awards that are being made, particularly in Ontario, are too high and, as a result, say, "Let us move our money somewhere else."
I sympathize with the member, as I do with all people who are caught in this bind. I am aware that at the end of this year some re-insurers will be withdrawing their coverage, and that is going to have an impact.
The only thing I can say is that by being aware of it and addressing it, we hope we will come to some resolution. The resolution, however, cannot be done just in this chamber unless, as the member suggests, this province wants to get into the insurance business. At this moment, we are not considering that option.
We are trying to get the industry to take a look at its operations. The other day the member stated in a question to me that the casualty and property insurers made $207 million net income in the first six months of the year. If that is the case, why are they not continuing to do business? They would then make $414 million. Obviously, the money is not quite there or there would be people filling the void in the marketplace.
In a free society, if there is money to be made, there is somebody out there doing it. We have a serious problem; there is no question about that. However, we also have to realize that we have a system whereby the insurance companies have been making money for many years by investing the premiums and making money on their investments. To chase those premiums, to get those premiums to invest, they were cost-cutting the premiums.
10:50 p.m.
With the drop in interest rates, they are not making those profits. They now find they are stuck with some very high awards by the courts. The only source of income they have to offset those high awards is premiums, and the premiums are rising.
We are addressing the problem on two levels. One is availability. If there is no availability, it does not make much sense. It does not matter what the rate is if one does not get insurance. On the other hand, I agree with the member that if one gets a rate that is too high, one might as well not have the availability since one cannot afford it.
These are the issues we are addressing. I am hoping in the very near future we will have a resolution to the problem.
The House adjourned at 10:51 p.m.