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July 10, 1986

33rd Parliament, 2nd Session

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Hansard Transcripts

L046 - Thu 10 Jul 1986 / Jeu 10 jul 1986

ORDERS OF THE DAY

PRESCRIPTION DRUG COST REGULATION ACT (CONTINUED)

HEALTH DISCIPLINES AMENDMENT ACT

PUBLIC SERVICE PAY EQUITY ACT

MEMBERS' STATEMENTS

ALLEGED CONFLICT OF INTEREST

TABLING OF INFORMATION

BACK-BENCHERS' QUESTIONS

TABLING OF INFORMATION

NORTHERN DEVELOPMENT

APPOINTMENTS IN PUBLIC SECTOR

NORTHERN DEVELOPMENT

VISITOR

STATEMENTS BY THE MINISTRY AND RESPONSES

SURVEYING

INNOVATION ONTARIO CORP.

INSURANCE RATES

CROWN EMPLOYEES

UNEMPLOYMENT INSURANCE

ORAL QUESTIONS

EXTRA BILLING

ABORTION CLINICS

CONFLICT OF INTEREST

DOCTORS' FEES

ALLEGED CONFLICT OF INTEREST

OCCUPATIONAL HEALTH AND SAFETY

SECURITIES INDUSTRY

RENTAL HOUSING PROTECTION LEGISLATION

RADIOACTIVE SOIL

HISTORICAL PRESERVATION

INSURANCE RATES

PENSION FUNDS

FREE TRADE

LANDFILL SITE

PENSION FUNDS

ENVIRONMENT CANADA

APPOINTMENTS IN PUBLIC SECTOR

PETITIONS

SALE OF BEER AND WINE

ONTARIO HUMANE SOCIETY

TAX INCREASES

GASOLINE PRICES

VEHICULAR TRAFFIC

NATUROPATHY

GILL NETTING

SIDEWALKS

REPORTS BY COMMITTEES

STANDING COMMITTEE ON GENERAL GOVERNMENT

STANDING COMMITTEE ON RESOURCES DEVELOPMENT

INTRODUCTION OF BILLS

SURVEYORS ACT

EMPLOYMENT STANDARDS AMENDMENT ACT

TORONTO HOSPITAL ACT

GOLD CLAUSES REPEAL ACT

ASSESSMENT AMENDMENT ACT

LABOUR RELATIONS AMENDMENT ACT

ORDERS OF THE DAY

RENTAL HOUSING PROTECTION ACT

ADJOURNMENT OF HOUSE

RENTAL HOUSING PROTECTION ACT (CONTINUED)

FAMILY LAW AMENDMENT ACT

METROPOLITAN TORONTO POLICE FORCE COMPLAINTS AMENDMENT ACT

REPORT, STANDING COMMITTEE ON THE LEGISLATIVE ASSEMBLY (CONTINUED)

MOTIONS

COMMITTEE BUSINESS

COMMITTEE REPORTS

COMMITTEE SITTINGS

COMMITTEE MEMBERSHIP

ADJOURNMENT OF HOUSE

THIRD READINGS

EDUCATION AMENDMENT ACT

THIRD READINGS (CONTINUED)

ROYAL ASSENT

The House met at 10 a.m.

Prayers.

ORDERS OF THE DAY

House in committee of the whole.

PRESCRIPTION DRUG COST REGULATION ACT (CONTINUED)

Consideration of Bill 55,

An Act to provide for the Protection of the Public in respect of the Cost of Certain Prescription Drugs.

section 1:

Mr. McClellan: On a point of order, Mr. Chairman: Who has the carriage of this bill?

Hon. Mr. Nixon: In the absence of the minister momentarily, the parliamentary assistant to the Minister of Health, the member for Wentworth North (Mr. Ward), is more than willing to assist in the discussion of these amendments. I will immediately go and ring the fire alarm.

Miss Stephenson: I shall not suggest that, although it is discouraging to watch totally uninterested faces when one is debating an issue such as this.

Mr. McClellan: We are all interested.

Miss Stephenson: I cannot see the face of the member for Bellwoods (Mr. McClellan); I can see only over there. It is even more discouraging when there is almost no one over there to talk to.

Hon. Mr. Nixon: They must have known the member was going to speak.

Miss Stephenson: They probably did. That is probably the reason they are absent at the moment.

The issue we are attempting to address at this point -- that is, the issue of interchangeability -- is one that is absolutely vital to the effective and appropriate function of the bill which we completed in committee yesterday and to this bill.

Having had some slight background in this area, I understand the lack of concern at the beginning of the development of this program under policy for the amount of security which one could introduce into the concept of interchangeability. With the increasing knowledge of the problems that are arising related to the administration of drugs and with the spate of publication which has occurred within the past year and a half, I find it almost unbelievable that the ministry would not be equally concerned about attempting to guarantee as far as possible the interchangeability of drugs.

Those who have written on this subject are agreed that although we do not have all the final answers, the one course we can pursue, beyond the chemical testing which is currently being done, is the clinical trial approach. That will at least give us some indication about whether there are characteristics of the drugs that are being prescribed as interchangeable which are sufficiently similar to allow that kind of description to be used.

Every person in this chamber is aware that there is no drug that is completely without risk. There is no pill that one can take that does not have some slight side-effect or some potentially damaging effect, depending upon the dosage, the length of time it is taken, the current health of the individual and other circumstances. Therefore, it is equally obvious that the science of pharmacotherapeutics is to balance the risks of the drugs which are available to us for the treatment of disease with the problems the patient is facing at that time to ensure that the risks are outweighed by the potential benefits.

If one does not know what the risks are of a specific medication, it is very difficult to make any type of judgement. As a result of the demands of the food and drug division of the Department of National Health and Welfare, the health protection branch, one does have a clinical trial experience with innovative drugs, which at least provides the information to those who are prescribing drugs about the potential side-effects, the potential problems and the potential difficulties. With that information, it is possible to make an informed judgement about the balancing of the risks and the benefits.

Unhappily, when it comes to interchangeability we do not have that information because we have no such clinical trials for 90 per cent of the drugs which are considered to be interchangeable by this province. There is no such information.

In the light of their responsibility for the health of patients, is it therefore unreasonable that this is one of the primary motivations of the representatives of the physicians of this province in their public statement yesterday that they will encourage their members -- they will not order them, because they cannot -- to write "no substitution" on all the prescriptions that are related to long-term therapy, therapy for elderly persons and certainly therapy for children?

That is a reasonable position. They cannot be sure that the substitutions which are mandated under Bill 54, and at least partially mandated under Bill 55, will be reasonable drugs to deliver to those patients. Therefore, they are saying very clearly: "You cannot afford to take that risk. The government will not provide the guarantees. Therefore, you must do your best, in your clinical judgement, to ensure that the drugs you prescribe are those whose characteristics you have some information about -- information which is provided by the mechanisms which are currently available through the health protection branch of the Department of National Health and Welfare."

I do not believe there is reluctance for any reason other than it is considered to be an increased cost to patients to have clinical trials carried out on drugs which are to be listed as interchangeable. However, I ask the members to weigh the cost of perhaps a few cents per tablet against the many thousands of dollars which it may cost to have that patient hospitalized and treated for a considerable period if he suffers a severe reaction as a result of that substitution. I am not sure that is a very sensible kind of economy at this stage of the game.

10:10 a.m.

The appropriate kind of economy to be exercised by this province is either not to mandate substitution, which I believe would be wrong at this point, or to ensure that drugs which are to be substituted, which are called interchangeable, are in fact interchangeable as a result of requiring the manufacturers to carry out the clinical trials that will provide, to the best of our capability at this point -- and that is not perfect yet, believe me -- an understanding that these drugs are truly interchangeable, that the degree of therapeutic effectiveness is comparable, that the degree or number or frequency of side-effects is comparable and that the degree of potentially lethal effects is comparable.

That is what we mean and that is what the government has to find out.

One cannot discover this, ladies and gentlemen, my friends in this House, as a result of biochemical tests carried out in very limited circumstances on significantly healthy human beings who do not have any kind of disease and are totally healthy. That is not the way to determine interchangeability.

It certainly gives one information about some of the pharmacokinetics of the drugs to be tested and about whether the active principle of that combination is going to be relatively equal to the active principle of the drug to which it is being compared; but it tells one nothing about all the other compounds that are in those drugs and their potential effect upon the patients who are likely to be taking them.

It is not impossible for thoughtful researchers to develop the kind of protocol, which would not be excessively costly, to ensure that drugs which are to be considered for interchangeability are subjected to a clinical trial that would provide the broad spectrum of administration and the broad spectrum of result which is necessary to have at least some indication of their true interchangeability.

I really hope the members of this Legislature understand that unless they move in this direction, they are probably doing what Dr. Levy has suggested legislators and others in authority are doing at present by mandating interchangeability without the proper, appropriate and sound foundation; that is, they are probably legislating the ill health of a considerable number of patients and the death of some.

I hope they know that unless they do something about this in this legislation, they are playing Russian roulette with patients' lives. If they do not understand that, they should not be in this chamber. Therefore, I ask sincerely that the members read the information I delivered to every member of the committee, and some to every member of this House -- information which has been developed in Canada by Canadian experts, even within the food and drug directorate of the health protection branch of the Department of National Health and Welfare, which is becoming known as one of the areas of real concern and expertise about the problems related to interchangeability.

The articles that have been published by Dr. Napke et al. in several journals have been published internationally on five occasions this year. This is not a problem which is limited to Ontario; it is worldwide in the developed world at present.

Surely Ontario must attempt to remain a leader in this area of health services. This is a very significant part of health services. I invite the members to read the articles which have been submitted to them and to take heed. Right now, they have the responsibility of ensuring that we either do our very best on behalf of patients in this province, in respect of the quality of the drugs prescribed by our mandate, or play fast and loose with the lives of Ontarians.

I know it is not easy and I know it is difficult to suggest that there should be a significant change in the procedure that is followed by the Ministry of Health in ensuring that drugs are listed within the formulary.

For a period of approximately 10 years, what it has done is something that was related to the growth of a program, based on a realistic principle and one that should be encouraged, given the spiralling costs of health care; but that activity has to be tempered with the judgement that has been developed as a result of the past decade of clinical examination, the development of natural history and the development of the kinds of information that have been published in medical journals and journals of pharmacology throughout North America and Europe.

Surely it is time for us to make that kind of change if we are going to legislate the mandatory substitution of drugs for senior citizens, for beneficiaries of drug benefit programs and for those who under Bill 55 will be told there is an interchangeable drug of lower price and given the opportunity to choose that drug without knowing anything about it.

If that is what we are going to legislate, I implore the members to do it on the basis of the best information available to us at present. That best information is that our current method of defining "interchangeability" is totally inadequate in that it does not provide information about the content of every single drug listed within the formulary, and because for many of the drugs, a vast majority of the generic drugs, there is no clinical trial experience for a reasonable comparison of the drugs in the formulary.

I do not believe this is an outlandish suggestion or terribly expensive suggestion. It will cost money, but surely the protection of the health of Ontarians is worth a little money to ensure that we are not legislating their ill health and perhaps their deaths. I hope the members understand this is what they are doing if they do not ensure that adequate clinical trial experience is required for every drug to be listed or designated as interchangeable in this province.

I am aware that change is anathema to bureaucrats. As a matter of fact, I am painfully aware of that. It is also anathema to a lot of professionals. However, there is change that is necessary and this change is absolutely essential if we are going to do the job we were elected to do, which is to protect the people of this province with our health legislation.

I hope the members have seriously considered the impact of the direction that is being suggested strongly to all the physicians in Ontario. I hope they are aware that under Bill 54, when "no sub" is written on every prescription and the additional form is signed, the minister and the ministry at present are required to provide the drug that is prescribed. I hope the members are aware that the cost could be extemely significant in this province, and that if this is carried out, they will probably have destroyed the consumer effectiveness of Bill 55, which is the purpose of introducing this bill, in terms of cost at any rate.

10:20 a.m.

If they are not aware of this, let me remind the members that they have in hand articles from the Journal of Clinical Pharmacology, both the January and March issues of 1986; Perspectives in Clinical Pharmacology from 1985; the Canadian Pharmaceutical Journal of May 1986 with an

article written by the dean of pharmacy in Manitoba, and innumerable articles that point out very clearly that the basis at present of our designation of interchangeability is woefully inadequate, terribly and abysmally void of the kind of security that is needed by those who prescribe, dispense and take drugs if we are going to carry out the types of programs we are talking about.

Interjection.

Miss Stephenson: I have no intention of filibustering this, because if the member does not understand this, he should not be here.

Mr. D. S. Cooke: We know how strongly the member for York Mills (Miss Stephenson) feels about this matter, and it was a very relevant and important issue that was raised before the committee. However, the amendment she tabled here and in the standing committee would have absolutely devastating results in terms of access to the generic drugs which are on the market at present.

Her amendment has the implications that every generic would have to be pulled out of the market right now and clinical studies would have to be carried out first. That would result in incredible increases in prices and consumers would be disadvantaged. I do not think there would be any advantage other than millions of dollars of windfall profits to brand-name manufacturers. I know how strongly the member feels about it, but I became convinced throughout the hearings that there were mechanisms in place that could be used to protect the consumers of this province adequately.

One aspect that perhaps should be examined is that the Ministry of Health and the Ontario Pharmacists' Association should look at a province-wide education program using the media and encouraging consumers to ask questions of their pharmacists about what is being prescribed. One of the problems is that consumers do not ask enough questions. I do not think it is appropriate to take all the generics off the market as of the day that these bills become proclaimed. That would result in millions of dollars of extra charges to individuals, who would have to pay for the higher-priced drugs and would not have access to generic drugs in the province.

Miss Stephenson: That is not the intent.

Mr. D. S. Cooke: That is what it does.

Miss Stephenson: The member keeps telling me that the amendments I am introducing, which I thought would improve the bill, address concerns that have already been met in the legislation. This amendment is effective from the date of the implementation of this bill onward. The Ontario Drug Benefit Formulary, which has already been established with generic drugs, is one which has been in use for some time. We know some of the problems there.

Surely the Drug Quality and Therapeutics Committee has enough -- at present, it might not, but in the future it should have enough understanding to know which of those may have to be tested, and there may be some which have to be tested, but we are talking about drugs which are to be introduced into the formulary from the date of implementation onward.

With respect to the current formulary, which is already printed, I have no intention of suggesting that this legislation require all those drugs to be tested. Many of them have been in use for some time. Obviously, if they have not been the subject of a lot of reports of adverse drug reactions, they are perfectly all right to keep on using. However, from the time of implementation of this act forward, there should be clinical testing of every drug which will be introduced into the formulary. That is all this amendment says and nothing more.

Mr. D. S. Cooke: I want to read this into the record so the member understands what her amendment says. She is scratching out the one section, and then clause (

b) says "equivalent therapeutic effectiveness with one or more other such products as determined by clinical trials."

It does not say that the ones which are interchangeable in the formulary now are considered to be grandfathered and are already determined as interchangeable. It says they cannot be interchangeable unless they have had clinical trials. That is what the member's amendment says. That is what it said in committee and that is what it says now. That would result in every generic drug being pulled off the market the day these bills are proclaimed.

Miss Stephenson: If the member is so convinced that this is what the amendment says, which I do not believe, then there is no reason why an additional fourth component could not be added to this definition. It would say that at the discretion of the minister -- I would anticipate that in this case the minister would use the expertise of the Drug Quality and Therapeutics Committee because I believe that would be the right thing to do -- drugs currently listed in the formulary might have to be subjected to clinical trials depending on the experience that has been had with them.

If there is a requirement that all new drugs to be listed have to be subjected to clinical trials, then there would be a little additional pressure on the DQTC to decide whether some of those have clinical trials. I am not suggesting, and this amendment does not suggest, that we have to do everything that is currently in the formulary. What we are saying is that from this date -- I see the Deputy Minister of Health, Dr. Dyer, nodding his head up and down. Shall I add the additional fourth part of the amendment?

Hon. Mr. Elston: He was nodding off, not nodding at the member.

Miss Stephenson: No. Dr. Dyer scarcely nods off when he is in the House. There are other times he may nod off -- ask Natalie; she will be happy to tell the minister -- but not when he is in the House.

Mr. D. S. Cooke: It is not all the time when he is in the House, but only when he is listening to the member.

Miss Stephenson: That may be.

Mr. Leluk: Not us.

Miss Stephenson: I am certainly glad to hear that.

If an amendment is necessary to clarify this for those whose minds are muddied about the direction we are attempting to pursue, then I would be happy to draft an additional fourth part of this definition. I thought it could be introduced under the regulatory capacity of the minister as far as those existing in the formulary were concerned. It was my understanding that in this area there could be an additional regulation that would empower the minister to grandfather those currently in the formulary, except where the DQTC has decided clinical trials are necessary.

Mr. D. S. Cooke: That is typical. The Tories want everything in regulations.

Miss Stephenson: The member was not listening to me yesterday when I was screaming bloody murder about the regulation he wanted to have, and the minister gave it to him. Do not talk to me.

May I ask whether it is possible to include that in the regulatory capacity to ensure that the concerns of the member for Windsor-Riverside (Mr. D. S. Cooke) and the concerns of the Deputy Minister of Health are met appropriately, or is it necessary to add an additional fourth item to this definition?

Hon. Mr. Elston: I rise to respond to the soothing strains of the member for York Mills, who had us all nodding at one stage or another during the presentation.

Specifically in answer to the honourable member's question, under clause 14(1)(

a) there are abilities for the minister to prescribe conditions to be met by products or manufacturers in order to be designated as interchangeable; so there already is a provision under which we can put these regulations into the act.

I can also tell the member that, even now, under the operation of the DQTC there are and there have been requests, or at least there is the authority to request more tests if the committee requires and requests it or finds it necessary to ask for more information, and it has done that on occasion, to ensure that it is convinced there is an interchangeability between products.

Probably the best-known recent item brought to my attention is the one raised by the member in conjunction with other members of her caucus; that is, the question of the interchangeability of ibuprofen, which was raised before Christmas 1985 and taken off the listed

section in January after the DQTC requested, but did not receive, extra information.

10:30 a.m.

The honourable member has good intentions. I spoke to her yesterday about the same items that were raised by my colleague the member for Windsor-Riverside with respect to grandfathering or so-called grandfathering the current book. I know her intention is not to eliminate the generics currently listed under the Ontario Drug Benefit Formulary. However, even though that is not her intention, the words speak clearly. I know she would like to amend them to include the fact that those listed currently in the book would not be affected by the amendment.

However, it is incumbent on me to indicate clearly to the member and to the members of the House that I do not see it advisable to follow the amendment she is providing. I feel that under the auspices of the DQTC we specifically have the opportunities and options. If people with certain expertise deem it necessary to go through a series of extra tests that they require, they can do that already.

As well, the member would have to agree that when we compare the Ontario system with that of other provinces, we have much more comprehensive coverage on these questions than do others. I understand that some other provinces receive advice from the federal authorities on the question of interchangeability, which is not deliberated upon by anybody in the provincial jurisdiction where that advice is received and accepted.

Under current circumstances, I see our DQTC system, which is in addition to the federal quality control system, as one that has been effective and that has done very well over the course of the past several years, even though I know the member holds very strongly the opinion that this would make it better. I do not think it would.

I want to make one other point. In committee we heard a good deal about the question of these tests and clinical trials that the member is requesting, which in those days were limited in terms of comment more specifically to the generic industry. She mentioned yesterday at the beginning of her remarks that she was broadening her concern considerably about the quality of all drug therapies, whether they be initiated under the auspices of the originators or under the auspices of the generic drug manufacturers.

We agree to a great extent that we all have to be assured of the quality control items necessary for the public to receive the best care we can possibly provide. The member has brought to our attention several quotations from authorities about past experiences, a number of them from the United States. She alluded to them again yesterday when she was commenting. We do not disagree with some of the observations made in those jurisdictions. Our jurisdiction, however, is considerably different. They do not have some of the quality control mechanisms that we have.

Miss Stephenson: We do not.

Hon. Mr. Elston: We do. The Drug Quality and Therapeutics Committee does extra things in Ontario that are not done in the United States. The member's concerns from a generic standpoint are concerns of all of us in terms of good health and the quality control of manufactured drug products, but we think we have a system that responds, first, to quality control at the federal level and, second, is backed up by expertise at the provincial level with a reasonable and rational exercise of discretion about information filed before the minister, who then makes a decision about listing.

The quality control items are there. The extra tests can be required, if needed. As a result, we will not support the amendment proposed in committee of the whole House, just as we did not support it in the committee where this bill first appeared.

Miss Stephenson: It is unfortunate the minister does not understand the difference between quality control of manufacture, quality control in terms of the development of drugs, and the therapeutic effect, or beneficial or nonbeneficial effect, of drugs when administered. He knows nothing about pharmacology and absolutely nothing about practising medicine. It is unfortunate that he is willing to accept the statement about quality control and tests of bioavailability, limited as they are in this province -- and we heard what they were. He cannot tell us what they were because we learned directly from the people who did them.

Hon. Mr. Elston: On a point of order, Mr. Chairman: What has happened to the soothing strains from the honourable member? They have deteriorated into a more agitated state.

The Deputy Chairman: This is not a point of order.

Miss Stephenson: It may be an opinion. If the minister thinks these are not soothing, just wait, Buster, because I will be out there leading the charge to write "no substitution" on any prescription that is written in Ontario, because he will not guarantee, as best he can, the security that is necessary. He is trying to persuade us that we should legislate the death of patients in Ontario. I refuse to accept that. That is not hyperbole; that is fact.

Hon. Mr. Elston: That is not fact.

Miss Stephenson: The minister tells us that the Drug Quality and Therapeutics Committee has the capacity to order the tests. It does, but how many times has it done it?

Hon. Mr. Elston: When it has found it necessary.

Miss Stephenson: In fewer than 10 per cent of all the drugs that were introduced. To my way of thinking, that is not quality control of the administration of interchangeability within the formulary.

Mr. Leluk: It is a big joke.

Hon. Mr. Elston: It is not a big joke.

Miss Stephenson: All the experts, even the members of the therapeutics committee are saying, "We should be doing this." Why cannot the minister understand that it is rational to do it since he does not have the same compounds in any of the drugs? Why is it not rational to require some clinical trial which will at least try to ensure that there is comparability?

Mr. G. I. Miller: Do the feds not do it?

Miss Stephenson: The feds do not do it.

Mr. G. I. Miller: Then what is their position?

Miss Stephenson: It is because they are not responsible for interchangeability. The member should ask his minister. They are responsible for ensuring the quality, the production of and the therapeutic effectiveness. They are not responsible for interchangeability. Ontario is, but apparently it is not willing to accept that responsibility.

I would be perfectly happy to begin the definition with the phrase, "except for those drugs currently listed in the formulary," and go on from there. That would provide the minister with the opportunity to exercise the expertise which is currently --

Mr. D. S. Cooke: And compromise the patient's health.

Miss Stephenson: I am not compromising the patient's health. I said that if they have been there, have been used for a time and have not provided much in the way of reports of adverse drug reactions, or there has not been a problem with them, then I would not see why the Drug Quality and Therapeutics Committee would recommend that they should have to be tried clinically again because they have already been tried clinically.

If the minister wants to have that type of exception, he should put it in right at the beginning of the definition to read, "interchangeability, except for those drugs currently listed in the formulary, must from this day forward be subjected to these trials."

It is not a waste of money; it is a sensible and economical expenditure of money. It is the appropriate foundation for the passage of these bills. I refuse to be a party to the type of Russian roulette the minister is asking us to play.

Hon. Mr. Elston: I take exception to those remarks and to the allegation that we are being invited here to pass legislation which endangers patients' health. Those are not remarks appropriate to the member because I have found her to be generally very sensible and I know her to be a very sensitive person; but when she makes those types of allegations, those types of remarks which are based upon legislation which is merely reflecting the current status of a program that has worked well in Ontario, I do not find that is helpful to the debate whatsoever.

I also have some very real concerns about the suggestion that we use this particular amendment to do certain things to try only generics clinically. With her information, if she is being reasonable and logical, then the amendment's application to our system would mean that we should require clinical tests of every new batch of drugs which is manufactured to be used in this province, not just the generics but every batch, whether it is the originator's second batch after it has done a clinical test on the first, or whatever.

That would logically be the consistent application of this, because what the member is saying would have to be applied in that sense. I do not think that is a practical way of going about this whole exercise.

10:40 a.m.

The member says it is not a waste of money, but it would spawn duplication. Again, I have to underscore, for the benefit of the members here and the public of the province, that we do have a system where people can request, under the DQTC, extra tests to ensure there is interchangeability. The member may not agree with the decisions of those people who have collectively been deliberating over the years upon these very questions. That being the case, I cannot say I have less faith in the 15 members of the DQTC than has a single member standing and saying they are not doing their job properly.

It is my understanding that they have done an excellent job over the past years. The member may disagree with that, but those people who have collectively been a part of the system for a long time --

Miss Stephenson: The minister is not listening to what I said.

Hon. Mr. Elston: The member said they had not ordered enough extra trials. She said they have done that 10 per cent of the time and she does not find it appropriate.

The member for York West (Mr. Leluk) said it is a joke. That group is not a joke.

Mr. Leluk: It is a joke.

Hon. Mr. Elston: The member for York West thinks the DQTC is a joke. Those people have very good qualifications.

Mr. Leluk: It is a joke the way they are currently doing their testing.

Hon. Mr. Elston: I do not think the member is being realistic when one analyses what they do and what they are required to do. There are some new people involved in this whole program and they have brought extremely good credentials to the tasks being put before them. We may end up having to disagree on that. I do not for a moment underestimate the strength of the feeling of the two opposition members who are putting the case. However, the system is one which we will continue to look at, review and make sure we expand their expertise and opportunities.

If extra tests are required, they can do them now. I will not prevent them from pursuing the best interests of the public in these cases, but we are not going to agree to pass this amendment because of the practical problems the member is inadvertently trying to put on the manufacturers of these drug therapies.

Miss Stephenson: It is unfortunate that the minister does not understand that when there is a change in the compound of a drug, when there is a change in the construction of a medication, testing should be done and, in most cases, testing is done -- not in all, but in most cases it is done when there is a change in the structure of the compound. That is the only kind of change that is necessary to undergo clinical testing.

I suggest the deputy minister would be well disposed to remember that he has been neither a pharmacist nor has he been in practice for a heck of a long time; but that is all right, neither have I. The concern the minister is expressing is specious. It is not necessary to test with every new batch. One does quality controls on every new --

Hon. Mr. Elston: That is what this is.

Miss Stephenson: That is not what I am saying. The minister knows this is not what that means. He is nitpicking to try to justify his intransigence in this matter.

The minister is saying there is already the capability of doing it but it is not being done. He is saying that just because we have not done it for 10 years we do not need to start now. I am telling him our experience over the past 10 years should direct us to move towards doing it now. That is what we have learned as a result of the policy and the kind of practice we have been carrying out. It was a good thing to do. It was a good direction to pursue, but we have learned a great deal from it.

One of the things we have learned is that interchangeable drugs are not necessarily interchangeable and that we really need to have a better foundation for trying to provide the security that is necessary to ensure there is safety for patients and some kind of reasonable support for the designation of interchangeability to be used by both physicians and pharmacists. That is a very reasonable point of view. However, it is not reasonable to suggest that this should not be done because we are going to have to do every batch of every drug. That is absolutely silly and it is not what the amendment says.

It is not even what it suggests. Any reasonable person reading the amendment would understand that is not what it means. It means for introduction.

We also have said very strongly that whenever there was a change of compound the ministry should be notified immediately. The minister would not accept that one either because he said the drug companies would not do it.

Mr. Laughren: Stop nitpicking.

Miss Stephenson: If this is nitpicking, then the member is the kind of nit who is probably going to be dosed with a lethal dose of an interchangeable drug that is not interchangeable.

I am concerned that the minister thinks my arguments are overblown. I do not believe they are. I believe they are sensible, rational and based on the knowledge that we in this province have developed as a result of our experience with the policy that led to the development of this legislation.

If this legislation is right, if we are really going to be helpful to consumers and if we are really going to be concerned about patients, we will include this kind of additional security for patients in the formulary.

Mr. Chairman: Does the minister have any comments? Does any other honourable member wish to speak to this amendment? No.

Miss Stephenson: I am truly disappointed in the minister's lack of understanding. I really am.

Mr. Chairman: There being no further comments, we appear to be ready for the question.

Miss Stephenson: Has my friendly amendment to my amendment been accepted, that we would insert, immediately following "interchangeability," the words "except for those drugs currently listed in the formulary"?

Mr. Chairman: We do not have in front of us any amendment to an amendment; only the amendment to

section 1.

Hon. Mr. Elston: We will accept that as having been provided as a friendly amendment.

Mr. Chairman: We are ready for the question on Miss Stephenson's amendment to

section 1.

All those in favour will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Interjections.

Miss Stephenson: I am standing up for this one. I am sorry.

11:10 a.m.

The committee divided on Miss Stephenson's amendment to

section 1 of the act, which was negatived on the following vote:

Ayes 32; nays 51.

Interjections.

Mr. Chairman: Order. As the members leave the chamber, will they please do so quietly, as we carry on with the committee of the whole House.

The next

section to be amended is

section 4.

Interjections.

Mr. Chairman: Order. Members cannot even hear.

Shall sections 1 to 3, inclusive, stand as part of the bill?

Miss Stephenson: No. We are not agreed.

Mr. Chairman: All those in favour will please say "aye."

All those opposed will please say "nay."

In my opinion the ayes have it.

Sections 1 to 3, inclusive, agreed to.

section 4:

Mr. Chairman: Mr. Leluk moves that subsection 4(1) of Bill 55 be amended by adding at the end "provided that the person for whom the product is prescribed or the person presenting the prescription shall be informed before the prescription is dispensed and consents to the change."

Mr. Leluk: The reason for putting forward this amendment is that consumers in this province have the right to know what they are getting in the way of prescription drugs and to consent to any change the pharmacist may make in the substitution of interchangeable products. Yesterday, when I spoke on consumers' rights under subsection 4(1) of Bill 54, I read into the record a letter that was received by the Minister of Health (Mr. Elston) on June 17 from the Epilepsy Association, Metro Toronto. I would now like to read into the record the same letter addressed to the Minister of Health from Kate Mather, president of the board of directors of the Epilepsy Association, Metro Toronto.

"Dear Mr. Elston:

"Our association, at its most recent board of directors' meeting, examined the proposed new legislation, Bills 54 and 55, and wishes to make the following comments on behalf of our board, our members and our clients and in our capacity as a social service agency. We find the provisions of

section 4 of Bill 55 unconscionable inasmuch as it appears to allow the dispensing of a substitute drug to the person presenting a prescription without informing him of the substitution. We believe that it is essential to inform the person presenting a prescription of the substitution."

They take further exception to provisions under

section 8 of Bill 55 where they say "which appears to provide immunity from legal recourse to the person dispensing the substitute drug where the person substituted a drug without informing the purchaser of a substitution and where harm results to the purchaser which may be accredited to the substitution."

They say, "Clearly, sections 4, 4a and 8 of Bill 55 abrogate the right of the purchaser to (

a) what drug is being administered to him and (

b) to take legal action against those administering a drug to him where harm results to him."

I feel very strongly about this amendment because I believe consumers in this province have certain rights. One of those rights is to know what they are getting and to consent to any change in a prescription drug. I have a case here in point; it is an affidavit. I have a whole pile of affidavits sworn by citizens of this province. To save time, I am going to read into the record one particular affidavit that deals with the case I am making for this amendment. I am not going to mention the name.

"I..., a senior citizen of the city of Mississauga in the province of Ontario, make oath and say as follows:

"1. I am a senior citizen. I have been taking Inderal six times a day for approximately two years. I am very pleased with this medication. Although I do not now recall the name of the company that makes this product, I am sure that I did know the name at one point.

"2. I am very aware of the colour, shape and size of the Inderal pills that I take. The pills are a very light orange colour; they are quite small and round. I rely on the appearance of these pills to be able to identify them as being Inderal. Up until a few weeks ago, I could have said that I had never seen, to the best of my recollection, a pill which had the same appearance.

11:20 a.m.

"3. A few weeks ago, I went to the druggist to have my prescription for Inderal repeated. The druggist gave me what I thought and assumed was Inderal, which I took home with me. The druggist did not tell me what he gave me was not Inderal.

"4. Later, after I got home, I happened to notice the label on the container which the druggist gave me. It did not say Inderal; it had some other name on it which I did not recognize. I do not always read the labels of my medication, but I happened to notice it on this occasion. I immediately called the druggist to see if some mistake had been made in giving me the wrong medication. The druggist informed me that he had given me a different brand, but that it was the same medication.

"5. When I opened the container the druggist had given me, I noticed that the pills appeared to be the Inderal pills that I had been used to taking: they were very small, round pills and had the same light-orange colouring. If I had not happened to see the label and talk to the druggist, I know that I would have assumed, because of their colour, shape, size and appearance, that the pills the druggist had given me were Inderal.

"6. I began taking the different brand of medicine that the druggist had given to me and I noticed, after the first day of taking this brand, that I began getting headaches and feeling slightly dizzy at times. I continued taking the medicine for two or three days, but the headaches and dizziness persisted. I finally talked to the pharmacist, who called my doctor, and she told the pharmacist to take me off this brand and put me back on Inderal. My headaches and dizziness stopped soon after I started the Inderal product again.

"7. I consider myself lucky that I happened to notice the label for the medication that the druggist gave me. If I had not noticed it, which could have easily been the case, I would never have known that my medication had been changed. Because the appearance of the different brand of pills is the same, I would have simply assumed that the pills were the same Inderal that I have been taking for two years.

"8. A few years ago, when my druggist had switched me from Valium, which I had been taking for several years, to a different brand of the same medication, the new brand was a different colour. This served as a good indication to me that I was getting a different product. I have been taking this new brand ever since.

"9. It is very upsetting to me to think that a company can copy the exact same colour, size and shape of pills for the same medication. This means that if the druggist does not tell me that a switch is being made in my medicine, I may never learn that I am getting a different brand. It is important to me to know what brand I am getting, and with pills, the easiest way for me to identify them is by their appearance."

This makes a very strong case for people who frequent pharmacies to get prescription drugs to be told if a substitution of an interchangeable product is being made. They should know what they are getting, in advance of the prescription being filled, and consent to the change.

As I said, I will not read all these affidavits because it would take me some four hours to get them on the record.

On June 23 in this House, in the minister's absence, I asked a question of the Premier (Mr. Peterson) relating to consumer rights in this province. Basically, I asked whether the Premier agreed "that consumers should be told in advance by a pharmacist whenever a prescribed drug is being substituted for with an interchangeable product and that consumers have the right to know and choose what they are getting." I asked the Premier whether he would guarantee consumer rights in the final legislation.

The Premier's answer was that we had had a full discussion in this House on the matter and, he said, "I gather the discussion will continue and the member will have a perfect opportunity to put forward all his very thoughtful views at that time."

I am doing so now for the minister's benefit and for the benefit of the government. However, the Premier also stated that his government was fighting all the time for "the consumers, the people of the province, and we are glad to have this member join us" -- the government.

I saw how the government supported consumer rights with respect to subsection 4(1) of Bill 54 on the right of consumers to pay the difference in price between a list product and the product that was prescribed. Yesterday in this House, his party, along with support from his partners there, voted it down. Similarly, when I introduced that very amendment in clause-by-clause discussion before the standing committee on social development, it was voted down. So much for consumer rights under this government. It is the same for consumer protection because there is no interest.

My colleague the member for York Mills just made a very strong case for consumer protection in this province. I have to say to the minister there is no consumer protection under his government. There is no interest in protecting the consumers of this province from inferior medication and drugs, and we should all be very concerned about that. Maybe we will be concerned a year or two down the road when we start to see what happens with the health care delivery system in this province because of this government.

Hon. Mr. Elston: I think we saw the wind-down of the remarks. I compliment the member on his consistency. He consistently misrepresents the position of our party, which is in favour of maintaining consistent vigilance for consumer rights and for opportunities to protect the public good. I can tell honourable members, as I did yesterday, that we will not be supporting this amendment.

I can tell members of the House that if they read the current subsection 4(1) --

Mr. Chairman: Perhaps you would like to rephrase that sentence.

Hon. Mr. Elston: I will withdraw the remark that offends. I apologize for that. I did not intend it to come out in that vein. I apologize to the House.

The honourable member misunderstands the position of our party and represents that understanding under that illusion. I think that clarifies the nature of the remarks made by that member when he tried to put the position of our party in this matter.

Subsection 4(1) of Bill 54 will authorize situations where the pharmacist can accept payment outside the plan if there is consent on the part of the authorized recipient. The member knows we spent considerable time in committee dealing with this item under subsection 4(1) and we built in that protection. I explained it to him then. He did not understand it, nor did he accept it. I do not expect him to change his opinion or his mind on that. That is the way it is and that is the way it will continue to be. I will not go on further other than to say that we will not be supporting this amendment.

Mr. Chairman: All those in favour of Mr. Leluk's amendment will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Motion negatived.

Miss Stephenson: The government really could not care less about it. This statement that it is concerned about consumers is just an absolute sham.

Hon. Mr. Nixon: The member is talking for the Ontario Medical Association as usual.

Miss Stephenson: No. I am not.

Mr. Chairman: Order. The member for York Mills and the Treasurer (Mr. Nixon) will please discontinue.

11:30 a.m.

Miss Stephenson: I do not talk for the OMA. I do not know who the Treasurer talks for.

Mr. Chairman: Order.

Sections 4 to 6, inclusive, agreed to.

section 7:

Mr. Chairman: Mr. Elston moves that subsection 7(1) of the bill be struck out and the following substituted therefor:

"

(1) In this section, `best available price,' in respect of a particular manufacturer's drug product in a particular dosage form and strength for which a prescription is dispensed, means the lowest price, calculated per gram, millilitre, capsule, tablet or other appropriate unit for which that product in that dosage form and strength can be purchased in Canada for wholesale or retail sale in Ontario,

"(

a) as determined by the minister from such sampling as the minister considers appropriate; or

"(

b) as estimated by the minister, if the minister considers the information reasonably available to the minister is insufficient for the purpose of ascertaining the best available price,

"which price shall be prescribed by the regulations and, in calculating that price, the Lieutenant Governor in Council shall deduct the value of any price reduction granted by the manufacturer or wholesaler or their representatives in the form of rebates, discounts, refunds, free goods or any other benefits of a like nature."

Hon. Mr. Elston: This is a companion amendment to that introduced and passed yesterday in Bill 54. It is to the same effect and adds a couple of items, such as tablet and appropriate unit size, but also gives the authority for sampling that is appropriate to ascertain best available price and allows the minister to estimate the price if the information available is insufficient to come to a categorical and conclusive decision with respect to best available price.

Mr. Leluk: I have an amendment to move to the minister's amendment.

Mr. Chairman: Does the member for York Mills wish to speak on this before the amendment is put? Does she wish to speak before the member for York West puts his amendment to the amendment?

Miss Stephenson: Yes, because I would like to remind the honourable members of the third party that they argued long and hard and worked diligently for the

section of the bill that is currently present. It does need to be amended by adding "tablet" -- there is no doubt about that -- but yesterday, to provide for whatever kind of subterranean agreement there is in this House, the members of the NDP turned their backs on the concern they previously had for establishing best available price and provided for the minister total licence in terms of developing the price that is to be used in this area of price setting for the purposes of reimbursement of pharmacists.

It is necessary to make it parallel in this piece of legislation. The minister is overstepping the bounds established in committee by careful examination and diligent work by the member for Windsor-Riverside in the development of this

section in the act. I would like everyone to know that the NDP has turned its back on that activity and now is voting in a different direction.

Hon. Mr. Elston: Although I cannot address the specific allegation of the member with respect to the NDP, I can say to the members of this committee that we have accepted the will of the majority of the committee when they amended the legislation to provide for best available price. As I said yesterday when addressing the issue of amending Bill 54, in my opinion this will make the system more workable. We may disagree on that, but we on this side accept the will of the majority of the elected members of this House, and we are going to make best available price work as best we can. This will help make the best-available-price system work.

I can tell the honourable member that, although she may be back to back with the third party at the moment, this situation will enhance the operation of this program rather than detract from it. I have to indicate to the House that the member and I have mild patches of disagreement when we discuss options and opportunities in summing up this legislation.

Mr. Sheppard: I would like to make a few comments on the bill. I see that both the minister and the deputy minister are here this morning. I received a letter from one of my pharmacists who is very concerned about Bills 54 and 55. With your permission, Mr. Chairman, I would like to read it into the record. It says:

"As our voice in parliament, I am begging you to speak out against the passage of Bill 54 and Bill 55. As you are aware, these bills were ill conceived and poorly constructed when introduced last September" --

Mr. Chairman: Order. I believe that is a little off topic on Bill 55, which is what we have in front of us.

Mr. Leluk moves that Bill 55, subsection 7(1), be amended by adding after the word "Canada" in line 8 the following, "from a wholesaler or director as the regulations prescribe," and striking out "for wholesale or" from line 8.

Mr. Leluk: The intent of this amendment is to preserve the present indirect and direct listing of drug products so that all pharmacies can continue to utilize the necessary services provided by drug wholesalers. We believe the ministry shares the pharmacists' views that the wholesaling function is necessary and vital to the drug distribution system in this province.

Without our proposed amendment, it has been drawn to our attention and to the government's attention by the drug wholesalers that the present wording could render the entire wholesale function noncompetitive. As I stated yesterday when a similar amendment was introduced to Bill 54, in the short run this might mean some marginal savings on some drugs, but in the long run we believe it will mean the demise of the community pharmacy as a viable entity.

We took the maintenance of the indirect and direct distinction for granted and therefore did not mention it in previous submissions. This is a very important amendment.

11:40 a.m.

Hon. Mr. Elston: As I did yesterday, I rise to indicate that this amendment is not acceptable to us. As I said to the members who were here yesterday, the style of wording would enshrine the problem of price spreading in the system. We have all set our minds to dealing with that issue. As a result, our party will not support this amendment to the amendment.

The Deputy Chairman: All those in favour of Mr. Leluk's motion will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Motion negatived.

The Deputy Chairman: Mr. Leluk moves that clause 7(1)(

a) of Bill 55 be amended by adding the word "reasonably" after the word "minister" in line 2, and that clause 7(1)(

b) be amended by adding the word "reasonably" before the word "estimated" in line 1 and striking out "reasonably" before the word "available" in line 3.

Mr. Leluk: I believe this amendment reflects more accurately the section.

Hon. Mr. Elston: Again, this amendment parallels those that were put yesterday to a similar section, and my comments remain parallel in nature. We will not support this amendment to the amendment.

The Deputy Chairman: All those in favour of Mr. Leluk's amendment to the amendment to subsection 7(1) will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Motion negatived.

The Deputy Chairman: All those in favour of Mr. Elston's amendment to subsection 7(1) will please say "aye."

All those opposed will please say "nay."

In my opinion the ayes have it.

Motion agreed to.

The Deputy Chairman: Mr. Leluk moves that subsection 7(2)(

a) of Bill 55 be amended by adding after the words "interchangeable product" in line 1, the following, "and the product is a listed drug product as defined in the Ontario Drug Benefit Act, 1986."

Mr. Leluk: The proposed government amendment to subsection 7(2) is not acceptable or desirable because it excludes single-source products from the best-available-price requirement to the detriment of the public; there will be neither uniformity of prices nor lists of prices for single-source drugs. Moreover, while we believe it is not intended, the result of deleting clause 7(2)(

a) is to preclude pharmacists from charging anything for the drug component where noninterchangeable products are involved.

Hon. Mr. Elston: This is the amendment that was suggested to us through the correspondence of the college, I believe, and deals with the items listed in the Ontario Drug Benefit Act. Coming to grips with the correspondence that has come in, we are not unhappy with this proposed amendment.

Motion agreed to.

Hon. Mr. Elston: The original suggestion in the list of amendments I provided was that I would move the deletion of clause 7(2)(a), but I will not be moving that amendment.

The Deputy Chairman: Mr. Leluk moves that subsection 7(3) of Bill 55 be struck out and replaced with the following:

"No person shall charge more for supplying an interchangeable product and a drug product specified in subsection 7(2)(

a) above pursuant to a prescription than the sum of,

"(

a) the base price determined under subsection (2);

"(

b) the percentage of that price, not less than 10 per cent and not greater than 20 per cent, that is prescribed by the regulations; and

"(

c) that person's usual and customary dispensing fee."

Mr. Leluk: This amendment makes it clear that specific amounts are not required in the regulations. Alternatively, we suggest the words "prescribed in the regulations" be changed to "permitted by the regulations." This is to make it clear that specific dollar figures need not be mentioned in the regulations.

Hon. Mr. Elston: I am trying to analyse the difference between the current subsection 3 and the member's subsection 3. I am not certain he is accomplishing what is needed to be accomplished by providing an amendment.

I acknowledge that we had understood there would be a need to provide in the regulations circumstances in which a greater amount might be provided, but we felt that regulation could be used to provide for that coverage. I do notice there is a difference in description of the change from a drug product to an interchangeable product, which is not defined.

I am a little confused by what the member is trying to accomplish, but I think he may be providing us with a little flexibility. Again, there does not appear to be any need for the changes in those terms. It may be that if he had not accomplished his amendment to the previous subsection, it would be required. At this stage, I do not think we need his amendment to subsection 3, particularly when we are moving that greater amounts may be set out under regulations in our amendment.

Mr. Leluk: I repeat what I stated earlier. The amendment makes it clear that specific amounts are not required in the regulations. Alternatively, this is to make it clear that specific dollar figures need not be mentioned in the regulations.

The Deputy Chairman: All those in favour of Mr. Leluk's amendment will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Motion negatived.

11:50 a.m.

The Deputy Chairman: Mr. Elston moves that clause 7(3)(

c) of the bill be amended by adding at the end thereof, "unless a greater amount is provided for in the regulations."

Hon. Mr. Elston: This is in recognition of the fact that there may be circumstances in which a greater amount may be required to be paid. We require some flexibility in this legislation, and we are prepared under regulation, in consultation with the college, to develop those circumstances in which a greater amount might be appropriate.

Motion agreed to.

Mr. McClellan: On a point of order, Mr. Chairman: In the interest of time, can we agree to dispense with repetition of amendments as a matter of course unless somebody requests that the amendments be repeated?

The Deputy Chairman: Is it agreed that the chair dispense with the reading of amendments?

Agreed to.

The Deputy Chairman: Mr. Leluk moves that Bill 55,

section 7, be amended by adding a new subsection as follows:

"

(4) Notwithstanding clause 7(3)(c), a fee other than the usual and customary fee may be charged in those circumstances set out in the regulations."

Hon. Mr. Elston: On a point of order, Mr. Chairman: We just amended clause 7(3)(

c) to provide for the very same thing. I presume the honourable member will be content if we leave clause 7(3)(

c) with that amendment rather than proposing another

section and will withdraw his proposed amendment.

Mr. Leluk: I will withdraw the amendment.

Section 7, as amended, agreed to.

section 8:

Miss Stephenson: I do not have an amendment to propose, but I want to comment that the members of this House should be aware that as a result of

section 8, the consumer of drug products in this province who has been subjected to substitution and has a problem therewith is going to be left entirely on his or her own to pursue whatever course of action the courts may deem necessary. This

section absolves everybody of any type of responsibility for the potentially irresponsible act that may have been perpetrated as a result of Bill 54 or Bill 55.

Hon. Mr. Elston: This is a reflection of the current practice under

section 155. The member knows that, I know that, everybody knows that. Under

section 155, if the member wants to deal with that, it is there and was requested by the association. It is part of the current system, and we are perpetuating that system in this legislation. I thought the member would want to acknowledge that. My concern is that we continue that. If she wishes to vote against that section, that is her privilege and appropriate action if she so desires. We think it is an important part of this legislation.

Miss Stephenson: I simply commented upon the fact that in the past, with the policy that was established for the purposes of attempting to ensure there was a good direction to be pursued, I can understand it was necessary to function in that way. In this legislated, mandated situation required by the government, there is no increased protection for the consumer. If the minister and the government were really concerned about consumer protection, they would have done something in this

section to ensure that at least the minister would take some liability for it since he is the one who is mandating the whole thing. It is an increased risk for the consumer.

Hon. Mr. Elston: Again, the member is not familiar with the current situation. I advise her to review the pharmacy section, subsection 155(4), of the Health Disciplines Act, take a look at what that provides and be aware of the fact that there is a continuation of the current circumstances. I am sure the member would be happy to agree that the regime is being continued in those circumstances in this new legislation and to acknowledge that it is necessary.

Miss Stephenson: There is a very significant change which the minister does not seem to realize. He is bringing in legislation that makes it law that what was policy in the past will be mandatory in a great number of circumstances. That is a change of situation. I guess if one is a lawyer, one is able to talk around the subject to convince oneself that there is no change at all. There is a very significant change, but the minister is not changing the whole aspect of liability, which I would have thought he would have considered seriously.

The Deputy Chairman: Shall

section 8 carry?

All those in favour will please say "aye."

All those opposed will please say "nay."

In my opinion the ayes have it.

Section 8 agreed to.

Sections 9 to 13, inclusive, agreed to.

section 14:

The Deputy Chairman: I believe the member for York West has an amendment to

section 14.

Mr. Leluk: I am going to withdraw my amendment to subsection 14(1), because it provides for the regulation-making authority for subsection 7(1), which was defeated earlier.

The Deputy Chairman: You are withdrawing your amendment to subsection 14(1)?

Mr. Leluk: I am withdrawing the amendment that would have added a new clause (e).

The Deputy Chairman: Mr. Leluk moves that clause 14(1)(

d) of Bill 55 be struck out and that clause 14(1)(

e) be renumbered clause 14(1)(d).

12 noon

Hon. Mr. Elston: We do not have a clause (

d) at the moment.

The Deputy Chairman: Clause 14(1)(d).

Hon. Mr. Elston: That is correct. We go to clause (

c) in the present bill. In the present bill, we do not have a clause (d). There is no clause (

d) under subsection 14(1). It would seem that we do not need that amendment at the moment.

Mr. Leluk: It should be clause 14(2)(d).

The Deputy Chairman: Would you read the amendment again?

Hon. Mr. Elston: If there is no amendment to subsection 14(1), perhaps I can move my amendment.

The Deputy Chairman: Hon. Mr. Elston moves that subsection 14(1) of the bill be amended by adding thereto the following clause:

"(

d) prescribing circumstances in which persons may charge more than their usual and customary dispensing fees."

Hon. Mr. Elston: It is necessary to have this to fall in line with what we have just accomplished under clause 7(3)(c).

Motion agreed to.

The Deputy Chairman: Mr. Leluk moves that subsection 14(2) of the bill be amended by adding a new clause (

g) as follows:

"prescribing the circumstances in which a fee, different from the usual and customary fee, may be charged."

We are supposed to do clause 14(2)(d). The amendment also reads that clause 14(2)(

d) be struck out and the subsection be renumbered.

Mr. Leluk: Give us a moment. I withdraw the amendment striking out clause 14(2)(d). That was not intended. I would like to read into the record the amended subsection 14(2) with the newly added clause (

g) that was just read into the record.

Hon. Mr. Elston: On a point of order, Mr. Chairman: I believe the essence of that amendment would be similar to that which was moved under clause 14(1)(

d) and passed by the Legislature just a few moments ago.

Miss Stephenson: The difference is that it would require --

The Deputy Chairman: Order, please. I will read the amendment again.

Mr. Leluk moves that subsection 14(2) be amended by adding a new clause (

g) as follows:

"(

g) prescribing the circumstances in which a fee different from the usual customary fee may be charged."

Miss Stephenson: The object of the amendment is to ensure that although the Lieutenant Governor in Council has the capability of ensuring there can be a fee that is different, the responsibility for making the designation and the circumstances specifically rest with the Ontario College of Pharmacists in the initial phase. It is the college's responsibility to determine the areas of professional expertise which would lead to a flexibility in the area of the usual and customary dispensing fee. As a result of discussing that with the minister, the Lieutenant Governor in Council would then have the capability to vary the fee the minister has already enacted in clause 14(1)(d).

Hon. Mr. Elston: We will not be supporting this amendment. We believe there is adequate opportunity to set out those circumstances and do what is required under those conditions under subsection 14(1).

Miss Stephenson: It was specifically discussed in committee and agreed to by all parties that there were certain areas of activity which were the responsibility of the college. The designation of the professional responsibilities is certainly the college's area of expertise and concern. It was for that reason this amendment was introduced, because this is most certainly an assessment of and an evaluation of, or a determination of, the professional expertise which is required to provide a variance of the fee the minister may recommend to the Lieutenant Governor in Council.

That is not a ministerial responsibility, it would appear, or a Lieutenant Governor in Council responsibility but a professional responsibility of the Ontario College of Pharmacists.

Hon. Mr. Elston: I do not think the college wishes to have this particular amendment passed either. I do not wish it. We can cover the situation which has been outlined by the honourable member. We are not going to support the amendment.

The Deputy Chairman: All those in favour of Mr. Leluk's amendment to subsection 14(2) will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Motion negatived.

Section 14, as amended, agreed to.

Section 15 agreed to.

section 16:

The Deputy Chairman: Mr. Leluk moves that

section 16 be amended by adding at the end:

"But if no such date is proclaimed to bring this act into force before the 31st day of December, 1986, this bill shall come into force on the 31st day of December, 1986."

12:10 p.m.

Mr. Leluk: These bills have been languishing for nine months in this Legislature, having been introduced on November 7, and the concern is that they be proclaimed as soon as possible. What we are trying to ensure with this amendment is that if they are not enforced before December 31, 1986, then the bill shall come into force on that day.

Hon. Mr. Elston: We will not be supporting this amendment, which is the same as one that was proposed for Bill 54. We intend to implement these bills and we do not see the necessity of putting a date on the legislation.

Mr. D. S. Cooke: Will the minister give the Legislature any indication of when the formulary will be ready for printing and publishing?

Hon. Mr. Elston: I am sorry, I was distracted. I think we will be putting this into effect in the fall. We hope to get the regulations put together so we can do it no later than November or December 1986. We anticipate it being operating and functioning early in 1987.

Miss Stephenson: In that case, is the minister going to make the pharmacists of this province wait until November or December for a modification of the dispensing fee and of the reimbursement which is now almost two years out of date, or is he going to distribute the formulary with the new price lists to the pharmacists on August 1, as has been suggested? It has been ready now for about six months.

Hon. Mr. Elston: The member knows that question deals with the previous piece of legislation we dealt with, but I will tell her that we are moving to share information with and are receiving information from members of the association and others to put a new formulary in place. However, when we are dealing with new legislation, we also have to make sure our regulations are in place. That requires us to ensure that the regulations are workable, which means the proclamation of this will have to be postponed a little. However, we are looking at putting out that formulary as soon as possible.

Miss Stephenson: The minister is saying the pharmacists will have to wait until November or December for the modification of the fee and the prices.

Hon. Mr. Elston: The member is asleep again.

Miss Stephenson: No, I am not asleep. The minister just said he had to redraft all the regulations to do this. He did not answer my question.

Hon. Mr. Elston: I said "the proclamation." The member should understand that the regulations for the new bill must be in place and must be workable as well. I said clearly we are moving now to put in a new formulary.

Miss Stephenson: I asked the minister how long are the pharmacists going to have to wait for the modification of a reimbursement that has been dependent upon the distribution of the new price list. Is it going to be November or December? That is what I asked. It was not any more complicated than that. Can the minister not answer? If he cannot, then he should say so.

Hon. Mr. Elston: I do not wish to accuse the member, but I have said we are moving as quickly as we can to put the new formula into effect. We have been working with association members to do that. I am saying I do not have a specific date at this moment. We are working towards the August date.

Miss Stephenson: Is it going to be November or December?

Hon. Mr. Elston: With respect to this legislation, we are going to proclaim it as soon as we can after regulations are put into effect. We expect that to be in the fall.

Miss Stephenson: I simply asked, is it going to be August 1, is it going to be November or December, or is it going to be somewhere between? Can the minister not answer that?

An hon. member: He does not know.

Miss Stephenson: Okay.

The Deputy Chairman: Mr. Leluk has moved an amendment to

section 16.

All those in favour will please say "aye."

All those opposed will please say "nay."

In my opinion the nays have it.

Motion negatived.

Section 16 agreed to.

Section 17 agreed to.

The Deputy Chairman: Shall the bill, as amended, be reported?

All those in favour will please say "aye."

All those opposed will please say "nay."

Bill, as amended, ordered to be reported.

On motion by Hon. Mr. Elston, the committee of the whole House reported one bill with certain amendments.

HEALTH DISCIPLINES AMENDMENT ACT

Hon. Mr. Elston moved second reading of Bill 109,

An Act to amend the Health Disciplines Act.

Hon. Mr. Elston: My comments are very few indeed.

This bill has been long awaited by the College of Nurses of Ontario, so that it can deal with its disciplinary proceedings in a more expeditious manner. We will see an increase in the number of members sitting as members of the college, and this will help deal with the considerable backlog of cases.

We saw the introduction of a similar piece of legislation a number of years ago. Unfortunately, on account of circumstances beyond its control, the Legislative Assembly was not able to deal with the bill at an earlier date. I think we are all anxious to see this legislation pass so that we can allow the college to perform its very important public function.

Mr. Andrewes: I would like to indicate our support for this bill. The minister is correct. I believe the previous member for Kingston and the Islands, Mr. Norton, introduced this bill originally. We have indicated to the minister and to the college that we would support this piece of legislation.

Mr. D. S. Cooke: There are certain things I would like before we pass this bill. However, we are in the spirit of passing things quickly today. It has been three years or whatever and complaint hearings are now being scheduled into 1987. The college and the nursing profession will be very happy that we were able to deal with this bill before adjournment today. We will be supporting it.

Motion agreed to.

Bill ordered for third reading.

Third reading also agreed to on motion.

PUBLIC SERVICE PAY EQUITY ACT

Hon. Mr. Wrye moved second reading of Bill 105,

An Act to provide Pay Equity for Employees in Predominantly Female Groups of Jobs in the Public Service.

Hon. Mr. Wrye: I am delighted this afternoon to introduce for second reading this legislation which is

an act to provide pay equity for employees in the public sector. When I introduced this bill for first reading, I explained why the government had embarked on this most important undertaking. I indicated at the time that this legislation represents but the first step in a process designed to achieve full equity for women in the work force.

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As both the Attorney General (Mr. Scott) and I noted, when we jointly commenced the process to establish pay equity in Ontario this past November, the most sensible and expeditious way of proceeding was to embark on a pay equity initiative in the public sector as a matter of first priority and, simultaneously, to undertake a consultative effort regarding implementation of pay equity in the broader public sector and in the private sector.

Certain differences in respect of the characteristics of the public and private sectors strongly suggested that implementation of pay equity might most appropriately require adoption of separate and specialized approaches in the two cases. A number of important factors collectively contributed to this assessment. First, the wage gap for the economy as a whole is almost twice as large as for the public service alone, suggesting there is a much larger problem in need of resolution in the other sector.

Second, public service institutions in general have a larger and more occupationally diverse work force, with implications for the nature of the pay equity challenge and the resources available to deal with it in the public service.

Third, the widespread coverage of collective bargaining in the public service permits, indeed requires, reliance on the bargaining process for implementing pay equity. Such coverage is much less significant elsewhere. Moreover, the multiplicity of separate bargaining units in some establishments outside the public service poses a greater co-ordination problem for pay equity job comparison purposes.

Fourth, the reconciliation of market-oriented and pay equity requirements and their cost implications represents a more difficult challenge outside the public service than within it.

Finally, practical experience with pay equity programs in other jurisdictions, which can be drawn upon as a useful guide for developing an Ontario program, primarily pertains to the public sector.

Mr. Speaker, the bill that has been put before you and before the House recognizes the needs of employees in the public service as well as the structural problems that need to be addressed in an initiative as complex as pay equity. The bill is long and detailed as it must be in order to respond fully to the many issues and concerns that have been raised in our process of consultation with the affected parties.

Before commenting on the highlights of the legislation, I want again to pay tribute to those who have been involved in the consultation process. It represents a high-water mark in the use of extensive consultation with both labour and management groups in crafting legislation that will fundamentally affect the conduct of their employment relationship.

My officials and those in other ministries met on a frequent basis with representatives of the unions and employer agencies covered by this legislation to ensure that all of the relevant issues were fully canvassed. As a result, we have a bill that is as comprehensive as possible and one which enjoys a wide degree of acceptance and support from those who are charged with its ongoing implementation.

This high measure of support has already been evident in reaction to the bill following first reading. While we have received a number of comments and useful suggestions for improvement, I am pleased to say that as a general proposition Bill 105 has been well received by both labour and management. On an issue as thorny as pay equity, this in itself is no small achievement.

The comments we have received thus far fall into two categories, the first of which deals with the question of coverage. There are a number of groups, particularly labour and women's groups, whose members wish to be included under the legislation. I can sympathize with their desires and I am grateful for the vote of confidence, in a sense, that they have given to this legislation. Nevertheless, as I indicated at the beginning of these remarks, there are sound reasons for proceeding separately in the public service on the one hand and the private and broader public sector on the other.

The government intends to continue on this course. I do not consider it to be an insubstantial undertaking on the part of this government to implement pay equity for almost 80,000 employees as a first step of a multi-step process.

The second category of comment we have received relates to the several technical aspects of the bill involving suggestions designed to help the legislation more precisely achieve its intent. The comments have been useful and the government will be proposing some amendments of its own when the bill comes before committee. In general, I want to submit to the Legislature that the structure and substance of the bill have met with favourable comment and I am pleased to put this bill before the House for approval in principle.

Let me review some of the highlights of the legislation.

First, the general structure of the bill: It comprises a number of parts reflecting, in the main, the need to tailor the development and implementation of pay equity in the public service to the nature of collective bargaining relationships that are already in place.

The bill begins by establishing some general principles.

Part I introduces a number of key concepts in the definition section, outlines the scope of the coverage and articulates the purpose of the legislation. The essential charging provisions identify what is required to achieve pay equity and indicate the components to be included in pay equity plans.

Part II of the bill also contains implementation principles of general application relating to such issues as exclusions from coverage, prohibition on pay reductions and the relationship of pay equity plans to collective agreements. Moreover, there is a detailed prescription of the implementation timetable that is to be achieved. In the three subsequent parts of the bill, the obligations of the employers and bargaining units are identified with regard to the development and implementation of pay equity plans.

The staging of pay equity implementation recognizes that it will be most expeditious to utilize existing bargaining relationships in the first instance in developing pay equity plans. These parts of the bill also provide for arbitration in the event that the employer and employees cannot agree on the plan.

In addition to recourse to arbitration, the bill also mandates the establishment of the Pay Equity Commission, which will have two main functions. It will monitor the development and implementation of pay equity plans by employers and unions to ensure that they conform with requirements of the act; as well, it will be empowered to receive and investigate complaints regarding the conduct of the parties during this phase.

After implementation of the pay equity plans is concluded, the commission will continue to be able to receive complaints about new compensation practices that may be introduced that have the effect of subverting pay equity. The legislation thus departs from the traditional reactive complaint-based model in favour of an obligation on the parties to introduce pay equity on a proactive basis.

Within the general framework I have described, the bill contains a number of important specific features to which I want to draw the attention of the House. First, it focuses exclusively on redressing gender-based pay discrimination. Potential beneficiaries will be those employees working in predominantly female occupations, most, but not all, of whom will be women.

As a threshold condition for the purposes of this legislation, a predominantly female group of jobs will be a group in which 60 per cent or more of the positions are occupied by women. Pay equity comparisons for these jobs will be undertaken with reference to predominantly male groups of jobs, those in which 70 per cent or more of the positions are occupied by men. The use of different ratios for the two gender predominance tests simply reflects differences in the relative proportions of men and women in the overall public service work force. I believe the figures are 42 or 43 per cent women and 57 or 58 per cent men.

To avoid the problems that arbitrary numerical cutoff points may create, the bill does provide for the designation of additional groups as either predominantly female or predominantly male by agreement between the parties, by regulation or by the employer, subject to approval by the Pay Equity Commission.

The targeting of pay equity adjustments to predominantly female groups of jobs will ensure that the benefits deriving from the new program will be directed to those who can be said to have suffered most in the past from gender-based pay discrimination. It is estimated that approximately 29,000 employees, more than 40 per cent of the total public service work force, will benefit in some measure from this new program.

The bill contemplates development of pay equity plans in a series of steps, commencing with the selection of a gender-neutral job comparison scheme and concluding with the implementation of any necessary pay adjustments following application of the job comparison scheme to the various job positions covered.

While the procedure is necessarily quite time-consuming, our determination to minimize delay is reflected in the fact that the bill establishes specific time limits for each stage in the overall process. We anticipate the entire process of developing and implementing pay equity in the Ontario public service will be completed within four years. No attempt has been made to seek to impose a particular type of job comparison or job evaluation scheme on employers or employees.

Where collective bargaining is well established, and it is in these situations, the parties directly involved are in the best possible position to select the comparison scheme most suited to the job positions under examination. The legislation we are proposing has been designed to interfere with collective bargaining only to the most minimal extent consistent with ensuring that our basic principles in developing pay equity are observed.

This legislation contains some general guidance on this question. For example, it requires that the value of the job be assessed with reference to four basic criteria; namely, the skill, effort and responsibility associated with those jobs and the conditions under which the work is performed. It spells out the test to be met in determining whether pay equity has been achieved. It will occur when the pay for the representative job level in a predominantly female group of jobs is at least equal to the pay in a comparably valued job level in a predominantly male group of jobs.

It is important for the House to note that I have used the words "comparably valued" rather than "identically valued," recognizing that situations may arise where job values are clearly comparable or substantially the same without necessarily being strictly identical.

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The government visualizes that pay equity plans will become an integral element in the collective bargains struck by employer and employee representatives negotiating in the public service. In situations where the respective language of a collective agreement and a pay equity plan covering the same group of employees appears inconsistent, the proposed pay equity statute resolves such conflict in favour of the pay equity plan itself, the terms of which will prevail over those of the collective agreement.

One other important principle is that equal value comparisons will be limited to the employer's own establishment. In most collective bargaining situations, the scope of the collective agreement is typically confined to one establishment in a similar fashion.

The bill also establishes a minimum level for annual pay equity adjustments equivalent to not less than one per cent of overall payroll for those employees covered by the pay equity plan in question. The first pay equity adjustments are expected to be made about two years after proclamation, and they will continue until all pay inequities are eliminated. The legislation will not be retroactive prior to proclamation.

Wage reductions for any employees as a means of achieving compliance with these statutory requirements will be prohibited. As a result, where existing pay levels are not in conformity with the pay equity standards established by the proposed bill, workers in the underpaid job positions will be guaranteed an actual wage increase resulting from application of the statutory scheme.

There are a number of other details of the legislation we could review at length. I look forward to elaborating on those during the committee part of this process. While a great deal of hard work and careful consideration has gone into the drafting of this comprehensive piece of legislation, no doubt there are areas where the bill can be improved. However, I am confident the legislation before the House now will achieve our most important goal; namely, the provision of full pay equity for all women who work in the Ontario public service.

Ms. Fish: I want to say at the outset that I am delighted this bill has finally been called for second reading debate in the House. We have been waiting for some considerable time to be able to deal with this, because the second reading debate and discussion at this level precedes another terribly important and critical phase for the bill, which is its referral to committee and the opportunity for hearings and public deputations.

I am particularly concerned that the hearings to be undertaken on this bill should look at, among other things, the total scope of the legislation before us, the question of whether we should confine ourselves to what my friend across the way seemed to describe as the narrow public service.

The first question that must be asked by any member of this Legislature, and it has been asked by a number of groups that have reviewed it since the introduction of this bill on April 22, is who is to achieve some protection under this bill. Who has the right to come forward and expect to be covered by this bill with its protections, many of which we hope to strengthen? What categories of employees will be covered?

My friend across the way trumpets with some pride the fact that a bill has been brought in that will affect a total of 76,000 employees. I reply that it is a good start, but a start is all it is. I am not at all satisfied that that is the limited place where we should start.

If we reflect a little bit on the basic understanding and

definitions that have been developed, not so much in a legal sense but in the sense of practice and the key and critical decisions that have been taken over the years, we can readily see in the past eight or 10 years that an understanding of the public sector has gone far beyond the narrow focus of 80,000 employees directly employed by the Ontario government or what I might describe as its most immediate agencies.

The 76,000 employees covered by this bill will include a fairly narrow band of employees whom I think this House has already begun to identify as being properly within the public sector. Let us review them for a moment. They include employees of the ministries of the government, the Ontario Provincial Police, the Niagara Parks Commission, the Liquor Control Board of Ontario, the Liquor Licence Board of Ontario, the Ontario Housing Corp., the Toronto Area Transit Authority, the Workers' Compensation Board and so on. In other words, the target is direct employees of the provincial government and its immediate agencies.

That is not the test this Legislature applied when other aspects directly affecting the wages of those in the public sector were dealt with only a few years ago. At a time of a very different economy, at a time of very different financial pressures on the government of the day and on the province as a whole, at a time of a very different circumstance with unemployment and an exceedingly deep recession, it was felt necessary to bring in wage restraint legislation. It was a difficult and onerous move, a move that is done in only the rarest of occasions, but brought in it was.

That legislation was directed to the public sector, restraining the wages and controlling and narrowing the options for employees in the public sector.

Because it interrupted some of the collective bargaining that was under way and imposed a cap, a limit and a standard, on occasion it had the potential to delay, by virtue of the conditions we faced at the time, the thrusts and the moves that would affect the position of employees one to another, directly in equal pay for equal work and indirectly in equal pay for work of equal value.

The definition used at that time, when in its wisdom the Legislature was restraining wages, was a broad public sector that encompassed some 650,000 employees of the province, a public sector that instead of touching upon 29,000 female-dominated jobs, which is the current estimate of the case in this bill, touched upon 224,000 female jobs. That broadened scope would include the civil service and all crown agencies; for example, Ontario Hydro, the Ontario Northland Transportation Commission and so forth, the universities, the hospitals, the municipalities, the school boards and provincially funded agencies and organizations.

It is my view and the view of my party that if it is appropriate to define "public sector" in a broad way when one is restraining, at a minimum it most surely is appropriate to define "public sector" in that same broad way when one is providing fundamental and basic protection from discrimination against unequal pay for work of equal value. We hope that this issue will be touched upon, as will so many others, in the course of the formal hearings that will follow this debate and that appropriate amendments will be brought forward to deal with the bill in this regard.

I might touch upon what I viewed as bordering on a threat offered by some ministers of the crown when they answered questions dealing with the appropriateness of amendments that might touch upon broadening the scope of this legislation: to wit, the suggestion that the legislation would be substantially delayed, if not potentially abandoned entirely, should there be successful amendments to broaden the protections to be provided by this bill and to broaden the categories of employees to be protected under it.

At this point, I think it is appropriate for me to say that this is callous politics in the extreme. Dealing with legislation and amendments is something this House has done since its inception. Being able to process amendments is nothing new to us. It is nothing new to legislative counsel. It is nothing new to the staff of the Ministry of the Attorney General residing in each of the ministries across this government.

12:40 p.m.

If the rest of the bill has been properly thought out and if the conditions and grounds are carefully provided to introduce equal pay for work of equal value within the more narrow public sector, then the application of those protections and careful groundwork and criteria to that broader public sector restrained only a few short years ago is surely not beyond the competence of the staff who would have to provide the necessary advice and afford the necessary implementation.

I hope the opportunity here as we proceed in dealing with this piece of legislation will be to deal at the outset with the first and most fundamental question of who is protected in the broad categories and afford an opportunity for us to introduce a degree of consistency to ensure that those who had been restrained only a few short years ago are those who, at the very outset and from the very first, will similarly be provided protection by this bill.

On a related question, in addition to the more immediate definition, I and my party are troubled by the question of specific exception, particularly the exception that looks to those working within a rehabilitation program. I hope that in the course of examining the details of this legislation, as we will, we will see amendments come forward that will ensure this exception is deleted and those who work within rehabilitation programs will be included within the scope.

I say that because many who work within rehabilitation programs are already suffering a degree of disability. Very often they are there as a result of perhaps mental or physical handicap in the course of rehabilitation work, in the course of learning to care for themselves and to be at some point fully reintegrated into the work force, or perhaps there are others simply seeking at every opportunity to stretch or expand their abilities to be full members of our society.

It seems to me we should be prepared, as we were in the course of establishing the rehabilitation programs in the first place, to move from there to the kind of protection that I think this act would envision when we are considering the fundamental question of whether one ought to be discriminated against by being paid unequally for work of equal value.

If the principle of the bill establishes that equal pay for equal value is the direction in which this Legislature wants to proceed because it is in keeping with the fundamental tenets of fairness, justice and equity that we hold dear in our society, then I believe we must be prepared to afford the extension in all areas possible and reasonable within the scope of the intention of public sector.

Similarly, I am particularly troubled by the possibility of exception for the category of labour shortage. In the main, the labour shortage issue, with unequal pay resulting, has tended to occur within those areas that have also tended to be male-dominated. If we are trying to introduce again that fundamental tenet of equity and fairness in the course of dealing with pay that is provided to employees in comparable areas who are undertaking work of equal value, I believe we must be very careful when we are looking at the question of exception on labour shortage.

We must be prepared to pierce the veil of why that exception is there and why that shortage might be there and to give some thought to the degree to which continuing that exception might indirectly strengthen an unfortunate systemic discrimination.

One of the questions that occurs to me at the outset is whether there is a shortage that may result from a particular technical training. The question that comes to mind is the degree of opportunity, access and participation in training programs and the encouragement that might be afforded to those who would go into them. It raises questions about the structure of our educational system. None of these questions is new or unique, as we are dealing in many areas and in many ways with the very subtle forms of discrimination that we now find in the middle 1980s.

I am put in mind of the initiatives such as Open Doors and others to try to encourage, through all the study areas and training areas, a better representation of both young men and women within our society as well as those of minority groups. The reason for that is not some magic in and of itself. The reason is that training opens other doors for employment opportunities. It opens doors to look at career options and career choices.

If we are in the business of trying to encourage that, we should at the same time look at the other end and ensure that perhaps prior to the time when encouragement was made, prior to the distribution of those programs being broadly available, or for whatever reason, we do not inadvertently afford a penalization to those who were unable to proceed through some of those sorts of skills acquisition efforts that may have created a short or temporary labour shortage.

That is something that has to be examined very carefully. In the course of the examination, we should be prepared to question why there was a labour shortage and to understand whether responding to that as an exception does not simply reinforce another pattern of unequal pay for work of equal value.

It is also important to look at the question of the numerical cutoffs. That was addressed a few moments ago by the minister when he was speaking about the minimum participation rates that are divided by gender in job categories.

I understand what the minister suggested in those cutoffs, but if we are looking for pay equity through a system, and just as I am concerned about a narrow definition of the scope of the bill or of exceptions that might be built in by virtue of the particular program, I am extremely concerned about those who may ford themselves on the wrong end of equity in their wages by virtue of simply being in a job category that does not meet the numerical cutoff requirement by gender.

It is my view that this again is something that can be dealt with more carefully as we proceed into clause-by-clause debate. It would be my view that we should initially remove those cutoffs and say that if it is pay equity we seek, then it must surely be pay equity across all job classifications and stand there, permitting the protection to extend to all our employees. That approach is in keeping with the fundamental approach that says if it is worth doing, it is worth doing right at the outset. I hope we can look at that side as well.

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If the necessary groundwork has been done on careful implementation -- what is required to receive a complaint on unequal pay for work of equal value, to respond to an expressed concern and to be able to examine the relationship of job categories -- then we can do so for all job categories. We do not need to apply another artificial barrier in the way of our employees, whom we are trying to afford a correction where the system requires a correction by virtue of decisions in the past or simply the way historical rates have extended themselves into the present.

It is also important to look at the effect the bill may have in terms of compliance and sanction. I am troubled that there appears to be very little in the way of sanction. I cannot find within the bill the clear and explicit statement that the payment of unequal wages for work of equal value is discriminatory. My initial reaction is that such a statement, found as it is in Quebec and elsewhere, forms the basis for action coming forward by those who feel themselves to be in receipt of unequal pay.

It will also form the base of action that will be tied in a complementary way to sanctions that can then be applied against those who, down the road, fail to bring themselves into accordance with this bill.

I hope we will have the opportunity of examining that, perhaps the specific wording I have just made note of, and there is nothing very original in utilizing that wording. I made mention of the fact that it is used already in Quebec. I am reminded it is also used at the federal level in the existing human rights legislation. Having had a recent opportunity to review, among other things, some questions associated with the Ontario Human Rights Code, I do not recall finding similar wording there.

Since we have an opportunity to proceed in respect of Bill 105, which begins with the premise that a public sector -- I argue a broader public sector -- is the place to begin, it seems to me we must also attend to providing that kind of clear statement directly within Bill 105.

Let me move for a moment to the question of what happens when there is noncompliance. What happens in a circumstance where there is a finding that there has been unequal pay and a corrective measure is not taken? The current bill provides for orders to be filed with the Supreme Court in the case of noncompliance. I recognize the severity of those orders, and I recognize the authority of the Supreme Court.

My concern is that there should be a recognition that engaging in unequal pay for work of equal value is discriminatory, that it should be stated as such and that clearly there should be sanctions for those who do not comply. We should give consideration to, among other things, the possibility of fines for noncompliance on the part of employers or to some other more specific sanctions that might accompany an order to correct, particularly when there has been noncompliance. We have done that in a number of other areas.

We have other legislation before this House, or at least it has been introduced, that moves in a similar fashion. As we look at this question of pay equity, we should be prepared to look at the possibility of substantially strengthening provisions for sanctions for those who do not comply.

This raises the question of observing the degree of compliance that may be undertaken by any employer covered by the bill when a finding has been made and it is clear there has been a problem with comparability in wages that have not been paid when there has been a roughly equal value of the jobs. The bill provides for what I would call an initial monitoring vehicle, a monitoring to look at getting the system to a point where it pretty well achieves pay equity as it might be understood and as it might be achieved through bargaining or stepped or phased programs.

I would say on that, as I said initially on the scope of the bill as presented, it is a good start, but that start can be broadened. I believe it should be broadened in an area of suggesting that there be an opportunity to do some monitoring within the period where pay equity has been achieved, to follow up on a regular or perhaps even random basis to review and assess what is happening down the road.

I recognize I am talking about things that are down the road, that are a few years in the future for us. However, that is the sort of thing legislation ought to be able to do. It ought to be able to take hold of an immediate problem and find the right kinds of ways of solving it in the immediate sense, but at the point where we think we have achieved pay equity in a particular case of a particular establishment with a particular employer and have in that sense solved that particular problem, we also ought to be able to look down the road and monitor the degree to which we have sustained that solution, which is perhaps the best way I can describe it.

As we look at the changes that occur, particularly within the broader public sector, the subsequent agreements that might be reached or the further job descriptions and changes to them and to classifications or the remuneration that might be given in distinction between those who are, for example, outside a collective agreement that might have made the initial correction in pay equity, we ought to be able to know they will not have the effect of reintroducing unequal pay for work of equal value.

We ought to have a mechanism -- as I say, I am not sure of the frequency; I do not know whether it should be regular or random, and I would welcome some discussion on this -- whereby we are able to review a bit down the road and ask, when the corrective measures have been brought in, when the system is in phase, if I can phrase it that way, how long does it seem to stay there?

1 p.m.

The reason I raise that as an area of concern and an area that, in my view, would provide for a ready extension of the monitoring function that is already contemplated in the bill, as I understand it, is that it would afford an opportunity of being able to identify those areas where there might be a change that begins to bring the pay back into an unequal circumstance or to bring a place of employment back out of phase or out of balance.

We might not be able to know about it on the day or month it occurs, but we would be able to have a sense of what is occurring not only within our own house as a narrow Ontario public service in which we might have more direct control, but also within the many smaller houses that form the broader public service of 650,000 employees across this province. We would be able to know those changes soon enough so that circumstances that might look as if they were going in the wrong direction and were going awry could be corrected with relatively little difficulty and the adjustment could be done in a timely way.

I hope this would put us in a circumstance where, in regard to the potential of an inequality creeping back, the margin of the inequality would be narrower and there would be less dislocation than if we found ourselves in a circumstance where we had monitored to the point of initial compliance and then withdrawn the opportunity of even occasional or random monitoring to tell us what was happening across the board, only to find ourselves, as we might find ourselves, with a more difficult problem to solve down the road.

To me, this is by way of saying that a little bit of monitoring in some of these areas is not unlike a little bit of prevention to ensure that what is initially desired, intended and achieved continues to be achieved over time. That is an awful lot better than failing to include that kind of mechanism, leaving the system open to the potential of having to deal with major problems well into the future that were not known by virtue of a lack of information collected and a lack of monitoring undertaken.

Finally, I touch upon the question of the date on which the bill will come into effect. We have had some exchanges in this Legislature already on this question. Considerable interest in the issue of effective date has been expressed by those who are directly affected by the bill as it stands, as well as by those who hope to be brought under the umbrella of protection of the bill. I find interesting a bill for pay equity that puts its effective implementation date well down the road into the future.

It almost does so with a suggestion that somehow the substance of the bill is less important than the substance of other pieces of legislation that are around us. The further down the road the effective date, the longer the period of time the pay inequity it proposes to correct will stand.

Given the number of pieces of legislation that have come into this House over the years that have dealt with similarly serious and compelling issues, that have looked at questions of discrimination, that perhaps have looked at issues within housing -- I am put in mind of some of the rent legislation -- there has been a preparedness to put effective dates on royal assent and, more important, in many cases on dates of introduction. The difference in the date selected in this case is a difference that will touch upon the period that will be covered through the inequity. Correcting a problem in a system is necessary.

Moving with this bill and the steps it takes is important. Because of the importance I attach to it and because of my belief that it merits an even broader scope, I believe we should be prepared to establish the opportunity for coverage on the date the bill was introduced.

In the course of a detailed examination, it is my hope we will be able to give consideration to what, at the moment, I believe are some very substantial differences in the opportunity to provide protection and the speed with which protection and corrective measures will be provided, as they apply to the question of the effective date.

In

summary, the bill is a welcome first step, but in the course of taking that step, we hope we on this side of the House can ensure that the step is lengthened a bit and that a giant step will be taken in the area of the scope to be covered, the individual categories to be dealt with, the sanctions that might be provided to those in noncompliance, the opportunity for further information and monitoring of future changes and shifts, and the immediate effectiveness of the bill, rather than the smaller step that we believe would occur if the bill were simply to move within its narrower scope and its delayed implementation.

Ms. Gigantes: As I sat here listening to the comments of the minister and the member for St. George (Ms. Fish) on Bill 105, I cast my eyes up, looking for inspiration and I saw the slogan printed above us, animo non astutia. My Latin is not very good. I guess that probably means it is not wise to get angry. However, I am angry.

Listening to the debate on this bill, one would think we were discussing some type of rearrangement of how we designate funeral plots in Ontario or some dry subject. This bill pretends to address one of the major social issues of our time. Part of the reason we are not hearing what I would consider inspired comments on the bill is that it does so in a very inadequate way.

The history of this legislation is well known to you, Mr. Speaker, and to other members of this assembly. It arises out of the accord the Liberals and the New Democratic Party undertook for the first session of this Legislature after the election of May 2, 1985, in which the NDP and the Liberals agreed that the first session would produce legislation to provide equal pay for work of equal value in both the public and private sectors in Ontario. More than a year later, we have a bill which says it will provide equal pay for work of equal value for about 24,000 women in Ontario, those employed in the direct public service and in a few other agencies.

When the minister read the bill, I noted with interest that he read it wrong. As the bill is entitled, as it is printed and as it is before us, it says, "An Act to provide Pay Equity for Employees in Predominantly Female Groups of Jobs in the Public Service." He read "public sector." I do not know whether he is trying to confuse us at this stage, but I do not think anyone is confused on that point. Surely he knows the difference between the public sector as he has defined it and the public service as it really exists and as it is covered in this bill. That is, as the member for St. George has mentioned, one of the key problems that exists with this legislation.

1:10 p.m.

There are two million women who are working in the paid labour force in Ontario; about 2,135,000 were counted in April. About one quarter were part-time workers. This bill does not address part-time work; so it is a very bad model if it is supposed to be a model of anything. Of those two million women, we are proposing to deal with providing equal pay to about 24,000.

In fact, about 300,000 women are probably employed in what in normal nomenclature is known as the public sector, including, for example, employees in hospitals, universities, community colleges and other institutions around the province that are heavily subsidized by the provincial government. About 224,000 of those women are in unions. If the bill before us is to be considered seriously, it ought to be dealing with providing protection for those 300,000 women.

It strikes me as painfully obvious that this bill is not worth the paper on which it is printed if it is supposed to be some kind of indication of a major social policy step forward for Ontario.

The member for St. George talked about addressing the immediate problem and then moving on to monitoring the results of this legislation and whatever further legislation we may be given by the government. This is not only an immediate problem but one that has been identified for years.

For 10 years in Ontario there has been a group known as the Equal Pay Coalition. It comprises a large number of groups in the province that have fought to get government to address the issue of unequal pay for work of equal value in Ontario. After all that time, this miserable bill covering 24,000 women is all we have to show for it.

The immediate problem and the past problem will continue to be a future problem until this Legislature, in all its maleness, becomes gripped with what the Ontario public knows must be addressed. For some time, public opinion polls have been telling this government and any party that wants to read them that the public has a great sense of urgency on this matter.

For example, last September in a large survey done by Goldfarb, the public of Ontario was asked to respond to the following: "On the question of equal pay for work of equal value, do you feel the government is acting too slowly, too quickly, just about right? No opinion?" On most subjects of this kind, when the public has a sense that the government is committed to some forward motion and if it approves of that motion, it will tend to say the government is acting just about right. However, last September -- this is many months ago -- the public of Ontario said the government was moving too slowly.

Those people were not talking about the question of 24,000 women; they were talking about equal pay for work of equal value for all women in the paid labour force in Ontario.

That survey showed that 62 per cent of women, whether they were employed in the home and probably not paid or employed in the paid work force, felt the government was moving too slowly on this issue. In fact, 45 per cent of the men surveyed were of the same mind. That was in September 1985. So far to July 1986, we have this bill which provides some protection for 24,000 women.

This morning I had the duty to attend an informal meeting of the standing committee on administration of justice. It was the third meeting of this type that members of the justice committee have held in recent days to try to determine how we will deal with this piece of legislation when it is referred to us, as we expect. It seemed clear what will be happening in the justice committee, certainly against my will, is that we will go through another round of what is called consultation on the question of equal pay.

Last year we had consultation leading up to the publication of the green paper. There was consultation by the minister; there was an interministerial task force set up and lots of consultation with the Equal Pay Coalition, labour and business groups; and, finally, there was a green paper.

When we had consultation with the public around the green paper, that went on from early this year until mid-May, and we do not even have a report out of that process yet. That consultation was to provide, by means of the appointment of three vigorous community representatives to an equal pay panel, a hearing of public opinion on how to implement equal pay in what the government calls the private sector and what I would call most of the economy of Ontario. It is all the economy of Ontario, except those 24,000 women employed in the groups referred to in this bill.

We have not had a report out of the green paper process, not from the government-appointed and government-paid consultants who were supposed to be the ears of the Attorney General around the province on this subject. We have had a report from the shadow member of that consultation pane