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December 5, 2018

HOUSE OF ASSEMBLY PROCEEDINGS

Vol. XLVIII No. 49

The

House met at 10 a.m.

MR. SPEAKER (Trimper):

Order, please!

Admit

strangers.

I would

like to catch up on some outstanding points of order. It's been a busy last few

days and why not tackle that right off the bat today.

There

were two points of order raised by the Member for St. John's Centre. At the

start of proceedings on November 21, 2018, the Member for St. John's Centre, the

Leader of the Third Party, rose on two points of order regarding comments made

by the Minister of Justice and Public Safety during proceedings, the proceeding

evening.

Point

number one: The first point of order was raised by the Member under Standing

Order 49 wherein she suggested that the minister had spoken of her in a tone

that was unconducive to the work that we do here. I have reviewed

Hansard and viewed the archived

broadcast and while the tone of the remarks was elevated, the words used by the

minister were not unparliamentary in accordance with the relevant Standing

Order. Therefore, I rule that there is no point of order; however, I would

remind all of our Members to please be tempered in their remarks and respect

each other in this hon. House.

Point

number two: In the second point of order raised by the Member for St. John's

Centre, the Member pointed out that in the previous evening's debate the

Minister of Justice and Public Safety referred to the Member for St. John's East

- Quidi Vidi as “the former Leader of the Third Party.” As with the previous

point of order, I reviewed Hansard and

viewed the archived broadcast. I find that the remarks by the minister were

historically accurate; therefore, I rule that there is no point of order.

One

further comment: I remind Members that a point of order must be raised at the

earliest possible opportunity in the course of debate. The points of order

raised by the Member for St. John's Centre were not raised at the earliest

opportunity and, therefore, were not in order on that basis alone.

Point

number three, raised by the Member for Cartwright - L'Anse au Clair: The Member

for Cartwright - L'Anse au Clair raised a point of order on November 21, 2018

respecting comments made by the Member for Fortune Bay - Cape La Hune. The point

of order was raised under Standing Order 49 and alleged that the other Member

used unparliamentarily language contrary to that Standing Order.

The word

in question was “corruption.” Again, I reviewed

Hansard and the webcast of the matter in question. Bosc and Gagnon,

at page 624, outlines the difficulty in characterizing unparliamentary language.

It says: “In dealing with unparliamentary language, the Speaker takes into

account the tone, manner and intention of the Member speaking; the person to

whom the words at issue were directed; the degree of provocation; and, most

importantly, whether or not the remarks created disorder in the Chamber. Thus,

language deemed unparliamentary one day may not necessarily be deemed

unparliamentary the following day.”

In the

current context, it is true that previous Speakers have made rulings respecting

the use of the word “corruption.” However, in this context, the intention of the

Member was based on a generality and was not directed to a particular Member or

government. I therefore rule that there is no point of order.

I thank

the Members for their attention.

Orders of the Day

MR. SPEAKER:

The hon. the Government House

Leader.

MR. A. PARSONS:

Thank you, Mr. Speaker.

I call

from the Order Paper, Order 2, third reading of Bill 41.

MR. SPEAKER:

The hon. the Government House

Leader.

MR. A. PARSONS:

Mr. Speaker, I move, seconded

by the Minister for Health and Community Services that Bill 41,

An Act To Amend

The Canada-Newfoundland And Labrador Atlantic Accord Implementation Newfoundland

And Labrador Act be now read a third time.

MR. SPEAKER:

Wrong number.

MR. A. PARSONS:

I got to say it again?

CLERK (Barnes):

You got the wrong Order

Paper.

MR. A. PARSONS:

My apologies, Mr. Speaker.

MR. SPEAKER:

No problem.

MR. A. PARSONS:

I did fourth reading on that

one.

I call,

still Order 2, Bill 35, third reading.

MR. SPEAKER:

Does that suffice?

CLERK:

Yes.

MR. SPEAKER:

Okay.

The hon.

the Government House Leader.

MR. A. PARSONS:

I move, seconded by the

Minister for Health and Community Services that Bill 35,

An Act To Amend The

Workplace Health, Safety And Compensation Act, be now read a third time.

MR. SPEAKER:

It is moved and seconded that

the said bill be now read a third time.

Is it

the pleasure of the House to adopt the motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against?

The

motion is carried.

CLERK:

A bill,

An Act To Amend The

Workplace Health, Safety And Compensation Act. (Bill 35)

MR. SPEAKER:

The bill is now read a third

time and it is ordered that the bill do pass and its title be as on the Order

Paper.

motion, a bill, “An Act To Amend The Workplace Health, Safety And Compensation

Act,” read a third time, ordered passed and its title be as on the Order Paper.

(Bill 35)

MR. SPEAKER:

The hon. the Government House

Leader.

MR. A. PARSONS:

Yes, Mr. Speaker, I call

Order 5, second reading of Bill 43.

MR. SPEAKER:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Mr. Speaker, thank you very

much.

I move,

seconded by the Minister of Justice and Public Safety, that Bill 43 be now read

a second time.

On motion, second reading of a bill, “An

Act Respecting The Provision Of Emergency Health And Paramedicine Services.”

(Bill 43)

MR. SPEAKER:

The hon. the Minister of

Health and Community Services.

Thank

you.

MR. HAGGIE:

Thank you very much, Mr.

Speaker.

I'm

pleased to rise in this hon. House to open the debate on Bill 43,

An Act

Respecting the Provision of Emergency Health and Paramedicine Services. I think

it's worthwhile to put this in the context of the legislative agenda from the

Department of Health and Community Services going back to 2016. The first bill

we had, which was enacted that session, was basically to redesign and

rationalize the legislative framework around hospital insurance and MCP.

Subsequent to that, there has been a sequence of bills. We have had legislation

around mental health and addictions, we have had secure detox and withdrawal, we

have had legislation for a prescription monitoring program and we have had

legislation on public health.

What you

see here is a pattern, whereby the foundations of the health care system in this

province have been rejuvenated or rebooted for the next generation to take them

from some of the disorder that had crept in over the years as the systems have

changed and evolved, to bring them up to, I would argue, in many cases, a

leading edge of Canadian jurisprudence.

This is

the last of those, in many respects, and it is the first bill ever, dedicated

legislation, for our province's ambulance program. We have referred to that,

however, in a broader title of emergency health and paramedicine services,

because that better describes the intent of the legislation. The definition

itself recognizes that it's no longer around simply providing emergency

road-side services, or picking up ill patients, but it also moves beyond

ambulance transportation into the realm of what is now described as pre-hospital

care and community paramedicine.

Currently, the program operates under various pieces of legislation, contracts,

standards and policies. And this is an evolutionary thing, simply based on how

the system evolved informally over the last several decades. At the initiation

of our ambulance service many decades ago, it was primarily a grassroots

initiative by communities that recognized the need to move sick and injured

people to a hospital or a clinic for service.

In fact,

funeral homes were in actual fact amongst the first operators, simply because

they had the ability to transport patients lying down rather than sitting up. In

time, these funeral homes purchased vehicles, communities fundraised and set up

community ambulance services, and over the course of time in turn they then

approached government and the department for funding to ensure viability and

sustainability.

today, Mr. Speaker, we have a system with 61 separate operators providing

ambulance services across the province. Twenty-two of these are community groups

or municipalities, 26 are operated by the private sector, and 13 are operated by

our regional health authorities. Because of the nature of this evolution, the

government of the day sequentially never really stepped back and considered a

strategic approach. They simply carried on with a piecemeal kind of activity.

In the

background, of course, industry policies and standards continually evolved and

progressed with no legislative authority or regulatory framework. This bill,

however, the future of the sector becomes grounded in best practices and

legislated mandate, and that past will be behind us. If you like, again, it is

another example of bringing some significant order from relative chaos.

Our

emergency health services, however, have also evolved from a simple

transportation system, for a health profession of their own with highly trained

practitioners with a whole sequence of advancing skills as they progress through

their training and through their certification. They provide time dependent,

life-saving care and are essential, a critical and essential component of our

health care system. We, our families, our communities take comfort in knowing

that that emergency medical service is there, that care is available, and

literally care starts with the arrival of these highly trained individuals and

an ambulance.

Our

residents rightly have an expectation that that service will be there when they

need it, and we agree with that. We wholeheartedly agree with that. However, if

you look at the reviews that have been conducted in recent years, we do not seem

to have a responsive, safe and high quality service that matches up to the

Canadian best practices. We have had concerns identified in sequential reports

with contract non-compliance, unacceptable response times, poor application of

provincial policies and standards, and all of these impact adversely on quality

and patient safety.

The

Fitch report identified the need to legislate standards. In addition, a 2016

report by the Auditor General found ineffective oversight with the program and a

lack of operator accountability. More recently, we've had the Grant Thornton

report which showed significant fiscal challenges, shall we say, in money

allocated to the program finding the home for which it was supposed to go. This

non-compliance has the potential to significantly affect every aspect of the

emergency service response time, care and recruitment, retention and service

delivery.

From a

fiscal perspective, on a grand scale the budget has grown from $14 million in

fiscal 2001 to over $60 million in fiscal 2016. We've managed to stabilize the

budget at that level of funding while we examine how we can do things better,

both from an improvement and quality perspective and sustainability.

It's

clear that we need authority to conduct better monitoring and oversight. When I

announced the findings of Grant Thornton's report, I committed to bringing

forward legislation to govern that program. Mr. Speaker, this piece of

legislation honours that commitment today. It's a key tool that will bring tools

to address the systemic concerns that plague our road ambulance program.

Firstly,

the bill provides the necessary government oversight for the program. It sets

out operator responsibilities, gives them the force of law and strengthens both

government and operators accountability to support patient safety and program

sustainability.

Second,

it actually consolidates various pieces of legislation and provides authority to

make policies, practices and standards related to the ambulance program.

Thirdly,

it enables us to better make program improvements such as establishing a central

medical dispatch centre, known as CMDC, a commitment we made in

The

Way Forward.

CMDC is

a centralized communications and coordination office that takes all requests for

emergency health services and dispatches the most appropriate emergency medical

vehicle and paramedicine provider to the scene. Such a centre also has a role in

collecting data that shows us, for example, where call volumes may be high at

particular times of day. It allows us to gauge shoot times, it allows us to

gauge response times. This information currently is difficult, if not

impossible, to obtain accurately with independent dispatch services for each

provider and currently a paper-base system. We need these tools for decision,

support and management.

Fourthly, and for the future – maybe most importantly – it allows us to move

into a modern emerging service with areas such as community paramedicine,

whereby paramedics can use their skills in the communities outside of the

traditional emergency response function; roles that they are now adequately

trained and perfectly prepared to provide, yet our system doesn't recognize that

ability or enable it be used to it's full. It has mutual benefits for paramedics

with the opportunity to maintain skills, and it has benefits for the

communities, particularly rural communities that have a need for outreach and

primary care services.

I'm

going to just use this opportunity to illustrate some of the key components of

the bill, but I'm not going to get down into the weeds because that's more of a

role probably for the Committee stage. One of the proposed legislation, the PUB

will no longer issue motor carrier certificates to operators under the

Motor Carrier Act . Currently, it

operates and issue certificates to an operator based on a particular region. We

have a

section in the bill which allows Health and Community Services, instead,

to do that. We've heard from the PUB that this was an area they didn't want to

be in, in first place, and they didn't feel was a good fit with their mandate.

We have

another section,

section 9, which outlines the requirements that operators will

need both a licence and an agreement with government to provide emergency and

paramedicine services. So this allows conditions to be placed around a licence

in terms of the services which an operator will be authorized to provide

emergency routing services and, ultimately, community paramedicine.

matches the ability to put a service where there's a need, and it also enables

us to ensure that that service meets acceptable quality standards. It does not

change how a vehicle is used to provide health and paramedicine services. The

licensing of the actual vehicle itself will remain under the

Highway Traffic Act with Service NL's

Motor Registration Division.

Section

10 outlines the operator responsibilities and requires, essentially, that the

operators comply with the act, its regulations, the conditions of its licence

and the agreement with government. This includes managing human and material

resources in conformity.

Sections

11 and 12 give the department authority to establish processes around issuing,

renewing, suspending or revoking licences. These might be engaged under

circumstances where the operators contravene the act, the agreement, or the

standards and protocols; or, for other reasons, is simply unable to comply; or

even where there are situations where the operator has just simply been

negligent.

In the

case of non-compliance, the department would require to give notice that they

need to take corrective action before taking any action that would affect their

licence. This time frame can be shortened however at the discretion of minister,

should there be a clear issue of public safety. These kinds of tools, these

levers, do not exist at the moment and we have heard very clearly that there is

risk from their lack.

provides the authority for government to establish standards for the management

and operation of emergency and paramedicine services, including the vehicles,

such as marking and mileage limits, as well as other features which fall outside

the Highway Traffic Act .

allows government then flexibility to designate in regulations other categories

of emergency vehicles rather than the traditional ambulances. Several

jurisdictions have different types of emergency response vehicles which are used

to separate triage and treatment from transport and it improved response times.

Rapid response vehicles such as an SUV actually exists, in theory, in Labrador

West, for example, but can't be categorized strictly as emergency vehicles

simply because the legislation is silent on that and it's a defect.

In an

emergency, the most important factor is to get the best care to the patient in

the best time possible. Most of the care paramedics provide actually occurs

outside of the ambulance; it's in the ditch or in the patient's house. Rapid

response vehicles are not designed or equipped to provide transport but they can

get skill, equipment and knowledge on site quickly.

These

vehicles are, in fact, emergency vehicles and must be permitted the scope

provided emergency vehicles, such as use of lights and sirens. Although after a

particularly unfortunate episode on the Trans-Canada Highway when I witnessed no

one except one vehicle out of eight prepared to pull over, I felt constrained to

We are

going to work closely with Service NL. There's obviously a level of integration

here in drafting the regulations to ensure that we get the right vehicles for

emergency response, as Service NL would then be responsible under the

Highway Traffic Act for some of their

mechanical kind of components. It also ensures that operators only use emergency

vehicles that meet the specs and use them only for the purposes outlined in the

regulations. They're not to be used to get ahead of the line at Tim Horton's.

In terms

of clinical services, Mr. Speaker,

section 6 requires the appointment of a

provincial medical director to establish clinical protocols and guidelines for

patient care. There's a position already existing in Eastern Health and its

associated responsibilities will now have the force of legislation and

regulation. It legislates an existing practice and simply safeguards that.

The

director's responsibility would also include managing and providing a quality

assurance program and monitoring of compliance. The operators will then be

required to comply with quality measures as specified by the medical director.

They will also be required to report and disclose to the patient and family any

adverse event. That does not exist at the moment and that is inconsistent with

any other health legislation and policy we have in place across the RHAs, for

example.

The

current processing for professional licensing of paramedics is through Eastern

Health provincial medical oversight. That will remain unchanged in the short

term for sure, and it's legislated in

section 15; however, the licensing process

is clarified in the bill to improve accountability and lessen uncertainty of a

paramedic qualifications and classifications.

We're

working with the Paramedic Association, however, because we feel and they feel

the ultimate goal of that profession is self-regulation. This bill would allow

that to happen when everybody feels that's the right time. It also allows a

paramedicine provider to enter premises by force, if necessary, if they believe

a person inside requires emergency medical services. Often, we find situations

of an elderly person with a locked door between the paramedic and the patient;

this gives them some comfort in knowing that they're not at jeopardy or at fault

legally if they have to use force to enter premises.

Section

27 also deals with another issue that we've had around advance health care

directives. When a paramedic is aware that they are in effect, they become bound

by the Advance Health Care Directives Act .

In the event the witness or an injury leaves a patient unable to communicate,

they can use the written documents as well. This clarifies their obligation.

Their obligation is to the patient, the client and their wishes under the

advance health care directive and not to any external pressure to deviate from

their wishes, which has happened in the past.

Sections

17 to 21 deal with the issue of inspections which, for us, is a monitoring and

oversight function which allows for an inspector to look at processes around the

provision of service, compliance with records and equipment as far as the

operation of this act and its regulations are concerned.

The

inspector would have the authority to enter a premise where anything is being

done related to paramedicine and emergency services to review records. The

operator, owner or individual in charge of those premises is required to grant

access. The exception to that, again, remains as with other legislation; if this

is a private dwelling house then a warrant would be required under those

circumstances, consistent with other legislation and the paramountcy of the

Charter of Rights and Freedoms and the

Constitution Act . The inspector would then be required to write reports for

the minister with a copy to the operator to outline any defects or issues.

So this

basically is a modern, comprehensive piece of legislation that takes best

practices across the country and puts them in a codified way. There's been a

wide variation across the country in how these programs are structured, and

we've done a lot of cross-jurisdictional work to try and find the best and craft

a made-in-Newfoundland-and-Labrador solution. We consulted widely as part of

process therefore with operators, community operators, private operators,

regional health authorities, the Paramedic Association and the general public.

We held six province-wide consultations: Labrador – Goose Bay, Corner Brook,

Gander, Grand Falls-Windsor, Clarenville and St. John's. We heard support in

every location from a wide constituency about the legislation and its approach,

and we had some very valuable discussions about making the drafts better, and

those are incorporated here.

The bill

is subject to proclamation, and will not come into force straight away. I have

directed on Royal Assent that that this would be a priority for our department,

as we view this as something that these regulations would need to be in place.

We think six months – I'm cautiously optimistic we could do it in five or four.

We shared the bill with OIPC to ensure it appropriately allows for compliance

with the Personal Health Information Act .

We continue to consult with them on the crafting of regulations.

One of

the initiatives we're currently involved in is a separate one, but related, in

the procurement of ambulance services. This bill does not comment or state

anything about procurement, but it's been structured in a manner that allows

complete flexibility for that process on an ongoing basis.

I want

to be clear: It won't change the current landscape. I think we've heard some

tentative worries that that there may be changes coming. The arrangement of

operators, the location of ambulances will not alter as a consequence of this

bill.

When it

comes into force, there will be little day-to-day change in the requirements for

providers or operators of these services. What it does do is allows us oversight

and accountability for monitoring. It provides provisions to exclude the act

from applying to students and other first responders such as police,

firefighters or lifeguards.

It also

excludes specific situations where emergency services are provided under either

the Emergency Medical Aid Act , the

good Samaritan act, the Emergency Services

Act or the Public Health Protection

and Promotion Act in the event of declaration of a public health emergency,

and that allows for protection of people involved under those circumstances.

It does

recognize the Labrador Inuit Land Claims

Agreement Act and that Nunatsiavut has the right to make its own legislation

in this area, and in the event of any conflict with this act, LILCA will

prevail.

There

are a number of consequential amendments that will apply to the

Motor Carrier Act and the

Highway Traffic Act , primarily

around

definitions and the shifting of certain mandates around the licensing

from the PUB, for example.

I'd like

to take the opportunity, as I wrap up now, Mr. Speaker, to thank those

individuals working in emergency health services across the province. In the

days before paramedicine existed as a profession, I jumped into the odd ditch

from time to time myself, and it's quite a stressful experience, and my hat's

off to them.

The bill

provides a foundation that will build a far better pre-hospital care service

than we have currently and will better serve the people of this province. As I

say, it's a milestone in the evolution of the health care system, and I would

regard it as one of the final foundational pieces of my job as Minister of

Health over the last three years.

I'd like

to take my seat with a request that Members of this House support this bill.

Thank

you very much.

SOME HON. MEMBERS:

Hear, hear!

MR. SPEAKER:

Thank you.

The hon.

the Member for the District of Conception Bay East - Bell Island.

MR. BRAZIL:

Thank you, Mr. Speaker.

It's

indeed an honour to again stand in this House as we debate and redefine

legislation and policy that are relevant to improving the lives of the programs

and services and those individuals who provide those services to the people of

Newfoundland and Labrador. Today we will be debating and discussing the changes

or the full formation of Bill 43,

An Act Respecting the Provision of Emergency

Health and Paramedicine Services.

Mr.

Speaker, I must thank the staff for the briefing that we had last week, or a

little over a week ago, and the outline itself, specifically around particular

changes that were there. We had some unique questions, because we were coming

from some totally different angles that may not have been first thought of or

may not be directly included in this but was food for thought.

wanted some clarification around the structure of licensing, the structure of

taking away licences, the key role here that the health providers, the

paramedics and the ambulance service employees play, not only when they respond

as a personal health technician on an ambulance, but the other roles that they

can play in our paramedicine. There was a great open discussion, and we went

from the regulatory outlines to some generic hypothetical situations about what

it is that we're doing and how we can make this more efficient.

The

minister outlined, and I go back a few years on some of the things here. We

talked about the Fitch report, and we talked about Grant Thornton, but

particularly we talked about, and he had noted, and it was a major concern for

me, the Auditor General's review of the ambulance service and the providing of

the services and the legislative regulatory processes that, in principle, didn't

exist to control and ensure that we get the best return on the investment and

that everybody involved would understand each role they have and have the proper

mechanism, the proper tools and the proper understanding of how you're going

best deliver that service.

I have

the privilege as the Chair of Public Accounts to be able to work with my

colleagues on Public Accounts to outline if there's a concern from the public's

point of view on the efficiency of a program that we're funding or the

efficiency to the outcomes of a program that we're funding to ensure it's done

properly. We have the ability to call the witnesses, as we call them, the entity

who provides those services, to come to the House and have that discussion. We

try to do it in an open concept so we ensure that the viability and the

information being shared is to be used for the betterment of providing the

particular service.

Sometimes it does get a little bit confrontational, because there may be a

differencing of what we, as the representatives for the people of Newfoundland

and Labrador, the elected representatives, and the provider may feel are

adequate levels of service, or the adequate process they use to ensure that

they're meeting their obligations.

We had

the privilege of calling in the department and the providers of the ambulance

service, or the contractors, as such, on the bigger picture from a regional

health authority point of view and, from the department, with the contractees

here, the providers, have a full-fledged discussion about how the monies are

being invested, are they meeting not only the particular needs, because there

may be a bigger picture here that the services are not being provided with the

adequate resources, from a multitude of ways, and it could be in recruitment; it

could be in training; it could be in the amounts of monies that are needed for

the actual physical asset, the ambulances and these types of things; it could be

in the partnering that's being done.

So we

spent a whole day, and myself and my six colleagues asked – I think at one point

I noted 94 different questions relevant to what would be the best approach or

the best ways that we could continue providing public and private and

community-based ambulance services but maximizing the return, from a health care

provider perspective, and from a community-based confidence by the general

public, that what we're providing is in the most timely fashion with the most

skilled people possible, who are themselves not overburdened with long shifts

or, for a multitude of reasons, are not happy in the environment because the pay

scales or being reimbursed for extra time. It becomes a hindrance to them.

These

are professionals, and so are the companies that run them, but the professionals

who provide the actual health services have to feel confident that, when they go

to work, all the amenities that they need are provided for them and, when they

do their service, that in return they should be remunerated accordingly.

I know

their first objective is to go and provide the best health possible, but to be

able to do that, you must have the confidence that your shifts are limited to

those that don't take away your physical ability to be able to provide the best

service, that you're being rewarded based on what you had agreed to sign up for

and that you have the actual equipment to be able to provide the best service

possible, not ambulances that you're worried about whether or not a battery is

going to go dead. You're not worrying about whether or not there are going to be

problems with getting up a steep hill because the tires are not up to standards.

All

things like that play havoc when you're trying to provide proper health care,

and there's stuff that we can very easily eliminate by having the regulatory

process and a checks and balance process that's in the best interest of

everybody.

I would

think and hope, and I'm confident, that everybody who's in the process of

providing health care want to be able to do it in the most efficient way

possible, want to be able to do it in the most timely way possible and also want

to be able to do it in the most financially viable way possible.

Now,

have no qualms, the private ambulance providers are business people. They, at

the end of the day, want to be able to provide the service that they're

contracted to provide and also sustain some type of profitability in what

they're providing.

So we

understand that and we've got to be cognizant when we do legislation on that.

But, primary, we've got to be cognizant of the people providing the health care

and the patients who are going to be acquiring that health care are given the

opportunity to (1) provide the health care and receive the health care in the

best modem possible.

What we

need to do here is look at exactly what are some of the challenges. This is

probably one of the better examples over the last five to six years where we

have a multitude of different perspectives on how we provide this service, and

how – more importantly – we put legislation in play so that everybody knows from

the start, from the get go, as they say, exactly what their roles and

responsibilities are, what they can expect from it, what their privileges are,

what the monitoring process would be, what the checks and balances would be, and

in some cases – and the minister mentioned this and I'm glad he mentioned this,

I think it was in the press conference itself – about self-policing to a certain

degree.

I'm a

real believer, as somebody who's worked in the civil service and somebody who

was a first responder and somebody who's worked from a business point of view in

the private sector also, that every industry, if you're a committed industry to

providing the services that you're contracted to do, or you're the provider

itself, the professional, you want to be able to have a certain degree of

self-policing because it's more accountability to that function, or to that

organization, or to that entity if your peers and those who represent that

particular entity have a certain set of standards that are acceptable. So that

everybody understands how those standards are achieved and how, if you start to

slip, before it gets too out of hand and it's detrimental to the service you're

providing, particularly this case, the health providing services, that you have

an ability to stop it there and then move it back up to where it's an acceptable

level. Those discussions, to me, would move it in the right direction.

We have

a number of agencies and organizations that are connected directly here. The

Paramedic Association, a professional group of individuals, who themselves would

know where there may be some gaps in services they need; that could be around

training. It could be in the time frames of how the system is done. It could be

in the geographic locations of how we do certain things. It could be in

dispatching. Having that input there and having that ability for the collective

partners to come together and discuss how we best find a solution here.

Self-policing to me, in certain categories here, that goes hand in hand with the

legislation. We've obviously got to have legislation because that becomes the

law and that becomes the standard, the minimal standard. I have no qualms with

organizations. I know a couple who, here's legislation, here's what you must do

from a minimal point of view, but they've added two or three more layers that

really make accountability and the importance of delivering a particular

service, or the ability to provide the best possible care, for example in this

case, or best possible product in some other cases to the people who would avail

of that particular product or service.

As was

noted here, this here really brings together three or four other components,

some were contracts, some were bills, some were policy, and puts it in a neat

package where at least now we have the particular sections and categories that

would outline roles, responsibilities and particular approaches to, if something

goes in a direction that's not acceptable and how you can stop it in midstream

and bring it back to where it needs to go.

Again,

we talked about the Fitch report that outlined a number of the challenges that

were taking place in Newfoundland and Labrador. And if you read that it's

cognizant of some of the unique challenge (inaudible) from geographics, to our

weather conditions, to the ambulance providers themselves – some of it is about

the culture – to the training components that we have, to our funding sources.

So there was a whole cognizant process there that we need to improve on. We need

to have something that fits neatly in a process so there's no confusion.

And you

want to eliminate a battle between providers, the business entity, the regional

health authorities, the service organizations that may represent particular

sectors in our society, be it seniors groups, be it health councils, whatever it

may be, and the Paramedic Association, the first responders who are working on

the ambulances. You want to have all of them, you want a cohesive organization

there.

They're

not always going to agree and there are debates about contracts and there are

debates about time frames and that but that's part of our collective bargaining

process. But this would be about everybody on the same page of how we provide

the best service.

To do

that, you first got to have a regulatory process so that there's no confusion,

there's no misinterpretation of

definitions, there's nobody having hidden

agendas that can be delayed on implementation of the positive things that we're

trying to do here by their

interpretation, or their legal definition of

something here.

So, as

we have debate, as the discussion is taking place, and I do compliment the

department and the minister with outlining the dialogue that they've had with

the particular stakeholders, it's always healthy. I've always said, in

government, it's a better process if you, unfortunately, have to delay a bill

for a month or two to get all the stakeholders because there's no doubt, 99 per

cent of the time you're going to go back and change that bill so it reflects the

best way that legislation can provide the best service for the people of

Newfoundland and Labrador.

In this

case, and the minister has noted he's been at it a few years, it's been

discussed before that, I know the former minister of Health had discussions and

was very diligently reading some of these reports as they were developed in the

2012, '13,'14 discussions there around how do we improve the service.

Unfortunately, the service had been provided for decades in a similar manner

that, as it evolved, bad habits, unfortunately, became bad practices and became

bad outcomes, and particularly around some of the services being provided. We

needed to modernize it, we needed to ensure that we had the best ability from a

holistic point of view to be able to provide those services. This gives us the

framework.

We've

been doing a lot of good work. I have no illusion. I gave a scrum one time and

talked about: We have a good health care system. We have a multitude of glitches

in it. We have some problems and there are some holes there that people fall

through the cracks. But in a general context, my concept there was we have very

highly skilled professionals. We have organizations that have, as their mandate,

to be able to provide the best service possible. We have, even the private

sector people, who have their understanding, their commitment to be able to

provide it, while they're making a profit on providing those particular

services.

What we

didn't have, and we need to get to, and this is the next step towards it, was a

fluent system where all of those who were in play would understand the roles

that need to be done. And if it meant some had to come back a step to providing

a better service, and if that was the providers, the ambulance providers

themselves, about how things have to be done, or redirect their investments to

ensure it's done. The role of the regional health authorities, if it was around

how they provide certain services, or a training mechanism, if it means talking

to our college systems, if it's also in conclusion of talking to our

organizations, our paramedic organizations, about what are the specific skill

sets that are needed, or the different levels of para-medicine that we will have

on a particular call on a given night, what are the skill sets that are needed

at what levels?

Do we

keep a standard and everybody's at this level? Sometimes there's over skill set,

particularly – I don't have a problem with an over skill set, I never see that

as an overabundance. It's like doing due diligence. You can never do too much

due diligence. But somewhere along the way you have to have a system in play

that makes sense and works and provides the service that you particularly want

to be able to provide.

So, this

here, as we look at it, gets to at least putting the framework in play. I mean,

as anybody knows, we have debate in this House of Assembly. The devil's in the

detail. The regulatory processes, the direct policies that are going to be

implemented themselves, have as much as an impact as the legislation does. The

difference is the legislation makes it law, so that once regulations and policy

are done, it's much easier for the regulatory body, be it in this case it could

be the minister, it could be the Department of Health, it could be a regional

health authority, it could be a collaborative organization made up of all the

entities who come together as an advisory component, who would oversee the

assurance that the act itself is being followed. And, as I said earlier, it's

not only self-policing – that's important, and I would hope self-policing would

be that you would raise the bar to another level.

But

under legislative regulatory processes, the policing is not self-policing, it's

regulatory policing; meaning if you do not follow the steps and the commitments

and the obligations, then there's a recourse, and there are processes outlined

here as to who or what entity has the ability to determine what that recourse

is.

In most

cases, it's about bringing you back to where you're supposed to be. If you've

strayed too far, or if you've strayed too far for particular reasons or it

becomes a continuous culture, then there's a real problem. Then the entity

involved here, be it the minister or the regulatory agency or, in some cases,

here it could be the chief medical authority for the province itself, that

individual or that entity would have the powers to cancel the providing of the

service; but based on a principle that you'll still be able to provide the

adequate service that was expected by everybody when this legislation was put in

play.

So we've

had an opportunity to discuss exactly the intent of why we're trying to do this.

As I normally say when I stand in this House, I will start – and I've gone

nearly 20 minutes into my starting point, but I want to start the way I will

finish it again by saying that I wholeheartedly and, on this side of the House,

we support this piece of legislation. We're particularly looking forward to the

regulatory part of it in the

definitions in certain areas, so that providers

would have a clear understanding of how they can take their skill set or take

the service they provide and move it to the next level. And the next level,

obviously, for everybody in Newfoundland and Labrador – and I know these

providers – is up. So how do we do that? How do we do that through the skill set

and the supports that we give?

The

minister talked about our investment into paramedicine and the ambulance

services over the last number of decades has quadrupled, and rightfully so.

There's an expectation of the skills that are needed for those first responders

who arrive at a situation or at somebody's home, the equipment that needs to be

used, the training, and the overall process to ensure timely fashion and the

best quality of care is there.

We've

had discussions with a number of providers and even some discussion and a

briefing around things like central dispatch and that. I know that's not exactly

where we're going with this piece of legislation, but it's all tied. The

minister today talked in the press conference, and so did his officials, there

are a multitude of pieces of legislation that need to fall in play, because one

supports the other, which in turn supports the other, which in turn makes a

continuum that gets us to our end result: Better outcomes for the service we're

providing.

For

those at home who may not understand the process here, somebody might say: Well,

why can't you just come in and change it? It makes no sense why you provide a

service this way or why contracts are this way; or why we don't do more training

in this component or why a particular health professional can't offer this type

of service in our community. Because there has to be regulatory processes there.

I know

it's frustrating and it's no more frustrating for somebody like myself who came

from the civil service, who would make recommendations and it would be three

years later before you'd get a call and say oh, we need this input. No more for

people in this House of Assembly who sit back and when bills are brought

forward, they shake their head and say this has been around eight years; we're

only now getting to it. And no more for a minister – and I've been there as a

minister and I can understand the minister's frustration of trying to get a

piece of legislation to where you need it to be so that, at the end of the day,

you know you got the best piece of legislation that provides the best service

and protects the people of Newfoundland and Labrador, taking into account every

particular nuance that may be necessary to make that successful.

Now,

when you do it at the end of that, it's a living entity. It doesn't end the day

you proclaim it or we pass it in this House and become law. Because in that

short period of time, things evolve differently and you realize, in a

definition, we need to add another

section or something we didn't think about

because now that we've brought attention to it, those providing a service or

those availing of the services have outlined to us other unique situations that

we never thought of and we didn't experience.

As the

evolution of our society changes and it could be the road network, it could be

communications, it could be the types of ailments that we're facing, it could be

the better use of technology that people don't have to be escorted in an

ambulance constantly or it could be end-of-life processes. The world has changed

on how we do things, so how do we provide those types of services?

So, the

benefit of legislation that is specific to certain clauses and

definitions, but

it's still open to readily being able to be changed to meet the growing needs.

Once you got a piece of legislation, when you've got the act in, it's very easy

to amend certain parts of it as you come back, particularly if you got the crux

or the meat of the piece of legislation itself.

For

anybody who's not in the health profession, it's very encompassing when you get

all the

definitions and the responsibilities for people. The minister has taken

people through most of it, so I'm not going to reiterate that again but I do

want to talk about some of the particular challenges that are around moving this

piece of legislation forward.

Because,

at the end of the day, we talk about paramedicine, what a great opportunity we

have now. We have skilled professionals who are now in a partnership, as

employees, with providers of an ambulance service who are, in turn, then in a

partnership with a regional health authority, who, in turn, are in partnership

with the Department of Health. So collaboratively, just look at all the

professionals you have there, all the information that you have at your

fingertips, all the ability to address new ways of providing health care.

In some

cases, and I know in my own district, we have health professionals, the

paramedics who for hours of the day are on call, are waiting, who have a skill

set that could be doing a multitude of other things. They've been trained;

they've taken it upon themselves to read new approaches to providing medicine

and these types of things, who could be used in particular areas to deal with

certain situations.

Also,

looking at, when there's a certain call, being able to assess the calls in

advance of responding, to what degree do you need to respond. Can the

paramedicine providers then at the end of the day in a particular household

provide a service that's a bit different than putting somebody on a stretcher,

taking them in an ambulance and then bringing them to some kind of health

centre? What are the types of services that can be provided there with the skill

set that these people already have?

So, it's

better utilizing the skill sets that we have and ensuring that the people who

want to provide those skill sets would have all the training necessary and all

the supports that would be part and parcel of it.

We've

talked about trying to keep, as much as possible, services within rural

communities, isolated communities as possible while, at the same time, being

able to provide the best services that we can. So we have an opportunity here,

once we pass this legislation, to take it to the next level.

With all

due respect, this is a good piece of legislation, but it's not the be-all and

end-all. There are a number of things here that will need to be added over the

coming months and over the coming years that will give a better opportunity for

the providers to move it to the next level and, as the evolution happens,

provide exactly what it is that's needed here for us.

I just

want to talk about some of the things here that we've talked about. We get beat

up internally and externally when we're the last, normally, to come onside with

some of these things. I understand that and, as we all say, sometimes you try to

defend it and sometimes you look at it that there's a process here that's a bit

unique. I accept the uniqueness of our great province here, but I also accept

the reality that we should not be the last to come on board on things that are

important to our society, and our residents here as part of it.

We're

getting to this point. We need to find a better way because this is only one

part of how we provide health care in Newfoundland and Labrador. We need to find

a better way that we can be leaders. We have the skill set second to none. We

have our own modes of research here that are second to none. We have now,

through communications, access to information and data that's equal to any other

jurisdiction anywhere in this world.

The days

of us having to catch up, we should try to find a way to put them behind. So if

it means we concentrate on getting our processes, our legislation, our delivery

of services to the acceptable standard, and then let's take them to the

Newfoundland and Labrador standards, which is beyond that, providing the best

services to the people in our province.

We need

to change our mindset also. Let's bring it up to the standard that Alberta has,

or BC has or Ontario may have. In some cases we even feel we don't need to go to

those levels because we're not in the same realm financially. Let's bring them

to Atlantic Canada. My argument to that is look, if you go back on other things,

we don't tout enough of the things we excel in, that we're the trendsetter and

that we're the leaders.

Health

care is another one where we could be. I've got full respect for those who

provide health care. I look at sometimes the level of care that's provided in

some of the dilapidated buildings we have, in some of the lack of new pieces of

equipment and that; yet, how our health care system, because of those who are

providing it, no matter what level they're at, are providing the best care,

equal to anything in this world.

So if we

can get to the next level, if we can get a more equitable, a more efficient way

of providing these services, then the monies we have to invest there can be done

in such a manner that we can provide additional training, other resources. So

that the bar we're trying to acquire to on some other jurisdiction, is not the

bar we aspire to. We set our own bars at a little bit higher. So there's nothing

stopping us from doing that, other than getting, as the old cliché goes, our

ducks in line. I do want to note again, this takes us to the next level of being

able to do that.

I want

to look at some of the things here that we're talking about. We're talking about

four-tier paramedicine professionals here. We know, the EMRs are here, the PCPs

plus the CCPs, all health professionals who have a different level of skill set

and a different ability to be able to respond and intervene in a particular

health situation.

What we

need to do now is to best maximize their skill sets in particular geographic

regions, or particular types of response calls or in a particular regional

process. And part of it could be one or all of these groups of professionals go

out and do particular training components within our society. It could be at

seniors' homes, for example. It could be with a group of school children. It

could be a group of athletes in some way of being able to identify or treat or

access certain things that may be more important or more fluent and more

beneficial in assessing particular ailments or interventions that may be

necessary. So we have that ability to do that.

We're

looking at authorities to create a central medical dispatch. I've met with the

Paramedic Association and I've met with the ambulance providers, and I get no

pushback from either one of those organizations. I met with two of the health

authorities who see this as a benefit, and even in the discussion with the

officials from the department, see it as a positive.

The

unfortunate thing, we've talked about this and we've talked about it and talked

about it, somewhere along the way somebody has got to take it and say okay,

let's sit down. Let's figure out what a central dispatch is and how it's going

to work. And if it's going to cost money, how if we invest money here we save in

the back end or we provide a better service.

We had

the same debate yesterday in a piece of legislation around PTSD. There are

certain monies you've got to invest. They're prudent investments, if you invest

them in the front end and you're going to save on the back end, because you're

providing better health care, or you're providing better piece of mind, or our

society's better off, or it encourages a better economic concurrency in our

society.

There's

a reason and a rationale why we do certain things. We can't be afraid that it

may cost money, and I know that becomes the first thing, but we need to look at

if it's going to cost us money, how do we still benefit? I know there's a

reality in life, you're restricted on X-number of dollars. There's no money

tree, as we used to talk about in the House of Assembly one time, that we can

just pick when we need. That would be great in a Utopia society, but it isn't.

The

reality is there are budget lines you have follow, but through the proper

dialogue and a proper discussion with those stakeholders –and there are a

multitude here – there's nothing that can't be achieved. It's just a matter of

determining how much you want to invest upfront, and what's the long-term

benefits down the road so that you can still sustain whatever restrictions you

have from a financial point of view.

I gave

the example yesterday when we talked about the pensions here, the teachers'

pension plan and the process we had used in the past and how relevant that is.

That when all the stakeholders sat down and said, what is it that you need us to

provide for you? That could be the same mechanism here.

From a

paramedicine point of view and the health professionals provided, to the

providers of the ambulance services themselves, to the regional health

authorities and any other service organization that may want to or may need to

have input: what is it that you want us to be able to provide?

When we

have those discussions, and it could be the regional health authorities with

clinics they have or cottage hospitals or further larger tertiary care

facilities, what is it that you want us to provide? Now, let's talk about what

that's going to look like. Then let's talk about what it's going to cost. Now,

let's talk about everybody's role. How do you fit within that costing and model

to be able to provide those services?

As we

found with the pension plans for all of our civil service here in Newfoundland

and Labrador, we came up with something that worked, that made it sustainable.

And that's no different than what we're trying to do here. We're trying to make

health care sustainable and equitable and accessible by all across the province,

and there's nothing restricting us from being able to do that if we follow the

right mechanism.

As we

adopt our piece of legislation, and as the bill itself, Bill 43, becomes law,

then if you don't have a particular entity come voluntarily, now they're coming

by legal jurisdiction. Once you get them in a room and say this is not a

particular attack on any one agency or organization or group to say you're not

doing your job in the right manner or the service you've been contracted to

provide is not being provided in the right manner, it's the opposite – pure

opposite.

This, I

see, comes – and we've had a discussion, and I've challenged the minister to a

certain degree when he said there's a blank sheet. That may be more about the

procurement of the ambulance service. Again, I say in this province blank sheets

are not where we need to go. Too many good things have happened.

Are

there some shaded areas on the sheet that need to be cleared up? Without a

doubt. Are there some things that need to be erased on the sheets? Without a

doubt. But we've done too many good things to erase them and not look at what

has worked, but, more importantly, what hasn't worked. So we ensure when we do

it now we get it right.

there's an opportunity to do that. The

definitions that we've talked about here,

it clearly outlines what roles each of the entities would play here. I do like

the fact that paramedicine is given a much bigger role, and it's very fluent

with the whole process here. I think that's a very positive step forward. I

think it's very progressive. It's thinking outside the normal box in

Newfoundland and Labrador.

It may

be the standard somewhere else, or it may be acceptable, but because of some of

the challenges in Newfoundland and Labrador, it probably wasn't the way most

would have thought of it. But now that we're thinking that way and there's an

openness to evolve that through some pilot projects – and I understand there's

at least one and maybe a couple of more in the works that will start in the very

near future that will give us an understanding of how we adjust and continue the

process forward.

The fact

that the open dialogue here talks about the inclusion of the major stakeholders,

it particularly talks about the definition so there's no confusion around if a

union group are included here or involved here. They would know exactly what the

regulatory process would be if they're negotiating, if there's a particular

grievance, if there's a particular set of public account issues they want to

bring forward. That could mean coming to the point where they may want to,

themselves, have public forums on how health care is provided but, in this case,

how the ambulance services and the services that are provided by the ambulance

providers themselves are done in a particular area.

It also

gives an opportunity for the other stakeholders, and we forget sometimes – and

I've talked about community groups – about the municipalities. Now

municipalities would have an understanding of – sometimes it's a bit confusing

between we talk about the public providers and the community providers and the

health providers themselves when it comes to the ambulance service. Somewhere

along the way, we've got to find the medium where everybody gets the same level

of training; the same level of service; the same response times, being cognizant

of geography and a few of the other things; but the same level of acceptance on

how we access our health care here.

There

are a multitude of

definitions here. Three key things I noted when going through

the briefing. One was that paramedicine is elevated to a higher standard here in

the sense of acceptance, support and definition on how this can expand and

become a holistic avenue and an alternative avenue or another process to

providing health care in regions for our people. The second was that the

regulatory process ensures now that every part of the group are accountable, but

particularly, and this is not to pick on them right now, but 90 per cent of the

last three reports we've had have been around the ambulance providers and the

standard there.

We know

in every scenario and every avenue of life, or every provider of whatever

service, there are certain ones that fall down on the standard, but in this

case, the accountability is there, the accountability for self-policing but,

particularly, the accountability for an authoritarian control mechanism here

that makes people accountable. The minister has that from his perspective. The

health authorities would also have that. The department would have it. The chief

medical officer would have it. We have various mechanisms there that would put

in play the reliability and accountability to ensure that we move this to what's

an acceptable level.

One of

the other things that needs to be noted, too, and we had this discussion on how

you would provide a service if you revoked a licence from a particular entity,

and we've already had experiences around that. It's happened recently in another

part of the province, where the department had to step in, or the regional

health authority, and cancel a contract with a provider and then look at

providing another service.

I know

they already have a protocol in play, but here I would see, as we define some of

the regulatory processes here, and the policies themselves and the

definitions,

it would be more explicitly spelled out, so there wouldn't be let's look through

50 things and understand this definition, that definition. Here would be the

protocol is already written, I would assume, and I'm fairly confident it does,

in the regional health authorities and with the department, but now every

definition related to that would be part and parcel of what happens here.

The

other thing, and there have been some questions, and we even had the same

question because, as you know, there's been a lot of discussion about the Public

Utilities Board, and they're the umbrella to oversee and represent society in a

larger point when it comes to accountability around procurement, to a degree,

and licensing and these types of things in providing particular services. Very

few people in the general public, other than, I guess, the ambulance providers,

would've known that the Public Utilities Board are the ones who give them the

licence to be able to operate as part of that.

A year

or so ago, when I was made aware that that was the case, I shook my head, too,

in saying is that really the best mechanism to use from a holistic health point

of view. When it was proposed in this piece of legislation that they would be

taken out of equation, and there's no disrespect to them, but if you want to

have a fluent process, the providers themselves should know all of the

regulatory things should be all in line, so if they're in a meeting to talk

about the equipment on a particular ambulance, or the training, then that should

also be part and parcel of their licensing regulatory process;

whereas the PUB

would do one part of it, and then there would be another section, and another

section, or another group of individuals separate from that.

Working

in isolation of two entities that really don't have a day-to-day collaborative,

cohesive working relationship, to me, didn't make a lot of sense, and it makes

sense to put it here so that the full licensing is part of this piece of

legislation that falls under the Department of Health and becomes part of what

we do in this House of Assembly as part of that.

Some of

the other things that I do remember having some discussion around was the

emergency health services and how we could change the approach by better

utilizing the ambulance services and the professionals that we have there. That

led into the whole discussion about thinking outside the box and providing

services in particular rural areas that might be in the best interests of using

the service that we have, keeping in mind a lot of cases may not have an

ambulance service or may not have a facility, be it a hospital or clinic, that

can provide certain services, but they still have those skill sets with those

individuals who work on the ambulance services themselves. Being able to better

utilize that itself will be something that's in the best interest of everybody

else.

The

other thing that I note, it streamlines the whole ambulatory services as

required to action in current request for proposals. It makes it more efficient

when there's a call for proposals to the general public for the providing of

services. This makes it a more efficient way of doing it.

certain cases here, we could be gone for expression of interest, request for

proposals; we could be going to direct procurement, depending on what the

process was. This here makes the existing legislation or bills that we used,

which sometimes got confusing and, in some cases, as it was explained to me, the

left hand didn't know what the right hand was doing, because there were two

entities that are on different sides of the fence for various reasons would not

know, so that cohesive, fluent, timely process here wasn't met in a lot of

cases.

We have

the ability to do that now with the new process, and we know there are going to

be big changes coming in 2020. Most contracts are up then. Obviously, and the

minister noted, this is not about the procurement of the ambulance service, this

piece of legislation, but in my opinion, and I would think most, this does have

a major impact on the procurement of the ambulance service as the contracts come

forward, and it should, because it should set the tone and the regulatory

process for what would be expected when we come for the procurement of ambulance

services, what's that going to look like. We have a little over a year to frame

out, from this piece of legislation and the positive things that we'll learn

from this, and probably some of the nuances that we haven't addressed yet in

this particular legislation, to move forward to ensure that the procurement

process gives us the best entity, or the best structure, to be able to provide

the services with the health professionals that we have.

Again, I

noted there about the Public Utilities Board here, one of the things – and I

checked into this after the statement, and I spoke to somebody at the board.

Unfortunately – and this was their words – and realistically, and I think it

probably would have been the consensus, they just rubber-stamped it in a lot of

cases. They weren't particularly skilled, or that wasn't particularly a

priority, while it was a responsibility. It's a big difference between a

responsibility and a priority in a particular entity, and we all know that from

whatever we work at, but I know that as a former civil servant and as a former

minister.

The

difference between what you're responsible for and your priorities, two

different things. And if it's a priority, well, it's going to go front and

centre; you're going to put everything into account as much as possible; you're

going to be able to do what you can. But if it's not a priority and it's just a

responsibility, then it probably doesn't move to the next level, as part of what

you need to do.

So, that

process there, I think, cleans that up, moves that, puts it in the framework

that it should be, that it could now be cohesive with what the legislation

itself is noting here as we talk about that.

Ambulatory services, too, I mean, defining the terms of that, another positive

in this piece of legislation. It brings the services here from a negative light

because that's all we've been hearing, it's unfortunate but it's a reality.

Media are not going to pick up on the positive things we're doing in providing

services and that's, I suppose, maybe it's not their job. I would think it would

be part of their job but they only have so many stories, they're going to get

stories that at least give more attention to it and brings it to the general

public.

In this

case here, now what this act does and the discussion we're having here and the

collaborative approach and the dialogue that's happened with the stakeholders,

now everybody is aware of exactly what the intent is, what we're trying to

achieve. Nobody is hidden behind the fact that, or hidden the fact that there

have been some challenges, some major challenges.

As I

mentioned at the beginning of this, there have been three major reports that

have said we're not going in the right direction and if we continue to do this,

it's going to be detrimental financially and, unfortunately, it's going to have

an effect on the delivery of health and maybe to an extreme situation that

nobody wants to face at this point. From this perspective, just having that

dialogue now has improved where we are in the next little period of time.

As we

move this forward, I am looking very closely at the

definitions and outlining

exactly what the policy would be in the future. Again, there's a number of

things here that – we're not suspicious of anything, that's not what this is

about. It's about clarification though, because it would be better if, when we

get into the regulatory process, the

definitions are responsive and

understanding of what the stakeholders and the providers understand so that

we're not delaying anything in advance.

So, as

we have those

definitions, I do encourage the minister and his officials and all

the other key players to ensure that as

definitions are being defined and the

policies are being rolled out, that there is a full-fledge inclusion with the

other providers here who've gotten you to this point. I mean, the invaluable

information and dialogue that they've had and statistical information has been

the framework for putting together this piece of legislation.

Now, we

need to continue it because the legislation itself just becomes the law in the

House of Assembly. The actual operational, the bricks and mortar, the rubber to

the road, is in the legislative

definitions, the regulatory

definitions. So we

may need to ensure that if we're going to define that, and they're the

regulatory processes, that they reflect exactly what it is that we're tying to

do here, and that we're going to get the best response and the best return from

doing that.

Again, I

was very much educated when I met with a number of the key stakeholders involved

here, particularly the paramedics, about some of the challenges that they faced,

some of the things that they could provide that I would've never ever thought

of. I suspect those who are not directly in the health care profession and, all

due respect, some who are in the health care profession, didn't understand or

didn't accept that this could be a role for the paramedics, particularly around

paramedicine.

So, it

gave me a different perspective, and I even backed off a little bit from some of

my perspectives of what I thought was the best way to move forward, and started

to re-read some of the reports, and got a better understanding and saw a better

approach by using that skill set.

Again, I

come from somebody who operated a business for a period of time, so I do

understand the business model, too, has to be workable if we're going to provide

a service by individuals because we have a very unique setup here. Unless we

change the full structure, which is, again, that's an open dialogue as we move

forward on this process. But a key message here now is that the dialogue we've

started, that got us to a good place with a good piece of legislation, it's not

the end of the legislation because the regulatory outlines and the

implementation of the policies have to be defined, and I would hope in an open

and transparent manner so that everybody's aware of it in advance.

If we're

going to be able to implement this by the end of the fiscal year, then over the

next three months all those involved would know because some may have to invest,

from a business point of view, financially, up front, some may have to invest

from a training point of view, be it the professionals providing them. The

regional health authorities may have to invest from a human resource point of

view, or from a structural point of view, or from an accountability point of

view. The department itself, we may have to look at again how this is going to

be done from a financial point of view. Are there going to be resources that are

necessary in the regional health authorities to monitor this, to put the

regulatory things in play from an inspection point of view, for example?

talked about the PUB is not going to be looking at the licensing. Well then what

process is going to be engaged there with Service NL, for example, on inspecting

ambulances as part of that? Who, within the health care system, would be looking

at the equipment that's on the ambulances themselves? Who will be looking at the

licensing part for the paramedics who are there?

Then as

we move to one of the other key components here, the key (inaudible) components,

how we're going to do the paramedicine in particular areas, how do we monitor

it? How do we look at the success of that? How do we make a determination

whether or not that has worked and how do we continue it? More importantly, how

do we expand it? Once we find something that's working how do we expand it to

other parts of the province?

There's

a multitude of things there that need to be looked at, that need to be defined

but I don't say that in any negative way. I say that holistically in a positive

way that we're moving this in the right direction. It's just in a three-month

period, is that ambitious? I don't know because, again, I'm not privy to exactly

all the information that has been shared, all the dialogue that has gone on, but

I do know the door is open for all the stakeholders to have that dialogue and to

continue it.

So,

there should be no restrictions or no major barriers in defining what the

regulations are going to be, how they are going to be enacted and, particularly,

what resources or what entity is going to be responsible for the oversite in

those particular areas. We have that ability to move that to the next level.

After

this, too, we looked at some of the

definitions and I've said it before, I used

to be a big proponent of not wanting to give the minister holistic control in a

lot of cases because I always felt there are other entities out there that

should be consulted in advance before a decision is made. Now, I know, at the

end of the day, somebody has to make a final decision.

But the

last couple of bills, I've looked at it and maybe I'm just reading, maybe

there's a difference in the type of bills, but what I've read in the last number

of ones, while the minister still has particular authorities, and rightfully so,

that they're tempered, not taken away from them but they're tempered to the

point where there's a bigger engagement process before the final decision is

made, or the information is gathered in advance before it gets to that point, or

there's another entity that advises.

I see

that as a positive. I see that you want to be able to ensure every perspective

has been looked at before you make a decision that's going to be detrimental to

a particular region, or to a provider, or to a group of staff when you implement

something.

I looked

at that and I saw that as a positive. I thought automatically – I remember a

piece of legislation we had a year ago, I spent most of my discussion – for want

of a better phrase – attacking the minister on having too much control and too

much influence over this, but the couple of bills I've seen as being very

positive and moving towards looking at how that works.

I do

know there are a number of other departments that would have to be engaged here.

Obviously, we're talking contracts, and one of the issues here is about

accountability and if you pull back a contract from somebody what does that mean

from a legal point of view? Because you've got to have all your i's dotted and

your t's crossed to ensure you're not spending money that is going to be good

money after bad, or that you're not punishing somebody and you didn't do due

diligence.

You'd

want to ensure that you have the regulatory process in play, but you also have

the legal advice that would ensure, at the end of the day, you have provided the

service, and you've done it; the person or the group who wasn't providing the

service were accountable. If their accountability is seen to be shrouded in

controversy or unacceptance of their responsibilities, then you have the right

to remove them from the equation and put in somebody who's willing to provide

that service based on the regulatory process you have. So I like that.

If you

read it, some would say it could be even – it's a little stern on some cases,

but we need to have more of that. I said that when I was minister in

Transportation and Works. Government needs to have more authority.

When

people are not living up to their commitments, be it staffing, be it

particularly outside entities that we contract with, that we would have a fluent

process that's not time restraining. That we could eliminate that barrier and

move in someone or some group or some other entity that can provide the service

at the level we need. The people of Newfoundland and Labrador deserve that. The

taxpayers deserve to ensure the money being spent is being spent in the way it

was contracted.

We need

to send a message that while we're open for business, we're open for business

for those who will follow the processes, follow the intent of their contracts

and live up to their obligations. That's fairly simple. And if those obligations

mean staff are to be paid at a certain level in a timely fashion and additional

staffing that are necessary are paid, or the hours that are put in by staffing

are reimbursed at the levels that are comparable in the industry, wherever they

may be.

We can't

say at one point we want to bring legislation to here, but how we treat the

people who provide the service we keep it at here. That can't work. You're

destined to have failure. You're destined to have confusion and you're destined

to have revolt, and we don't want that. That shouldn't be that. We should be

able to come up with systems that continuously move forward and meet the goals

that we want, improving our health care.

So we've

got an opportunity to do this. We've got an opportunity with how we've outlined

this piece of legislation, how we've seriously included the industry into what

needs to be done, how we've also talked about expanding the type of services

that are being provided out there, but also how we talked about resourcing

whatever may be needed.

In 2020,

when we look at the whole atmosphere of this, there may be a whole different

picture on how that's provided. Maybe there are built-in mechanisms for

additional training monies for the providers, or maybe they're not part of that

process. Maybe it's the Paramedic Association or the regional health authorities

or another entity that's given that ability to provide particular training, if

there's a new type of intervention we're going to use or new approach to it.

So we

have an opportunity here because this is stage – probably stage three or four,

because I think there are two or three pieces of legislation that's come into

play that have started to move forward that are very positive. This is another

one. As we get to the procurement of the ambulance services here and some of the

services that will be provided through that or some of the pieces of legislation

that may have to be changed, that will have a major impact on what happens

there.

As we

continue to move towards that process, I just wanted to note one of the last key

components of support here and that's particularly around the regional health

authorities having a more influential stake in providing the direction to the

services that need to be here. I know the minister, obviously, has the umbrella

in charge of the regional health authorities, but, again, the particular

differences in Newfoundland and Labrador – and you don't want to segregate how

we do things, but you want to be cognizant of being able to be flexible on

providing the service in a particular area that may have some particular

challenges.

In here,

the health authorities, through the dialogue with the minister, has the ability

to be able to do that. That's why we talk about some of the paramedicine pilot

projects and how they can be either farmed out to other parts of the province or

new ones can be developed that are unique to that particular area.

So, at

the end of the day, I think this is a very positive step forward. We joke

sometimes when we say it is housekeeping. It's housekeeping, but not in the same

manner that we talk about in some of the other bills here that it's just a

change of a sentence or a word or a definition. It's housekeeping by bringing

everything together under one neat package, defining exactly the process and

then setting the tone for setting the regulations that are going to be very

important to make sure all the stakeholders have the ability, the understanding,

the commitment and the resources to provide the best health care that we can in

Newfoundland and Labrador, particularly around our ambulance services.

Mr.

Speaker, on that note, I will sit by saying that I will be supporting this bill

when we get to that and I will be asking some questions in Committee, maybe a

multitude of those. I probably gave a number of them to the minister already in

the conversation because I know he was taking notes, day in and day out. So

he'll probably be able to answer when he speaks again.

Anyway,

thank you, Mr. Speaker, for that.

MR. SPEAKER:

Thank you very much.

The hon.

the Member for the District of St. John's Centre and Leader of the Third Party.

MS. ROGERS:

Thank you very much, Mr.

Speaker.

I'm very

happy; I really am very, very happy to stand and speak to Bill 43, the

Emergency Health and Paramedicine Services

Act .

Mr.

Speaker, this is a bill that is 20 years in the making. It's about time, and I

think that I would like to applaud the minister and his staff for doing this

work. I'd also like to thank those who were involved in developing this

legislation. I understand there has been much consultation.

Mr.

Speaker, have we ever heard throughout the past – I don't know – six years since

the Fitch report was done, and prior to the Fitch report, we have heard from so

many people in the province. We have heard from individuals. We've heard from

town councils. We have heard from service providers. We've heard from people in

the medical field. We've heard from people in emergency services and

paramedicine. We've heard from everybody. Then this government has done that all

over again by doing their consultations.

What we

know, Mr. Speaker, is this is so necessary and this is so welcome. Of course,

we'll see how it rolls out and how it works on a day-to-day level and on a

community-to-community level. That's yet to be worked out. Some of the

regulations are yet to be worked out, but I would like to thank those who gave a

very thorough briefing. The briefing was about an hour and a half. So I'd like

to thank those who took the time to do that.

Then I'd

also like to thank all those folks who all over the province have provided

ambulance services, paramedicine services, the public providers, the private

providers, the community providers for oftentimes doing work under really,

really tough circumstances. The work they provide and the service they provide

are often sometimes life and death situations.

SOME HON. MEMBERS:

Oh, oh!

MR. SPEAKER:

Just a little bit more quiet,

please.

Thank

you.

MS. ROGERS:

Thank you very much, Mr.

Speaker.

I do

appreciate that.

So they

often provide services that might mean life or death. We've heard from

paramedicine workers, from paramedics, all the categories of those who provide

this kind of emergency services, about PTSD and how difficult it is at times for

first responders. Imagine, Mr. Speaker, doing that work, that in and of itself

is so difficult, and then often under a system that they know is not working

well. That it has been a real patchwork system.

So we

have challenges. We have absolute challenges around this area of service

provision in the province because of our geography, because of our aging

population, because of our fiscal situation, because of the patchwork kind of

system that we've had. That includes public, private, community, not-for-profit,

for-profit, well-educated and at times not educated enough to provide the

services. So imagine the people who do provide these services, which are so

crucial and so critical, and at times very difficult, under a system that really

wasn't working really well.

again, this has been 20 years in the making, and thank goodness that we have

this here today, as we begin to wrap up this session of the House, to know that

this piece of legislation has come before us and is so necessary. One of the

officials in the briefing said: To move to more modern systems of emergency

care, you need more modern legislation, and I believe that that's what this

legislation reflects.

The

ambulance system, the delivery of emergency and paramedicine services, has

needed these changes for a very, very long time, and hopefully what we will see

is a more – it's not just about efficiencies. Sometimes government or political

watchers talk about how do we make our systems more efficient, and they're often

talking about how you cut costs. I'd like to say, really, the question we need

to be asking is how we make it more effective, because that's really what we

want.

We want

the best bang we can for our dollar, we want the best service possible we can

get from our people who are engaged, so how do we make it more effective? And

hopefully, Mr. Speaker, that's what this bill will do. It will make our

emergency health and paramedicine services more effective and serve the people

of the province more effectively and more securely because, again, it's such an

important service.

So our

challenge is, again, our geography. In a number of provinces, the challenges

they have comes with having such a large population. Our challenge to provide a

real effective service is because of our small population in relation to our

geographic mass. When we look at different parts of Labrador, when we look down

on the southern coast, when we look in Central, when we look at Eastern, the

West Coast, the Northern Peninsula, the real geographic challenges that we face,

but also because our population is so small and so spread out, and because we

have an aging population. It is my hope that it will address some of those

challenges.

We, in

the NDP, our party has been calling consistently for a high-quality service

across the province, and perhaps this bill is a step in the right direction. The

name of the bill reflects the fact that we do, in this province, have emergency

responders who are also, at times, not paramedics, and that proves its

challenges as well. So we will be supporting this bill, Mr. Speaker. We do have

some questions, and I look forward to Committee where we can ask – we just a few

questions, really.

The

Fitch report came out in 2013. After a real, extensive study, looking at the

provision of emergency health and paramedicine services in the province, it came

up with some very solid recommendations that really sat on a shelf somewhere. We

didn't see them implemented, and some of them were really solid and really

supported by communities, because this involves municipalities, it involves

town, it involves service providers, the medical field.

We've

all heard stories of inappropriate use of our medical transportation service.

Sometimes not because of ill intent, but because the services just weren't

provided in a way that really met the different level of services that they

needed to provide. For instance, someone needing to come into St. John's for eye

surgery, who would walk from their house to the ambulance and then lay down

because that was their only transportation in.

Also

what's reflected is our lack of a really good overall public transportation

system, and so sometimes some of the services were used inappropriately, again

not necessarily for ill intent, but basically because, again, the challenge we

face with a small population spread over a huge geographic area and an aging

population; perhaps people who cannot drive or do not have family members here

because family members are in Fort McMurray and so they don't have the community

supports they need in order to be able to avail of medical services.

Fitch

had 10 recommendations and the very critical recommendation that they had was

calling for the immediate creation of one central medical dispatch system which

can track where all of the province's ambulances are to ensure the nearest

available one responds to a call. Really, nothing has been done about that.

section 5(1)(

c) of the bill says: “establish one or more communication centres

for the dispatch of paramedicine providers and emergency medical vehicles

throughout the province.” So, hopefully this is pointing to a real, strong,

robust central dispatch system which will make the whole system more effective.

It's

critical that people can rely on a high-performance, reliable ambulance system

and this is a service where response time can literally save lives. We don't

know how much it's going to cost. In 2014, the cost to implement the central

dispatch had been pegged at $5 million by industry observers. So, it will be

interesting. I look forward to asking the minister about that, what he thinks it

might provide and asking him for a little more description on how he sees

central dispatch.

Then

Grant Thornton, in September 28, pointed to some real challenges again in the

whole system. They weren't able to get all the information they needed around

the spending, so that would be also a matter of efficiency but, again, what

we're looking for is effectiveness.

So, the

bill really puts everything under the control and the authority of the minister.

That's where our health services belong. They really do belong under the

ministry of Health and Community Services.

We know

that a number of the contracts are up in 2020. The minister said that this

particular act is not dealing with procurement, but there are some concerns

about really what's going to happen. Will there be a change in providers and

operators? We know that different communities and different businesses have a

lot invested in providing these services. It's a time of uncertainty right now

in what this might mean. We will see, Mr. Speaker.

There

are rumours floating around about the possibility, as in the rest of the

Atlantic provinces, of a Medavie Blue Cross providing these services to the

provinces. Will that happen? Is that the direction that government is going in?

We don't know, but we know that that is a concern. Medavie is supposedly a

non-profit organization that provides these kinds of services across the

country, primarily in the Atlantic provinces, so we'll see what government's

plans are in that area.

I'm

happy that the government has done such an extensive form of consultation, both

in the community and with service providers, and that, as the minister said in

his opening statements, they are looking at providing the best possible care at

the best possible time. That's what we all want. That's what effective services

will be.

The

appointment of a provincial medical director with broad powers looks like a

really good thing. Again, we need that expertise in directing any kind of

change. The provision to have a mandatory five-year review – we see the field of

medicine is changing so rapidly, also the demographics in the province are

changing quite rapidly, so I would even like to see that review done a little

bit earlier than five years.

Also,

looking at the areas of the expansion of the scope of practice for emergency

health workers and for paramedicine workers, we've seen that happening in a

number of jurisdictions, where they do a number of different kinds of services,

and we have to look at that. Our paramedicine personnel, what kinds of services

can they provide? How can we, again, make their jobs more effective in the

delivery of a health care system? For instance, in some places they do house

calls to do blood work and take blood pressure measurements, et cetera, so maybe

we will see the expansion of services, the expansion of the scope of practice in

that way. Again, to be able to use the best of our people in the best way and

deliver the most effective services is really what we all hope for.

So, Mr.

Speaker, I have no more to say to that. I do have some questions that I will be

asking in Committee. Again, I would like to thank the minister and his staff for

this robust piece of legislation. I feel hopeful – we have to feel hopeful –

that we will see some of the changes that we have so desperately – desperately –

needed to make our emergency health and paramedicine services more effective.

Thank

you very much, Mr. Speaker.

MR. SPEAKER:

Thank you.

The hon.

the Member for Mount Pearl - Southlands.

MR. LANE:

Thank you, Mr. Speaker.

It's a

pleasure to stand just for a couple of minutes and offer my support for Bill 43,

An Act Respecting the Provision of Emergency Health and Paramedicine Services

and, really, what we're referring to as ambulance services in the province.

We've

seen a number of issues over the years arise when it comes to provincial

ambulance services, problems when it relates to a number of the providers in

different parts of our province and issues that have arisen in terms of possibly

inappropriate use of ambulances at times, service that was supposed to be

provided, staffing levels that were supposed to be provided that actually didn't

happen and so on. We saw the issues that were uncovered by the Auditor General.

I think

it's in the best interest of the province as a whole that all these matters be

addressed and that we have an ambulance service that's going to be appropriate,

that's going to be appropriately staffed and resourced, the appropriate

training, providing the services that are required for the people when they need

it, different levels of service and so on. It's also important that it's done in

not just an effective way, but we have to bear in mind costs and so on as well.

Really what we have here is a piece of legislation that's sort of bringing all

the pieces together under one umbrella. It's adding a lot of accountability,

which is very, very important, and oversight to ensure that our people actually

receive those services they require and they receive them in a timely manner.

From

that perspective, I certainly support this bill. The only thing I would say is

that, as I said to the other bill we had here in the House not too long ago

around public health and so on, we can write all the legislation we want and put

it here on paper, we can pass it and so on, but at the end of the day, the devil

will be in the details. It will flow not just from the legislation, but really

the details will come out in the regulations and in the policies. Of course, the

regulations and the policies are things that nobody in this House of Assembly

has control over, so to speak, other than the minister, so we have to trust the

minister of the day, whoever that might be, that those regulations and those

policies are going to be appropriate and that they're going to be effective and

so on.

We won't

really know until all this rolls out. We can only trust that it will be done. As

this rolls out over time, if we see issues that arise from said regulations and

policies, then obviously it would be up to us as Members of the House,

particularly on the Opposition side, to bring those issues forward in this hon.

House and any other way we can to make sure that the issue is brought to the

public light and that it gets addressed.

With

that said, in terms of this actual bill itself and what's contained within it

and the overarching guidelines and so on that are contained in this – as I

indicated, the accountability mechanisms and so on that are contained within

this, I certainly do support that in principle. As I said, hopefully, as all

this rolls out, it will go the way that we all hope that it will. Again, it will

come down to policies; it will come down to regulations, and it will come down

to resources.

One of

the complaints that we've heard over the years when we've seen issues arise with

private ambulance services, and so on, that were contracted out through the

procurement process – and we've seen issues where services weren't provided as

they were supposed to. What we hear from ambulance operators – at least their

side of the story, and I know that's just one side of the story – is the fact

that quite often it's with the public procurement process.

different than the school buses, by the way. School bus operators would argue it

all comes down to the low bidder. As a result, ambulance operators – no

different than school operators – would argue it's certainly hard to maintain

the appropriate levels of staffing and equipment and training and everything

else if the only thing the government is going to be interested in is who can

provide the absolute lowest bid, as opposed to looking at who can provide the

best service and the most reasonable service.

I would

certainly hope that, as this unfolds, the whole concept around ensuring that any

operators, whoever they may be, that are going to be providing the service and

who are going to be ultimately expected to be in compliance with this piece of

legislation and the powers vested in certain individuals under this legislation,

I would hope that whoever those organizations are, that as government decides to

contract that work out, that they bear in mind that it should be about who can

provide appropriate service. While cost obviously has to be a factor, because

all of us as taxpayers have to pay for it, it can't just simply be about cost

and cost alone.

companies are bidding on things and the bids are obviously unreasonable, then

someone is going to do the due diligence to figure out, well, how do you intend

on doing this? Are you going to be cutting corners? Are you going to have

equipment that's going to be up to spec? Are your operators going to be trained

and so on? What are the response times going to be like? That would be the only

thing which is sort of related to this bill but not contained directly in this

bill.

I would

say to the minister, that as all this rolls out, we got to make sure we get the

appropriate services. This bill provides a guideline for that, but this written

on paper means nothing, so to speak, in terms of if someone is in some part of

Newfoundland and they call for an ambulance, whether they get it or not, whether

they show up on time, whether the appropriate staff are on that ambulance,

whether they're trained, whether the vehicle they show up in is fit to be on the

road and so on. Those things, while in a general sense flow from this, the devil

will be in the details. And the details in many cases, will come from that

procurement contract.

So doing

this is great, but the other pieces that will follow after this are probably the

most important, and I certainly encourage the minister to keep that in mind.

Thank

you, Mr. Speaker.

MR. SPEAKER:

Thank you.

The hon.

the Member for Mount Pearl North.

MR. LESTER:

Thank you, Mr. Speaker.

It gives

me great pleasure to rise to speak to Bill 43,

An Act Respecting the Provision

of Emergency Health and Paramedicine Services.

This is

a great bill. As my colleagues from both Mount Pearl - Southlands had said and

the Leader of the NDP, it's a bill that's been a long time in the making and

definitely a necessity that we need to put in play as the demographics change

within our province to a more elderly population and a population that will

require more immediate services.

efforts to keep people in their homes, we also have a responsibility to make

sure they have access to basic and emergency medical care. The intent of this

act is to provide those parameters that will enable government and service

providers to have a document and a mandate to do that. It also provides an

element of front-line efficiency.

Our

emergency departments, everybody is hearing the long waits at the Health

Sciences' department and other emergency departments throughout the province.

Yes, there are severe emergencies at times, but a lot of the issues that are

showing up at our emergency departments are issues that could be dealt with at

home if they were acted on appropriately or monitored appropriately.

These in

particular, the ambulance staff are highly-trained, skilled and quite capable of

administering some pre-emptive medical care and some pre-emptive medical

observation. I always say, well, an ounce of prevention is worth a pound of

cure. So every time we can prevent those people, especially the elderly or those

who may be of compromised health, from having to go actually to the emergency

department, that goes a long way to reducing the burden upon our health system

and upon the provincial Treasury, of course.

This

bill also puts in protocols and parameters of the oversight that is necessary to

operate a system such as the paramedicine services. Everything from outlining

the powers of what the minister can do and can condone and also can condemn.

That is very important, because in bureaucracy it's often a question of, okay,

well whose job is it to do this? It very clearly outlines that the minister is

the one with the ultimate say and ultimate power. That is very important,

because you really do need the go-to when there's a crisis or when there is a

situation where a decision has to be made. It's very, very clear within the act

that the minister is the one with the ultimate power.

Another

thing we should really look at, too, is the non-application of the act. “This

Act does not apply to (

a) a person providing emergency medical services or first

aid assistance in circumstances to which the

Emergency Medical Aid Act applies;” – sorry, does not apply – is

“(

b) a person based outside the province providing a service for the

interprovincial transportation of patients; (

c) police, firefighters, lifeguards

and other persons prescribed in the regulations who are not paramedicine

providers; (

d) a person providing an emergency service during (

i) an emergency

declared under the Emergency Services Act ,

or …” Emergency Health and Paramedicine

Services Act .

Actually, just to speak to that, it was only last week that I received a text

message as part of our provincial alert system as it pertains to the

Emergency Services Act . It's great to see we're testing these

systems and we do have those in place, because as our world evolves and we

become more of a transient population, we're basically exposed to all health

concerns throughout our globe. We need to be able to react to that.

Once

upon a time we were a sheltered population and were largely immune from global

effects, but because our population is so movable and can get from places so

quick via air travel or whatever it may be, even a terrorist threat could show

up in a priority post or a courier package. You have a huge issue show up, and

it's wonderful to see this service act is in place and we're prepared for it.

Some of

the powers of the minister that we'd like to speak to are the establishment of

standards for the management, operation and use of emergency vehicles.

Obviously, the vehicles are the conduit of the personnel and the patient. It's

very important that those vehicles are, at all times, kept in the highest level

of maintenance, routine maintenances done and inspections are carried out, not

periodically but mandatorily on a frequent basis.

doesn't take long for a vehicle to deteriorate, especially – I know on my farm I

always say, well, a vehicle sitting idle is almost worse than a vehicle working

every day because that's when the issues manifest themselves. As the vehicles

are sitting up they become a little bit stiff and we have issues with

transmissions, issues with engines and even issues with doors.

When

somebody shows up to deliver paramedicine services in the form of an ambulance

in an emergency situation, you don't want to have to be comprised on delivery of

service because the vehicle is not maintained properly.

Mr.

Speaker, as our population does become more centralized, it's going to be

impossible to keep primary health care facilities in everybody's town, in

everybody's neighbourhood. We're going to see more of a centralization of

services because, number one, it's obviously becoming very costly and skilled

professionals are going to increase their rate of pay. Unfortunately, we can't

have a hospital or an emergency department in all locations throughout our

province. I'm sure we all would love to have that, but we only have so many

dollars and it's becoming more of a burden on the taxpayers' contribution to

deliver those services. And so we will see more of a role for paramedicine as we

have no choice but to streamline our health care system.

These

paramedicine providers will be the liaison between the patient and a more

advanced health authority. And not only will they provide immediate physical

medical care – but especially in the case of our elderly or people who live

alone, often things are overlooked or gradually build up over a course of time

and quickly develop into an emergency situation. By having a regular focused

visit by the paramedicine providers, a lot of these issues will be able to be

mitigated before they get to the crisis point. But when it does get to that

crisis point, we do want to have the service there and it has to be reliable.

The people of the province have to be confident that when they are faced with an

emergency medical situation that there is someone on the way.

As I

said, that's going to have to evolve into more of a focus, because as we

centralize our, I guess, emergency centres and emergency care and advanced care,

it's going to be more on the shoulders of the people and the services outlined

in this act. Other jurisdictions have already started centralizing their health

and, I guess, while our situation is far different, I would like to refer to the

model in Australia where, of course, the air ambulance is a big component of the

paramedicine services. You have far out cattle ranches, sheep ranches or mining

installations. Obviously, we can't have emergency facilities out in those areas.

But instead of providing those services there, they have focused on a very, very

efficient, well-maintained air ambulance service that can get people to the

services that they need in their time of crisis. Not only that, they also do

provide regular checkups and some primary care and pre-emptive care to those

individuals in outlying areas.

So that

facility of paramedicine services works quite well in such a large geographic

area as Australia. Australia is basically the size of Quebec and Ontario

doubled, so Newfoundland and Labrador would be a very, very small portion of

that. So if that type of facility and that type of service is attainable in such

a large continent, well I'm sure that the virtue of this act will enable us to

provide the same type of care to our citizens as that of Australia and anywhere

else that does operate a more centralized care system with fantastic

paramedicine services.

Something that we also have to address, of course, is when an operator does

deviate from the standards of what we have outlined, as a government within this

bill, as acceptable and standard practices, there has to be facility there to

move in and suspend the licence or provide a probationary period. But that also

has to be outlined, because one of the worst actions when a problem occurs, in

any situation, is no action. We have to be able to have a clear directive as to

what we can and cannot do.

This is

also outlined in the act in

section 12(1), and under the authority of the

minister, it may vary, but basically the minister can suspend or cancel an

operator licence. It's clearly identified in such a case where “the operator

contravenes this Act, the regulations, any other Act or regulations of the

province or of Canada ….” So this goes beyond our provincial regulations; it

also refers to federal regulations.

I can

only imagine what kind of bureaucratic nightmare that must have created for the

producers of this document to coordinate between provincial and federal

regulations and jurisdictions. That's something that we have to take more of an

aggressive approach to because so often not only do we see it in this service,

but we also see it in our fishery, our offshore where there is a convoluted line

whether we have federal or provincial jurisdiction. So it's great to see that

issue has been addressed and it's outlined how we will deal with that.

The

minister basically has the final say. When the minister is satisfied that the

licence, the minister has the complete and utter authority to cancel that

licence. And so should it be, because the minister and, of course, the

government is responsible for the health of our people. If someone is committed

to providing a service and they are not providing the service that they agreed

to, we as stewards of the taxpayers' dollars have to be able to step in there

and act quickly and make sure that the true intent of this service and contract

is fulfilled. Yes, there will, no doubt, be legal challenges at times. But our

ultimate goal and directive and mandate is to provide this service in the

respect that is outlined in this document to the people of our province.

While I

look and read this, I can see that it's not only just a primary paramedicine

services act, it's also about improving our general health in our province. That

is about taking care of ourselves, taking care of our elderly, taking care of

those who are unable to get back and forth on a regular basis to their doctors

because of geographic or personal situations. So this is really a major step

forward in looking after the overall health of the people of our province. And

for that reason, I will personally be supporting this bill and I thank you very

much for the opportunity to speak to it.

MR. SPEAKER:

Any further speakers to the

bill?

If the

hon. the Minister of Health and Community Services speaks now he will close

debate.

The hon.

the Minister of Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Speaker.

I was

delighted to hear such loquacious praise for the bill and I look forward to the

Committee stage. I would just highlight two things: one, it's not just about

ambulances, it's far bigger than that; and, the second thing is that the passage

of this bill will considerably reduce uncertainty within the sphere of operators

in paramedicine.

MR. SPEAKER:

Is the House ready for the

question?

The

motion is that Bill 43 be now read a second time.

Is it

the pleasure of the House to adopt the motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

The

motion is carried.

CLERK:

A bill,

An Act Respecting The Provision Of Emergency Health And Paramedicine

Services. (Bill 43)

MR. SPEAKER:

This bill has now been read a

second time.

When

shall the bill be referred to a Committee of the Whole House?

MR. A. PARSONS:

Now.

MR. SPEAKER:

Now.

motion, a bill, “An Act Respecting The Provision Of Emergency Health And

Paramedicine Services,” read a second time, ordered referred to a Committee of

the Whole House presently, by leave. (Bill 43)

MR. SPEAKER:

The hon. the Government House

Leader.

MR. A. PARSONS:

Mr. Speaker, I move, seconded

by the Minister of Health and Community Services that the House resolve itself

into a Committee of the Whole to consider Bill 43.

MR. SPEAKER:

It is moved and seconded that

I do now leave the Chair for the House to resolve itself into a Committee of the

Whole to consider the said bill.

Is it

the pleasure of the House to adopt the motion?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

MR. SPEAKER:

All those against, 'nay.'

Carried.

motion, that the House resolve itself into a Committee of the Whole, the Speaker

left the Chair.

Committee of the

Whole

CHAIR (Warr):

Order, please!

We are

now considering Bill 43,

An Act Respecting The Provision Of Emergency Health And

Paramedicine Services.

A bill,

“An Act Respecting The Provision Of Emergency Health And Paramedicine Services.”

(Bill 43)

CLERK:

Clause 1.

CHAIR:

Shall clause 1 carry?

The

Chair recognizes the hon. the Member for Conception Bay East - Bell Island.

MR. BRAZIL:

Thank you, Mr. Chair.

Just a

couple of questions here for clarification and to further the process.

I just

ask the minister: Will there be further consultation in the development of the

regulations over the next couple of months?

CHAIR:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Yes.

CHAIR:

The hon. the Member for

Conception Bay East - Bell Island.

MR. BRAZIL:

Mr. Chair, that's good hear.

We're moving in the right direction.

Can the

minister outline just some of the paramedicine services that he sees on a

go-forward basis that would be positive for the province?

CHAIR:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much.

Currently paramedicine is defined by protocols and algorithms developed by the

Provincial Medical Oversight office. The possibilities around scopes of practice

for paramedicine would really depend on whether or not they went down the route

of self-regulation, but certainly they run from community paramedicine,

traditional first responder roles, and right through to advance care

paramedicine and critical care transport paramedicine, any and all of those. So,

the scope is quite wide.

CHAIR:

The hon. the Member for

Conception Bay East - Bell Island.

MR. BRAZIL:

Thank you, Mr. Chair.

That's

good hear that there's an opportunity here, as we talked about earlier, to think

outside the box and provide better health care in particular areas.

The

appeals process for an ambulance provider whose licence may be revoked or there

may be some restrictions on that, can you just outline exactly the process there

for that individual or group of companies to be able to appeal, or is there an

appeal process on being able to either reinstate or have an operational process

where there are some regulatory conditions attached to it?

CHAIR:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Chair.

The idea

in the act that when an issue is identified, currently, there is a built-in,

60-day period during which the operator would have time to put in place

corrective or remedial activities. What happens after that, really would rather

depend on the nature of the defect and how egregious it may or may not have

been.

We can

certainly look at putting in an appeal mechanism other than that, but our prime

concern around enshrining these time limits in the act was concerned with

patient safety and rapidity of action.

CHAIR:

The hon. the Member for

Conception Bay East - Bell Island.

MR. BRAZIL:

Thank you, Mr. Chair.

I thank

the minister for that answer. I only have one last question here: Does the

minister anticipate any additional revenues being needed by the regional health

authorities or particular branch of his department or another entity outside,

maybe Service NL or some other contracting or partnering entity there when it

comes to implementing the legislation and particularly the regulatory process

afterwards?

CHAIR:

The hon. the Minister of

Health and Community Services.

MR. HAGGIE:

Thank you very much, Mr.

Chair.

Short

term the answer is no. This simply enshrines practices that we currently have.

As we go forward with program development through the newly revamped

paramedicine services, then obviously that would feed into a regular budgetary

process.

CHAIR:

Shall the motion carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, clause 1 carried.

CLERK:

Clauses 2 through 37

inclusive.

CHAIR:

Clauses 2 through 37

inclusive, shall they carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, clauses 2 through 37 carried.

CLERK:

Be it enacted by the

Lieutenant Governor and House of Assembly in Legislative Session convened, as

follows.

CHAIR:

Shall the enacting clause

carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, enacting clause carried.

CLERK:

An Act Respecting The

Provision Of Emergency Health And Paramedicine Services.

CHAIR:

Shall the title carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, title carried.

CHAIR:

Shall I report the bill

without amendment?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

Motion,

that the Committee report having passed the bill without amendment, carried.

CHAIR:

The hon. the Government House

Leader.

MR. A. PARSONS:

I move, Mr. Chair, that the

Committee rise and report Bill 43.

CHAIR:

The motion is that the

Committee rise and report Bill 43.

Shall

the motion carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Carried.

motion, that the Committee rise, report progress and ask leave to sit again, the

Speaker returned to the Chair.

MR. SPEAKER (Trimper):

The hon. the Member for

the District of Baie Verte - Green Bay and Chair of the Committee of the Whole

House.

MR. WARR:

Thank you, Mr. Speaker.

The

Committee of the Whole have considered the matters to them referred and have

directed me to report Bill 43 without amendment.

MR. SPEAKER:

The Chair of th