Volume 1 \ PROVINCE OF NEWFOUNDLAND AND LABRADOR HOUSE OF ASSEMBL~ Number 33 5th Session 34th. General Assembly VERBATIM REPORT MONDAY, MAY 3, 1971 SPEAKER: THE HONOURABLE GEORGE W. CLARKE

May 3rd, 1971 The House met at 11:00 A.M. Mr. Speaker in the Chair. MR. SPEAKER: Order! .Tape 420 JM - 1 RON. W.N. ROWE(MINISTER OF COMMUNITY AND SOCIAL DEVELOPMENT): Mr. Speaker, I wish to make a ministerial statement concerning a national award won by one of our Rural Development Committees in the Province. Hon. members will be interested to hear that national recognition has been accorded to the efforts of the Rural Development Programme of the Department of Connnunity and Social Development and of the prominent Rural Development Colllllittee working in the Eastport Peninsula area of this Province.

The Travel Industry Association of Canada has advised me that· the first orize in their national area pTomotion contest has been won by the Eastport Peninsula Committee for the development of progress. A submission prepared by the Department of Commmity and Social Development in ~~njunction with that development committee was entered in the national contest and took top honours. The submission gives,by way of written text,pictares, and newspaper clippings the details of a three year self-help development progrann.e.with emphasis on internal and external promotion.

The project covered by .the subn.ission war;_ ca~ied out by the Eastport Peninsula Cotllllittee with Government assistance being provided through the Rural Development Programne 01 the Department of Co111111unity and Social Development. Mr. Neville Squire, field worker for the Development Committee,wtll be accepting the award on behalf of the Eastport Committee at the annual convention of the Travel Industry Association of Canada in Montreal 1 from May 2 to ~ay 5. The Depart~ent of Community and Social Development will be represented by ~iss Christiana Francen, Social Plannin~ 8ffice and Mr.

Frederick Cook, Assistant Director of Rural Development. Miss Francen and Mr. Cook will be participating as ~analists at a seminar durin~ the four day affair. In making a statement, Mr. Speaker, I wish to stress that the total 2169

May 3rd, 1971 Tape 420 JM - 2 MR. ROWF.(W.N): effect of this particular project both in the area concerned and national!~ by virture of the recognition which it has receivedtis an example of what can be acc0111plished by means of co-ordinated work and ideas of people in local communities and Government. A veritable precedent and example has been established for the other proposed and existing Rural Development Associations in Newfoundland and Labrador.

The people of the Eastport Peninsula, ,the members of the Development Committee, the officials of the Government who have been closely connected with this programme and all other persons or bodies who have been associated with it are to be highly cotmnended for their efforts and their ini~iative. ORDERS OF THE DAY: MR. H.R.V. EARLE: Mr. Speaker, before we go into Orders of the Day I wonder if I might address a question to th~ Minister of Fisheries?

As the Minister undoubtedly knows,there has been appointed by the Federal Minister of Fisheries a committee on seals and sealing._ As this is a v~ry live issue at the present time I wonder if the hon. Minister has invited or requested that this Committee meet in St. John's or meet in Newfoundland? HON. E. WINSOR(~INISTER OF LABRADOR AFFAIRS): I will look into it, Mr. Speaker. MR. J.C. CROSBIE: Mr.

Speaker, before Orders of the Day I would like to ask the Minister of Justice, the leader of the House, whether he will inform the House or the Opposition what the order of business is going to be each day.at least a day in advance? At the moment we do not know whether it is estimates, Budget or Legislation.So could we be informed,particularily if the House is to meet morning, afternoon and night,so we can have some way of being ready for what business is to come before the House? HON.L.R. CURTIS(MINISTER OF JUSTICE): Tentatively, Mr.

Speaker, we are proposing to start the Legislation in the morning, the estimates in the after­ noon and Budget in the night, that is the tentative plan. MR. A.J. MURPHY(LEADER OF TRE OPPOSITION): Mr. Speaker, before we ~o into Orders 2170

May 3rd, 1971 Tape 420 JM - 3 MR. MURPHY: of the Day I would like to direct a question to the Minister of Mines, Agriculture and Resources, Thie is with reference, Sir, to the great amount of labour unrest in the mining industry. Would the Minister care to clarify statements attributed to him with reference to the phasing out of certain mines in the Province and perhaps to comment on this having an affect on negotiations between the mines and the employees? MR. SPEAKER: Orders of the Day! MOTIONS: On motion, the hon. the Minister of Justice, a Bill, "An Act To Empower The St.

John's Municipal Council To Raise A Loan For Municipal Purposes By The Issue Of Bonds," read a first time, ordered read a second time on tomorrow. On motion, the hon. the Minister of Health, a Bill, "An Act To Provide For The Establishment· Of A Cancer Treatment And Research Foundation," read a first time, ordered read a second time on to1110rrow. On motion, the hon. the Minister of Provincial Affairs, a Bill, "An Act Further To Amend The Automobile Il'.l,&~!'ance Act, 1968," read a first time, ordered read a second on toll!Orrow.

On motion, the hon. the Minister of Mines, Agriculture and Resources, a Bill, ••>d,, Act To Provide For A Veterinary L.icensin~ Board For The Province And To Incorporate The Newfoundland And Labrador Veterinary Medical Association," read a first time, ordered read a second time on tomorrow. On motion, the hon. the Minister of Mines, Agriculture and Resources, a Bill, "An Act Further To Amend The Churchill Falls (Labrador) Corporation Limited (Lease) Act, 191'1," read a first time, ordered read a second time on tomo.rrow.

On motion, the hon. the Minister of Mines, Agriculture and Resources, a Bill, "An Act Further To Amend The Crown Lands A-ct," read a first time, ordered read a second time on tomorrow. 2171

Kay 3rd, 1971 Tape 420 JM - 4 On motion, the hon. the Minister of Mines, Agriculture and Resources, a Bill, "An Act Further To Amend The Co-Operative Societies Act," read a first time, ordered read a second time on tomorrow. Motion, Second Reading of a Bill, "An Act To Amend The Newfoundland Medical Care Insurance Act." Bill No. 54. HON. E.M. ROBERTS(MINISTER OF HEALTH): Mr. Speaker, it is now, Sir, a little over two years since the Medicare scheme came into effect in this Province. Medir.are ,as it has become known.was a revolutionary step forward in the development of our medical services.

For the first time in our history,with Medicare no Newfoundlander need feel that financial consideration stand between him and his doctor. Under Medicare as Your Honour knows, a person goes to see the doctor of his choice and the Government pays the bill. Now it goes without saying, Sir, that Medicare has not met all of our needs for health care. Indeed, Sir, in some ways it may have made our needs greater because_ it,,with~ut any doubt, increased the demand in this Province for the services of doctors. The cause of it, Sir, is quite obvious. People now go to a doctor in cases where formally they would not.

I think it is fair to say, I think it is a tribute that should be paid to the doctors of this Province to say that Newfoundlanders always got emergency treatment, always got good emergency treatment, always got that emergency treatment without any concern with whether they could pay or not. If a person could not afford to pay_, then the doctor did the work and just wrote it off and did it as a contribution to society. Under Medica.re Sir, this no longer happens. A person now need have no worries about financial matters when he wants to go to a doctor. When first we brought in Medicare.

Sir, there were fears expressed that this would mean that all sorts of people would ~o to doctors and that the doctors would be heavily overloaded and there were, I believe, even those who predicted that the Medical Services in the Province would collapse.But, of course, Sir, that has not happened. Our doctors·are workin~ hard, the fact that there are 2172

May 3rd, 1971 Tape 420 JM - 5 MR. ROBERTS: fewer doctors throughout the Province means that they are working harder than most doctors elsewhere in canada. • None the less, Mr. Speaker, I can say categorically that after two years we know of no evidence which shows any widespread or far-ranging abuse by patients of Medicare. I We have isolated some cases where people have gone to a doctor a little mre often than would seem medically necessary.

I do not think Medicare can be blamed for that because almost without exception the people who have taken advantage of Medi­ eare in the sense of goinr. to a doctor for reasons other than medical'or strictly medical 1 those people tend to be among the better off. All that happened, Mr. Speaker, in the past was that they could afford to induige their hypochondria, could afford to-indulge their taste for going to doctors needlessly 1

whereas now everybody is entitled to indu!ge his taste and the result is that very few really are going, very few people, Sir, are going without having need to see a doctor. I sta-te that categorically, Str, because it is a very widely hela belief that Medica~e is being widely abused. Well, Sir. I know of no evidence to support it and indeed the evidence that I have, we have quite a • lot of statistical data, the evidence that I have is directly to the ·contrary. It is a strain on our doctors.

Any person who tries to make an ~ppointment to see a doctor will discover that,particularily in the rarer specialities, ophthalmology, some aspectsof psychiatry and some of the other one of a kind specialities like ear, nose and throat and some of the sub-specialities in surgery. But, Mr. Speaker, we Jcnow:;_of no evidence of any abuse. We know that our doctors are working hard. After two years, Sir, and I have been Minister of Health for nearly the full period that Medicare ~ bas been in operation, I have no hesitation at all in declaring that it has been a great success. Let me just give the Rouse.

Sir, a couple of very brief examplesr During the two years that ended March 31 last,the Governm.ent,through Medica;-~ paid the doctors of Newfoundland 2173

May 3rd, 1971 Tape 420 JM - 6 MR. ROBERTS: 81l4 Labra'dor for •bout 2:,SOO.i0:00 separate senrl.ces ,· vis-its to doetors. 'l'hat ts an •~11taRe,, Mr. Speatcer,. of about fi'IN!I v!ai ta f:or every person 1~ this· Pattnce. The coat: t'o the Govetn,mellt vu about $18 •. S million and to that ,n,.rk load, lir, must be .aded the won doue by doctors .in oar cotfag~. h()sp.itals; .. 2174

~!ay l, 1971 1 Tape 421, Pare 1 - apb MR. ROBERTS: and in the other areas where doctors are not practicing fee for service. My own constituency,where the Grenfell Mission provides service as they do in Labrador South, Labrador North, St. Barbe North, St. Barbe South, part of Labrador West, the constituency of Twillingate, part of Lewisporte District,where the Notre Dame Memorial Hospital provides service to the District of White Bay South and part of Green Bay l believe where the M.J.Boylen Hospital at Baie Verte.

There is a tremendous amount of work done in these hospitals Sir by doctors who are paid annual salaries. As just an example of out­ patients alone; our cottage hospital doctors saw well over 600,000 out­ patients in the past two years. Mr. Speaker, it is also interesting to note that the number of doctors in Newfoundland has increased substantially since we brou~ht in ~!edicare. When it began, there were about three hundred and forty-six men and women registered with the Medical Care Commission as actively practicing medicine in this Province.

As of today Sir, the total is 446, an increase of 100, Our doctor~patient, in two years we have gone from 350 in round figures to 450·doctors actively practicing in this Province. Si~ in that two year period. Our doctor•patient relationship is still the lowest in Canada, but we must remember,in stressing that.Mr. Speaker, that in the areas of fee-for-service practice, basically St John's. Conception Bay, Grand Falls and Corner Brook, our doctor-patient relationships are comparable with most other areas of the same size in Canada.

Where we are really short of medical services in this Province still is in the more remote districts, the rural parts of the Province; and that is where our expanded programme of increased district medical pratices are goin~ to be placed with,we hope,~reat improvements. Now Sir, while we have a very successful scheme in operation, we have run into some problems in administration of the plan. That is the reason that this Bill is before the House today. These problems,I should 2175

May 3, 1971, Tape 421, Page 2 -- apb emphasize,do not go to the heart of the plan at all. They are almost all problems of administration, the problems that affect certain small aspects of the overall Medicare plan, but they are problems which the Government believe must be dealt with and which we are advised must be dealt with by legislation. The legislation however,Sir, should be read in conjunction with some regulation changes we have made. We have made some very significant changes in the regulations. The first of these I tabled in the House some little while ago. These regulations,which were made in full agreement - with the full agreement of the Medical Association, changed the fee

schedule for some of Che items of the services of psychiatrists, ophthalmologists and surgeons. There were some anomalies in the ways tn which those fee schedules were working out 1 Mr. Speaker. The fee schedules were not designed for the purposes for which they were being used 1 so we sat down with the doctors and agreed upon som_e changes. The net effect of those,we estimate 1will be to save the Province about twenty or thirty thousand dollars a year.

But more importantly still, we believe that it will provide a better service and will provide for payment to the doctor more closely related to fhe ser;vice he was givin,. · Those changes,Sir,are temporary. They will remaic in effect only until a new fee

schedule is negot19~ed, and 1as I announced in the House some while ago, we are about to sit down with the Medical Association to begin negotiating a new fee schedule. Othere changes we made in regulations are also temporary. thus the restraints upon doctor's earnings that I announced in the House late in March, again Sir, these were made with the agreement of the }{edical Association. I think that shows their concern, it shows their desire to try to correct the problem. We intend to impose these by regulations, to implement the a,reements by regulations, and they will take effect as of the 1st. of April. Our legal advisers,however, tell us that we are 2176

May 3, 1971, Tape 421, Page 3 -: -apb going to need Legislative authority to be certain we can implement these proration changes, and accordingly there is a

section in the Bill before the House,Sir, which will give the Government authority to implement the agreement we have •de with the doctors. That is one purpose of the Bill,Sir: there is a second, one which is far more important. Tbat,Sir, is the part of the Bill which gives the commission powers to impose certain sanctions on a doctor who has made an improper claim for medical services. There is no authority in the present Act to deal with such a matter, to hold a hearing about it or to impose any penalties if there is anything wrong. Mr. Speaker, there is a need for such powers.

This has become quite apparent during the past year. I am not very proud about it Sir, but we have some evidence that a few doctors in this Province have attempted to practice,under Medicare practice medicine in a manner completely contradictory to the spirit with which Medicare was adopted. The Medicare Collllllission have investigated each of these matters 1 Mr. Speaker, and in one or two cases we have had the R.C.M.Police investigate through the agency of my colleague the Minister of Justice. Those two cases in particular that have been referred to the Department of Justice are . still under consideration.

I propose to say nothing more except to say' that if we have evidence that there have been deliberate infractions we will proceed to take the appropriate action. We will take it under the Criminal code,Sir. AN HON. "'ID'BER: (Inaudible) --------·- MR. ROBE'f1TS: No, these are doctors. I am speaking only of doctors. There are two cases which are in the hands of the Department of Justice, with a possible vit11t•7 to considered prosecution, if the evidence holds out under the Criminal code of Canada. The proseeutions would be under the False Pretenses Act. I do not know Mr.

Speaker, if the evidence will justify it, so I propose to say nothing more about it, except to say that ·2.177

May 3, 1971, Tape 421, Page 4 -- apb doubts have been raised. I have.therefore,referred them to the Minister of Justice and the R.C.M.P. are doing the necessary investigations. Mr. Speaker, there were a number of other cases where we could not resolve the matters in dispute. I may add that throughout this we kept in close touch with the Medical Association 1who represent about eighty per~ent of the doctors in this Province, represent almost all of the doctors practicing within medicare on fee.for.services.

We could not resolve these disputes,Sir, and I think it is fair to say the Medical Association was not able to resolve them either. The doctors concerned took the position,! think, that what they were doing.was within the letter of the law, therefore, they intended to do it. Well,Sir, the fact that the Government are powerless to act is a matter we believe should be remedied, and accordingly we drafted these amendments.

The proposals,which we believe will enable us to set straight the situation,are now set forth in the Bill before us,in the form of three new sections .which will be added to the main Act if the House adopts this Bill. Let me say,Mr. Speaker, these proposals have been drawn up in full consultation with the ~edical Association. I think it is fair to say that while they regret the nee4 to enforce such legislation, they feel that it is necessary. I am very glad they have taken this position.

I think it is a responsible one, and I think it is one that is in the best interest of the people of this Province and of the ~edical Profession of this Province. Mr. Speake~, the purpose of the three new sections,which will be numbered (39A), (39B), and (39C), and which will be found in the Bill before us,Mr.

Speaker, as sections four and five, the purpose of these Sir, is to allow the Medical Care Commission, which is an afent~for these purposes,of the Government and acts as our administrative body, to allow that commission to impose sanctions upon a doctor who is not practicing properl, and thus is abusinr. the Nedical Care Plan. 2178

May 3, 1971, Tape 421, Page 5 -- apb The types of situation in which the commission could act are spelled out in the first of these three sections, that is (39A). In reading these sections 1?!r. Speaker, hon. members who wish to read them,together with the changes we are going to make in the regulations, the change which we tnade in the definition of the term '"insured services,' is a very important change 1 ¥.r. Speaker, because.,under the Medical Care Plan, payment is made to a doctor in return for the rendering by him of an insured service.

Previously any service,with ·the exception of some items that were spelled out in the rerulations, third party examinations, insurance examinations and so forth~ any service rendered by a doctor to a citizen of Newfoundland was an insured service. Under the new regulation,which is now in the hands of the draftsman, .·and which will be tabled as soon as it is done, the service will only be insured service if the service is rendered properly and - adequately. In other words, the Medical Care Commission,in the future, will pay only if the service is proper and necessary.

So much for the definition of the situations in which the sanctions can be itrposed. Hon. members will see they are referred to in detail in the Act, and the tie-in with the insured services,for the benefit of hon. gentlemenJis with the reference to an offence under the Act. In 9ther words, the providing of the service inadequately or improperly will be an offence under the Act, and that is enough to trigger the application of the sanctions sections. MR. CROSBIE: !!R. 'ROBERTS: Inadequate trea~ment,as _it were, or inadequate claim? Improper or inadequate treatment.

In other words, the service,to be an insured service 1 Mr. Speaker, must be provided properly and adequately. I realize that these are matters of judgement, but as hon. gentlemen will see from reading the legislation 1Sir, and as I will mention briefly,there is quite adequate provision for enabling that judgement to be made properly and with,I think,the best possible advice 2179

May 3, 1971, Tape 421, Page 6 apb and with all possible safeguards for the people concerned. Now Sir, under the legislation the sanctions can be applied if the physician submits a claim for services which have not been provided. Sanctions can also be invoked if the commission have reason to believe that a physician practicing under Medicare fails to provide a patient with proper and adequate treatment and advice.

They would also apply if the commission have reason to believe that the characteristics of a physician's pattern of practice deviates significantly and improperly from the accepted patterns of the practice of other doctors. It is a technical term.Sir, and let me expand on it briefly: Using the computers- of course all of Medicare's information is on the computers. They cost us about three or four hundred thousand dollars a year, ~he bi~r,est item in our cost of administration indeed,Sir.

Under the Medical Care Plan, using the computers, we print up and I get regularly, and the officials of Medicare get it, my own officials in the department get information about the pattern of practice of each individual doctor in this Pro~ince, or each doctor practicing within Medicare. That includes all the fee-for-service doctors acept I think eleven who have opted out,out .of about two hundred in the fee-for-practice areas. That information 1Sir, enables us to tell both 1 by speciality - by medical speciality , and by geographic area,what work that doctor is doing.

That enables us 9 for example, to see that the average doctor in this Province may see - the average general practitioner may see 1,500 patients in a three month period,for house calls. We have a physician in this Province who is billing us and seeing 4,500 p~tients for hoUse calls,in a three month period. Thus we mean by pattern of practice,Mr. Speaker, we can look at this data and see what type of work the doctor is doing statistically.

We have no way to judge the quality, but we can of course say that he is doing twice as much as anybody els~, or that the avera~e doctor normally takes an hour for a certain type of p~ocedure, and 2180

t~y 3, 1~71, TApe 421, Page 7 - apb this individual doctor may be doing it in fifteen minutes. That is what I mean by pattern of practice,Sir. We feel, and I think it is accepted that if a pattern of practice changes significantly, that raises almost what you could call a prima facie case for feeling that there are Fome questions that should be asked. So, we intend to ask those questions. Now ~r. Speaker, unlike the change in the fee

schedule and the restraints on the doctor's eamings,which I mentioned earlier, these changes are not temporary. If ttey are adopted by the House, they will br part of the Act, and they will be in effect as long as the Act itself is in effect and assuming always that they are not amended. The procedure, once the commission feel that there is a case, that a sanctions process needs to be be~n. the procedure is quite straightforward and set out in the Act, and we v~ry carefully designed this to protect the doctor and to protect the public. The commission is obligated to consult with a professional bo4y.

The Medical Association,in the case of the doctor, or the Dental Association,in the case of a dentist, because, as hon. gentlemen are aware, dental services performed in the hospital are covered under 21~1

May 3, 1971 Tape No. 422 NC - 1 MR. ROBERTS: ~edicare. I think that is important, Mr. Speaker, that the Commission must consult with the Professional Association, I think the Cou.mission need their advice, and I think also the fact professional peers,his fellow doctors, his fellow dentists are aware of the evidence that the Medicare Commission has, I think that,in many cases,is a more severe penalty to a conscientious doctor or conscientious dentist than any other statutory penalty that we could impose in the Act.

I remember the profession myself, although I never practiced my profession, I think I can understand the professional person saying that the opinion of his fellow professionals, his peere, his equals, the men with whom he works, that is of great importance to him.

If they feel he has not done something properly and in accordance with the traditions and the code of ethics and everything of the profession, I think that is at least as importan~ fo any worthwhile and honourable person that is as least as important as the procedures and penalties that come under statute, In any event,Sir, we have provided that the Commission must consult with the Association.

There is also provision that the individual physician concerned, who would have been notified before there is any consultation with the Association, will consult only if the Physician cannot answer the questions satisfactorily. The Physician concerned can ask for a hearing, a hearing at which he is enabled to have counsel, a hearing r.efore the Medical Care Commission,ror that purpose the Commissioners will have powers under The Public Enquiries Act.

Following that, following the hearing by the Commission, the Commission itself will determine whether they need to take action, Taking of action is subject to approval by the Minister, prior approval, I think that is right and proper 1 since the Minister must answer to the Government and 1 on behalf of the Govemment,to the House, for the administration of the plan 21~2

May 3, 1971 Tape No. 422 NC - 2 MR. ROBERTS: The penalties that can be invoked or provided in 39lC) they could include withholding from a participating physician any money claimed for services in dispute. They do provide for the imposition of a penalty, and the amount of any money already paid out in respect of a claim, together with an amount of ten per cent, and they also provide that the Co11D11issions can order that the individual patients be excluded from the Medical Care Plan.

This latter action means that any person who wantBto go to see that doctor from that day on would have to pay the doctor directly and they could then submit the bill for his services to Medicare. Medicare would reimburse them to the amount they would have paid the doctor normally. That may or may not, Mr. Speaker, be the same as the amount the doctor charges, It is quite a severe penalty, because it makes life very much more difficult for the doctor who must try to collect from his individual patients instead of merely sending claims in to Medicare and getting his cheque once a month. Mr.

Speaker, the other feature in the Bill.to which I draw the House's attention, is the provision for appeals to Supreme Court. on matters of law and indeed I believe on any matter that comes before the Connnission in its hearing. Yes,Mr. Speaker, it is not restricted to matters of law. We think this is a necessary matter and accordingly we have provided the power in the Bill before the House. Finally, Mr. Speaker, I draw the House's attention to two minor amendments . contained in this Bill.

The first is to give us the statutory obligation to consult with the hntal Association, I think that was left out originally, Although an oversight,we think it should be remedied and so we propose the amendment. Finally, there is a

section allowing the Governor in Council to liake use of the statistical information collected. We think that is necessary. Medicare has probably the best statistical information of any department of any Government in this Province and I think we have better information than 21~3

Hay 3, 1971 Tape No. 422 NC - 3 HR. ROBERTS: the Government of Canada, certainly better information than _any other Government Department. My colleagues and I feel this is necessary and that we should have access to this for the purposes of the Government of the Province and this amendment is necessary to enable that to be done. Except for the Courts, Sir, there is no way in which any personal information will be made public beyond Medicare, beyond the Medical Care Commission itself or those administering it.

But the general statistical information; Medicare,for instance, can tell us how 1118DY people are living ' in a comrnunit~~ By far the 1110st reliable indicator we have a~ ' to how many people live in any individual COIIIIUD.ity, since the Medicare files are up­ to-date and they are all on computers,so we have ready access to them. Briefly then, Sir, let me in conclusion say that our Medicare plan is a good one. With the help of our doctors we are providing Newfoundlanders with better medical care than they have ever had.

The amendments introduced in this Bill will enable us to make the Medicare Plan even better than it is, Accordingly,I have much pleasure in moving that this Bill be now read a second time. MR. MARSRAEL: Mr.

Speaker, vhen I first read this Bill when it was supplied · a few days ago, I thought at that time that certain of the provisions in the Bill, particularly with respect to the taking of a doctor off of the Medicare Plan,~rpunneceasary and that certain of the sections indeed~in the Act, particularly with respect to the enforcing of thia·utter,,were unfortunate that they had to be brought in, I thought,on reading them over, Mr.

Speaker, that there were actually certain phases of this section (5) of the amending Act were repugnant and dangerous to any professional association and indeed to the general public of Newfoundland, After hearing the Minister, although he did explain the situation in which the Medicare Commission h&II found itself, I still did not change my views because I feel,in the first instance,it is unnecessary. If a participating physician is abusing the system, the Medicare syste•, or flogging the dog,as ,21e4

May 3, 1971 Tape No. 422 NC - 4 MR. MARSHALL: it were, that it would be much better to deal with the matter privately, it would be much better for the Government to deal with it as between itself and the Medical Association,as such. Although the Medical Association, at this present time, does not apparently have the power, the Government could confer the power on it, to set up proper disciplinary committees.

If this did not work, obviously the Government has to have the ultimate say in playing the tune,as it were, and if somebody is patently abusing the system as such, I am of the opinion, regardless of what the Minister said, that the Government could withhold payment under the Medicare scheme,as it presently exists now,and could in effect opt that physician out of the Medicare practice without putting them through the hearings and through the provisions of this Act itself. So in the first place 1 1 would say it is unnecessary.

But even more so than that,Mr, Speaker, I think that the provision in the Bill to which the hon. Minister referred, referable to the pattern of practice of the physician,and that patieular

section I think is repugnant and certainly dangerous. Not so much that it is repugnant, I know it is a professional association, but it is dangerous because it may ultimately, as a result of this, effect the health and well-being of many hundreds of Newfoundlanders. Now I want to read, refer to this

section particularly. Under

section 39 (a) "·Where after making due enquiries the Commissioner finds it has reasonable or probable cause to believe that the pattern of practice of a physician;''pattern of practice, you will note, constitutes a significant deviation from the accepted pattern of practice adopted ~y physicians practicing in the Province,and such deviation is not in the best interest of the beneficiary or is in conflict with the proper administration of the Act, then the various procedures in the Act leading up to the sanctions that are spelled out here come into effect. 2135

May 3, 1971 Tape No. 422 NC - 5 MR. MARSHALL: So in one instance then, now I might say at the outset that nobody will have any brief or any regard for any doctor who has been convicted of an offence under the Act or submitted false information. That particular doctor, that physician, should get what he deserves.

But when you come down to the business of enquiring or the Government comes to the point of enquiring into the pattern of practice, whether you have computers or whether you do not have computers, all the computers are going to do is to give statistical data and it requires human civil servants, human beings, administrators, to interpret the computer.a as such. What does this mean. the 'pattem of practice? Does it mean that if a doctor has to work sixteen hours a day, that his pattern of practice is going to be enquired into? Who is going to make this valued judgment?

The Minister has made the statement to the effect that he had inquired of the Medical Association before this Bill was brought in or certain executive members of the Medical Association. Well I myself have also made certain inquiries amongst their respective general practioners, practicing in this Province since this Bill has been introduced,and there is no doubt from what they have told me that they are not very satisfied with this

section 1 with respect to the pattern of practice. From what they have told me1 ' they are not very satisfied with this

section with respect to the pattern of practice. After all, how would a teacher,for instance, in the case of the hon. Minister of Education, how would he be able to function if a group of civil servants,as it were, wera ·able to hold an enquiry with sanctions being provided, as to whether or not the pattern of teaching constitutes.as a pattem.within the normal norms whatever they are. How would the Minister of Fisheries,•• a sea captain,want a group of laymen to conduct that type of enquiry as well or any of the learned members here, the junior member for Harbour Main, if that particular situation pertained. 21~6

May l, 1971 Tape No. 422 NC - 6 MR._MARSHALL: It is not going to do any good, Mr. Speaker, and I do not see there is any reason for bringing in this Act; it is unnecessary and repugnant. I am told, I have not done the calculations from the report of the Medicare Conaission as yet, but I am told and I will accept it until it is proven otherwise, that we have one of the lowest per capita costs of Medicare,in this Province, lt is something certainly that the Medicare Commission and the Department of Health can be proud of. This being so, I wonder why it is necessary to bring in this Act.

It should be left, these sanctions I would submit,Mr. Speaker, should be left with the Medical Association itself as between the Health ., Department.

Certainly there has to be a stick that can be used or weilded by the Govemment if the Medicare system is being abused but it is not going to do the general public any good to have it blatently set forth in this Act where we have enquiries set up and various courts of enquiry It is all very well to say ;!10.K., you have an appeal to the Supreme Court, they have their rights, etc. etc." !ut what are we talking about, we are talking about practicing physicians, a group of people who are looking after the health and well-being of this Province, th~ people in this Province.

Now we have come to the stage where we are going to enquire into the pattem and their nature of practice and this could very much detrimentally effect the overall supplying -of medical Rervices. I would urge, I would really urge the Minister of Education or the Minister of Health to reconsider the provisions of this Sill~ they are much too strong. Is it really necessary?

I do not care what kind of le,al opinions or civil service advice, administrative red tape advice the Minister of Health may have, the old situation pertains, the person paying, that is the Government, is not satisfied, : has the right to withhold if the services are not being supplied in accordance with the contract 1 and this is really what should be done here. 21~7

May 3, 1971 Tape No. 422 NC - '1 MR. MARSHALL: If a complai~t ia made with respect to this, if there ia a hearing, the professional reputation of the doctor involved is going to be very.very much damaged and it is a dangerous situation because the public will Ret it all out of perspective,completely. I do not think that this is really necessary, Now I hear the Minister talk about insured services, there are only going to be those services which are proper and adequate.

Well I want to know who is going to make this judgaeDt~ who are the people who are going to make this judgment as to whether the services themselves are going to be proper and adequate? Ia this going to cause a doctor to sit back and not practice» with the same interest and with the same vigorousness as he practiced before?

I am afraid that this is going to materiallJ, could well, I am not going to say is going to but could .well adversely affect the health services in this Province and I think the Minister would be much better to bring in the necessary, if there are any necessary amendments to the Medical Association Act, to give the Medical:.. Association power to police. The Minister ia bringilag in this, not tum over of private plan5 at all, just to have the public body co-operate with the Medical Association for the purpose. There is not doubt, Mr.

Speaker, in my.mind, from what I have seen in examining this Act, and from what I have inquired before, that this is just a political manoeuvre on the 21~8

May 3 1971 Tape 423 page 1. part of the Health Oepartment, the Minister of Health playing with the health and well-being of the people in this election year. It is absolutely unnecessary. The Minister of Health is a very intelligent individual but he obviously has an old head on a young body and he is practising the same old pork-barrel politics of the past and unfortunately it is beclouding th~ Health Department to the great detriment of the people of this Province,it could be. Now he talks about the opinion'of the peers of the doctor, of his peer~ the accused individual.

I note that in subsection (4) of the Act, they say that one of the people on this · Committee of Enquiry in this court, this ultimate court that the Minister is setting up,that one of the members of the committee of the Commission should be a physician.

I feel quite strongly that that should be enlarged or if the Minister insists on keeping this Bill in, this Bill that could effect immensely and adversely the health and well-being-of the people of this Province, hut if he insists»he probably will in this election year,on keeping it in; he should at least amend that, to make it, to provide that the physician on this co-nnittee should be a practising physician and a physician who is participating himself in private practise in the medicare scheme. ·im..ROBERTS:. Are you ever off base, that physician must be a member of the Commission.

The members of the Commission are nominated by the 'NMA. MR.MARSHALL: Yes, the whole point, we are setting up an entirely different system here. We are setting up a Court of Enquiry into the pattern of practise of the doctors 1 which I am afraid could very much adversely affect the health and well-being of the people of this Province, I would urge the Minister of Health to look at it very, very much more closely than he obviously has done, perhaps could seek 21~9

May 3, 1971 Tape 423 page 2. advice outside of the eKecutive of the medical association itself. MR.ROBERTS: Yes, Kevin Linegar - ~a~ Hat Ha! Ha~ MR.EARLE: Mr. Speaker, I just like to ask the Minister one question under this particular Bill, perhaps he might prefer to answer when we get into Committee on the Bill but in order to give him an opportunity to prepare his facts and figures 1 I have been searching through the estimates of the Department of Health on the cost of Medicare - MR.ROBERTS: If the hon. gentleman would search on the last page of the estimates he would find the ~udget for medicare printed.

MR.EARLE: May I just finish, there is a total grant there of $3,970,000 for_the coming year for Medicare. My question is, is that the net cost of Medicare to the Province, because at the time that Medicare was brought in we were told that for at least two to three years it would not cost the Province anything, as a matter of fact we should make money on it, But last year we voted $3,654,000 and this year $3·,900,000 or practically $4 million.

So I am wondering in ;he maze of all these grants and deductions and so on,can the Minister clarify for me what the actual net coat of Medica~e is to the Province of Newfoundland, is it this $3,900,000 or is it more or is it less? MR.ROBERTS: The hon. member for St. John's West? MR.CROSBIE: Yes, I would like to have a word or two,Mr. Sp~aker. I do not know why the Minister mentioned Dr. Kevin Linegar's name and then gave a fiendish laugh .aa though there was no reason why he should advise the Minister on Medicare.

I mean he is a practising physician and presumably he is entitled to and is as much interested in this as any other member of the medical profession. MR.ROBERTS: l will take the executive of the NMA before I wou!d take Dr. Linegar and that was the point the hon. gentleman for St. John's East made. MR.CROSBIE: I do not see why the mention of Dr. Linegar by the Minister would cause him to laugh so fiendishly,as though Dr. Linegar was somebody 2190

May 3 1971 Tape 423 page 3. who should just be thrown in the waste basket. f{R.ROBERTS: I would not suggest that. HR.SMALLWOOD: (inaudible) HR.CROSBIE: The Hon.,the Premier is piping up.Me spoke on Mr. Crosbie out at Gander long enough last Saturday morning. I will just let the hon. member speak without interruption for a change. Mr. Speaker, the Newfoundland Medical Care Insurance Act has worked well as far as I am able to discover and as one who had something to do with it, I am still proud that that is the case. Medicare has worked well in Newfound­ land.

We have more doctors since it came into effect, In fact it was necessary for us to go into Medicare to make sure that we retain the doctors and attracted more doctors to the Province. I have heard very few if any complaints from patients or people .seeking the care of doctors about the scheme and all in all it &as worked well. Now the Minister's amendments that he has presented in the House are to deal with~presumably,the points he raised in the speech to the private meeting -._of doctors in St. John's in January.

In that speech which was afterwards published in the Toronto Globe and Mail, MR.ROBERTS: That is not what the amendments are about. MR.CROSBIE: Well, I am coming to that,the Minister can answer me when I am finished. II " That speech was published in the Toronto Globe and Mail Kr. Speaker, with a picture of the hon. minister. I must say it probably frightened the doctors of Ontario. The picture of the minister and what he was doing in Newfoundland probably got the doctors in Ontario quite a scare. They were worried that he might ~migrate up to Ontario and get in as Minister of Health.

The Minister then said that if the Newfound- land Medical Association does not move quickly to curb excessive demands by certain doctors under the Province's Medicare Plan,the Government will have; "no choice but to take action on our own." Now, Mr. Speaker that statement would make one believe that there was quite a lot of abuse by 2191

May 3, 1971 Tape 423 page 4. doctors in the carrying out of the Medicare Plan here in Newfonndland, that if the doctors did not move quickly to curb excessive demands by certain doctors,the Government would have nn choice but to take action on ita own. 1 woul~ like to ask the Minister, when he replies,to clarify for me this poJnt, have these amendments that are embodied in Bill 54, have they been approved by the Newfoundladd Medical Association or has the Minister received any objections by the Newfoundland Medical Association to these amendments which he has not met or accepted!

In other words.I would like to know definitely whether the Newfoundland Medical Association have accepted the changes that are proposed in this Bill or whether they have made representations that the Minister has found that he could not accept. I think that is quite important. Now the Minister in his remarks said that two doctors or activities of two doctors,in connection with the Medicare Plan,were being investigated by the R.C.M.P and that possibly there may be charges under the Criminal tode against these two particular doctors. Well, Mr.

Speaker, if that is the case, if that is the fact, certainly that does not indicate that excessive demands by doctors that would leave the Government no choice but to take action on their own. The Minister's statement implied tha~ there were considerably more abuses under the Medicare Plan. MR.ROBERTS: You have confused it, that speech was directed at doctors incomes and subsequently,. March 25,t I think I announced that the NMA had agreed with us to curb doctors incomes. That is all my speech in January was about. That is all it was about,it had nothing to do with quasi-criminal or that sort of abuse.

In other words, well, it could easily be taken,Mr. Speaker, - MR.CROSBIE: What can excessive demands by doctors be other than that they are attempting to get more money under the Medicare Plan than they are legitimately entitled to. Ia other words; they are abusing the Plan. But the Minister clarifies and says that r~lates to doctors income. 2192

Ma¥ 3, 1971 Tape 423 pages. MR.ROBERTS: The doctors who were there know about it, and know full well, I am surprised the hon. gentleman did - a.et6SBIE: It is not only doctors were concerned in this, this is a speech that is made public. MR.ROBERTS: I did not make it public. MR.CROSBIE: That the public reads. Well the Toronto"Globe and Mail" made it public. MR.ROBERTS: Yes, I know but I did not give it to them MR.CROSBIE: I know where they got it. MR.ROBERTS: Not from me. MR.CROSBIE: The Minister says that two are being investigated. That does not indicate excessive demands. MR.ROBERTS: criminal.

There were 137 investigated last year, two of them quasi- MR.&ROSBIE: Now, that is more like it. MR.ROBERTS: All right, 137. MR.CROSBIE: Now that is more like it, 137 doctors the Minister says, 18.IOBl!t'H; That may merely be, you know 135 bf them may be quite straightforward. MR.CROSBIE: The Minister now says that 137 doctors were checked into last year in connection with their ~la:lms under Medicare legislation. MR.ROBERTS: That is right. MR.CROSBIE: That is a far different matter than aavin~ thRt only two of thfbc.doctors are being looked into with a view to prosecution.

MR.ROBERTS: Right, that is closer. ~IR.CROSBIE: l would love to be able to make my speech here without having to answer back, it is not a partisan subject it is about ~edicare. There are two doctors being investigated, in other words two were found to be so abusing the claims under Medicare that they have had now been 2193

May 3 1971 Tape 423 page~. looking at criminal action. But 137 were checked into - KR.ROBERTS: Would the hon. gentleman permit a question? Would he re-read the phrase be quoted,allegedly by me, from that speech I made. I think he· har misquot~ mlf'. KR.CROSBIE: Here is what the Minister says~ This is a newspaper reporting what the Minister.,said: "If the Newfoundland Medical Association does not move quickly to curb excessive demands by certain doctors,under the Province's Medicare Plan,the Government will have no choice but to take action on their own." This was issued to a private meeting.

The Minister went on, this is another quote further down, now he is talking about doctors incomes,''what is sobering however is that it appears that more than half of the fee-for-service doctors will be paid mor~ than $50,000 this year and more than a tenth of tbe fee-for­ service doctors will be paid more than $90,000 this year." Mr. Roberts ~ . said; he had no intention of making public the amount paid to any individual doctor under Medicare but the overall figures will undoubt­ edly will be released." KR.ROBERTS: What is the hon. gentleman quoting, will he table it?

MR.CROSBIE: •Evening TelegramtMarch 22, 1971, MR.ROBERTS: Because I have bo'th the speech and I have the"Globe and Mail" you know, that is not what I said. MR.CROSBIE: Then the Minister says:"such facts as the fact that there will be at least eight or ten doctors earning more than $100,000 this year are not conducive to calm,rational debate in a province, many communities,all the people who yet do not earn $100,000 a year." I could go on but I do not need to - MR..ROBERTS:Who said that? It is a good speech.

MR.CROSBIE: I am not saying whether it is good or bad,I am just - MR..lt6B!R~8: I did not say doctors demand - that is the point. MR.CROSBIE: Mr. Speaker, I would like to speak uninterruptedly.

May 3 1971 Tape 423 P~B• 1. MR.ROBERTS: Mr. Speaker. then,to a Point of Order. MR.SPEAKER: Order please.If an hon. member rises to speak and addresses his remarks to another hon. member of the House, it is very difficult for the Speaker to know just what the attitude of the hon. member is. If hon. members will address themselves to Mr. Speaker it will be much easier for Mr. Speaker to maint~in order. MR.CROSBIE: Mr. Speaker, I thought that is what I was doing.I am not addressing myself to the Minister of Health.I am addressing myself to this House.

I do not want to be interrupted,1n particula4 it is not a partisan matter,we are discussing Medicare. What I say is that in the Minister's speech of January he gives the impression that there is widespread abuse under the Medicare Plan. The facts he presented to the House today show the contrary, that there are two doctors being investigated by the R.C.M.P. in connection with alleged fraudulent claims. Now, the minister's amendments are designed to discourage fraudulent claims and other claims of that nature, That is what this legislation is to deal with.

So, what I would like clarified is just how widespread is the alleged abuse of the plan. The Minister says there were 137 doctors -investigated last year. Let us have some facts on that, ~e know there are two being looked into for criminal charges. What were the kinds of abuses of the other doctors? Would these be an innocent type of mistake or what kind of mistakes are theyJ What is the evil whir.h these amend­ ments are supposed to correct? What is the point.

Now, when the Minister talks about the excessive demands by doctors,! do not see there being any excessive demands by doctors.If the pattents are there and need to be treated and the doctor treats them,then I do not see that there is excessive demands by doctors; there is an excessive demand by patients in Newfoundland. There are a great many more patients per do~tor in Newfoundland than there3re in any other province. 2195

May 3, 1971 Tape 423 page a. So the large income of doctors in Newfoundland,if that is the case,is not caused by the excessive demands of those doctors it is caused by the excessive demands of the~patients,the large number of patients they have to treat and the rest of it. So when the Minister warns the doctors against excessive demands by doctors,under Medicare,to my mind he is not being fair. Now, if he warned the doctors against abuse or some kind of abuses that some doctors are perpetrating under Medicare, and that this is going to be corrected and theee will be prosecutions if these people are caught. Good!

Well and ioodt As I see it,Mr. Speaker, there are not any excessive demands by doctors under Medicare Now, the Minister has entered into an arrangement with the doctors of Newfoundland.which seems to be sensible, whether it will-work out in practise or not remains to be seen, where they have agreed to certain ceilings on their income. In other words a general practitioner will agree that he gets paid 2196

May 3, 1971 Tape 424 PK - 1 MR. CROSBIE: his ninety percent of the fee

schedule up to, I think, it is up to $i500 a month. That if he sees more patients than $4~00 in one month that he then pays for the excess of over $~00 on a sliding scale, less than ninety percent of the fee

schedule 1 It goes doim. I do not know how it goes down, but it goes down in proportion, and the interim rises for that particular month. Now that appears to be a reasonable compromise, How it will work or how it will._not work, I do not know. But there is this about it, Mr. Speaker, that as long as we have a large number of people for a doctor in this Province,there is a danger that the minister's sliding scale and the minister's ceiling is going to result in people being undoctored.

Because if a G.P. ,a General Practioner, sees - I do not know, say he sees ' 600 patients in three weeks and he~- gone beyond his $4500, there is nothing to stop that doctor stopping practice for the next week, take the next week o~ fishin,. Why work for the fourth week, when he is going to be p.aid on the declining scale. why not just take that week off. Now there is also a provision that if a doctor misses a month that this can be averaged, if he goes on vacation for a month that he . can use that allat.rance of $4,500 on rreceding and proceedinP months, which is a wise thing.

But,although these amendments are ,oing to curb doctors' incomes, Mr. Speaker. there is a grave danger that they are also ·going to curb doctors' services. After all, when you consider income tax and these fi~ures are only gross,by the way. lonten the Medicare figures show that a doctor receives $60,000, as the minister has pointed out,quite rightly, that is gross to the doctor. He has his office expenses, and the average doctor has his office expenses,at least twenty percent of his ~ross income.

Secretary, office rent, equip111ent, typinp and all the rest of it, amounts to at least twenty percent, so from $60,000 you can deduct one-fifth, Sl2,000, That means a doctor might be makin~ $4R,OOO. Then, Mr, Speaker, he has to pay, he is then in the fifty percent tax bracket at $48,000 net. or fifty-five percent tax bracket, 2197

May 3, 1971 Tape 424 PK - 2 AN HON. MEMBER: Inaudible. "'1l. CROSBIE: Listen to that silly twittery, ptarmigan. So, Mr. Speaker, he then is paying fifty percent, fifty-five percent of an income tax. What is there to encourage a doctor·to continue providing a service, if he is going to reduce income. when he gets over a certain amount, in addition to which he has to pay income tax. All of this combined may result in doctors working a lot less during the year, because there is not enough incentive left for them to work.

Now whether the hon. the Premier wants a handkerchief to sniffle about that or not, it is a serious problem. :MR. SMALLWOOD: He gets $4.000 a month and has to pay income tax? MR. CROSBIE: Not that he has to pay income tax, I am pointing out, Mr. Speaker, that the doctor may very well decide that, when he makes $30,000 or $40,000 he is going to practice no more, that the other two or three months of the year he will take off and go south like other people do, or get a condominium somewhere, like other people do, and that he will not be here in Newfoundland to look after the patients here in Newfoundland.

That is the problem that I am pointing out, not that the doctors have to pay income tax. Can,-you1 can discuss anythin,z seriously here without a lot of tripe. MR. CALLAHAN: We are hearing some tripe from over there. MR. CROSBIE: We are hearing no trife. We are hearing a problem that the minister has to deal with and he well knows he has to deal with it. MR. CALLAHAN: The minister will deal with . it·. :MR.

CROSBIE: And if his ceiling on income and the rest of it are too rigid, it will mean that the people in Newfoundland will not be able to get doctor servicesp they will all take off two or three months a year. ~fR. R~BF.RTS: Pay them all $150,000 a year. MR. CROSBIE: I am not sayin~ pay them all $150,000 a year. What. what a tribe? What a bunch? You cannot discuss any serious problem in this House without that kind of blarney, Pay the doctors a $150,000,_yes, give them all a lease, A liquor store lease. 2198 MR. ROBEF.TS: Proper thing.

May 3, 1971 Tape 424 PK - 3 MR. CROSBIE: To help them out that way, like other people are being helped out in this Province. So that is a problem, Mr. Speaker, that the minister has to deal with. And all of these scales and so on have to be carefully weighed with that in view. The minister want~ doctors here in Newfoundland,number one, he wants the people who need to see a doctor servicei If the doctors are treated too rou~hly, the people here,who need medical attention,are not ~oing to be serviced. That is a simple answer.

So, what I say the problem is; is not the excess of demands of doctors tmder Medicare, but the fact that there is an excessive number of patients for the doctors of Newfotmdland to see. And that the Government are not . careful, if the Government are not careful, so that the atmosphere in Newfotmdland is conductive to doctors, we will find we have got declining numbers of doctors, and that has to be kept in mind also. MR. SMALL~TOOD: If Newfoundland is going to be a~ forecast here,just double the number of doctors. MR. CROSBIE: Oh, sure, the Premier is going to double the number of doctors.

It is so easy to get doctors for Newfotmdland. He is going to double the number of doctors, that is excellent. That is wonderful. So I mention that, Mr. Speaker, MR. SMALLWOOD: Give then $100,000 a year, and half the year in Flordia and double the number of doctors. MR. CROSBIE: Double the number of doctors. He is going to pull them out of the hat now. The hon. the Premier is going to pull doctors out of the hat. MR. SMALLWOOD: We got fifty a year for the last two years. ~- CFOSBIF.: Right by the ears out of the hat. The doctors can make this kind of pay in other provinces. MR. ROBERTS: Nonsense! Now come on! MR.

CROSBIE: And they can make it in the United States of America. MR, ROBERTS: Maybe in the United States. MR. CROSBIE: And they can make it elsewhere. 2199

May 3, 1971 Tape 424 PK - 4 MR. ROBERTS: Nonaencal The doctors are the highest paid in Canada, MR. CROSBIE: And do you not fool yourself about that. Because the doctors are the highest paid in Canada, if they are on the average, MR. ROBERTS: They are. "1R. CROSBIE: they are doing more work and have more patients to see than the doctors in other parts of Canada. MR. ROBF.RTS: Inaudible. 'MF. CROSBIE: So, as I say, Mr, Speaker, . 'HR. ROBERTS: Inaudible, "1R.. SPEAKER: Order, please! MR. CROSBIE: The tiinister's speech, Mr.

Speaker, gave a false impression, and the minister's speech today gave a false impression, There are two doctors in Newfoundland who are being investigated for fraudulence claims~ that is what the minister says. And that is what these amendments are all about. Now the minister says that he is going to amend the definition of insured services, so that, if there is any improper or inadequate treatment, it will not be considered an insured service. Well, to my mind, Mr.

Speaker, that is giving the minister and the Commission a very large whip indeed over the doctors of this Province, to decide in each individual case whether a doctor is giving a proper or adequate service. A doctor sees the patient and send him a bill. Is the Commission going to go back to him and say, '"look, you did not give John Jones adequate service or you did not give him proper treatment and we are not going to pay your bill.'' That is what the minister is suggesting with this amendment. Has the Newfoundland Medical Association agreed to that1 Yes, they have agreed to that. MR. ROBERTS: Y.E S. MR.

CROSBIE: Who is deciding whether they have given adequate or proper treatment? 1-'R, ROBF.RTS: That is what the Act is all about. MR, CROSBIE: That is not what the Act is all about. MR. ROBERTS: It is what the Act is all about. 2200

1-'ay 3, 1971 Tape 424 PK - 5 MR. CROSBIE· Who decides in the first case? Who decides in the first case whether this doctor has given adequate or proper treatment? We know that the Commission can write a doctor, and he can appeal and the rest of it, but, who decides in the first instance whether his treatment is adequate or proper? The Minister? HR. ROBERTS: The officials of the Commission. MR. CROSBIE: The officials of the Conmission. Which officials of the Commission? MR.ROBERTS:: Well, I su~pose Art Knowling, I do not know who handles these down there. MR.

CROSBIE: I mean is it to be a doctor in the Commission, that is what I am asking. Is it to be some layman in the Newfoundland Medicare Commission who is going to decide whether a doctor gave adequate or proper treatment? MR. ROBERTS: Sure. And some of the things we itot., bloody well any layman could do it. MR. CROSBIE: There is the Minister of Health. There is the Minister of Health. MR. ROBERTS: Yes, tell me about psychiatrist. MR. CROSBIE: That is a kind of slander on the medical profession. MR.

CROSBIE: Tell me about the psychiatrist who billed for eighty-seven consultations in a four hour period, and tell me a layman could not decide on that. ?4. CROSBIE: The minister should tell us about that. I cannot tell the House about that, the minister can tell the House about it. MR. RORERTS: I can. MR. CROSBIE: If a psychiatrist had made eighty-seven consultations in four hours then he should be prosecuted. ~. ROBF.RT~: Why? There is nothin~ illegal about it. MR. CROSBIE: Why do the minister not tell the House about it. MR. ROB~RTS· Nothing illegal. under what power prosecute? 2201

May 3, 1971 Tape 424 PK - 6 MR. CROSBIE: But now the minister and the Premier are trying to imply, the Premier's comment there just iJD1'lies, that they are all guilty. His heart is bleeding for the doctors, when someone · makes eighty-seven consultations in four hours. 1"R. S'MALLWOOD: Inaudible. MR. ROBERTS~ He needs a doctor. MR. SMAE'tWOOD: I need a doctor? MR. CROSBIE: He needs a psychiatrist. The hon. the Premier needs two. That is what he needs. So some official, Mr.

Speaker, is going to be deciding some functionary.according to the minister, who might not be a doctor, and the Medicare Commission is going to decide whether a doctor gave proper and adequate treatment, when he sends in a bill. ~ell,that is certainly not proper or right. The powers given in this Bill, which,if there are satisfactory explanations, I am not saying I am going to vote against, are certain wide-reaching powers.

Section 39(a)(

l) where the Commission has reasonable cause to believe that the pattern of practice of a physician constitutes a si81lificant deviation from the accepted pattern of practice adopted by a physician, and it is not in the best interest of a beneficiary, that is an offence. "Or is in conflict with the proper ad111inistration of this Act." Now what does that phrase mean? The Commission can decide whether the pattern of practice of a physician aonstitutes a significant deviation from the accepted ~at terr of practice adopted by physician practising in the Province. Yes, he can see how they can do that.

And they can decide such deviations not in the best interest of the beneficiary. I could see how they could decide that. Or is in conflict with the proper administration of this Act. That is a different quintal of fish. 1-lhat is this? that the doctor has a pattern of practice that conflicts with the proper administration of the Act? What kind of nonsense is that? Either he has a pattern of practice that is a deviation from what other physicians here do, which might be an offence, properly so, or not, but to 5ay that he has a pattern of practice 2202

May 3, 1971 Tape 424 PK - 7 MR, CROSBIF.: that is in conflict with the proper administration of the Medicare Act, what is that? Does that mean that some functionary in the Medicare Commission decides that this doctor is just not practicing, he is in conflict ~dth the proper administration of the Act, he has conunitted an offence? That is far too sweeping. The minister is not interested anyway whether these are too far sweeping or might be chan~ed or not, I gather. Under the le~islation - l'R, ROBERTS: Inaudible. MR, CROSBIF.: Yes, in committee.

Under the legislation the physician concerned can appeal,to whom To a committee of the COtlllllission. In other words, the Appeal Board is going to be a committee of the Medicare Cormnission,apparently. And when it says a committee of a Co111111ission, does this mean that an Appeal Committee are to be members of the Commission or employees of the Commission or what? •Who is a coI11111ittee of the Commission, consisting of not more than three persons.~ I would like to hear more than that. MR.

ROBERTS: The Commission is defined in the Act. ~- CROSBIE: In other words, this C0tn111ittee then is to be three members of the Medicare Commission? MR. ROBERTS: Right. MR. CROSBIE: This is peculiar then, ~r. Speaker. Here is a Medicare Co11111tission which has written the physician saying;your pattern of practice deviates, you are in violation of the Act,and then the Commission receives an appeal from him, He disagrees. There is an appeal. He wants a hearing, and who sits on the hearing?

The three members of the Medicare Commission that wrote him in the first place and said that he has committed an offence under the Act. Surely, there should be some better appeal ~oard than that. There should be an independent appeal board. MR, ROBERTS: There is. MR. CP.OSBIE: If the board is a committee of the COl!ltnission, it is not an 2203

May 3, 1971 Tape 424 PK - 8 MR. CROSBIE: independent appeal board. MR. ROBERTS: The Co111111ission makes the determination, then there is an appeal to the Supreme Court on any matter, fact, law,mixed fact and law. ~CROSBIE: Never mind the Supreme Court, First there is an administrative board. MR. ROBERTS: If he does not like it, I do, MR. CROSBIE: A Committee of the Conmdaaion is the first appeal. MR. ROBERTS: Makes the determination. MR, CROSBIE: So the first appeal - MR.

ROBERTS: There is no appeal• MR, CROSBIE: So the first appeal is heard and determined by an interested party who has charged the doctor with an offence. Now that is not ritht. MR. ROBERTS: Nonsense, MR. CROSBIE: Then the sub-COD111ittee makes a report to the C011111ission. Then, after the hearing, and,by the way,after the hearing. but before the Committee of the Commission, they can withhold from'the physician all or part of the monies which he clai'IIIS to be owing and so on, in the meantime tha~ can all be done. They can eat~te and impose a penalty on them.

They can deem him not to be a participating physician for purposes of the Act. They serve the order on him, then after he gets an order and has agreed, he can in sixty days appeal . to a judge of the Supreme Court of Newfoundl·and, by serving a copy of a 110tice of appeal. How thank heavens the minister has got that in there, that is some kind of a safeguard. B~, Mr. Speaker, that does not gainsay the fact that the original appeal committee• and why should a doctor be forced ._to go on to the Supreme Court on an appeal to get justice?

It would be much better for the doctors, if this could be settled by the Medicare Committee. It does not have the publicity and so on, that an appeal to the Supreme Court will have. So I feel that it is wrong in principle for this appeal to a three metnb~r Co11111ittee of the Medicare Commission. It should be to a board comprised of three members, one suggested by N.M.A., one sugFested by the ~edicare Commission and one agreed upon by them or appointed by the:.:.minister, some 2204

May 3, 1971 Tape 424 PK - 9 MR. CROSBIE: impartial Chairma11. There ehould be an independent board for that appeal. Now we had the Medicare COll!llliHicm Report, by the way,

Section 39 is something the minil!lt.er should think about, 39(c). That the physician has to aer,e his notice of appeal on the '111:ltdeter and on the Chairman of the Coadssion. Now the Chairman• of the COllll!lisaion is part-time. 2205

May 3, 1971 Tape ·no. 425 Page 1 Mr. Crosbie That gentleman may or may not be in Newfoundland. He might be off for thirty days or sixty days going somewhere. Obviously, Mr. Speaker, the copy of the appeal should be served on the executive-manager or on some official who is going to be a~ailable to have it served on them. Sixty days could go and the man vould be unable to find the Chai~ of the Medicare Comnissian to serve his notice of appeal on. So that should be changed. It should say: "served at the offices of the Medicare Commission," see or some wording like that.

The figures that we~in the Medicare Commission laport were for 1969. I ~eel that there are questions asked that ask for more up-to-date. figures on medicare for the year 1970. The figures should be available now to show what incomes were during 1970,under the different categories. MR. ROBERTS: They are not available yet. MR. CROSBIE: They are not available yet. Mil. ROBERTS: It will be a few days or a couple of weeks. Ml. CROSBIE: Now, Mr. Speaker, there is another point in this. The llinister. ays at the end of Hay they are going to be negotiated with on their fee schedule.

In other words, and t · agree that the present fee

schedule in this Province and in moat of the provinces was drafted in Che day before medicare. It was drafted to suit a situation where the individual patient paid or did not pay the doctor. Now that doctors are all paid by the Medicare Condssion ninety per cent of ·the fee they charge, then obvioualy it is time to revise this fee schedule,in ligh~ of that fact, which the minister says is going to be done. I would like to know if those negotiations have started yet? MR. ROBERTS:No. ~CROSBIE: Does the departmant er the Medicare CCNlllllission have a Qgg,asted new fee scheduler 2206

May 3. 1971 Tape no. 425 Page 2 MR. ROBERTS: Yea. MR. CROSBIE: They do. How does· the Medical Association view the-changes auggeated in Section (6) of thia amendment, where there can be varying rates for different classes of phyeicians or for the same class of physicians in different circuaatances or locations. That certainly gives qui~e a wide discretion that a doctor can be .paid at a different rate. d~pnding on where he lives and what ~ia location is or because of different circumstances. It seeu to me quite a sweeping discretion to give the minister or the •dicare commission.

What repreaentations have been received from the N.M.A. on that point? Nov. Mr. Speaker. I think that the doctors of Newfoundland are doing well under medicare. 1 think that they are doing well by the Province of Newfotm.dland Ullder medicare. I agree tha~ it is quite easy for a politician, when he can point to a small group like doctors,to try to turn the public against them by saying that there are doctors making $100.000 or $90,000. $80,000 or $60,000. It is easy and cheap to do tha.t. What bu to be remembered first, Mr. Speaker •• MR. SMALLWOOD: It is not cheap. MR.

CROSBIE: What has to be remembered first is that the doctors of Newfoundland or in any other Province did not invite medicare. They did not invite medicare. The Government enacted medicare. I favour 111edicare. It is governments or legislaturers that have enacted medicare. It is not that doctors have asked for it. So, if doctors are making high incomes under medicare and doin1 it legitimately and ninety-nine per cent are not submitting fraudulent claims. they are not to be blamed ,to my view, if they make high incomes.

It 1a the Government that made it possible for them. the Legislature.to make those high incomes. I do not think any cheap advantage should be ·taken of them. The hon. the Premier sneers about the incomes they are making and the rest of it. The doctors that are making those high incomes, if they are not submitting fraudulent claims, which most of them. are not, are working .va~, 'l&r1 bard for it. Aa I heard the minister 2207

May 3, 1971 'Iape no. 42) rage: J Hr. Crosbie hi•elf on the analysis progranme a ,ew weeks ago talking about that. The minister said that there was a general practioner making in excess of $100,000. The minister said that he was working eighteen hours a day. Re will go out any time of the day or night, whenever he is called. So that G. P. is making $100,000. So he deserves to make $100,000 a year, because he is doing the work.

The point is that if the man is prepared to work like a horse, like that, if he will go when anyone calls him, if he will go to the Blackhead Road, when they call him to the Blackhead Road or wherever •• MR. SMALLWOOD: Does the hon. gentleman lose his patience,lose his patience at the eighteenth hour of the day? MR • CROSBIE: If he is doing the work, then the Government can hardly I \ point their finger at him and say what a racket the doctors are making out of medicare • . That is cheap insinuation. Now "ti aps he should be discouraged from working over ten or twelve hours.

Is it the aim of the Government to eventually put them \ all under rigid control as to how many hours they can work and what income they can make? ls that what the Government are aiming for? I would not think so. I would think that there has to be a reasonable compromise. I do not think you would find that doctors will accept the Government telling them how many hours a day they can work, Mr. Speaker, which is what the hon. Bremier suggrsts.he would like to see happen. So, I would like to hear the minister answer some of these points, Mr. Speaker, I think that there are controls needed.

I feel that there are some deficiencies in the legislation that we have before us now which can be dealt with, if the Government agree in colllllittee. So, therefore, I will not vote against the Bill at this point. I want to see whether the minister is open to considering a few minor changes, that is minor in the sense of wording that could improve this Bill. MI said, when I started, I think medicare 1aas worked well in this 2208

May 3, 1971 Tape no. 425 Page 4 Mr. Crosbie Province, Mr. Speaker. There are improvements to be made.- There are a few who have taken advantage of it that have to be checked. That 1a why the amendments are needed. But as to pointing the finger at them and trying to make them the fall guys and s~ying that the doctors are really, you know. lashing this scheme and making it appear as though they demanded it and that they are now taking advantage of it, is wrong. The minister has not done that previously when I have seen him on television and so on.

No, but one of his colleagues, the hon. the Premier tried to give that impression. So. Mr. Speaker, I would like to hear some of the answers to those queations. MR. HICKMAN: Mr. Speaker, if I may_hsve just one or two words. I do not propose to review what the other hon. members have talked about.

The question of income of doctors ~ractiGing , in this Province is a two-edge sword, I submit, and one p1:0blem- I am sure that the hon. the llinister ia aware of and a problem that could become of serious proportions unless more benefits are made available to these particular doctors, is the effect or the difficulty in retaining doctors in the areas of Newfoundland where they are most needed. In that reapect, I refer particulady to the district medical officers and to the cottage hospital doctors.

True it is that with medicare there h.1111 been an improvement in the number of doctors staying in Newfoundland and the number of doctors coming to Newfoundland. That 1 I think madicare was the pri• nuc,p for it, but I do suggest that a change in recruiting methods also contributed to that as well. But whatever the reason is, the - AN HON. MEMBER: (Inaudible) MR.. HICKMAN: That could very well be but the recruiting method was changed under a previoua minister. The cottage hospital doctors, in my opitJbn, and 2209

May 3. 1971 Tape no. 425 Page 5 Mr. Hickman the district medical officers are the 1110st over-worked members of the medical profession. I saw a study, and I am sure that hon. minister has read it. It was prepared prior to this Province entering medicare. It shoved that if the cottage hospital doctors elected to go on a fee-for-service basis that a fair number of them would make close to $100,000 a year. Now, Mr. Speaker, that is a fa~ cry from a doctor staggering at 11 p.m. tnto somebody's house for the purpose of picking up another fee. Because here is what is happening, Mr.

Speaker, in the cottage hospitals and district medical offices in this Province: When the doctor appears in his surgery, he has got a line-up stretching outside the hospital. Now what can he dol True it is that come 6 p.m. or 7 p.m. or 8 p.m., he can get up and say, "Ladies and gentlemen, I will see you tomorrow. I am on• salary. I am going to work the hours prescribed or suggested or the hours that I feel are adequate for me for the income I get.• But instead of that most of these doctors are staying at their posts.

But, you cannot expect a doctor to go into a cottage hospital, work seven days a week. and try and perform the quality of medicine that 1971 dictates should be given, if it means that he gets six hours at home at night and he is subject to call during the evening, if it means that he gets two weeks vacation a year or three weeks vacation a year and that is all he gets. His fad.ly will not put up with it.

I suspect that one of the real reasons why we have so few doctors,and Newfoundland doctors at that,staying in the cottage hospital system is because their families are insisting that the doctors spend more time at home. This he knows he can do, if he moves to St. John's or Comer Brook or Grand Falls or Gander and go on a fee-for.service basis. Now the salaries that are being paid to cottage hospital doctors are pretty good. They are good compared to what they were making in the past. They are not good compared to what the men on fee-for-service are making. I suggest, Mr.

Speaker, that it is the cottage hospital doctors who are really , carrying the load and this is where the real crunch is going to come. 2210

Kay' l, 1971 Tape no. 425 Page 6 Mr. Hickman One cottage hospital doctor was kind enough to let me read a brief which he submitted recently to the hon. the minister. It is a good brief. It ee~s forth very clearly the problems that cottage hospital doctors are facing. Now many cottage hospital doctors come back from medical school under the Government's scheme. They regard it as an area where the apprenticeship is good, where you get a broad general practice for a couple of years and then they go on and they do post-graduate work. But, Mr.

Speaker, some of them ' would like to make a career of practicing in rural Newfoundland. They would like to make a career of practicing in the cottage hospitals. But if they are not going to do that, if the work load is so heavy that they just cannot possibly handle it, and this is happening. It has to affect patient care. There is no question about that. You cannot have a doctor in Stephenville or Grand Bank working from 7a.m. until 12 at night, night after night after night without it affecting not only patient care but his health and obviously he is not going to stay.

Now what is the answer? - Obviously, you cannot pull fifty doctors out of a hat if you need them. The medical school will help produce, hopefully. more doctors. But I believe, Mr. Speaker, that this is where the Federal Government let the provinces down very, very badly when medicare first came on the scene.

When the Hall Commission Report recommended universal medical care throughout Canada, it had to know, in -fact, it knew and it found that in a country where there was already a dangerously high patient-doctor ratio that this was bound to get worst not becauae - I do not particularly agree with what the hon. member for St. John's West says when he suggests that there has been patient abuse. I do not think there has been any real patient abuse of medicare.

I think a lot of people who should have gone to see doctors, who should have received medical attention, postponed going there, because they simply could not afford it. Now that they can afford it, they are going. But whatever the reasbn is, '·there is no .question at all that the work load on the doctor no matter : 22:l1

May 31 1971 'l'ape no. 425 Page 7 Hr. Bickman how generous he is, no matter how charitable he is, the work loat has increased. It has increased tremendously. I am subject to correction by the minister on this, but I believe that our doctor/patient ratio in this Province is still the highest of any Canadian provinces, particularly the district and Mdical cottage hospitals. Now salary obviously ia not the only answer. 'l'here has to be an increase in the number of doctors going into the cottage hospitals and hopefully the retention of doctors in that particular branch of medicine must increase.

If they want sabbatical leave, then I believe they are entitled to have that kind of leave. Maybe the medical school at the University will improve the situation if doctors can get back and forth to the medical school to do certain post-graduate studies and to listen to certain papers presented by experts in their field. The other possible solution is one that was recently mentioned by the hon. the Minister of Public Health and Welfare, Hr. Monroe.

He, now. is instituting and I believe this i~ being done with the approbation. of the medical profession, a pretty intensive study into the type of practice that is being carried on by medical doctors throughout Canada. Because obviously it is a waste of a doctor's time to treat a person for coughs and colds. Yet at this time if a person anywhere in Newfoundland feel that he or she is suffering from a cough or a cold that is worrying or discouraging to them. they have to call a doctor.

Any nurse, any para-medical worker properly trained could do that work and free the doctor to practice a more sophisticated form of medicine. Now these are problems and the hon. minister is aware of them u I am. But I think that these things have to be taken into consideration when you deal withl the quality or practice, the type of practice that a doctor is carrying on. If you have over-worked doctors,in t~is Province, then obviously the standard that you impose and the degree of scrutiny that you impose must be in the light of that type of burden that they are carrying.

There is no question about it, they are carrying it, Hr. Speaker one other 911&11 suggestion and I have no doubt at all that the medicare people or the minister thoudit of it 2212

April 29, 1971, Tape 426, Page 1 -- apb MR. HICKMAN: There i  a question that baa been asked of me by many people who have seen doctors since Medicare came in. There is a suggestion to maybe keep better control. When we went into Medicare every Newfoundlander was i sued a charge plate, it looks exactly like a charge plate. It is the same ·size and they have their number. Now as I understand it, if I go to a doctor today his secretary will ask • to produce my card and she copies down the number and my name and I leave.

The suggestion that I have heard from uny quarters is that each doctor, each participating physician,should have in his office the same sort of thing that you find in the service station. That when I go iA, that little charger plate is put ::.into the machine, pulled across, the secretary writes on it the reason for my visit and I sign it. What the doctor charges is no concern of mine, but at least the Medicare Coaaiasion or the computer when it picks it up, they know - well house calla may be a problem, but at leut ••• MR.. ROBERTS"l ?fit,: BICKMAN:_ AN RON. MEMBER: enters? MR..

HICKMAN: That is two-thirds of the service. There still should be some signing by the patient. Would it not be better when he is leaving not when he Well either way. I do not care if it is when he is leaving or when - sometime, when the visit is o-.klr'or when the work is being performed, there should be a place where the patient signa. This then is proof positive to the computer and to the Medicare Commission that the aervices have been rendered. MR.. ROBERTS: MR. BICI<MAN: Proof positive that a service has been done, there a~e 5,000 ••.

Oh I realize that, I realize that there is no way that you can - that if I sign, or even if it is put in medical terms, I may not know whether that is the service that wu rendered to me or not. MRl..ROBE_!tTS: If a doctor is going to cheat, all he is going to do is see you for a five dollar item and put in a fifty dollar item and you are no wiser. So it does not stop cheating,as I see it. 2213

May 3, 19711 TApe 426, Pa~e 2 - apb MR. HICICHAN: I am only passing on a suggestion that is coming from the general public. you know. MR. ROBERTS: It 1 not a new one. MR. HlCI<MAN: I cannot ee anything wrong with it. ~-·...!.O~_Tii.!.. I can, I will explain it. MR. BICKMAN: Oh, there may be administrative problems. but not that many. ~- ROBERTS.!_ Enter two million claims a year by hand. ~ICKMAN2_ No, not tvo million claims, but they still go through the computer, they still go through the computer. MR. ROBERTS: What does the computer do'l MR.

HICKMAN: The computer authorizes the payments and my understanding is that if there has been in the opinion of the computer too many claims emanating from one doctor, the computer will spit back the claims, then the claims manager at the !-'edicare Commission will review them. When-.. he 1a reviewing them, if he sees that John Jones has signed that receipt, he knawa at least that the doctor visited John Jones or alternatively John Jones visited the doctor's surgery.

That is out of the way, he may then have to go on and ask whether the standard or pattern of practice is one which indicates that the doctor should be paid for the number of claims that he ls ·seeking. Mr. Speaker, 1n conlcusion, I see nothing wrong with this Bill except that it should be made abundantly clear to the medical profession that this Bill is not designed to invade their pattern of practice. Because, whether you ca~ arouse sympathy or not for the income of the doctor, it is really not relevant. This Province above all Provinces cannot afford to lose the good will of the medical profession .

The only Province that ever lost the good will of the medical profession was the Province of Sasketchewan under the N.D.P.Goverrur.ent,aud immediately thereafter they paid the price of it. MR. ROBERTS: Quebec had some trouble laat fall. 2214

Hay 3, 1971, Tape 426, Page 3 --·apb Quebec, well we will see what the results of Quebec's lo•• of favour was. We cannot afford to lose the good will of the doctor. Whether the doctor can make less in Nova Scotia, or whether he can make more in Ontario, it is really not that relevant. The relevant thing is• that any qualified doctor today,who is prepared to put in ten or twelve hours work,can make a D10re than satisfactory living, and if we lose their good will they will make it in other places~ Mr.

Speaker, this as I see it is the one thing in that Bill that I think is incumbent on the minister to make abundantly clear,that the pattern of practice of medicine is not going to be interfered with by Governments nor lay commissions nor any one else. MR. SPEAKER: If the hon. minister speaks now he closes the debate. MR. ROBERTS: Mr. Speaker, I will try to conclude by one o'clock so we can dispose of the item one way or another, but I do want to try to deal with some of the points raised by the hon. gentlemen opposite. Pirst,with reference to the points made by the hon. 'ltember for Burin.

I think moat of what he said made good sense. I am not so sure that - let me touch juat very briefly on two points he made, or three. First of all the cottage hospital doctors, I aa not so sure that is relevant to the Bill, but, what he says -is correct and this is where the real attention should be paid, and where it is being paid. The letter from Dr. Patey at Grand Bank, who is one of the best men we have in the cottage hospital aervice, and that means he is one of the best among a great number of very good men ,ha• some good suggestions in it.

I understand that it is to be published in the Medical Association, they have a little news letter that comes around. I think the November 1969 one has just come out. They are a long way behind, but it is to be published ~n that. The bit about signing 1Mr. Speaker, signing for ones services i  a suggestion that has been put up a number of times. I have looked at it a number of timea, but it never aeema to make any sense. If it is merely to certify that a doctor saw a - the only thing it could do,Sir, :1a that a doctor saw a patient, and anybody who th:lnka for a minute would 2215

Kay 3, 1971, Tape 426, Page 4 -- apb realize that the couple of thousand ite1111 in the fee schedule, and there are a couple of thousand items in the fee schedule,Sir; the average patient does not know whether the doctor is charging them correctly or not, especially when you realize that on the forms that are used the service is not written out, there is a c:ode number. Now, the only thing that could indicate is that the doctor ••• AN HON. MEMBER: (Inaudible) MR. ROBER'IS: If the facts are as I have them that is straight criminal. That is not a matter of anything else. We found out about that.

TI1e interesting thing is, ~x. Speaker, that the only thing it could prove is that the doctor actually saw a patient. Now we wou1d have to find a way around the business of house calls,which is a very significant part of the work-load. I do not have ready figures, but it might be as much as half of the work-load under Medicare. Half of the services are house calls. Also we would have to find a way around the problem of what happens when a person forgets his card or loses it. I do not know about every member, every person in this Province,Mr. Speaker, but I do not carry my Medicare card with me.

Occasionally when I go down to see a doctor I find that I have forgotten to br~~~ .it away with me. I have had occasion ••• MR. CURTIS: (Inaudible) !f!l· ROBE,!l_JS:_ Yes, and as my colleague says, the gentleman has my number and the secretary fills it in. 'What we do instead, we do two things, using the modern methods,and these are the modern management methods,Mr. Speaker, not anything we have dreamt up. They.are not unique to Newfoundland. First of all we spot-check. We send out notices, .,_son:.e hon. members may have FOtten them or hon. members may know of people who has them.

Dear, so and so, the doctor says you saw him on such ans such a date, did you? Please check and send back in the stamp~d self-addressed envelope. We ~et a fair number of them back and in most cases the doctors are honest. One of the cases to which I referred as being possibly fradulent involved that sort of situation. I ay say, we checked it out and it ill almost impossible to 2216

May 3, 1971, Tape 426, Page 5 -- apb prove one way or the other, because the doctor says he did see the person and the person concerned said, "well, I am not so sure." There are cases you run into~Mr. Speaker, where a person sees the doctor six times in ten days, and these are usually house calls. The other problem with them~the other thing we do,Mr. Speaker, ia when a doctor's pattern of practice is significantly different one asks questions. One wants to know why. Why there are people in this Province who ~ave seen the doctor two hundred times in the past two years, why? It is most unusual,but why?

Every person who sees a doctor more than thirty­ nine times in a year the computer picks them out,the way it is now programmed. In 999 out of every 1,000 cases 1 perfectly straightforward. The person has a bad illness and is in hospital _ the person has a continuing condition. I have a problem with my eyes and I see a doctor maybe once every two or three months. You know, many people have continuing conditions that require continuous visits to doctors. AN HON. MEMBER: --------·-- (Inaudible) MR.

ROBERTS: I cannot reveal details of whether the hon. gentleman on the far left has seen people or not, no • • Let me ftow, ~eal Mr. Speaker, briefly with the hon. gentle~an from Fortune •••• Ho! ho! ho! ho! HR. ROBERTS: I do not think the hon. member from Fortune is a laughing matter, but if the hon. member for St. John's West does, then I will defend the hon. gentleman from Fortune. He needs help, but I will defend him. He asked about the net cost of ~..edicare and he is quite correct. He has just forgotten one point. The grant to Medicare is of the order of $4 million a year and is so recorded in the estimates.

We will come to it in detail when the Connittee on Ways and Means - the Committee on Supply deals with it. We are making money on Medicare because, the amount - making money in the sense that, and this is the only way in which that term was ever used, the contribution we get from Medicare in respect of services 2?17

May 3, 1971, Tape 426, Page 6 -- apb we were already providing. Childrens' Health Plan, the Cottage Hospital Plan. Mr. Speaker, the money we have to pay out under Medicare is less than we get from Ottawa, therefore, we are making money. Now I do not know if the hon. gentleman follows me, let me try an example. In the past, our services would come to say, $4 million for the cottage hospitals, district medical practice and the childrens' health plan. The net cost under ?-~edicare which has replaced those plans is less than $4 million.

In this current year, it will be between three hundred and five hundred thousand dollars. Of course we will not know until the year has ended. In the year just ended, the figures I presently have are that we have made if onewishes to use that term, about $300 thousand on Medicare. I do not know how long that will last. The question of how quickly the costs goes up, because our costs are one half the national average per capita cost. MR. SMALLWOOD (J.R.): The average we expect to make they told us was about $4 millions a year net. MR.

ROBERTS: ---- ~----- Well, you know, we are gettin, $4 million worth of services for the cost of $3.6 million. I was not in the Cabinet a couple of years ago Mr. Speaker, so I .•• AM HON. ?~EMBER:_ (Inaudible) ~- ROB!_RTS~_ Yes, it is three to five hundred thousand, and it is not a net saving. We would have been spending the $4 million anyway, that is the point,Mr. Speaker. 2218

May 3rd, 1971 Tape 427 JM - 1 MR. ROBERTS: It is roughly on, yes. The average cost of Hedica Care across Canada is rising considerably, our per capita cost is very low something of which we ahould not be proud.and for that reason we- are ahead. It is low even though our doctors are far higher and their incomes, this is where the fewer doctors per person works out. Now, Mr. Speaker, let me tum to the points raised by the hon. ~entle­ man from St. John's West and then I will attempt to deal with the points raised by the hon. gentleman from St. John's East. The hon. gentleman from St.

John's West must let me first of all assure him that, he mentioned changes, if there are any changes which would improve the Bill then, of course, the Government are quite prepared to accept them. I think we would have to look very hard at any changes that affected the principles in the Bill because we have talked them through and discussed them and consulted, as I will explain in a minute, but any changes that will improve the wording of any section,within the principles we have adopted, of course we will undertake to have a look at thern.

It might expedite matters if the hon. member could let me have copies of them so I could have them checked with the law officers because,as he will recall from his days in the Government, it is bad practice for a Minister to accept amendments on the floor without checking with the legal advisers to make sure they are properly tied in. I think the hon. member from Burin would concur that that is a - AN HON. MEMBER: (Inaudible). MR..

ROBERTS: Well, I will deal with ophthalmologists simply by saying that under the present Federal-Provincial relationships optometry is not included as a service that can be provided and we have taken the position, we have made representations to Ottawa that it should be included and we have taken the position that when Ottawa will include it,then we will include it and find our balf of the cost. 2219

May 3rd, 1971 Tape 427 JM - 2 MR. HICKMAN: (Inaudible). MR. ROBERTS: The opthalmologists are doctors and accordingly their services are covered. There is an area of service, Mr. Speaker, that both opthalmologists who are the doctors and optometrists who are not medical doctors do provide in common that is the so called refraction, measuring your eyes and it is most unfair. I see an opthalmologist because my problems are far more than just measuring an eye. He measures my eye for glasses, sends the bill to Medica Care, Medica Care quite properly pays it.

The hon. gentleman may wish to go to see an optometrist to have his eyes measured, quite confident and quite in order to have it done but the hon. gentleman must pay the bill himself. It is an anomaly. It is not unique to Newfoundland, I think about seven Provinces have the same thing and the other three they have picked it up and go on with it. MR. HICKMAN: The other problem ia that the optometrists are more inclined to travel around the Province. ~- ROBERTS: Oh, true, true •. MR. HICKMAN: So that that is the only eye care that is available. MR.

ROBERTS: Oh agreed and I have had some long talks with the optometrists. I am a little worried about the fee achedule,which seems to be rather high 1and we have been talking with them about Le~islation,as their present incorporating act is not a very good one and we may be able to bring in a new act this session. Mr. Speaker, the hon. the member for St. John's West,really• I think. his comments fell into two categories. The first was founded, I think, on his misapprehension of the speech which I made to the NMA,at a meeting here in St. John's in January.

Now the speech was largely printed in the 1YGlobe and Mail." I- d:fd not give it to the 11 Globe," I did not cause it to be given, I did not know it was being given,but I know how it was given, I have since discovered. I agree with the hon. gentleman the picture is not a very good oneJbut he might want to ask the 'Evening Telegram "because they supplied the picture to the "Globe 22~0

May 3rd, 1971 Tape 427 JM - 3 MR. ROBERTS: and Mail" not me. But I think he misunderstood or misread the speech, Mr. Speaker. At no point in this speech did I refer- "demands by doctors·." The hon.gentleman seemed to think I did. Apparently there was a report in . ,, the Evening Telegram saying that I did but,if so,the report is not correct. "The Globe and Mail" had a copy of the text of the speech, which I have here I have the' Globe'' cut tin~, and there is no mention -,f "demands•" The whole point of that speech, Mr.

Speaker, the whole point, the only point was that the level of doctors incomes in Newfoundland was gettin~ too high. The doctors themselves recognize this and the proof of that is that we were able to negotiate with the doctors the restraints on earnings, call them proration, call them variable ceilings, call them what one will, Mr. Speaker, they were negotiated and agreed with the NMA. The NMA were not enthusiastic about it, of course not. It will cost some doctors a lot of 1110ney or it could. But, Mr. Speaker, there was no talk of demands by doctors, it was merely the situation that was caused by the fee

schedule which was inappropriate. Fee schedules were not designed for Medica Care plans, they were designed for private insurance plans and as a guidance to private practice medicine where some people made more so other people could pay less or nothing,as the case may be, that is the way they were. Doctors incomes in this Provinceleapec dramatically following Medical Care and the rate of increase was too high in our opinion. So I went to the NMA and I made a speech in June and we had some talks ~hroughout the fall, both myself,on one hand ,and the Commission and then the NMA.

Then it culminated in a meeting where I made the speech referred to, no mention of demands. I made no public reference at the time, I marvelled that the press did not pick it up. There were 150 doctors at that meetinp. in the Grace Hospital and there was no mention of it. I made no statement, I made no reference until I made an announcement in this House that the ne~otiations had been concluded. They were concluded, the NMA agreed. The only connection 2221

May 3rd, 1971 Tape 427 JM - 4 MR. ROBERTS: between that situation and this Bill is ~hat this Bill, as I mentioned, gives us,in the view of our legal advisers,the option to implement that agreement. That is particularily so with reft!rence to the section(6)the hon. gentleman mentioned. If the hon. gentleman reads the section, again . in that light 1 1 think he will see it is designed to implement the agreement we made with the NMA. The NMA have accepted it. All these amendments, Sir, were discussed with them. I know they had their solicitor meet with them and ~o through it.

I had a meeting with representatives of the NMA, the executive_.Dr. Parsons, the President;and Dr. Way, their honourary secretary. Some of my officials had further meetings. I do not know,it it is fair to say that the NMA have agreed to this Legislation but I think it is fair -to say they were consulted and they raised some objections and I think we have met all the fundamental ones and met nearly all the procedural ones. I do not think they are any more happier over this, Mr. Speaker, than the Government are at having to bring this Legislation in. The other points raised by the hon. member for St.

John's West dealt with the procedure to be followed,and I think he is quite wrong, Sir. The procedure, he made a lot of noise, a lot of heavy weather about an appeal to a Commission that was the complainant. Be felt that was wrong. Now, Mr. Speaker, I would agree with him except that is not the way the Act reads. The Act, Sir, provides that if the C011111ission feels that an offence may have been connitted, an offence is defined in Legislation, they will get in touch with the doctor concerned and say, in effect, ''Well, look old man we have some questions.

You are a psychiatrist and you have seen more people than one would normally expect." Bearing in mind the psychiatrists fee scale is tied to time, it is one of the few areas of the fee scale which is specifically tied to time, and that was at the psychiatrists own request when the original fee scale was negotiated,a little over two yeara ago. The hon. gentleman was probably Minister at the time. I do not know if he was involved in the negotiations or not. 2222

Hay 3rd, 1971 Tape 427 JM - 5 MR. ROBERTS: If the psyehiatrist or the medical person in question cannot satisfy the Connissio11of Enquiry. I do not know whether it be made by - I assume it would ~ thro~ -h the medical director • it may well be a clerk who notices it first, If he cannot satisfy it,then the matter is referred. The procedure ia :all spelled out in the Act. It is referred at that stage to the Medical Association for their opinion. It is still a private procedure, we will not be putting notices in the newspaper.

The doctor can request a hearing if he vishe , if the doctor wishes,and if he does not it goes forward. Followin~ the hearing,if one is to be held,and followin~ consultation with the Medical Association or the Dental Association, the CoDlllission make a finding. So there ill no appeal, Mr. Speaker, that is the first findiniz. They say, ''Well, look old man we have heard you out and we are not convinced.

We still think there ill a problem, we still think there is an offence, we still think we should invoke this procedure, these sanctions." so.with the consent of the Minister, they therefore invoke them, they make an order. At that stage, Mr. Speaker, an appeal may be taken, an appeal may be taken quickly to the Supreme Court, to a judge in the Supreme Court,and I know of no better place for an appeal to lie. I would be reluctant to see an appeal go in effect in an Arbitration Board.

I think this is a matter where a man could appear to his lawyer before a judge and the Commission be represented by a council, the matter would be argued out, evidence would be bad witnesses would be heard and then the judge would make a decision and that is final. So I think the hon. ~entleman's point is based incorrectly, I think it has no foundation and,accordin~ly,I do not see any need to change the Act. I think his criticism 1s not valid. Now, Mr. S~eaker, it is one o'clock and I would need another five or ten minutes to deal with some of the incredibly stupid points raised by the hon. ~entleman from St.

John's East,who either has not read the Legislation or does not under tand it•but it is one 9'clock and - Should I move the 22·23

May 3rd, 1~71 Tape 427 JM - 6 MR. ROBERTS : adjouftllllent or should I juat call it one o'clock? May I call it then one o'clock, Mr. Speaker, and I will deal with thia quickly after we return. MR •. SCWQ; It being now one o'clock I do leave the Chait: until 3:00 P.M. This House stands recessed until 3:00 P.M. ..

PROVINCE OF NEWFOUNDLAND AND LABRADOR HOUSE OF ASSEMBLY Volume 1 Number 34 5th Session 34th. General Assembly VERBATIM REPORT MONDAY, MAY 3, 1971 SPEAKER: THE HONOURABLE GEORGE W. CLARKE

May 3, 1971 The l!C!luse resumed at 3:00 P.H. Mr. Speaker in the Chair. }ffi. St'f'.AY.£R: Order! Tape 428 Hefore the hon. mini ster con tinu es his speech I would like PK - 1 you to welcome to the italleries some fifteen students from St. Patri ck ' s Central High. They are Grade VIII s tudents. They are accompanied by their teacher, Mr. Vicars !ION. E. M. ROnf.RT!-:_QilNISTF.R OF HEALTH): }'r. Speake r, when the Chair called it one o'clock 1 was just £inishing my remarks in reply to the points made by the hon, the member for St.

John's West,with respect to his speech on the second reading of this Bill, the amendments to the 1-fedicare Act. There are, I think, n•o further points the hon. gentleman made to which I will make some reference . The first was a Question he bro1,1f!ht up and said it was a concern to me and to the Government, and it was to him and I would a~ree with him. He is correct. It is of concern to us , and that, ~•r.

Speaker, is the question of the effect upon the doctors of this Province of the restraints upon incomes which were negotiated between t he Government on the one hand and the doctors on t he other, the restraint which I announced to the House at the end of Harch,in a statereent. Now, Sir, he waxed r elevantly eloquent, well for him, Mr. Speaker, AN HON, MEMBER: Inaudible. MR. ROBERTS: for him it was eloquent, when he drew a picture for us of a doctor working for six months and a doctor f!Oing to Flordia for six months, because he bad Teached the ceiling. Well, 1 think he was slandering the doctors of the rrovince.

I do not think he meant to, but I think he was doing them a very serious dissetvice because, of course, the doctors of this Province, I think, are not: moti'1'ated by money. Of course, they expect to be paid for their effort. That seems to be the basic principle of our society. But, T do not think they are motivat ed sole~y by money, and I do not think there are any doctors around who would knock off simply because they have reached the income ceiling. In any event, in case there are any who are so strlckly conscious of money, of course,the Agreement, and I think this was sug~ested by the doctonJ- 2225

May 3, 1971 Tape 428 PR - 2 MR. ROBERTS: I am not sure, but it was agreed by N.M.A, and this applies to monthly incomes , not annual. So a doctor then would have to , you know, in effect to do . as the hon, ~entleman then suggested, knock off every fourth week. I do not think the doctors would do that, Sir, The restraints as we have negotiated them wi.ll not affect all that many doctors. The President of t he N .M.A. has estimated that it may affect, over a course of a year~one-third. I am not certain of that, Sir, I think, we will have to -wait and see.

But, I do not think there are any doctors in Newfoundland who would sort of have a cash r egiste r mantality and will say at the twenty­ second day of the month. "Sure ,boys, I have racked up my $4500 gross for the month, I am goin~ to take the next week off end not do any work,n I do not think there are, Sir, I do not thin k so. I do not think that is what makes doctors tick . That is not what motivates them. If there be any such,tben . I would be prepared to enga~ed in a public debate with that doctor. If the only think that concerns them is makin g that sort of money.

I think, there i s a.legitimate ground for public dehate in there. This is the point the Premier touched upon,and it is one that is of ~reat concern to the liedical profession. I have a lot of dealings with the medical profession , Mr. Speaker, a lot of them,in my capacity as a minister,and I get it from all angels, I get the official C.M.A. line across the breakfast table. The hon~ rentleman told us this morning, the doctors did not ask for ?!edicare • that somehow was relevant.. I s;tet that every morning at breakfast.

I have a brother who is in third year medical schoo l and,like all third year students, knows all about medicine. He knows everythin~ there iii to know, I know one or wo doctors,personally, and there are other connections, indeed some of the people,to whom the hon. gentleman i s close. are close to me, Perhaps, my ties are ties of blood and not •~i. social and friendships, but we have some contacts in co1111110n.

The doctors are becomin~ concerned across Canada, Mr. ~peaker, about the fact that some doctors are working much too hard under Medicare, workin~ much too ha~d,apparently from monetary reasons, Now I do not mean doctors who a~e one of a kind. We have specalities in this Province, but we only have 2226

May 3. 1971 Tl!.pe 428 PK - 3 MR. RCl:BF.RTS: one or two men. And I wish we had, you know. five. or six men,because 1ve need them. Those rnen worked extremely hard, bec,mse of the foot they are alone . They are the only ones in the Province with " skU 1 in this particular field. And the restraints now that have been ae~otiate d allow means to deal w1.th these.

However, the hon . gentleman made a point and I did want to col!l!!!ent upon it, I do not think it is especially a sound point, but I do agree , we have to be concerned and should be concerned and are concerned with making sure that we do not do anytinJ?: in tledicarc or outside of Hedicarc tho.t will harm our efforts to attract more doctors and to hold the doctors we now have.

Along those lines, I t hink the commen1Sfrom the hon. the member for Burin, were much more to the point, because the real prohiem is holding the doctors in the cottage hospitals service in the district medical practices and the I.G.A.,Raie Verte, Twillingate areas, These are the areas where our concern should increasin~ly be put and I CSI\ assure you it is the area wbere our concern is being put more and more .

T also ment·ioned, I think probably durin g an interjection, that we had 137 doctors whom we investiga ted in some star,e last yea~ that is true, but I think, perhaps I should expand a little on it, because to leava a statment like that, Mr. Speaker. gives the wrong imµress ion. Last year , for example, during the month of November, to show you how the 137 fig ure is made up~.during the month of November. tb~ Medicare Commission investi~ated every consultation for which they were sent a bill. Now consultation, Mr.

Speaker, as Your Honour knows and the House is aware, is where a specialist doctor has a patient referred to him, because the doctor originally treatin p, the patient wants a seco nd opinion. It is a very valuable part of medicine . It is a very integral part of the operation. But, during the month of Nove~ber, we ran a check on every consultation. Because a consultation, Mr. Speaker, is paid at a hip.her rate than a first reference , a first visit. We wanted to make sure, we had some evidence that m.aybe it was not so.

We wanted to make sure that e~ery consultation for which we had been billed was a consultation and not just a first visit, 2227

May 3, 1971 Tape 428 PK - ~ "4R. _ROBERTS: However,to come a little 1110re to the point, and I should say we investigate all doctors and dentist claims by routine audit. But up to March 31, 1971, over the two years, a total of twenty-seven physicians and thirteen dentists have had their claims completely investigated over apecific periods of time. Not to indicate that there is anything wrong with any of those men, Mr. Speake r , in.deed the contrary is usually the case. Just that this ie the uomal administrative, ~on-going routine, day to day operational audits that we make on all claims.

We have had talks with the Medical Association about, •aybe a dozen doctors, maybe a few more; patterns of practice have been very m1us0Al. There is a continuing liaison between the Medicare Commission, Dr. J<nowling, the Medical Director and the Medical Association through the so-called ~edical Review C=ittee, Medical Advisory Comittee,and they do discuss details of individual practice patterns. Individual claims are discussed in detail th~re. We turn over to that Cffl!IJl!ission,which is made up of doctors, we tum over a ~r~t deal of s tatistical information .

I would not want to leave the impression that there are 1?7 doctors or dentists in this Province who are in any sort of trouble with 1-!edicare. They are not. They said there are only two cases where we felt 1t necessary to ask the nepartment of Justice to investigate. One of those cases the investi~ation is nearly completed, the r,ther one is in progress. Mt HON. ~F:R: Inaudible. MR. ROBERTS: The psychiatrists have not been involved with the Department of Justice in any way. No, no. MR. CROSBIE: What about the claim for the ei~hty-seven patients? MR.

ROBERTS: Well, that was not referred to the Departm.ent of Justice , which brings ~e to the point,really, because those claims were perfectly le,itimate. They were insured services. And this really, Mr. Speaker, brings me to the point of the analo~ies that were muttered, not muttered, but were spoken by the gentleman from St. John's East. l think it 1s noteworthy, Mr. Speaker, that the two former Ministers of Health, who sit opposte ~e, the member for Burin and the member for St. John's West, each of whom spoke in this debate , each of them made a very 2228

May 3, 1971 Tape 42R PK - 5 MR, ROBERTS: intelli~ent and worthwile contribution. It is not to say that I ap:ree with what they say any more than they did not ap;ree with everytM .n~ that I' say. But. I think, they showed their knowled~e. The hon. the r,entleman from St. John's East I am afraid showed that he doe~ not have any knowled~e of the Bill under discussion nor has he any knowledge of the ~ledi care scheme itself. I do not know where he gets his advice , ~r. Speaker, I have no idea. But, he is not p:etting good advice, I can tell him . nr. Speaker. first of all, the hon. the g entleman fro m St.

John's East .. I made some rouih notes and if I do him the discourtes y to misquote him, I do hope he will set me et rair,ht, 1hey were rough notes and of course the Hansard will not be available for a day or so. AN HON . MfilfRER: Inaudible. MR. ROBERTS! Well, maybe the hon. , gen t leman did not write the speech, I do not know. 'He read it badly anyway . First of all, Mr. Speaker, tbe hon. gentleman said he found the amendment offensive, repur.nant, somehow quite contrary to the whole spi rit of things and sup,gested that we deal privately. Now I n ever before, Mr.

Speaker, heard the SURgestion that a programme of $14 million in public funds each year, should be dealt with privately, and measures to make sure that,that money was spent for th~ purposes for which it should be , which it was voted by the Rouse, the purposes for which the agreem ents were ne~otiated, ever before heard a sur,gestion that should be dealt with privatel y . 1f there i s a Tory doctrine, there is such a thini as a Tory doctorine, then that is it.

I can point out further, I can point out further that the very reason these amendments are here ! is that these matters cannot be dealt with under the present le~islation . The hon. gentleman makes me ~onder if he ever read the Act. Re stands there as the critic. He is of the opinion that we could opt out doctors under the present Act, ~r. Speaker, the hon. p.entleman mir,ht choos e to look at the Act. There is no such power in it. Then he thou~ht , we could withhold money under the Act . l will tell the hon. ~entle1!111n that 2229

Moy 3, 1971 Tape 428 PK - 6 MR. ROBERTS~ we cannot. I think an order would lie against us., Whenever insured service. as it has beet\ defined, has been rendered by a doctor pracitising in this Province,to a person resident in this Province, we must pay. I have heard a lot of stupid nonsense, ~r. Speaker, and I am not speaking in partsian politics, I am just speakinr of straight; actual 1 stupid nonsense. That is all it is. If he does not like the principle of the Bill let him attack it, hut, let him ~t least know what he is talking about, Mr. Speaker. lie stood in this House and accussed us of playinp. politics.

I do not know what in the devil the politics are;our coming in and saying we have problems administering the scheme~ we have problems in makinz it work properly, we have been told we need new measures in the Act, We sat down with the doctor s and we have hammered them out. Here they are. This ls what the Government brin~sil, and then he sits there and says that is playin[t politics. Re thinks we should maybe act illegally. Re thinks, we should say to a doctor; •·you are not practi s ing inside of the Act any more." He said that here, Mr. Speaker. I am not making it up9 He said it this morning in this House.

We have no such power. Stupid nonsense! Then he said we can withhold money. Then, again, stupid nonsense! I mentioned problems of psychiatrists, and. I think . it was well known to all m~bers of tbe House,.not officially. but, I think it is well known to anyone who has any connection with the Medical profession in this Province, any knowled~e of them or any involvement with them. Those psychiatrists rendered insured services. But, I think . their own profession­ ! spoke of peer ~roup pressures. Mr.

Speaker, there were peer group pressures on those psychiatrists, very stronr. and definite pressures from their fellows, who said that is