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July 26, 1993

35th Parliament, 3rd Session

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Hansard Transcripts

vol. A

Hansard Transcripts

vol. B

INTERNATIONAL PLOWING MATCH

FOREST INDUSTRY

GO TRANSIT

COMPENSATION FOR AIDS PATIENTS

ALIENATED PARENTS ASSOCIATION

RURAL ECONOMIC DEVELOPMENT

KIDNEY DIALYSIS

TAXATION

PICKERING AIRPORT LAND

SPECIAL REPORT, OMBUDSMAN

VISITORS

TRANSPORTATION

ONTARIO HYDRO CONTRACT

HEALTH CARDS

PRODUCE-YOUR-OWN BEER AND WINE

CHARITABLE GAMING

FREEDOM OF INFORMATION

MENTAL HEALTH REFORM

WATER QUALITY

CASINO GAMBLING

ENVIRONMENTAL SENSITIVITY

AMBULANCE SERVICE

SOCIAL CONTRACT

ONTARIO DRUG BENEFIT PROGRAM

SOCIAL CONTRACT

HEALTH CARE

RETAIL STORE HOURS

GO BUS SERVICE

GAMBLING

HEALTH CARE

MENTAL HEALTH SERVICES

AUTOMOBILE INSURANCE

HEALTH CARE

ONTARIO DRUG BENEFIT PROGRAM

HEALTH CARE

MENTAL HEALTH SERVICES

PUBLIC SERVICES

MENTAL HEALTH SERVICES

NATIVE HUNTING AND FISHING

WRITTEN QUESTIONS

STANDING COMMITTEE ON GENERAL GOVERNMENT

EXPENDITURE CONTROL PLAN STATUTE LAW AMENDMENT ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LE PLAN DE CONTRÔLE DES DÉPENSES

The House met at 1334.

Prayers.

MEMBERS' STATEMENTS

INTERNATIONAL PLOWING MATCH

Mr Murray J. Elston (Bruce): I rise today to let the folks in Ontario know about the 1993 Bruce county hosting of the International Plowing Match. That match is being held on September 21 through the end of the 25th, and all the people around the Walkerton area, in particular the Johnston family, and Bruce county and Brant township are looking forward to entertaining more people than have ever been entertained before at a match of this sort.

As everyone knows, in 1976 Bruce hosted what has been, I think, the most successful match ever in the province, and this year it looks like Jim MacKay, the president of the Bruce County Plowmen's Association, and Jack Cumming, who is the chairman of this year's international event in Bruce, have planned a very wonderful event indeed.

Along with the regular sorts of events of course there will be lots of activity, the professional plowing contest held for the real farming personnel of this province and internationally, and also for those of us who plow on these very special occasions.

I extend again to all members of the Legislative Assembly an invitation to plow with us in Bruce county, in Brant township, my home township. I know David Thomson, the reeve, and the council will be willing to entertain all of us as we try to get things straight, at least for once. We're all invited to the international plowing match September 21 through 25 in Brant township, at Walkerton, Ontario.

FOREST INDUSTRY

Mr Leo Jordan (Lanark-Renfrew): The effects of the NDP's forestry policies are devastating the industry's operations in Ontario, both large and small.

Due to the opposition pressure in this House and from the Ontario Lumber Manufacturers' Association, the Minister of Natural Resources will now delay the 100% increase on stumpage fees. Although this was perhaps the correct decision, I think it was the only option, given the fact that the minister was prepared to charge an additional $11 tax per cord on employers who only make $8 profit per cord.

This planned tax grab shows just how desperate and out of touch this government really is. The minister's decision last Thursday to delay the stumpage fee increase until October 1, 1993, was a clear admission that his policies were not well researched.

However, I think the minister has still missed the point. Small independent contractors and small mills cannot afford to have their rates on parity with large integrated mills. Any new increase in stumpage fees will result in major job losses throughout Ontario. The only logical course of action is to scrap the plan of raising stumpage fees altogether.

Thank you, Mr Speaker, and the plowing match that the member for Bruce just described will be in Renfrew county in 1994.

GO TRANSIT

Mr Larry O'Connor (Durham-York): I have received a lot of phone calls and letters over the past couple of weeks about the decision by GO Transit to cut its peak-hour Uxbridge-Elizabeth Street terminal bus service.

In fact, I was at a meeting on Monday, July 19, held by the planning committee of the Uxbridge township council that took deputations from residents and the council, and GO Transit officials were present at the meeting to explain how their decisions were based on subsidy rates and ridership. That's fine for them, but that doesn't deal with the rage of my constituents from Uxbridge who have no public transportation alternative to get to Toronto.

I attended another meeting Thursday night that was held in Stouffville. Both Uxbridge and Stouffville residents were present because both groups of commuters feel threatened. The Stouffville residents are protesting the time of the GO trains as being inconvenient for people who have flexible work arrangements or child care commitments. The earliest train departs from Union Station at 5:20 pm.

I want the members of the Legislature to realize how GO Transit decisions in dealing with the expenditure control plan have impacted on my constituents. Many of these residents will be moving away from these areas after investigating GO services that have been stolen from them.

My constituents not only want to help GO Transit, but they've put together a riding profile, they've put together alternatives, and I hope the GO Transit officials will take these into serious consideration.

COMPENSATION FOR AIDS PATIENTS

Mrs Barbara Sullivan (Halton Centre): Once again, I speak to the House on the question of a compensation package for those who have contracted the HIV virus through a tainted blood supply. Once again, I bring to the attention of the Legislature that the Minister of Health is stalling in this important area of public policy, where she has made a personal commitment.

Time is running out for haemophiliacs and blood transfusion recipients who were infected with the AIDS virus. The government has admitted its culpability in the matter, and while other governments, such as Nova Scotia, have acted in a forward-looking manner, this government has stalled.

Hemophilia Ontario has maintained all along that the compensation requested is not a matter of benevolence or welfare; it is a recompense for grievous injury. The fallback of the social assistance system isn't adequate to address this injury. A compensation package is required.

Last Thursday, Hemophilia Ontario was told that there would be a meeting, at which time the government would present its proposal for a package. Instead of that meeting, they received a call saying there would be no meeting to present that proposal. Further, they learned from the media that Health Minister Grier had told reporters that no compensation package would be announced until September.

Many of the HIV-positive hemophiliacs and transfusion recipients are nearing the end of their lives. Many of those who are dying have dependent families, many of whom have been financially ruined by AIDS. One or two of the people who were infected by the AIDS virus die every week. Hemophilia Ontario rightly asks if this government is expecting a settlement by attrition. We certainly hope not.

ALIENATED PARENTS ASSOCIATION

Mr Gary Carr (Oakville South): A group of people in my riding have formed an association of parents whose children have been alienated from them by their ex-partners. They are the Alienated Parents Association. They have no significant relationship with their children, and this in some cases has lasted for years. In fact, their children have been encouraged to see them as unfit and mentally unbalanced. Their children have no experience to draw on, are young and vulnerable, and are being used as a pawn in a deadly game.

Members of the new association feel it's time that the public is made aware of the existence of these deprived parents and just how large a segment of the population they are, and that their story is told. They know their children deserve the love and support of both parental figures; otherwise, their ability to form future relationships and their mental wellbeing may be at risk. They are good and loving parents, and there's a great need to educate the public, the school system and the legal system in order to stop this injustice.

A member in my riding, Mary Anne Morrison, at 338-7175, is available if you need the assistance of the Alienated Parents Association or if you can assist with this worthwhile association.

RURAL ECONOMIC DEVELOPMENT

Mr Randy R. Hope (Chatham-Kent): I want to take a moment to call to the attention of this House the fact that the third party is truly out of touch with rural Ontario. It's clearly indicated in the Toronto Sun, where I find out they're asking a Liberal to be a Tory, which is very close.

Last week the member from Don Mills stood in his place and actually suggested that putting manufacturing in rural settings was "out of whack." As a member of a rural riding, I must once again take exception to the comments of the members opposite.

Rural Ontario is made up of much more than feed stores, as the member from Don Mills suggested. In my riding, farmers have gathered together to bring an ethanol production facility to Kent county, a facility that will not only create much-needed jobs but will also create a market for their corn, a market needed since the federal cousins of the member opposite started signing the free trade agreement.

Farmers are studying the feasibility of production of tomato paste in a shut-down facility in Chatham. Farmers and rural communities in Ontario are progressive in seeing the future, and their future means finding creative manufacturing bases to produce their crops in Ontario.

When it comes to telecommunications, rural Ontario is once again a leader. Smart Talk Network started in Kent county with eight employees. Two years later, the company has 165 employees and expects to hire another 200 employees over the next two years in the city of Chatham. This company from rural Ontario supplies long-distance service to Ontario, Quebec and British Columbia and will soon be expanding to Manitoba.

Feed stores are not the answer for rural Ontario; productivity is.

KIDNEY DIALYSIS

Mr James J. Bradley (St Catharines): The patients who are involved with the kidney dialysis unit at Hotel Dieu Hospital in St Catharines are eagerly awaiting the announcement of the Minister of Health or at least the funding to be forthcoming so that this project may be undertaken.

Members of the Legislature may be aware that this issue has been raised on numerous occasions over the last couple of years. I had the opportunity, with some of my Niagara colleagues, to attend a press conference at which it was announced that the funding for the renovation of the haemodialysis unit in St Catharines at the Hotel Dieu Hospital would be forthcoming.

I have been in contact with a patient who is a spokesperson for the patients who take advantage of the facilities that are there, and he has informed me that as of last Friday the funding had not yet reached the Hotel Dieu Hospital.

I call upon the Minister of Health today to flow the funds, which were promised appropriately several months ago, in order that the very crowded conditions that those of us from the Niagara Peninsula witnessed on a tour that all the members took of the facility can be overcome, and that the facilities provided for the patients will be such that they will be served in an appropriate manner and that the staff which have been so dedicated in providing this service under adverse conditions will indeed be in a better position to assist those patients.

TAXATION

Mr Noble Villeneuve (S-D-G & East Grenville): For many years, it has been a matter of fact that because of taxes Ontario is a much more attractive place to live and to do business than the province of Quebec. By far the main reason for that was our comparative tax advantage and less restrictive government regulatory environment.

Beginning with the former Liberal administration, and continued by this government, Ontario is becoming a much less attractive place in which to live and do business. Last week, the Ottawa Citizen reported that a married taxpayer earning $40,000 a year saw his or her income tax advantage drop from over $2,000 in 1983 to a tax disadvantage of almost $100. Half of the drop occurred under the Liberal administration and continues in free fall with this government.

The NDP tries to describe the current situation as a revenue shortfall. Let me suggest to them that what many residents of eastern Ontario see when they look east: The revenue shortfall they see is their own personal revenue. They see the NDP claim of cost-cutting, but they also see no change in patronage appointments or in favoured NDP political projects.

Mr Gordon Mills (Durham East): You should talk.

The Speaker (Hon David Warner): Order, the member for Durham East.

Mr Villeneuve: They see NDP claims of cutting cabinet size, but they see more cabinet ministers. They see the NDP announce program cuts and then they see confusion in the social contract legislation. They see that the deficit continues to rise. They also see Ontario doing nothing when Ontario businesses are shut out of Quebec and when Ontario commercial vehicles are harassed on Quebec highways.

This is a terrible situation and it must change soon.

PICKERING AIRPORT LAND

Mr Jim Wiseman (Durham West): I rise today as I'm gravely concerned about plans that the federal government has for thousands of acres of land in the northern part of my riding; to be more specific, the Pickering airport lands.

I have been involved with this community since the early 1970s when I joined a group called People or Planes. Our fight was somewhat successful. We were, however, unable to prevent the massive expropriation of 18,600 acres of land, which drove thousands of people from their homes, many of whom had roots that extended back many generations. This assault caused a complete change in the complexion of the community almost overnight.

Since that time, other families have moved into these homes. This long-term tenancy has transformed the desolate post-expropriation area into a community once again. Many of these families have raised their children in these homes. They've developed their own roots and a strong attachment to this community. Now their fate is uncertain once again. Nearly half of the 350 leases have been reduced to 30-day renewals.

But why now? Why sell this land when the province, the region of Durham and the town of Pickering are all in the middle of a number of critical planning processes?

The feds have been announcing that they would be selling this land for almost a decade, but this time I believe they're really going to do it. My concern is that this land has great potential, not only now but for future generations. It makes up a substantial portion of the green space of the GTA. How can anyone begin to put a price on its value?

I have extended an offer to the federal government to join in the extensive planning processes that are taking place in this area.

It has been 21 years and I'm still fighting for this land. This is a fight I will not give up until something positive results from it.

SPECIAL REPORT, OMBUDSMAN

The Speaker (Hon David Warner): I beg to inform the House that I have today laid upon the table a special report of the Ombudsman, Ontario, on the cases of Ms R., Ms M. and the Ontario Human Rights Commission.

VISITORS

The Speaker (Hon David Warner): I would invite you to welcome the Ombudsman, who is seated in the Speaker's gallery. Welcome.

I would also invite all members to welcome to our gallery this afternoon, seated in the Speaker's gallery, Mr Harry Greenway, member of Parliament, the House of Commons, London, England. He is joined by his wife, Carol, and son, Mark. Please join me in welcoming them to our assembly.

Interjections.

The Speaker: Order. It is now time for oral questions and the honourable member for Renfrew North.

Mr Sean G. Conway (Renfrew North): The member for Durham East perhaps has a question he might wish to put to our visitor.

ORAL QUESTIONS

TRANSPORTATION

Mr Sean G. Conway (Renfrew North): I have a question to the Premier and it concerns his social contract.

The Premier and his government, as part of their social contract, appear to have committed their government to a new policy which could very well see, within a short period of time, hundreds of thousands of young people as young as four years of age being bused to school, not as they have traditionally been bused in almost all cases in the yellow school buses but, rather, as part of the social contract arrangement, these young people in urban environments could very well find themselves being bused to school in municipal buses which do not of course have many of the same special safety provisions that are built into the yellow school buses.

My question to the Premier, in the absence of the Treasurer and the Minister of Transportation, is, can he confirm that his government is prepared to contemplate a new school busing policy which would see tens of thousands of young Ontarians, many of them as young as four years of age, being transported to school, not in the very safety-conscious yellow school buses but rather on municipal buses?

Hon Bob Rae (Premier): I think I'll refer this question to the Minister of Education.

Hon David S. Cooke (Minister of Education and Training): I can tell the member that in terms of busing policy for the schools in the province, we are obviously first and foremost concerned about the safety of students in the province. Secondly, we're also concerned and interested in any and every way that taxpayers' money can be saved.

The member will know that there are some areas of the province, at least at the secondary level, where the public transit system is used by the secondary students. With respect to his specific question about school boards at the elementary level looking at using municipal transit, I'm not aware of specific cases. If he wants to raise them, I would be glad to look at them. Certainly, our ministry and this government would look at all of these issues in terms of saving money, but first and foremost, safety of students.

Mr Conway: There can be no doubt that the primary concern here for all members must be safety, and the safety of young children, many of whom are four and five years of age. That's why I was astonished to read in the appendix to the municipal-provincial agreement which the government of Bob Rae has signed that the provincial government seems to be clearly committing the province to a process that is going to see tens of thousands of very young students in urban Ontario being shifted off yellow school buses and on to municipal buses. It's very clear from this appendix.

Hon Mr Rae: No, it is not clear from the appendix.

Mr Conway: Well, the Premier wouldn't answer my question. I don't even think they know what's in their own social contract. Every day is a day of discovery, particularly as we race down to fail-safe day, August 1.

The Highway Traffic Act is replete with regulations that attach to yellow school buses, which must meet certain very stringent safety conditions that are nowhere attached, as I understand it, to municipal buses. Will the government give an assurance to parents and students that the safety of their children and those students will in no way be jeopardized by the social contract agreements that the Rae government has already signed?

Hon Mr Cooke: This government of course would give the assurance that children's safety is not going to be put at risk, but I think we have all learned to understand that questions from the member -- making statements that tens of thousands of students are going to be put at risk because of his

interpretation of a particular segment of the social contract legislation is absolute nonsense at its worst, and fearmongering for students and parents, which is unfortunate, but we've become used to that kind of fearmongering from this member.

Mr Conway: The accord that the Rae government has signed in the municipal sector commits the provincial government to an action plan to get on with integration in this connection, to transfer these responsibilities from school bus operators to municipal transit authorities in urban areas.

I can understand how the government might want to discount what I have to say, but the Ontario Motor Coach Association has today issued a release highlighting its concern around the safety question. Is the Minister of Education and Training aware of the concerns on the safety count that the motor coach association has raised?

Is the Minister of Education, the member for Windsor-Riverside, aware that in his own city, in recent times, Ernst and Young have concluded a study which indicates that when one compares the cost of running the current system of school busing versus the municipal system, the municipal system, to which the Rae government wants to move, is substantially higher in cost? Is the minister, the member from Windsor, aware of that study as well?

Hon Mr Cooke: Well, I certainly will take a look at the release the member is referring to. I haven't seen it today. We'll take a look at it. But I can assure the member that there is no grand plan to move all the students in this province from the school buses, which he says are safer than municipal buses. There is no grand plan to do this. It's an exaggeration, inappropriate at the least, for the member to make that kind of an accusation today.

The Speaker (Hon David Warner): New question.

Mr Conway: I think it's time that the Rae government read its own social contract, because it's quite clear that the Minister of Education and the Premier do not know what's in this appendix, which clearly commits this government to this very significant new process.

The Speaker: And your second question?

ONTARIO HYDRO CONTRACT

Mr Sean G. Conway (Renfrew North): A second question is to my friend the minister responsible for Hydro. I want to say to my friend the minister responsible for Hydro that since the interesting discussion of some six or eight days ago, when members of the Legislature and Hydro ratepayers were painfully made aware of the polling that was going on over at Hydro, the $1.3 million worth of money that Hydro does not have that's been spent to ascertain the love interests of ratepayers across the province, since that time, my mail has been busy.

I have received an envelope, a brown envelope; my favourite kind of envelope, a brown envelope. But the envelope contained some very interesting new data. I'm just wondering whether or not my friend the minister responsible for Hydro is aware of the following: that in October 1991 -- it seems to be part of the earlier poll referred to, the so-called Goldfarb poll, which was $1.3 million worth of data collection. But it appears there's more. It appears that a Mr Greg White of Market Vision Research was given, in October 1991, on an untendered basis, an opportunity to do $1.3 million worth of poll analysis for Hydro.

Is the minister aware that Market Vision Research has been given a $1.3-million contract, on an untendered basis, to develop a communication strategy to assist Hydro in making its customers consume less in the coming years?

Hon Bud Wildman (Minister of Environment and Energy): Mr Speaker, as you will know, in the business of polling, it is quite normal for firms, particularly the largest firm in Ontario that is responsible for serving the ratepayers of commercial, residential and industrial across Ontario, to have included in polls some lifestyle questions to determine what kind of people are providing which kinds of answers with regard to the electricity-consuming public.

Having said that, we will agree that there may in fact have been on occasion in the past in the history of Ontario Hydro some excesses, and it is for that very reason that we brought Mr Strong in to restructure the corporation so we don't have the continuation of these kinds of wasteful practices in the future.

Mr Conway: Supplementary to my friend the minister, this untendered contract appears to have been let during the pontificate of one Marc Eliesen. It is to cover a period of October 1991 to October 1993, the first of three parts valued at $1.3 million, and Mr Greg White of Market Vision Research, who is expected, for his $53,000-a-month retainer, to commit himself at least half-time to this project; he must commit himself, according to the terms of this contract, to at least half-time.

He is to develop a strategic plan to assist Hydro to develop a marketing strategy to develop -- get this -- "among other things, the psychological precursors that will be necessary to reduce hydro-electricity consumption in Ontario in the coming years."

Is the minister not concerned? Is he not, like the rest of us, just fed up with on the one hand hearing that Hydro is broke, up to its neck in red ink, so broke that it of course can't contribute anything to the social contract, yet it continues to give up, on an untendered basis, multimillion-dollar contracts to develop psychological precursors to help us all conserve? Is the minister aware of this boondoggle and will he take steps to stop it forthwith?

Hon Mr Wildman: I suppose the member was speaking ex cathedra when he was talking about a pontificate.

I would say that the member knows that the current decisions that are being taken to restructure Ontario Hydro are being taken at a time when we now have a chairperson and a board having the responsibility to ensure that we do indeed cut the use of Ontario Hydro's product, electricity, in the province and that we ensure that the operations of Ontario Hydro are done in the most effective and most economic ways possible.

I do not have the information about the particular contract, which I understand from the member was let in 1991. I will look into it and report back to the House.

Mr Conway: I appreciate that, because I've got to tell you, the people of Ontario, at least the people I represent, are fed up with this kind of crap. Week after week they face tax increases --

The Speaker (Hon David Warner): Would the honourable member choose better --

Mr Conway: -- and job losses; they're told that we must all share the pain to get out of this misery. They want to believe, but every week -- last week we were told $1.3 million was spent by Hydro to do field research to find out about things like their love life. Now we're told that another firm has been hired at $1.3 million for just the first part, October 1991 to October 1993, to analyse that field research and to provide strategic advice to develop the psychological precursors that will help us all reduce electricity consumption. I mean, the people have had it to their teeth.

This contract is in three parts. It can be terminated, according to the information I have, with fairly short notice. The first phase of it, $1.3 million, is concluded in October 1993, but it's very clear that a second and third phase, committing millions more, undoubtedly, is contemplated.

The Speaker: Could the member place a question, please.

Mr Conway: Will the minister give me and, more importantly, the Hydro ratepayers this assurance: that he will inquire into this and ensure that at the end of this phase one $1.3-million boondoggle, this kind of insane spending at Hydro will stop?

Hon Mr Wildman: I've already indicated to the member that I will inquire into this matter and I will respond to the House. I also agree with the member that the kind of insane spending we've seen at Ontario Hydro which, under his government, completed Darlington at a cost of $14 billion and has put the whole province into debt, must end. That's why we're doing it, and it's unfortunate that his government didn't do it itself.

HEALTH CARDS

Mr Jim Wilson (Simcoe West): I have a question for the Minister of Health. Minister, you'll know that on several occasions I have risen in this House and brought to your attention the numerous wounds that continue to plague Ontario's health card system.

Recently, I was contacted by a doctor who told me that he was aware that OHIP, in early 1992, sent 400 health cards to one address in Ontario. Last week, I contacted your OHIP officials in Kingston to make them aware of what this doctor had told me. I ask you, given that you have never been able to give me an exact dollar figure on the extent of fraud in the health card system, have you at least been able to determine whether or not 400 health cards were mailed to one individual at one address?

Hon Ruth Grier (Minister of Health): I'm shocked at that accusation. If the member in fact wrote to my office, I have not received any indication from the member. I would really hope that he would provide me with the name of the doctor and the address, and I can assure the House that I will look into that and make sure that that, if it happened, never happens again.

Mr Jim Wilson: As I indicated in my question to the minister, I did phone and speak to your OHIP officials last week in Kingston. I'm shocked that you're unable to manage the system, that you're unable to check out these allegations to discover whether or not 400 health cards had been mailed to one individual. I hope you'll get back and report to this House immediately, because that could spell millions of dollars of fraud to the health card system.

My supplementary refers to Saturday's Montreal Gazette, in which it was reported that health officials in Quebec have launched an investigation to determine whether members of the Akwesasne native reserve are eligible for health care benefits in Quebec.

As you know, this reserve borders Quebec, New York and Ontario, and the Quebec government is concerned that some residents of Akwesasne could be American citizens who are registered under Quebec's health plan; in fact, as many as 900 residents could be American citizens who are illegally registered in either Quebec or Ontario. A Quebec medicare board investigator was quoted as saying it is possible that some might be registered with both Quebec and Ontario.

Minister, are you carrying out a similar investigation to that which has been launched in Quebec and, if not, why not?

Hon Mrs Grier: Let me first of all make it clear that the majority of residents of Akwesasne are permanent residents of the province of Ontario and therefore are entitled to be covered by the Ontario health insurance plan. In those cases where there may be some questions as to their eligibility, then I can assure the member that, yes, an investigation is being done, and because of that, I really have no further comment to make.

Mr Jim Wilson: In my final supplementary, I want to point out to the minister that last Thursday's Toronto Sun reported that your ministry's bureaucrats have decided to change the health card system and bring in a new system featuring photo ID.

It's encouraging to see that at long last, at least someone in government has realized that the system that was brought in by the Liberals is completely flawed and needs to be overhauled. But what is not encouraging is that the decision to go forward with photo ID was apparently made in mid-June, yet your cabinet may not be approving the new photo ID system till at least the end of August.

You know I've raised this particular issue on seven different occasions in the House. Your own studies show a potential fraud of some $10 million per week in this province. Your foot-dragging could be costing the taxpayers of Ontario millions of precious health care dollars. I ask you, why aren't you proceeding immediately with the new photo ID system?

Hon Mrs Grier: First of all, the member has raised very exaggerated figures with respect to misuse of OHIP cards in the past. I have acknowledged that there is in fact misuse, and for that reason have instructed officials within the ministry to begin to examine an alternative to the current health card.

But when the member says a decision was made in June and the issue won't be before cabinet until August, I would remind him that this is a cabinet government, and if cabinet has not yet dealt with the issue, then no decision has been made. We are examining a number of ways of improving the health card system. A photo ID is certainly one that I want to take a very careful look at, but no final decision has yet been made.

PRODUCE-YOUR-OWN BEER AND WINE

Mr Gary Carr (Oakville South): I don't know if the Premier knows what this is: It's an empty. It's what some people in Ontario use to fill at the you-brews in the stores across this province.

Unfortunately, this is as empty as the budget promise to create jobs in your introduction on page 1 of the budget. This weekend your tax grab in the spring budget will cost the you-brews jobs. This weekend your 26-cent-a-litre tax will go on the you-brews.

My question is this: Do you have any idea how many you-brews will close as a result of the tax grab that was introduced in the spring budget?

Hon Bob Rae (Premier): Mr Speaker, I'm just getting a late communiqué here that will help the Premier through a difficult moment.

This tax was brought in to create a sense of balance in the overall industry. The member will of course appreciate that to have one segment of the industry untaxed and to have other sectors of the industry paying a level of tax creates an unfairness. That's a fundamental reality of the situation we face.

With the expansion of the number of brew-onpremises and other places, obviously it was a feeling of many, including many in the industry, I would say to the honourable member, that some steps had to be taken to provide for a degree of fairness. I would say to the honourable member that the fact is that the tax on this kind of beer as opposed to other kinds of beer still gives a tax advantage to the people you mentioned.

Mr Carr: The problem is that in your budget this spring you said you were going to put people back to work. The Brew on Premise Association of Ontario says that your 26-cent-a-litre tax will kill 40% of the businesses; that 40% of the businesses will close as a direct result of this tax in your spring budget. And why? All so your Treasurer, Floyd, can get $5 million in new taxes; that is all the result will be.

Is it worth putting 40% of the industry out, closing, losing jobs? Is it worth losing 40% of an industry just so you can get $5 million in new tax revenue?

Hon Mr Rae: First of all, I would say to the honourable member that I certainly appreciate the fact that he comes armed with numbers and statistics provided by the group the Brew on Premise Association of Ontario. I would say to him that the assumption behind the numbers I think is something one would want to at least look at. I certainly wouldn't want to leap to the conclusion that the member is correct in the assertion that the tax will have the impact that is being described.

I would say to the honourable member that we have to look at a number of factors. First of all, we have to look at the relative fairness of a tax as it affects the entire brewing industry. We have to look at the entire wine and beer industry and look at all of those together. We have to recognize that the very efficient, effective and increasingly well-known and now world-exported wine industry in the province pays a tax. They pay a share of revenues to the province. Others pay a share of revenue to the province. Of course, when a tax has not been imposed in the past, when there are new taxes imposed, people don't initially take too kindly to it.

I think the lesson of experience would be that one should not overreact to what is, it seems to me, done in the interests of trying to create a sense of fairness in the industry and also recognize that, as I say, even with the tax that was contained in the Treasurer's budget, we're not looking at a huge imposition. We're looking at an imposition which is still going to be substantially less than would be the case, and than is the case, in the rest of the industry, and substantially less, for example, than we're charging the wineries.

Mr Carr: I'm sure the people who are in that industry will be very reassured by that, the people who will be losing their jobs. The problem is that small business has been the backbone in this province for many years. You-brews were one of the few growing businesses here in the province of Ontario.

There aren't many pleasures left in Bob Rae's Ontario, and you couldn't leave well enough alone. You have no regard for the jobs that are going to be lost. You don't even know how many jobs are going to be lost; you couldn't even give us an indication here today. There's no regard for small businesses. My question to the Premier is this: For the sake of the people who work in the you-brew industry, will you cancel the tax so that August 1 does not become last call for this industry in the province of Ontario?

Hon Mr Rae: I would say to the honourable member -- and I appreciate these very helpful notes provided by the taxation policy branch at the Ministry of Finance, and I express my appreciation publicly to it -- that a case of 24 at a regular beer store is now going for $26.40 and that a case of 24 at a you-brew, after the tax increase, will now be the grand total of $15.85, which means that August 1, 1993, it costs you 60% of the cost of regular beer. There's still a substantial consumer saving if that's what consumers choose to do, to produce their own. There's still a substantial saving there if that's what people choose to do, but it means that there's --

Interjections.

The Speaker (Hon David Warner): Order.

Hon Mr Rae: The member's quite right. There's no longer going to be a completely free ride and the cost will go up from being about 52% of the cost of a case of 24 to about 60% of the cost of 24, still a substantial saving to the consumer, if that's what the consumer chooses to do, but a guarantee of fairness across the board as it relates to the industry. I think we have an obligation to do that rather than simply parrot the numbers and arguments that are made by those who have an interest in seeing those arguments presented.

CHARITABLE GAMING

Mr Murray J. Elston (Bruce): I'd like to ask the Minister of Consumer and Commercial Relations if she would confirm, as all of the people who read the Hamilton Spectator, as I do, already know, that there are roving casinos that are available for play in the Hamilton-Wentworth area up to seven days a week at 10 different locations. I would like to know, on the very day that we begin our casino bill, whether or not she sees any need to continue with her casino bill, bearing in mind that people are operating these roving casinos for the benefit of local charities in several cities around the province.

Hon Marilyn Churley (Minister of Consumer and Commercial Relations): When I introduced the new Gaming Services Act last year, we introduced some new guidelines and regulations around charitable Monte Carlo nights. This was after consultation with many of the over 50,000 charities out there which raise money for their charities and churches through these kinds of events. We came up with some new guidelines.

It's quite true that there are still some wrinkles to be ironed out in terms of the huge growth in that charitable industry, and we're working on that. But these kinds of roving casinos he's talking about are not in fact full-blown casinos. They do not involve video lottery terminals, for instance. They are table games primarily. We are working with the industry to iron out some of the problems, but it in no way is the same thing as the kind of casino we're going to be building in Windsor.

Mr Elston: I think that's precisely the point. The minister and the government have maintained that these casinos are to raise money particularly for public purposes. Already we know that charities are using the casino nights in various of our communities to do the fund-raising they need to do good local work. The wrinkles that this minister has pointed out need to be removed are the wrinkles that don't give the government of Ontario the major take on all the work that's done by volunteers around the province.

I want the minister to tell us today that she is not going to proceed with this casino legislation and put out of business the charitable casino operations which all our communities are sponsoring, put out of business the racing employees around the province; in fact, put everybody out of business but the government of this province so that it can take the money and do with it what the New Democrats want to do for their own political partisan purposes.

Hon Ms Churley: Once again, the member of the opposition is taking this whole thing out of perspective. The whole gaming industry in Ontario is a $4-billion industry at this time. That includes horse racing. That includes charitable gaming in church halls and for charities. That includes the lotteries. This is one pilot project we're talking about in Windsor. In fact, with the Windsor charities, we made a commitment that we would not hold bingos in the casino, in that most of the charities in Windsor hold bingos. We made that commitment. So this has to be kept in perspective.

Charitable gaming has blossomed considerably within the past couple of years, partly because of what we have done as a government to make it more accessible and easier for them to compete in the marketplace.

FREEDOM OF INFORMATION

Mr Charles Harnick (Willowdale): My question is to the Attorney General. Are you aware that the Freedom of Information and Protection of Privacy Act can be used by incarcerated criminals to obtain information from crown files?

Hon Marion Boyd (Attorney General): The act is intended for the use of any citizen who is attempting to gain the information to which he or she is entitled as a citizen.

Mr Harnick: The answer surprises me. The fact is that convicted criminals can gain access to crown prosecutors' files. They can gain access to the names and addresses of informants and of victims of crime. When the process comes to the crown attorney two or three or five years later, that crown attorney may not be there any longer. He or she may have moved on, or after prosecuting thousands of other cases, may not have any recollection of this particular case. How are you permitting this to go on, and go on in a way that is not protecting victims of crime?

Hon Mrs Boyd: Under the act, the ministry to which a request is directed must look at the file that's concerned. There has to be an assessment that is made as to the kind of information that is going to be released, to protect individuals who are named in those files. That happens in every kind of file that's looked at under freedom of information.

It may well be that the particular crown attorney has moved ahead, but there are supervising crown attorneys who would then do the task. I would suggest to the member, given his experience with knowing what legal case files are like, that it is very important for him to understand that the protection of privacy is just as much a part of this act as the freedom of information, and that the protection of privacy of those who might be harmed in these instances can be protected by the ministry. Obviously there are appeals to that, but that is in fact what does happen.

MENTAL HEALTH REFORM

Mr Peter North (Elgin): My question is for the Minister of Health. Over the past nine months there has been a considerable amount of concern in my riding, the riding of Elgin, and some of the other ridings that are around us such as Norfolk, Chatham-Kent and Essex-Kent, and I think across the province as a whole, as to the downsizing of psychiatric hospitals in Ontario. I am aware of the lengthy consultations which have been carried out by your ministry staff with regard to this matter. Madam Minister, could you inform the House today of the results of those consultations?

Hon Ruth Grier (Minister of Health): There have certainly been consultations and there has been a base budget review that was undertaken last year. Recommendations contained in that report on the St Thomas-London psychiatric hospital are still under consideration, so I can't give the member a definitive answer today, but I can assure him that those recommendations will be considered within the context of all mental health services in the region and the provincial mental health reform initiative.

Mr North: Madam Minister, you mentioned the word "consider." I hope that the people in the ministry and yourself will consider very strongly that Elgin county and the surrounding areas have not fared well in terms of economics during the recession. We have had great difficulties in keeping the unemployment numbers from increasing dramatically. The real numbers, I think, are somewhere in the 22% range. For us, that's very, very difficult.

There have been, as you know, a lot of rumours that either London or St Thomas or both, or something, is going to happen in the area. We have employment numbers around 800 at the St Thomas Psychiatric Hospital, so at this point it would probably, aside from the Ford plant, be considered our largest employer. I ask you very directly, Minister, on behalf of my constituents, will the St Thomas Psychiatric Hospital be closing, yes or no?

Hon Mrs Grier: I suspected, in my answer to the member's first question, that he might be thinking of just a definitive yes or no. I regret that I'm unable to give him a yes or no answer at this point.

But I am aware, let me assure him, of the important role this hospital plays in the region which he so ably represents. Let me assure him and his constituents that any future decisions about the hospital will be made in consultation with not only senior management at the hospital, but with all the people who work there, and will comply with the terms set out in the collective agreement which the ministry has and will be consistent with the restructuring of hospital services and the policies that cover those.

WATER QUALITY

Mr James J. Bradley (St Catharines): I have a question for the Minister of Environment and Energy. The Minister of Environment will recall that in the winter of 1987, after several months of extremely difficult negotiations and after Ontario stood alone to hold out against a very weak agreement, finally a good agreement was signed for the cleanup of the Niagara River. The Niagara River, he would recognize, flows into Lake Ontario, which is the source of drinking water and recreational water for millions of people from Ontario and from New York State.

Now, even today, high levels of PCBs, dioxins and other hazardous chemicals are continuing to show up in the flesh of mussels exposed to the Niagara River. I ask the Minister of Environment if we can tell the House whether he is satisfied with the degree of progress which has been forthcoming in fulfilling the agreement between the four parties, and if not, what specific action he is taking to ensure a speedup in the cleanup of the Niagara River.

Hon Bud Wildman (Minister of Environment and Energy): I'm sorry, I didn't hear the first part of the member's question. I just received a note regarding the question his colleague posed earlier to the effect that Ontario Hydro has cancelled the contract to which the member referred.

The member raises a very important question. I know that he is personally very interested and concerned about it, and I know that as Minister of the Environment he played a very important role in raising the concerns and taking action to clean up the Niagara River.

He will know that there has been some improvement. He asked me if I'm satisfied. No, I'm not satisfied until we have a clean bill of health for the Niagara River, but the member will know that largely due to the work of the ministry and the other officials on both sides of the river, Ontario industries and municipalities show a 95% reduction in persistent toxic chemicals known to be a problem in the river. We are not satisfied, but we are making some progress.

Mr Bradley: The minister will know that American authorities have put forward a program which is designed to clean up, specifically, the dump sites which are the main source of pollution for the Niagara River. In fact Ontario and Canada have consistently had a better record than others in dealing with those issues in terms of the Niagara River.

In light of the fact that Dr Ian Brindle, a chemist at Brock University, a past chairman of the remedial action committee on the Canadian side governing the Niagara River, has said that the US plans are "a whitewash job" and "a bunch of rubbish," will the Minister of Environment and Energy undertake to endeavour to get a meeting immediately with the commissioner of the Department of Environmental Conservation of New York state and authorities of the US federal government under the Environmental Protection Agency to insist, on behalf of the people of Ontario and ultimately the people of Canada, that the United States take far more drastic action to clean up those dump sites and that it do it in an expeditious fashion?

Hon Mr Wildman: The member is correct in his comments that the monitoring studies by the Ministry of Environment and Energy in Ontario show that persistent toxic contaminants continue to enter the Niagara River, mostly from sources on the American side of the river.

The member also knows that the COA agreement expired at the end of March 1991 and was extended on an interim basis to the end of March 1993. On this side of the river, we must deal with the problem of the fact there is some concern between the provincial government and the federal authorities as to how we should properly share the cost of fulfilling the requirements.

It is very important if we enter into international agreements with the United States authorities, the federal and state authorities on the American side, that the federal government in Canada ensure that that government is making a proper contribution to the cost of the remedial action required on the Ontario side of the river.

We will be meeting later next month in August with the new federal minister and his officials to try to ensure there is a fair sharing of the cost. I'll take as notice and under advisement the member's suggestion that we should meet directly with the American authorities and I will report back to the House later.

CASINO GAMBLING

Mr Ernie L. Eves (Parry Sound): My question is to the Minister of Consumer and Commercial Relations with respect to the issue of casino gambling. Prior to September 1990 when the last provincial election was held, the Premier of the province was quoted as saying, "The casino plays on greed." On May 17 of this year my leader asked the Premier if your government would hold a referendum on whether or not casino gambling should be introduced into the province of Ontario. The Premier said no.

When a government turns its back on the very principles and reasons it was elected to power, should not that government give the public an opportunity to express its opinion?

Hon Marilyn Churley (Minister of Consumer and Commercial Relations): I believe the Premier has said, and I certainly have said, that no casino would go to any community which did not demonstrate its wishes for a casino to be in that community. Windsor has had many consultations with the people of Windsor, and in fact the city council has made it very clear to us its overwhelming interest in that community. However, we have said that we would move very slowly and cautiously to make sure that if and when casino gambling is extended, we will look at ways that communities can be sure the people of their community are interested in having a casino.

But I want to say that every day there are thousands of Ontarians travelling outside of this province and spending millions of dollars of money outside of this country. It's not a question any more of hiding our heads in the sand and pretending that casino gambling doesn't exist. It's starting to spread out all across Canada and in the United States, so we have to look very carefully at where we're going with this. But of course we will make sure that a community is fully supportive of having a casino.

Mr Eves: The minister steadfastly refuses to answer this question directly, because I suspect that she knows her government said one thing before the election and one thing after the election.

On three separate occasions the state of Michigan has provided the people of Detroit with a vote on whether or not to establish a casino. The people of Detroit have rejected it three times. In Mississippi there have been two referendums on the establishment of a casino; the first one failed, the second one was successful.

In Colorado, Connecticut, Indiana, Illinois, Florida, Missouri, New Jersey, North Dakota, Ohio and South Dakota referendums were held on the establishment of casino gambling. Some won; some lost. Why won't you give the people of Ontario and the people of Windsor the same democratic right that the people in these states have had?

Hon Ms Churley: The people of Windsor spoke through their city council loudly and clearly. We did a lot of work to make sure that the people of Windsor wanted a casino in that town. Referendums are part of the American system.

Interjections.

The Speaker (Hon David Warner): Order. Would the minister take her seat, please.

Interjections.

The Speaker: Minister.

Hon Ms Churley: Referendums, as we know, are part of the American system much more than here in Canada. You haven't said anything about Quebec, which is in the process of opening up casinos. You haven't said anything about Manitoba. You haven't said anything about Alberta. You haven't said anything about BC. You haven't said anything about the Yukon. All those jurisdictions within Canada have casinos and they didn't call referendums. We have a different kind of system than in the United States.

Mr Eves: You are part of the New Democratic Party, are you? What's new and what's democratic about it?

The Speaker: Order, the member for Parry Sound.

Hon Ms Churley: As I said before, we will be paying close attention and making sure that any community which, down the road, gets a casino -- that is, if we decide to expand -- will be thoroughly consulted.

ENVIRONMENTAL SENSITIVITY

Mr Donald Abel (Wentworth North): My question is for the Minister of Health. Recently it has been brought to my attention by a constituent in my riding of Wentworth North the terrible suffering that people with environmental sensitivities have to endure, not only as a result of their condition but also at the hands of uninformed health professionals. I would like to know what your ministry is doing to address this situation.

Hon Ruth Grier (Minister of Health): I appreciate an opportunity to speak on this issue, because I agree with the member that it is in fact suffering for a great many people. Environmental sensitivities encompass a number of conditions which have been difficult to address for many reasons, some of which have to do with a lack of understanding about the nature of the illnesses.

The ministry wishes to contribute to greater understanding of these and of the people affected by them. I have approved funding for the establishment of a joint clinical research program where individuals with sensitivities may come for complete assessment and appropriate referral and where research on diagnosis, treatment and prevention can take place.

We've also approved the establishment of a new provincial committee with a very broad representation, including consumer groups, which will develop and distribute information material for health care providers and consumers. This follows upon many previous initiatives in the Ministry of Health to promote more understanding of this condition.

Mr Abel: How do these initiatives help people who are suffering now as I speak? How will this help people who, in addition to their illness, are put through more pain as a result of inaccurate diagnosis?

Hon Mrs Grier: I appreciate the member's concern. He's right. There aren't any quick and easy solutions for the victims of these often extremely debilitating illnesses. However, we are attempting to increase awareness among the medical community, not only awareness of the condition and its serious effects, but also about the avenues that are now open to practitioners right now for more appropriate detection and treatment.

I hope that as awareness increases among doctors and others, these professionals could, where appropriate, begin to rule out environmental causes before moving to consider other diagnoses, for example.

AMBULANCE SERVICE

Mr Steven Offer (Mississauga North): I have a question for the Minister of Health. This question deals with the issue of ambulance service in my area. I think you should be aware that, though you have frozen the budget of an independent ambulance service, the only ambulance service in my area, you and your government have increased the cost of running that ambulance service.

You have increased the cost by virtue of increasing salaries of attendants, you have increased the cost through increases in premiums of the WCB, you have increased the cost through your new tax on auto insurance premiums and you have increased the cost through the new tax, the sales tax on health premiums.

The impact of this is that the ambulance service can now no longer replace an attendant when that person happens to be on sick leave, on compensation or indeed on vacation. This has severe consequences, two in fact; the first is that if two attendants happen to be absent, then one ambulance is taken off the road. The area that I represent has but two ambulances, so one of two is taken off the road. The second consequence is that if one attendant is absent, then an ambulance is staffed by only one person. An ambulance with only a driver attends to the scene of any occurrence.

My question to the Minister of Health is, as the Minister of Health, is it adequate that an ambulance with only one person in it attends at the scene of an emergency?

Hon Ruth Grier (Minister of Health): I'm not going to give a categorical answer to that kind of question. But let me say to the member that as we constrain expenditures in every area of the public service, it is incumbent upon all of those involved to examine the way in which they operate and to examine the functions that they carry out and to reallocate funding to those that are most critical and certainly to those that meet emergencies.

I would suggest to the member that within that service there have to be ways of looking at what is most critical and how that service can be provided, because I would agree with him that the provision of emergency services is a basic responsibility of government at all levels.

Mr Offer: By way of supplementary, it's strange that the Minister of Health cannot give a categorical answer. The question is, is it appropriate that an ambulance attend at the scene with only one person? God forbid it should happen to any one of us with any of our loved ones. Is it appropriate that an ambulance come to our home or to the scene of an accident with only one person? What type of emergency service can be performed by only the driver?

Madam Minister, it does require a categorical answer from you. You must stand up and say that it is inappropriate that an ambulance has only one person in the car at any time and that you have mandated, through your ministry, that in my area and in all areas -- I'll use mine -- there are two cars that must be on the road.

Madam Minister, are you going to stand by your own ministry's mandate? The question is important to thousands and thousands of people who may require emergency ambulance services. An ambulance with one person in it will not provide that service. Madam Minister, stand up and tell us, is that appropriate?

Hon Mrs Grier: What I said in my first answer was that we all have to look at how we do things, and all levels of government have to find how in fact they can do better with less.

If in fact a fire engine and a police car are at an accident and it is as yet unknown that it is a serious accident, there may be occasions where one person from the ambulance is appropriate; there are many other occasions where it is inappropriate. If the ambulance is the only vehicle responding, I would agree with him there would have to be more than a driver in the ambulance. But I don't know the circumstances he is describing. I don't accept that what he is describing applies in every particular circumstance.

I agree with him that emergency services are critical components of our health and our safety systems and, as municipalities, private sector ambulances and the ministry look carefully at how they can constrain their costs, they have to take the critical nature of those services into consideration.

SOCIAL CONTRACT

Mr David Johnson (Don Mills): My question is again to the Minister of Health, and it concerns the health sector social contract and its impact, for example, on the homes for the aged.

The health sector agreement was approved by this government, was signed by the government and was signed by the union before the employers even had the opportunity to look at it and to comment on it, and of course it was rejected by the employers.

It indicated that the powers of the joint workplace committee should be expanded and that the powers of the union would therefore be expanded in terms of its influence on the running of our health care facilities, facilities such as homes for the aged. These additional union powers would impact on planning, on budgeting and on human resources planning, and they would in fact not only be temporary powers but would be permanent powers beyond the term of the social contract.

The municipalities have said they do not want the unions running our cities. Now the health care sector is saying it does not want the unions running our homes for the aged and our hospitals.

The Speaker (Hon David Warner): Could the member place a question, please.

Mr David Johnson: The question is, why is the government attempting to force these greater union powers on the health care system, such as the homes for the aged?

Hon Ruth Grier (Minister of Health): As the member knows, we are still discussing the terms of the social contract. The deadline is not until August 1, and I still believe an agreement can be reached in that entire sector.

But the principle of involving the employees and using the talents, the skills and the experience of the employees in any institution as we try to find ways of saving money and performing our services better is a principle that we completely support. I am surprised that he, as well as the employers in nursing homes, would want to disregard the ability of the people who work with them and not want to take advantage of every opportunity to work coherently in a coordinated way to achieve savings and better management.

Mr David Johnson: Of course the municipalities and the health sector use every opportunity to hear what the employees are saying. But they do not want greater mandated or legislated authorities to the unions. That was the issue with the municipalities -- they spoke loud and clear -- and this government backtracked.

The health sector is saying it wants an agreement based on the municipal model. The municipal model permits the government to obtain its prime objective, which is to reduce spending, but at the same time it does not restrict management abilities in our health care system.

Again, the homes for the aged do not want legislated union authority in terms of planning, budgeting, and human resources planning.

The Speaker: Could the member place a supplementary.

Mr David Johnson: Madam Minister, my question to you today is, will you permit the health sector to have an agreement based on the municipal model?

Hon Mrs Grier: This is not the social contract negotiating table. I'm sure the member is aware, as I said in response to his first question, that discussions with respect to the social contract are proceeding and will proceed until the end of this week. I still remain optimistic that it may be possible to gain an agreement in that sector.

I would point out to him that the municipal sector has signed an agreement. And when he says that municipalities and all institutions work with their employees, I would suggest to him that that is not perhaps as even across the entire sector as he might wish to believe, and that if it were working as effectively as he implied, then there would be no need to try to negotiate or to find a way of making sure that happens. But I would say to him that it is not my intention to do these negotiations either on the floor of this Legislature or in public.

ONTARIO DRUG BENEFIT PROGRAM

Mr Pat Hayes (Essex-Kent): My question is to the Minister of Health. I've been approached by a number of pharmacists in my area who have some real concerns about Bill 29.

This bill gives cabinet authority to set dispensing fees under the Ontario drug benefit program, and the minister has actually rejected a fact-finder's report that called for a 3% increase in fees retroactive to December 1991.

I understand that there is a need to exercise restraint, given the fiscal outlook for the province and the sacrifices that are being required in the broader public sector. None the less, the pharmacists feel they don't have enough input. Will the minister assure this House and the pharmacists in my area and across the province that their ideas and suggestions on controlling the cost of drugs and their dispensation would receive fair consideration and that they will be consulted fully before any changes are made to dispensing fees, the schedule?

Hon Ruth Grier (Minister of Health): Yes.

PETITIONS

SOCIAL CONTRACT

Mr Hugh O'Neil (Quinte): I have a petition that has been handed to me by hundreds of people in my riding of Quinte, which is the Trenton-Belleville-Frankford area, and it reads:

"To the Honourable Lieutenant Governor, Legislative Assembly of Ontario, from the people of Ontario:

"We, the undersigned, beg leave to petition the Parliament of Ontario as follows:

"That free and open collective bargaining for public service employees be restored and be returned to its honourable position in Ontario;

"That the social contract in its present form be destroyed and that the valuable programs and services in the public sector be maintained for the betterment of all Ontarians; and

"That the government withdraw Bill 48, and in place of this bill the government work cooperatively with the public service unions to find an equitable solution rather than eliminating valuable public services."

HEALTH CARE

Mr Charles Harnick (Willowdale): I have a petition addressed to the Legislative Assembly of Ontario and it reads as follows:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact on access to and delivery of health care; and

"Whereas these proposals will result in severe reduction in the provision of quality health care services across the province,

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government of Ontario move immediately to withdraw these proposed measures and reaffirm its commitment to rational reform of Ontario's health care system through its obligations under the 1991 Ontario Medical Association/government framework and economic agreement."

I have affixed my signature.

Mr Kimble Sutherland (Oxford): I have a petition on the letterhead of the Oxford County Medical Association. It has been sent to me by Dr Munnoch in my riding and has about 150 names on it. They want the government to withdraw proposed measures and reaffirm its commitment to rational reform under the 1991 Ontario Medical Association/government framework.

RETAIL STORE HOURS

Mr Alvin Curling (Scarborough North): I have a petition to the members of the provincial Parliament:

"I, the undersigned, hereby register my opposition to wide-open Sunday business.

"I believe in the need of keeping Sunday as a holiday for family time, quality of life and religious freedom. The elimination of such a day would be detrimental to the fabric of society in Ontario and cause increased hardship on retailers, retail employees and their families.

"The proposed amendments to the Retail Business Holidays Act, Bill 38, dated June 3, 1992, to delete all Sundays except Easter from the definition of legal holiday and reclassify them as working days should be defeated."

I affix my signature to this petition.

GO BUS SERVICE

Mr Gary Carr (Oakville South): On behalf of my colleague David Tilson, MPP for Dufferin-Peel, I'd like to table a petition signed by a number of his constituents which reads as follows:

"To the Legislative Assembly of Ontario:

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"To object to the recent cuts to GO Transit bus service to Woodbridge, Kleinburg, Nobleton, Bolton, Palgrave and Highway 9; and

"Whereas this will be a major inconvenience to non-drivers; and

"Whereas it will have a negative impact on the local economy; and

"Whereas the lack of transit services will increase traffic, thereby increasing air pollution levels at a time when all levels of government are making efforts to reduce pollution and encourage the public transportation system; and

"Whereas the cuts leave no alternative means of commuting in and out of Toronto during peak hours; and

"Whereas the lack of GO buses will force passengers, at one of the worst economic times in Ontario's history, to incur extra expenses, finding another form of transportation;

"We, the undersigned, respectfully petition the Legislative Assembly of Ontario to overturn GO Transit's decision and restore GO Transit service to Woodbridge, Kleinburg, Nobleton, Bolton and Highway 9."

GAMBLING

Mr Dennis Drainville (Victoria-Haliburton): Again, I read one of the many thousands of petitions I've brought to this House:

"To the Legislative Assembly of Ontario:

"Whereas the New Democratic Party government has not consulted the citizens of the province regarding the expansion of gambling; and

"Whereas families are made more emotionally and economically vulnerable by the operation of various gaming and gambling ventures; and

"Whereas creditable academic studies have shown that state-operated gambling is nothing more than a regressive tax on the poor; and

"Whereas the New Democratic Party has in the past vociferously opposed the raising of moneys for the state through gambling; and

"Whereas the government has not attempted to address the very serious concerns that have been raised by groups and individuals regarding the potential growth in crime;

"Therefore, we, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government immediately cease all moves to establish gambling casinos and refrain from introducing video lottery terminals in the province of Ontario."

It's my great pleasure to affix my name to this petition.

HEALTH CARE

Mr Mike Cooper (Kitchener-Wilmot): I have a petition to the Legislative Assembly of Ontario:

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government of Ontario move immediately to withdraw these proposed measures and reaffirm its commitment to rational reform of Ontario's health care system through its obligations under the 1991 Ontario Medical Association/government framework and economic agreement."

MENTAL HEALTH SERVICES

Mrs Barbara Sullivan (Halton Centre): I have a petition to the Legislative Assembly of Ontario which reads as follows:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact on access to and the delivery of psychotherapy; and

"Whereas these proposals will enable government to unilaterally and arbitrarily restrict payments for psychotherapy; and

"Whereas these proposals will result in a severe reduction in the provision of quality mental health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"The government of Ontario move immediately to withdraw the proposal to restrict payments for psychotherapy and withdraw the proposal to allow the cabinet to make decisions with respect to the number of times patients may receive particular insured services and set maximums with respect thereto. The government of Ontario must reaffirm its commitment to the process of joint management and rational reform of the delivery of medical services in the province as specified under the Ontario Medical Association/government framework agreement."

I concur with this petition and affix my name to it.

AUTOMOBILE INSURANCE

Mr Bob Huget (Sarnia): I have a petition to the Legislative Assembly of Ontario. This petition is signed by 235 members of my riding of Sarnia and surrounding area. The petition reads as follows:

"Whereas the people of Ontario are undergoing economic hardship, high unemployment and are faced with the prospect of imminent tax increases; and

"Whereas the Ontario motorist protection plan currently delivers cost-effective insurance benefits to Ontario drivers; and

"Whereas the passing of Bill 164 into law will result in higher automobile insurance premiums for Ontario drivers;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That Bill 164 be withdrawn."

HEALTH CARE

Mrs Joan M. Fawcett (Northumberland): I have a petition to the Legislative Assembly of Ontario:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact on access to and the delivery of health care; and

"Whereas these proposals will result in a severe reduction in the provision of quality health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government of Ontario move immediately to withdraw these proposed measures and reaffirm its commitment to rational reform of Ontario's health care system through its obligations under the 1991 Ontario Medical Association/government framework and economic agreement."

I have signed the petition.

ONTARIO DRUG BENEFIT PROGRAM

Mr Leo Jordan (Lanark-Renfrew): I have a petition to the Legislative Assembly of Ontario:

"We, the undersigned, beg leave to petition the Legislative Assembly of Ontario as follows:

"The expenditure control plan announced in the Legislature by Treasurer Floyd Laughren on April 23, 1993, includes reductions in health care services by $4 billion. This means that the Ontario drug benefit program is in jeopardy. We quote:

"'The reform on the Ontario drug benefits program will result in a savings of $195 million.' To be reformed are pharmacy services, prescribing guidelines, management of nutritional products and over-the-counter products. There will also be price changes and cost-sharing.

"We therefore request that the House refrain from supporting this piece of legislation which will result in a serious burden to senior citizens in Ontario."

There are 165 signatures on this petition and I will sign it on their behalf.

HEALTH CARE

Mr Kimble Sutherland (Oxford): I have another petition submitted by a member of the Oxford County Medical Association. It's sent to me by Dr M. Dowdee, and it's similar to the petition I read in earlier. It has about 40 names on it.

Mr Ron Eddy (Brant-Haldimand): I have a petition to the Legislative Assembly of Ontario:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact on access to and the delivery of health care; and

"Whereas these proposals will result in a severe reduction in the provision of quality health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"The government of Ontario move immediately to withdraw these proposed measures and reaffirm its commitment to rational reform of Ontario's health care system through its obligations under the Ontario Medical Association-government framework and economic agreement."

It is signed by 230 residents of Brant county and the city of Brantford. I affix my signature.

MENTAL HEALTH SERVICES

Mr Jim Wilson (Simcoe West): I have a petition addressed to the Legislative Assembly of Ontario:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact upon access to and the delivery of psychotherapy; and

"Whereas these proposals will enable government to unilaterally and arbitrarily restrict payments for psychotherapy; and

"Whereas these proposals will result in a severe reduction in the provision of quality mental health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"The government of Ontario move immediately to withdraw the proposal to restrict payments for psychotherapy and withdraw the proposal to allow the cabinet to make decisions with respect to the number of times patients may receive particular insured services and set maximums with respect thereto. The government of Ontario must reaffirm its commitment to the process of joint management and rational reform of the delivery of medical services in the province, as specified under the Ontario Medical Association/government framework agreement."

That's signed by a number of very concerned taxpayers in this province who are worried about Bill 50 and the unilateral decisions being taken by this government. Some of those residents are with us today in the gallery. I too have affixed my name to this petition.

PUBLIC SERVICES

Mr Bob Huget (Sarnia): I have a petition signed by 29 constituents of mine in the riding of Sarnia. The petition reads as follows:

"We, the following undersigned citizens of Sarnia, beg leave to petition the Parliament of Ontario as follows:

"We, the undersigned, call on the Ontario government to maintain and improve our public services. Public services are vital to our communities and our way of life. We can't afford to lose them."

I've affixed my signature to the petition.

MENTAL HEALTH SERVICES

Mrs Barbara Sullivan (Halton Centre): I have an additional petition to the Legislative Assembly of Ontario which reads as follows:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact on access to and the delivery of psychotherapy; and

"Whereas these proposals will enable government to unilaterally and arbitrarily restrict payments for psychotherapy; and

"Whereas these proposals will result in a severe reduction in the provision of quality mental health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government move immediately to withdraw the proposal to restrict payments for psychotherapy and withdraw the proposal to allow the cabinet to make decisions with respect to the number of times patients may receive particular insured services and set maximums with respect thereto.

"The government of Ontario must reaffirm its commitment to the process of joint management and rational reform of the delivery of medical services in the province as specified under the Ontario Medical Association government/framework agreement."

Once again, hundreds of signatures are on this petition, and I concur with it and affix mine as well.

NATIVE HUNTING AND FISHING

Mr Leo Jordan (Lanark-Renfrew): I have a petition to the Legislative Assembly of Ontario:

"Whereas in 1923, seven Ontario bands signed the Williams Treaty, which guaranteed that native peoples would fish and hunt according to provincial and federal conservation laws, like everyone else; and

"Whereas the bands were paid the 1993 equivalent of $20 million; and

"Whereas that treaty was upheld by Ontario's highest court last year; and

"Whereas Bob Rae is not enforcing existing laws which prohibit native peoples from hunting and fishing out of season; and

"Whereas this will put at risk an already pressured part of Ontario's environment;

"We, the undersigned, adamantly demand that the government honour the principles of fish and wildlife conservation; to respect our native and non-native ancestors and to respect the Williams Treaty."

This is signed by 501 constituents, and I also affix my signature.

The Acting Speaker (Mr Noble Villeneuve): This terminates the time allotted for petitions.

WRITTEN QUESTIONS

Mrs Barbara Sullivan (Halton Centre): On a point of order, Mr Speaker: On June 16, I placed two Order and Notices paper questions, number 224 and number 226, to the Ministry of Health, the first with respect to documentation about impact studies, consultative meetings held with respect to reducing technical fees paid to facilities and hospitals; the second requesting cost-benefit studies, health outcomes analysis and studies undertaken, consultative meetings held, surveys conducted etc with respect to the delisting of psychotherapy.

I had an indication that while the material could not be available in the time required under standing order 97(d), a final answer would be available on or about July 14. That day has long passed, and I'm asking once again for the material that as a member I have the right to access.

The Acting Speaker (Mr Noble Villeneuve): Your request is on record on the order paper and indeed on a point of order here in the Legislature, and I'm quite sure officials at the Ministry of Health are looking into it.

REPORTS BY COMMITTEES

STANDING COMMITTEE ON GENERAL GOVERNMENT

Mr David Johnson from the standing committee on general government presented the following report and moved its adoption:

Your committee begs to report the following bill as amended:

Bill 7,

An Act to amend certain Acts related to Municipalities concerning Waste Management / Loi modifiant certaines lois relatives aux municipalités en ce qui concerne la gestion des déchets.

The Acting Speaker (Mr Noble Villeneuve): Shall the report be received and adopted? Agreed.

Shall Bill 7 be ordered for third reading? Agreed.

The bill is therefore ordered for third reading.

ORDERS OF THE DAY

EXPENDITURE CONTROL PLAN STATUTE LAW AMENDMENT ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LE PLAN DE CONTRÔLE DES DÉPENSES

Mrs Grier moved second reading of the following bill:

Bill 50,

An Act to implement the Government's expenditure control plan and, in that connection, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act / Loi visant à mettre en oeuvre le Plan de contrôle des dépenses du gouvernement et modifiant la

Loi sur l'assurance-santé et la

Loi sur l'arbitrage des conflits de travail dans les hôpitaux.

The Acting Speaker (Mr Noble Villeneuve): Does the minister have some opening remarks?

Hon Brian A. Charlton (Government House Leader): Mr Speaker, just before the minister commences her opening remarks, two things: I believe we have consent to sit till 8:30 this evening.

The Acting Speaker: Do we have agreement to sit until 8:30 this evening? Agreed.

Hon Mr Charlton: Secondly, I believe we have an agreement to adjourn the debate on this bill, Bill 50, and to move then to the debate on Bill 8, the casinos act, at 6 o'clock.

The Acting Speaker: Do we have agreement to cease debate on Bill 50 at 6 o'clock and begin the Bill 8 debate? We have agreement.

Hon Ruth Grier (Minister of Health): This motion is for second reading of Bill 50, the Expenditure Control Plan Statute Law Amendment Act, and this, as the title says, is

an act to implement the government's expenditure control plan, and connected to that, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act.

Bill 50 is consistent with that health reform strategy and will enable the government to meet its targeted expenditure reductions.

The first major challenge we faced as we moved to implement our health reform strategy was restructuring the hospital system, and this has also been our greatest success. When hospitals were forced to trim their budgets a couple of years ago, critics sounded the alarm bells, unnecessarily, as it turned out, and today we see more efficient hospitals offering better quality care. We've seen that because of great achievements from hospital administrators and hospital workers.

The average length of stay in a hospital has fallen from nine days in 1988 to seven days today. The number of people treated has increased by almost 8%, or about one million cases, with more cases being served on an outpatient basis. Day surgery, as a percentage of all surgeries, has risen from 53% to 70%, and we also have in place a five-year reform plan that includes reorganizing services on a regional basis to eliminate duplication, work that is being spearheaded by the district health councils across the province.

I believe our success in the hospital sector is due in large part to the constructive role of the Ontario Hospital Association through the joint policy and planning committee, the local and regional planning that, as I say, is being done by district health councils, and a much more open decision-making process at each hospital through the implementation of operating guidelines.

In the early life of this government a framework agreement was signed with the Ontario Medical Association, and that again was a very important step in our reform of the health care system. That agreement created two very important tools, tools that enable us and the Ontario Medical Association to manage the ministry in a way that improves effectiveness as well as controlling costs. One of those tools is the joint management committee, working very effectively, and another is the Institute for Clinical Evaluative Sciences, known as ICES.

This institute, about which I believe not enough is yet known by the people of this province, provides us with technical information to help doctors to do their jobs better. Research conducted on issues such as small variations in coronary surgery rates and ultrasound examinations will help improve the quality and effectiveness of our medical services.

Earlier this year, again consistent with our reform agenda, I announced two major policy frameworks, that for long-term care as well as a strategy for mental health reform, and we recently released a discussion paper on reform of the Ontario drug benefit plan.

Work has also begun on development of a primary health services framework that will help us ensure that basic health care is effective and truly accessible. This policy is part of the ongoing work on a community health framework and will look at the role of physicians and other health care professionals such as nurses, pharmacists, chiropractors and midwives and what role they should play in primary health services.

We are very proud, and I think the people of Ontario can be proud, of the progress that has been made in the last two years, because only by reforming the health care system to manage it better can we continue to afford it and also provide every citizen with high-quality care.

The current fiscal situation forces us to face an inescapable truth: Our system is the most expensive publicly funded system in the world. Between 1982 and 1992, the Ministry of Health's budget increased annually by 10% and doubled to the $17.8 billion it stands at today. If we keep spending as though the sky were the limit, we will not have a universal health care system to pass on to our children and our children's children, because the system would become unsustainable.

Last year, we kept growth in spending to an increase of 1%. This year, with our expenditure control measures as well as savings in the public sector payroll achieved through the social contract, the budget will increase by just 0.1%, an amazing achievement.

However, I think it's important for everyone to understand that Ministry of Health spending in 1993-94 will still be more than $17 billion, or one third of the provincial budget. So our task is not only to keep health expenditures under control, but to bring costs down while at the same time reallocating money from one sector of health care to another.

We do that in order to be able to meet the needs of the aging population, of people with AIDS or for more community-based services, in order to fill the gaps that have for too many years been allowed to develop. I believe this presents us with an opportunity to deal with a situation that has been ignored for too long while at the same time advancing our health reform agenda.

For years Canada's provincial and federal governments have been hearing the warning calls from health economists and planners, as well as from doctors and other health professionals, that spending on health care was getting out of hand and that some of the money was not being spent as wisely as it could be.

One prominent health policy expert, Jonathan Lomas, who coordinates the Centre for Health Economics and Policy Analysis at McMaster University, has said that he would like to see ministries of health across Canada move from simply being insurers and payers to becoming managers. We believe the job of government is to invest in health, not merely to pay the bills, and that's what our reform agenda is all about.

One fact that ministries of health across Canada ignored as long ago as the mid-1970s was that the growth in the number of physicians was far outstripping the growth in the population. This imbalance came from health planning decisions made 30 years ago, when the planned growth of physicians was designed for 37 million people, not the 27 million we have in Canada today.

In Ontario the increase in physicians has been more tied to our capacity to train doctors than to our population needs. There has been a lack of planning and management resulting in shortages of specialists in some areas and an oversupply in others.

For example, there was a 46% increase in paediatricians between 1981 and 1989, but only a 4% increase in their young patients. Meanwhile, there's a growing need for health services in the areas of geriatrics and chronic diseases. We saw a 33% overall increase in doctors, but we still have communities that have no doctors: 24 years of incentive plans have not been able to get enough doctors to rural and northern communities.

Even in the past three months, despite the publicity and controversy that there has been about our proposals to try to redistribute physicians to areas where they are needed, we have been forced to bring in doctors from other provinces, from Australia, Israel, the United Kingdom, South Africa and the United States: bring in doctors to work where our own doctors don't want to go. As well, Ontario has specific populations that remain chronically underserved, such as women, native people, AIDS sufferers and francophones.

Physician resource management has long been under discussion by every health ministry across the country. In 1991, professors Morris Barer and Greg Stoddart submitted a report to all of the provincial and the federal ministers of health. It was called Toward Integrated Medical Resource Policies for Canada, and the recommendations in that report have played a significant role in provincial strategies to deal with physician resource management.

Last February, Ontario's universities agreed to enrol 70 fewer medical students, starting this fall. The ministry also announced better ways to control entry into the health system of graduates of foreign medical schools who come to Canada as visa trainees.

But development of a policy to better manage our human resources has only just begun. There needs to be a broad discussion, and some of that is occurring through the recently created Provincial Coordinating Committee on Postgraduate Medical Education. That committee, chaired by Dr John Evans, includes people from district health councils, from academic health science centres, hospitals, as well as organizations representing physicians. The committee will look at the issues related to post-graduate medical education and the management of physician resources, and I want to say that so far I'm extremely encouraged by the work that committee has done.

The second thing we have to do is to encourage payment approaches or means of payment that give us much greater flexibility than the current fee-for-service system.

Thirdly, we need to ensure a much more effective match of needs and resources.

This brings us to Bill 50, legislation that is not for the purpose of allowing government to practise medicine, as I'm sure members will hear in the debate this afternoon, nor does it allow the government to stop paying for medically necessary services. In fact, the Canada Health Act ensures that we provide medically necessary services, along with reasonable access to them, for all our permanent residents.

The legislative amendments we have proposed clarify the authority required to proceed with the types of proposals that have been made under the expenditure control plan.

With respect to the changes to the Health Insurance Act, the amendments are the first major changes to the act since 1972. These changes will allow for better management of the health insurance plan, and some would argue that they are long overdue.

This legislation is a fail-safe mechanism to ensure that the government can meet its fiscal targets in the event that we cannot reach agreement through negotiations with the Ontario Medical Association. These negotiations with the OMA have been taking place for some time, very intensely, and indeed are occurring as I speak.

We have proposed a number of measures through the expenditure control plan, such as income thresholds, discounts and changes to the fee schedule. These, plus the social contract reductions, are designed to reduce the fee-for-service budget for physicians this year to approximately $3.6 billion, a decrease of 8.6% from last year, and we plan that they should continue to be at that level for the next two years. Expenditure control plan measures and a successful social contract will result in a decline of 7.5% from last year on payments for physicians, other fee-for-service health providers, out-of-country care and laboratories.

While I hope we can arrive at our savings through successful negotiations with the Ontario Medical Association, I want to make it clear that our target must be met. But I also want to make it very clear, once again, that with this bill the government has no intention of limiting medically necessary treatments.

I want to speak for a moment on some of the details of the three key sections of Bill 50.

First of all, there are amendments being proposed to the Health Insurance Act. Under the current act, the Minister of Health has the power to prescribe the amounts payable by the health insurance plan for insured services. We are expanding that already existing regulation-making authority to make it more precise. The expanded authority will allow us to pass regulations with respect to other matters that may be agreed upon between the government and the Ontario Medical Association.

There will be more specific authority with respect to payment, based on classes of physicians, practitioners or health facilities or where the service is rendered. We will have the authority to lower fees to new entrants, but also to pay 100% of fees to a new entrant in an underserviced area or specialty.

The changes will ensure that regulations under the Health Insurance Act can control government expenditures, encourage appropriate distribution of doctors in the province and discourage doctors, practitioners and health facilities in overserviced locations.

Other amendments in the Health Insurance Act will allow increases, through regulation, in the number of members of the Medical Review Committee and the practitioner review committees. The ratio of lay to professional members will be maintained.

The Medical Review Committee, at the request of the ministry, reviews cases of physicians who appear to be inappropriately submitting claims for insured services, an issue that I know all members of this House have raised and are concerned about. But I want to point out that there is currently a backlog of 49 cases at that committee and the response time is now averaging more than two years, up from seven and a half months in 1984 and 20 1/2 months three years ago.

The committee has only eight members. In 1990, the Provincial Auditor asked the previous government to expand the committee. We are acting on that recommendation through Bill 50. We need that expansion so that we can more quickly get back the money taxpayers have incorrectly paid to doctors who billed inappropriately.

This bill also includes amendments to the Hospital Labour Disputes Arbitration Act, amendments that require parties to share the cost of arbitrations in hospitals and nursing homes. At present the government pays the full amount of these costs, which on average has been nearly half a million dollars every year.

What we see in the health sector, where government picks up the full cost of arbitration, is 40% of negotiations going to arbitration. Contrast that with the fact that in police bargaining, where there is a sharing of costs, only 8% of cases go to arbitration.

Cost-sharing is already the norm for firefighters, teachers and community college employees. This amendment to the Hospital Labour Disputes Arbitration Act is also consistent with the policies of most other provinces where there is mandatory arbitration in the public sector.

Lastly, Bill 50 enables the government to override existing agreements where new agreements have not been reached to achieve fiscal targets. While it is not our wish to override any collective agreements, the alternative would mean a crisis for health care spending in the future, and that we cannot allow to happen.

Let me close by re-emphasizing the fact that the Expenditure Control Plan Statute Law Amendment Act is a tool that will help the ministry to effectively manage the health care system. We intend to hold the line on spending for health services. We intend to preserve the best of what we have in Ontario's excellent health care system while reforming to meet new needs and new demands. Far from dismantling the system, we are making it better and making sure the taxpayers can continue to afford to pay for it.

In 1979, Tommy Douglas, whose New Democratic government in Saskatchewan introduced medicare to Canada, said that public health insurance was only the first step in the setting up of medicare. The second step, he said, would involve the reorganization of medical and health practice and an emphasis on health promotion and disease prevention. He predicted the second step would be even tougher than the first.

Our government has taken on that second step. It is not an easy task, but with discussion and participation by everyone involved in Ontario's health care system, we will succeed. This legislation is one step in that direction.

The Acting Speaker (Mr Dennis Drainville): I thank the honourable minister for her participation in the debate. Questions or comments? If there are no questions or comments, further debate?

Mrs Barbara Sullivan (Halton Centre): I listened to the comments of the Minister of Health with some interest and was quite taken with the fact that she described Bill 50 as being a fail-safe mechanism which will entitle the government to make targeted expenditures. I did not hear her, however, in the course of her discussion talking about the implications for health care delivery which is so very much a part of the Ontario medicare participation and so important to every single person in the province.

I believe that Bill 50 has extraordinary implications for the public, for physicians, for hospitals, for the health care system generally and indeed for our medicare system as a whole. It provides the Ontario government with draconian powers to impose massive cuts on medical services and, hence, patient care. Those cuts can be made without reference to the need for such services or to whether an individual or a group of people will be adversely affected.

Through this bill, the government is giving itself the sole power to determine the circumstances and the conditions under which doctors, other practitioners and patients will be reimbursed for medical services. It would allow the Minister of Health and the government of the province to determine behind closed doors that a person could only see a doctor for a specific treatment a certain number of times. It would allow the Minister of Health to say that a doctor will not be paid for services that he or she has provided to patients.

It does not require that limitations be put on the use of doctors' services only when such services aren't really necessary. In fact, the bill gives the minister and her bureaucrats in the Ministry of Health the unilateral power to ration insured and medically necessary services no matter what the effect that rationing will have on the person who needs to receive those services, and the bill says that those cuts can be made not because those services aren't needed but simply because the minister doesn't want to pay for them. That is what this bill is all about.

The bill gives the minister the power to say where and how a doctor can practise medicine. An older doctor may have different rules to follow than a younger doctor, and those rules could be imposed without any check on the minister or the government, without negotiations with the Ontario Medical Association nor any discussion required of the efficacy of that decision.

In fact, Bill 50 overrides the framework and economic agreement which the government has with the OMA and says that whatever contractual arrangements exist for payments to doctors are of no value. They can be set aside by decree of the minister, and there is no recourse by the individual doctor nor by the association which represents all of the doctors in the province and is legally required and entitled to negotiate on their behalf.

Bill 50 doesn't end with the physicians. It also applies to chiropodists, dentists, chiropractors, optometrists, osteopaths and any other practitioner who is paid by OHIP for providing health care services.

Just before he was elected in 1990, Bob Rae, who was then the leader of the New Democratic Party -- he's now Premier of Ontario, much to some of our regret -- had this to say to the Ontario Medical Association, and this is a direct quote:

"There's no fairness in a system that allows the government to dictate unilaterally your level of pay. A monolithic system in which one insurer has all of the political cards can't work without checks and balances, professions free to speak out on the quality of care, a partnership in which planning decisions about the system emerge from a genuine dialogue and not from the cabinet room alone, and above all, a sense of fairness and pluralism when it comes to management of the system. These are all essential if the health care system is to maintain the confidence of everyone working in it, as well as the public it serves.

"Fair arbitration between the professions and the government is a critical element in creating a more open health care system. You have a right to it," Premier Rae told the doctors, "under international law and under every standard of natural justice."

I'm going to hold that quote aside because I may want to come back to it as we proceed through the debate on this bill, because this piece of legislation takes away the very checks and balances that Bob Rae spoke about when he was addressing the Ontario Medical Association.

It removes the partnership and it leaves the cabinet room in charge of how people are cared for and what medical services they can receive and when. It leaves everyone, patients and their families, physicians and other health professionals, and hospitals and health facilities at the whim of a government that is intent on slashing costs no matter what the effect.

The president of the Ontario Medical Association pointed out in a letter to all members of the Legislature on June 18 that this bill, and I just would like to quote from that letter, "gives government the power to say, for example, that if your child has an ear infection and needs more than the government-dictated number of visits, those medical services might not be covered by OHIP, or worse, might not be available at all."

He goes on to point out, "There are no limits on what services can be restricted by government under this legislation. The legislation is not specific to psychotherapy or eye examinations as originally proposed in the expenditure control plan for physician services; the power to ration insured and medically necessary services applies to everyone and everything. The number of medical services deemed appropriate can be decided unilaterally by some bureaucrat whose mandate extends no further than saving money."

That is precisely the crux of the problem with this bill.

Tom Walkom, who writes, as you know, for the Toronto Star, had a look at the bill and listened to what people were saying about it, and on July 3 he wrote a column about what's happening with Bill 50. In his column he said: "It's unclear what exactly the government hopes to win from all of this. Bill 50 would allow the cabinet to busy itself in the minutiae of deciding how many times patients can see their doctors."

He quotes Health ministry spokesman Layne Verbeek -- and I want to quote this from the column -- who says, "The government has little intention of using this blunt instrument."

If the government has no intention of using what is self-described as a blunt instrument, if the government has no intention of using the extensive and extraordinary powers which it is giving itself under this legislation, then why has this bill been drafted and why is the bill before the House? Why are we discussing this bill if the government does not intend to use the bill?

My view is that indeed the government is not only committed to this law, but it intends to implement it with all its force, no matter what the consequences to any patient or to any practitioner anywhere in Ontario. Frankly, the Minister of Health made that very, very clear in her introductory remarks.

I want to ask some questions.

What about the patient? If a patient needs a medical treatment that the government has arbitrarily deemed to be not medically necessary, according to its own arbitrary standards or calculations based on cost, where will the patient be?

Will the patient have to reach into his or her own pocket to pay for medical care, perhaps because the doctor has provided that same treatment to too many others? Will the patient be refused treatment because the government has said that the treatment has been provided too many times in a geographic region and that the practitioner isn't allowed to provide that treatment again? Will the patient be forced to travel to another site to get the treatment from another care giver who perhaps hasn't met the quota, or isn't as young, or isn't as old? Or will the patient have to take out a loan to cover the costs of medical care if he or she doesn't have the resources?

What if the patient is to be admitted to a hospital for surgery but, too bad, the cabinet said that hospital's done too much of that same kind of surgery, too many of those operations? Can the patient have the operation if she pays for it? Well, then where is the commensurate right of the hospital to charge for that necessary surgery if that's the intention of the bill?

If hospitals and doctors and other practitioners must recoup their costs by charging patients for necessary medical care, what then is the place of medicare in Ontario? For it is clear this bill creates a two-tier system, where those who can pay for the care they need will receive it, and those who can't pay will have to take their lumps if the government deems that they have to take their lumps.

That is exactly what the federal-provincial medicare plan was designed precisely to avoid. Medicare's primary objective, as defined in the Canada Health Act, and I'm quoting directly from the act, is "to protect, promote and restore the physical and mental wellbeing of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."

It doesn't say that an insured service can be an insured service in one place on one day but not an insured service in another place on the same day. It doesn't say that an insured service isn't an insured service if the patient has received it before. It doesn't say that an insured service isn't an insured service if a quota has been met.

But Bill 50 means that the government can determine unilaterally, without notice or consultation, what medical services persons can receive, where they can receive them, how often they can receive them, from whom they can receive them. The Minister of Health and her officials could determine whether a person in Toronto can receive treatment when a person in Cornwall cannot, although it's more likely in fact to be the very opposite case. The Minister of Health, under this legislation, could say that a doctor in Windsor must practise in a different way than a doctor in Renfrew.

The Minister of Health and her bureaucrats can say that a person cannot receive medical care, even if that care is medically necessary, because the patient has received treatment before.

I would like to move to that

section of the Canada Health Act, which is

section 12, and read directly from that very important piece of Canadian law:

"(

b) must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province;

"(

c) must provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists; and

"(

d) must provide for the payment of amounts to hospitals, including hospitals owned or operated by Canada, in respect of the cost of insured health services."

"

(2) In respect of any province in which extra billing is not permitted, paragraph (1)(c)" -- that is with respect to the reasonable compensation for medical practitioners -- "shall be deemed to be complied with if the province has chosen to enter into, and has entered into, an agreement with the medical practitioners and dentists of the province that provides

"(

a) for negotiations relating to compensation for insured health services between the province and the provincial organizations that represent practicing medical practitioners or dentists in the province;

"(

b) for the settlement of disputes relating to compensation through, at the option of the appropriate provincial organizations referred to in paragraph (a), conciliation or binding arbitration by a panel that is equally representative of the provincial organizations and the province and that has an independent chairman; and

"(

c) that a decision of the panel referred to in paragraph (

b) may not be altered except by

an act of the legislature of the province."

That is what the Canada Health Act requires, and indeed Ontario does have an agreement with the Ontario Medical Association. We heard all about it on May 6, 1991, and we have watched the progress of that framework and economic agreement with enormous interest since that time.

When it was announced on May 6, 1991, Health Minister Frances Lankin called it a "landmark agreement." I'd just like to read a couple of quotes from the speech she gave at the time the agreement was signed:

"This agreement brings to the system a new cooperative approach to management that will allow for the kind of health care planning that this province has always needed.

"Physicians have agreed to help the government achieve more value for health care spending in Ontario," she said. "They have agreed to help achieve the appropriate number, mix and distribution of physicians, based upon Ontario's needs.

"A joint management committee, with representatives from the OMA and from government, will work to enhance the quality and effectiveness of medical care, including the pursuit of more value for existing spending."

That's what the government said in 1991, and those were the exact words of the then Minister of Health, the Honourable Frances Lankin. But today, Bill 50 will mean that the provisions of the Ontario Medical Association/province of Ontario framework and economic agreement are -- I'm going to read some direct quotes from this act, because this is what the effect of this bill is. It says provisions of the agreement are "not enforceable." There is no obligation, if the government so designates, for the Minister of Health to "pay money in connection with the provision of health services and to engage in related negotiation, mediation or arbitration."

I remind you that the Canada Health Act requires that very negotiation, mediation or arbitration. It requires that physicians and practitioners be reasonably compensated and fairly compensated for the services they provide. This bill not only overrides the framework and economic agreement which the government has enacted with the Ontario Medical Association, but in those very circumstances overrides the Canada Health Act.

Bill 50 will allow the Minister of Health to decide that a physician can receive "a reduced amount or no amount" for treatment provided to patients. Furthermore, in case people missed this, the provisions are all retroactive to April 1, 1993. That means that the government can claw back payments that it has already made to physicians three months ago if it decides that the GP had treated too many patients for the same problem or because the GP didn't meet a regional quota that was also imposed retroactively.

Without negotiation or the clinical expertise that's so desperately needed, the Minister of Health can decide what is medically necessary or under what circumstances health care services are medically necessary.

Let's look at one, specifically, of the services which the government has arbitrarily decided is not medically necessary. The government has signalled its intent to prescribe the conditions for receiving service. The government's expenditure control plan singles out psychotherapy for particular treatment. I want to make it clear that whatever gobbledegook the Minister of Health puts before you, you should listen very carefully on this issue, because this was an idea that sprang out of somebody's head in the Ministry of Health. The proposal does not have and never has had the approval of the joint management committee or the Ontario Medical Association.

The Ministry of Health expenditure control plan for physicians' services explicitly states that the goal is to establish yearly per-patient maximums for psychotherapy. It says that Ontario spends more per capita on psychotherapy than any other province; that some patients see their physicians several hours a day every week and the medical benefits of such intensive therapy are questionable. The proposal is to restrict payments to 100 hours per year per patient, which equates to two hours per week per patient. This will result in 1993-94 savings of $26.5 million.

I believe, in another document, those savings are projected to a much higher amount, in the area of some $40 million, but I will have that figure.

That is the target and that is the goal.

The government has itself said that the value of intensive psychotherapy is questionable, but on June 16, I asked the minister -- and you will know that in the House today I stood up on a point of order, through an order paper question, to ask the minister to provide any kind of and all documentation relating to the ministry's proposal to restrict patient access to psychotherapy services to two hours per week per patient, including -- this was part of the information that I asked for -- cost-benefit studies prepared, health outcomes analysis and studies undertaken, minutes of consultative meetings that were held, surveys that were conducted or any other activities which were undertaken by the Ministry of Health to formulate this proposal.

As you know, Mr Speaker, under the rules of the House, I was entitled to a response on or about June 26. Instead, I received a notice stating that the answer could not be provided until July 14. Well, July 14 came and went and I do not to this day have an answer. I don't believe there will be one, or, if there is one, it won't be a complete response, because the health outcomes analysis, in my view, was not done. I would assume that if the minister wants to refute that statement, she will do so in questions and comments subsequent to my discussion.

I do not believe, given the expert opinion which has come in to all members of this Legislature, that the health outcomes analysis of this proposal, which has been put forward by the Ministry of Health, was done; I do not believe that the consultative meetings were held, and I will have some more discussion on that particular question later on; nor do I believe that the patient surveys were conducted. This proposal is an off-the-top-of-the-head proposal, and there's nothing to back it up.

On June 7, the Ministry of Health issued a backgrounder. It made some statements that have been characterized by the Ontario branches of the Canadian Psychoanalytic Society as, and I quote this, "misleading and inaccurate." The society presented some information to clarify the facts, and I would like to read some of that information into the record. The ministry statement, which the society says is false, reads as follows:

"In intensive, long-term psychotherapy, a patient may attend therapy many hours a day, several days a week, indefinitely. The intensity of treatment is seen by many experts in the field of psychiatry to be of questionable medical benefit."

What is true, according to the Canadian Psychoanalytic Society, is:

"Psychoanalysis is a proven, effective treatment for serious mental illness. Psychoanalysis treats severe and chronic mental disorders that prevent individuals from functioning as productive parents, employees and citizens. For this small group of patients, it is a treatment of last resort. Psychoanalysis takes place for one hour each day, four or five times per week. It is an intensive therapy designed to break t