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June 22, 1976

30th Parliament, 3rd Session

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Hansard Transcripts

L092 - Tue 22 Jun 1976 / Mar 22 jun 1976

ESTIMATES, MINISTRY OF HEALTH

MERCURY POISONING IN IRAQ AND JAPAN

COW-CALF PROGRAMME

CLOSURE OF ARENAS

ASSISTANCE FOR ARENA REPAIRS

CLOSURE OF ARENAS

CLAIMS FOR LUNG CANCER

ELLIOT LAKE RETRAINING PROGRAMME

FREEDOM OF INFORMATION LEGISLATION

HOSPITAL CLOSINGS APPEAL

ALCOHOL CONSUMPTION

MILK PRODUCTION

VINYL CHLORIDE LEVELS

AIR TRAFFIC CONTROL DISPUTE

AIB RULING ON TEACHERS’ CONTRACT

TELEPHONE SOLICITATIONS

TAXI INSURANCE PREMIUMS

LEGISLATIVE PAGES

ANSWERS TO WRITTEN QUESTIONS

CONCURRENCE IN SUPPLY

ENVIRONMENTAL PROTECTION AMENDMENT ACT

EDUCATION AMENDMENT ACT (CONCLUDED)

MUNICIPAL AMENDMENT ACT (CONCLUDED)

ONTARIO NEW HOME WARRANTIES PLAN ACT (CONCLUDED)

THIRD READINGS

NOTICE OF MOTION NO. 6

ANSWERS TO WRITTEN QUESTIONS

ESTIMATES, MINISTRY OF HEALTH (CONCLUDED)

ANSWERS TO WRITTEN QUESTIONS

ROYAL ASSENT

The House met at 10 am.

Prayers.

Mr. Speaker: Orders of the day.

Clerk of the House: The 12th order, House in committee of supply.

ESTIMATES, MINISTRY OF HEALTH

Mr. Deputy Chairman: Perhaps I should mention to the hon. members of the committee that seven hours remain in the committee of supply. Does the hon. Minister of Health wish to make any opening comments?

Hon. F. S. Miller: Mr. Chairman, I have just been moved to another seat and am moving my equipment.

Mr. Deputy Chairman: While we’re waiting for the hon. minister, perhaps it would be in order for the Chair to remind the hon. members of the committee that the stacked votes in the committee of the whole House will take place after the question period this I afternoon.

Hon. Mr. Welch: Mr. Chairman, if I might at this point, it was our plan after routine proceedings this afternoon to clear up the work that’s in committee of the whole House, do our third readings, put government notice of motion No. 6 before the House and then go back to these estimates until they’re finished.

There is a motion on the floor now, and I know we’re in committee, and I would like some direction from the committee that we would go through the lunch hour. That’s not really necessary today. If, in fact, we wanted to break between 1 and 2, we could decide at 6 o’clock how much more time we might need to complete these estimates. I’m in the committee’s hands as to whether or not we would like to rise at 1 and have a break between 1 and 2, or sit through lunch.

Mr. Deans: Mr. Chairman, I think we should have a break between 1 and 2 today and a dinner break as well. I think we have sufficient time today to complete all the work that’s before us and it makes no sense to sit all day as we did yesterday. I think it tends to be a bit much.

Hon. Mr. Welch: How would it be if we agree to break between 1 and 2 anyway and we could see where we are as we get closer to 6 o’clock?

Mr. Deputy Chairman: It is the understanding of the committee that we will rise at 1 o’clock. Agreed?

Mr. Nixon: There will be seven or eight people here between 1 and 2 whether we are sitting or not.

Hon. Mr. Welch: What do you want to do?

Mr. Deputy Chairman: The committee will rise at 1 o’clock.

Hon. Mr. Welch: Actually, by resolution of the House, we in fact are sitting until 2 unless we agree otherwise, so that’s why I’m raising the question now.

Mr. Deans: If I can put it this way to you, since I’m likely to be one of the seven or eight who will be here, I’d rather rise and have lunch.

Mr. Nixon: Since I am one of the seven or eight who will be here, I say let’s sit.

Mr. Deputy Chairman: Perhaps it might be in order for the --

Hon. Mr. Welch: I think I grasp the consensus to be that we will sit. Therefore, we will go from 10 to 2, and then we’ll have routine proceedings at 2 and we’ll break at suppertime in the regular way, depending on circumstances at that time.

Mr. Deputy Chairman: The hon. Minister of Health.

Hon. F. S. Miller: Mr. Chairman, it is now certain that I will be one of the seven or eight here between 1 and 2.

Mr. Deans: I thought you weren’t supposed to work that long?

Hon. F. S. Miller: I believe that was the intent of the House, to try to let me have an hour’s rest, but I don’t think it matters.

Mr. Deans: That’s what I was hoping for, but obviously the Liberals don’t care about your health.

Hon. F. S. Miller: Mr. Chairman, before I read my opening statement, perhaps I could have it distributed to the members.

Mr. Nixon: Mr. Chairman, on a point of order. I just don’t know how serious that exchange is.

Mr. Deans: Oh, it was a joke.

Mr. Nixon: Because, obviously, anytime the Minister of Health feels these proceedings ought to adjourn for a while we are more than willing to do so.

Hon. F. S. Miller: Mr. Chairman, I do appreciate the sincerity of that. I was asked by the House leader if I could, in fact, stand four hours at a time. The answer is yes I can. I will not be present during question period as a result of it, but since you will have me all day on the grill anyway, I think probably you can miss me at question period.

Before I begin my opening statement, I know the Ministry of Health estimates are sometimes difficult for the members to discuss in a sequence that suits them, because they are never quite sure under which vote a particular topic might fall.

Last year, we rushed into trying to get some printed material. This time, I have enough pieces of paper here, which I’d like to distribute, showing the vote and the item so that the members of the opposition parties and our own party will know roughly where a particular topic pops up. I think it would be wise if, in fact, albeit we only have seven hours, we try to discuss them item by item in sequence rather than doing what we’ve done in the past and that is cover all topics at one time. I hope and trust then that the items of interest will get the time they deserve.

I would like to open my estimates debate with a statement that I hope will put into perspective some significant changes that have recently taken place in our health programmes. I’m sure the members are well aware that since the 1950s there has been a steady escalation in the number of public services provided by government, particularly in the social service areas.

This quite properly was brought about by ever increasing public demand. The public felt that an industrialized, affluent society should provide appropriate hospital, medical and social services. The federal government bowed to this pressure and introduced, first, universal hospital care, and then later a universal medical care scheme, neither of which had any flexibility in meeting varying provincial needs.

As we all so well know, the British North America Act delineates federal and provincial powers. It is the specific responsibility of the provinces to provide for the legislative, regulatory, financial and service components of health care. The federal government through its national taxing scheme altered this through financial manipulation, which warped the natural evolution of a balanced health care system. The responsibility of providing services has remained with the provinces. But, until now, we have been unable totally to call the shot.

This government has fully accepted the responsibility of protecting the public from health hazards, of preventing the outbreak and spread of disease and of providing for care of the sick and the injured.

As health services came under the hospital and medical care insurance plans, expectations and demands of both the public and of professionals providing health care have increasingly strained our financial resources. The situation became difficult to control and financially intolerable with large wage settlements, rising cost of products and a high rate of inflation. Under the federal shared-cost programme, services tended to gravitate toward hospitals because of the funding scheme and availability of 50-cent dollars from the federal government -- that’s on a Canada-wide basis.

This overburdened the system with expensive, top-heavy hospital facilities offering a variety of services which could have been delivered in a less costly manner if they had been cost-shared.

Even though there was no federal funding, this province took the initiative of introducing insurance coverage for nursing homes. This has added to the rising costs but it was needed to achieve a balance in the system and to lessen the work load of acute treatment facilities while still providing long-term health care for senior citizens. While this was happening, the economic climate was changing and inflation began taking its toll.

There have been reams of reports and dozens of investigations and task forces looking into health care services and making hundreds of recommendations on the organization of a balanced health care system. We knew something had to be done to rationalize health care and its rapidly increasing cost. The limitations of shared-cost programmes have repeatedly been brought to the attention of the federal government without success in many rounds of our federal-provincial meetings. Federal counter-proposals were found unacceptable to the majority of provinces, because they put them at a financial disadvantage in providing health care.

Mr. S. Smith: Excuse me. On a point of order, Mr. Chairman, I apologize for interrupting but would the minister prefer to make his remarks while seated?

Hon. F. S. Miller: No. I’m fine.

Mr. S. Smith: It certainly wouldn’t matter to us at all.

Hon. F. S. Miller: Thank you, I’m quite okay. They’ve got me on a training programme these days. I turn out to have better wind power than most of you who are not suffering from heart trouble.

Mr. S. Smith: I was hoping then I could make my remarks sitting down.

Hon. F. S. Miller: In your case, you may need it. I would say prevention is the best part of this deal.

Mr. R. S. Smith: You have to start early though.

Hon. F. S. Miller: Yes.

As members are aware, the first ministers were in Ottawa last week to work out a new basis for shared-cost programmes which will be fairer to all parties. The federal government put forward a proposal of combined tax points and cash which reflects ideas Ontario has put forward over the past decade. This was a positive step toward improving the accountability and flexibility of the partners in Confederation and toward the removal of petty administrative details.

The federal proposal partially transforms conditional federal grants into unconditional form. However, it does not present the comprehensive reform we would like to see in health financing. It deals with only part of the total health programme and leaves out such vital components as psychiatric care and nursing homes. I have to point out, however, that there are a number of details to be worked out and I think it’s premature for us to prejudge the package offered. It’s a significant step forward in our opinion in any event.

[10:15]

Under the proposal, the federal government has suggested a global health review. Our Premier (Mr. Davis) had said a review was not necessary and that a more constructive approach would be to include all alternative forms of health care in the present financial base. This would be in keeping with the spirit of the federal proposal and would spare us yet another exhaustive study. I think the Premier’s words were that health has been studied, restudied and restudied in the last few years. We have volumes and volumes of studies. The time has come to act.

As members are well aware, we in Ontario are not alone in our attempts to achieve affordable health care. All jurisdictions across Canada are faced with containing health care costs.

I would like to report on the progress of our constraint programme. Initially, we estimated a total saving of $48.2 million from hospital closures and selected budgetary controls. Breaking this figure down, it meant $37.8 million would have been saved through bed closings and budget controls, and a further $10.4 million through hospital closures. With respect to hospital closures, the members are aware that four hospitals have been affected by the division court decision with respect to closure by the province. The government is respecting that decision while launching an appeal against the decision of the court. Four hospitals have closed.

During the time required for the appeal, the hospitals will, of course, continue to operate financially under the general funding principles of the ministry. Should the appeal fail, the government will consider possible legislative action. To do so now, however, would be to prejudge the appeal process, about which we are hopeful.

Because of the court decision and the adjustments in our control programme, the projected net constraint saving amounts to $23.3 million in total; or $22 million from bed closures and budgetary controls, and about $1.3 million from hospital closures.

In general, hospitals have been very cooperative and have tried to live within the established guidelines. That is not to say that these guidelines were perfect. There is room for improvement and we have been working closely with hospitals in their submissions.

I am also pleased to report that we have been successful in our constraint programme as it related to the closing of psychiatric hospitals and public laboratories. Along with the savings achieved in the public hospital sector, another $3.4 million has been saved by convening the provincial psychiatric hospitals at Goderich and Timmins. A further $375,000 net savings this year will be realized through the closure of four laboratories, even with the expenses attendant on closure.

This government is making a substantial saving, a total in excess of $27 million this year, but what is more important is that these savings will he realized annually, thereby saving Ontario taxpayers many more millions of dollars in the future.

Within the Ministry of Health itself we have made determined efforts to make savings ourselves. In fact, the ministry has reduced its staff by 2,192 persons in the past two years -- staff at all levels, including senior management. That’s roughly two-thirds of the provincial total. We have consolidated branches and divisions within the ministry to streamline operations and improve management.

Earlier this month, I spoke about the measures we have taken to strengthen this ministry’s occupational health protection branch. These measures include changes within the branch organization and management, and the “beefing up” of staff.

At the time of the original statement on occupational and environmental health I indicated there was a shortage of occupational health personnel. I am now pleased to report that my ministry has made an inventory of all occupational health manpower within the province and has contacted all health science centres to encourage them to train occupational health specialists. It is expected that by 1977-1978 there will be a substantial increase in the number being trained.

The “Interministerial Accord on Occupational and Environmental Health” was completed in draft form in October, 1975. Implementation of the accord is being effected through regular meetings of the four deputy ministers and through an interministerial standing committee on occupational and environmental health.

I would now like to discuss the Ontario Health Insurance Plan. During 1975-1976, 8,240,000 Ontario residents were covered under OHIP. There were 50.1 million claims representing a total of $728.3 million. Another $13.8 million was paid out for non-fee for service payments, which include doctors’ salaries, sessional and capitation payments. In total then, the plan paid out $742.1 million. For the record, I would like to note that administrative costs were only 5.06 per cent of the total expenditures which compares favourably with other similar health insurance plans.

Under OHIP we have active committees which review and scrutinize professional activity and billing procedures. These are the medical review committee and the practitioner review committees. The medical review committee deals with physicians and the practitioner review committees deal with chiropractors, chiropodists, optometrists and dentists. These committees monitor the professions’ billing practices.

I would also like to touch on the drug benefit plan which in 1975 covered one million Ontarians. One million prescriptions a month are filled under the programme which provides drugs to persons over 65 or on family benefit, extended care patients or home care patients, people receiving vocational rehabilitation and indigent diabetics. In September, we will be adding general welfare recipients as well. The average drug benefit prescription was 68 cents less or 16 per cent lower than the overall average paid by other drug insurance plans, like Blue Cross or Green Shield. The control features of the drug benefit plan were responsible for the savings.

Medical manpower planning is important. The ministry has supported a careful review of specialty and family-practice manpower needs by the medical profession and medical schools. The rate of physician immigration has now been brought under control in Ontario. Between July 1, 1975, and March 31, 1976, 81 immigrant doctors were admitted, nine with a landed status. This compares to 236 in the first six months of the year. The distribution of physicians is improving. The underserviced area programme has been successful in placing doctors and to a degree dentists and nurses in communities previously with inadequate health care.

With respect to controlling laboratory costs, I indicated several days ago that legislation controlling laboratories, specifically Bill 59, will remain on the order paper but will not go forward this session. We intend thoroughly to review it with a view to amending it. I would like to outline for the House today some of the specific steps this government is presently taking to control the cost of medical laboratory services in this province.

Regulations are being developed under the Public Health Act to control conflicts of interest in the ownership of laboratories. I can say that that legislation or regulation is practised and we are simply awaiting a series of appendices to it to be included in the regulations naming labs by specific location. Regulations under the Health Disciplines Act are also being drafted to eliminate kickbacks. Again, I believe those have been circulated to the various professions in the last few days.

In addition, a new laboratory test requisition form is being developed to discourage unnecessary utilization of medical laboratories. I can also say that new requisition form clearly states the cost of each laboratory procedure ordered by the doctor so that he will be aware of the cost.

Reimbursement mechanisms for laboratory procedures are currently under consideration. Global budgets, tendering and other mechanisms all have strong points and, unfortunately, weaknesses, all of which we will take into consideration. The methods of reimbursement of both private and hospital labs are under review for obvious reasons. We are faced with rapidly escalating utilization and costs in the private sector, a factor that has been promoted by vigorous and aggressive marketing techniques on the part of private lab owners.

Also, current mechanisms must be revised to provide some incentives to hospitals to use their laboratory capacities more fully by doing more of their own outpatient tests.

Our effort in the first instance will be geared toward the limitation of growth of medical laboratory workload while encouraging shift in volumes to the hospital labs. Sixteen regional advisory laboratory committees are studying available spare capacity in hospital and public health laboratory services to assess the possibilities of increasing their share of outpatient testing. The committee is developing proposals for a regional laboratory system which will make maximum use of resources, eliminate duplication of services and equipment and make labs more cost-effective.

I have outlined a few of the areas of current interest in the Ministry of Health and its historical financial perspective. We’ve had our difficulties in aligning health care service to meet the legitimate needs of our citizens, but on the whole we’ve had a positive response both from the public at large and those who provide health care services. Everyone recognizes the need for eliminating unnecessary costs.

We have one of the best health care systems in the world and we should be proud of it. We are in a new era of challenge and change that can ensure a reasonable, affordable and rational health care system without sacrificing quality. This government has taken effective bold steps in this regard.

Apart from the prepared statement, I wanted to refer, if I may, to the Browndale situation and the request that the auditors’ study be summarized in this House, since this is my last opportunity to do so. While I haven’t got a prepared statement, I’d like to sketch out the information given to me.

I might indulge the interest of the leader of the Liberal Party because I’m going to talk about Browndale right now and I thought perhaps he might want to hear it. As you know, the internal auditors of the Ministry of Health have looked into the Browndale situation; at the same time, I understand the Attorney General is looking at certain aspects of the Browndale operation. I can’t speak for those things taking place in his ministry because I’m not aware of them in detail. However, I can summarize our ministry’s findings. I’m going to read parts of the report to me.

Our auditors found three areas in question when they looked through Browndale’s expenditures and accounting methods. The first was the overcounting of children days. As I’m sure you know, they are paid on a certain per diem per child in care. Browndale has overcounted the number of patient days by 145 in 1974 and 161 in 1975. These were included in the days they reported to us and they were paid at the approved per diem rates. Overpayment amounts to $8,700 in 1974 and $10,600 in 1975, for a total of $19,300. As this is an incorrect count of days, we have requested the money back from Browndale and I understand it will be paid.

I’ll digress a second to point out they were counting the day of arrival and the day of departure in their days and that is not according to regulations, You count either the one or the other but not both.

The second issue was expenditures on houses in Don Vale. The auditors found that in 1974, Browndale Ontario had entered into a lease for 10 houses in the Don Vale area. These houses were on Winchester St., Sumach St. and Gerrard St. A number of expenditures were made for rent, taxes, furniture and equipment and property improvement. These totalled $368,810 on the 10 homes. Browndale Ontario paid for these expenditures out of the funds which were flowed to them on the per diem rate; they weren’t extra moneys given to them.

[10:30]

At this point, our ministry questioned whether that was the appropriate use of the per diem money. Now, as you know, if a person is paid money on a per diem there is no specific requirement that it go for a particular part of the programme. Our auditor stated to Mrs. Brown that he did not consider this to be an allowable cost under the regulations, and that a refund should be made to the ministry. Mrs. Brown has stated to us that she’s consulted her lawyer, and that, in his opinion, the amount paid on a per diem basis was a global amount as the price for their services and that Browndale had discretion as to how it should be used for the programme.

This may well be the correct assessment, but this is under discussion right now. I would have to point out to the House that there is no question our ministry encouraged Browndale to believe that some of those homes would be licensed two years ago, because it was part of our urban re-entry programme and we felt homes had to be provided for children who were otherwise in areas like Haliburton, closer to their homes and more adaptable to the city environment.

The purpose, as you know, of the four-phase programme is perhaps to get children out into the country for a while who need to be stabilized, but before they can return to their parents they often require some time in residence in a city environment. I can safely say though that the reaction of the community of Don Vale, through the Don Vale residents association and ratepayers association, was such that this ministry did not move forward with the licensing of those homes.

The last issue that the auditor referred to was the question of the management contract with Browndale National, and the possible duplication of payments by Browndale Ontario, I believe, in the Browndale budget, something in the order of $900,004 in a year is paid from Browndale Ontario to Browndale National for training services and for professional help. Our concern was that, in fact, that money may have been transferred without services being given in return. This was the point on which we were waiting for extra information.

We requested details from Browndale Ontario as to the names of the people on the payroll of Browndale National and Browndale Ontario daring the periods in question. That information was given to us last week, partially by Browndale National, partially by Browndale Ontario. I can say a quick perusal of it would seem to indicate that there was no incorrect billing. I’m going to reserve final judgement, since the last papers just arrived Friday morning, until the auditors have had more opportunity to review carefully the exact names and, if possible, the salaries attached to them so that we’re satisfied on that.

Browndale remains at a per diem rate in the range of $65.94 per child per day. The highest rate that we pay to similar organizations is $84.29 a day; the lowest rate we pay is to Youthdale at $36.28 a day, and Browndale is just about in the middle of that system. Of the $65.94 paid per day, $61.45 is for residential care, the balance is for outpatient care.

Mr. Dukszta: Mr. Chairman, the minister has more than difficulties in management of his ministry. The Ministry of Health wrought havoc in this province in its recent attempt to close nine general and two psychiatric hospitals, while at the same time demonstrating its utter disorganization, mismanagement and incompetence. It brought about this chaos, moreover, not because it had to, not as a result of a careful and studied professional decision, and not in an effort to improve the health and well-being of the people of Ontario.

It tried to close these hospitals because the minister and his aides have run out of ideas because the health system is, in fact, out of control administratively, and because the ministry had to make some feeble attempt to convince the people that it was doing something. In other words, the ministry was forced to try to close these hospitals in order to prop up its own failing public image.

The ministry estimated it would save $13 million by closing these hospitals. This figure, however, is totally illusory because the so-called savings would have been largely picked up again as costs by other hospitals, the federal government and the Ministry of Community and Social Services. Indeed, it was only the action of the divisional court in ruling that the government did not have the authority to close the hospitals that saved the Conservative government from further embarrassment.

Let us look at these supposed savings carefully. As I say, originally the ministry estimated savings from closing hospitals would he a total of about $13 million, but the divisional court decision removed virtually $9 million of this. Add on to that the costs of opening mental retardation resources centres of $4 million to replace the closed psychiatric hospitals and you get a figure of $13 million. When you subtract that from the original estimate you are left with savings as a result of the closing of only $536,100.

In effect then, the most that the ministry could have hoped actually to save would have been about half a million dollars. This should be related to the total health budget for this province of more than $3.4 billion. And at what cost? At the cost of enormous inconvenience, dislocation and personal agony for the health workers involved and the people they served. This rhetorical exercise produced a flurry of spurious activity and real excitement and anger throughout Ontario. It also served to point out the main structural defects of the system that is the responsibility of the Minister of Health.

Under this futile restraint programme of closing hospitals and public labs lies a much more significant theme. Successive Ministers of Health have again and again stated that their responsibility was to clean up the Ontario health care system. But this cleaning up has always been interpreted in terms of a right-wing desire to move in favour of private decisions and high costs rather than public planning and co-ordination.

What puzzles so many people in the community health field, as well as health systems analysts and even the public at large, is the minister’s determined resistance to change and his inability to reform or restructure his ministry, that is, to operate when the need for surgery is already obvious and imperative.

Mr. Warner: Resign.

Ms. Dukszta: What most casual observers and even professional people fail to understand is that decisions for change at the ministry are not based on technical and value-free criteria but on political and ideological grounds. The favourite literary conceit of the present Minister of Health is to describe himself as a simple engineer -- just a folksy systems analyst who responds according to need.

Mr. Laughren: That’s the minister.

Mr. Dukszta: Of course, the minister is nothing of the sort. He is a complicated, intransigent ideologue of the right with a messianic belief in the so-called free market economy.

Hon. F. S. Miller: I think I could rise on a point of privilege at that. That’s the nicest thing anybody has ever said about me.

Mr. Dukszta: He states repeatedly, even if all public health services couldn’t be sold off to the private sector, still nothing should be done to interfere with the present dominance of health care by that private sector.

Mr. S. Smith: Where is the member for Durham West (Mr. Godfrey) today?

Mr. Dukszta: As a result, when it comes to actually controlling the cost of the health system, the minister is really a sheep in wolf’s clothing. When the minister early this year was extravagantly journeying to and from about the province closing small hospitals, he said it was to save money, but saving on paper probably no more than a million dollars increasing the real costs by several million.

He reminds me of Count Potemkin, pointing out from a distance the painted back-drops of tidy villages to Empress Catherine II, in order to persuade her that he was competent to manage the welfare of her subjects. Our own Potemkin, the Minister of Health, closes four public labs and gives $20 million of unnecessary money to the corrupt private lab system, where the work done is often unnecessary and simply designed to line the pockets of the owners and the referring physicians, who indeed often seem to be the same people.

This incompetence, this mismanagement and this ideologically based intransigence in the face of real and pressing problems are serious enough in themselves. But the problem does not stop there. It goes much deeper. The minister, his aides, his officers, indeed the entire Ministry of Health fails to understand, and as a result to deal with, a crucial facet of the relationship between sickness and health, between illness and wellbeing. “Health” is not simply the absence of “sickness,” and “well-being” goes beyond the absence of “illness.”

Because of this, the Ministry of Health cannot, like a fire department, simply respond to illness or sickness when it occurs. It must actively seek out ways of improving people’s health and obliterating the sources of threats to their well-being. It must be proactive rather than simply reactive. The ministry is not only opposed to this under the rubric of its so-called “free market economy,” but is actually incapable of it anyway under its present leadership.

It has always been clear that not only have the greatest advances been made in preventive medicine, but that, logically, primary prevention should take precedence over any simply reactive medical system, despite whatever short-term gains may be made through that type of system. The development in western medicine toward allopathic medicine instead of towards a more holistic preventive type of approach has resulted in the development of acute illness centres and remarkable advancements in diagnosis, treatment and even success in some aspects of medicine.

Meanwhile, however, the whole area of concern in health which covers nutrition, health education and occupational health has been largely abandoned.

The medical model which has resulted in such remarkable success in acute treatment cannot simply be applied to preventive medicine. Primary medical care can function only by using a different set of strategies.

Let me expand on this. The use of this medical model has led physicians to perform too many procedures on largely healthy individuals. For example, the physical examination, which is quite useful in determining the cause of a complaint once an individual already knows there is something wrong, has failed to yield expected results when the individual being examined thinks of himself as healthy. The majority of procedures such as this general examination have been quite unsuccessful in detecting disease, and in effect have been a misuse of the physician’s time.

In a significant

article entitled “Preventive Medicine by Risk Factor Analysis,” published in JAMA, Oct. 16, 1972, D. G. Miller has specified that the criteria for examination should be three-fold.

1. The disease should have public health significance in the population.

2. There should be a clear benefit to the patient as a result of early case detection. There is no gain to the patient or to society in the early detection of a disease which cannot be ameliorated or whose outcome is unalterable.

3. An acceptable diagnostic procedure should be available for the early detection of the disease.

One way of estimating the benefit of early diagnosis is to compare the mortality with the incidence of a disease. When mortality approaches incidence, one can conclude that there is little efficacy in early diagnosis and treatment. For example, some malignant neoplasms have an inexorable course irrespective of what is done. In others, like cancer of the breast, the survival rate is affected by early detection, diagnosis and treatment. Here palpation can be largely done by the patient herself if she is properly prepared. This would lead to early diagnosis by a physician, then mammography, cytological tests and correction through surgery if necessary. This will affect the mortality rate.

If we have a wholly reactive medical system -- and we will as long as we have a government in power which only sees its role as the passive paymaster for medical care provided by a private sector -- overall strategies for treatment of disease like this cannot be carried out. It requires an intelligent, active and planned approach Ito health care.

In cases where highly significant diseases can be detected in the early stages and where early detection can reduce mortality, large scale screenings should be carried out. We are accustomed to this for such individual diseases as tuberculosis, syphilis, diabetes, and cancer of the cervix. In each of these cases the whole structure of our health care system moves decisively to deal with the disease once it occurs, and often quite successfully.

[10:45]

Our medical system, however, is not oriented to prevent illness before it occurs. As a result we are so far from being vigilant that our health system now appears unable to deal with important dangers to public health. We have simply accepted our inheritance of great 19th century public health programmes, like sanitation and inoculation, but we have allowed them to run down and have not been as vigilant as we should in this area. There are recent studies showing alarming gaps in our programme for inoculation of school children. Ontario is now almost alone in the world in using the Salk vaccine as a means of inoculation against poliomyelitis as opposed to the preferred Sabin vaccine.

We in the New Democratic Party have for many years criticized this government’s lack of commitment to preventive health services. This year the failure has become even more apparent. In the rash of hospital closings and hospital budget cuts, no serious consideration was given to replacing the services being destroyed with community-based primary and preventive services. At the same time that acute services are to be cut, public health services are frozen.

If one were seriously concerned about the misallocation of resources in a health system, concerned about the lack of preventive services, about the failures of the reactive medical model, surely one does not cut preventive services spending. Is it not ironic that in this era of rising health costs payments to physicians are increasing by 16 per cent this year, operating costs for hospitals by 18 per cent and operating costs to local health units by only 8 per cent? Does this not reflect the distorted priorities of our present government?

When questioned about public disease control measures, an important part of this reactive system, the Ministry of Health is typically vague. On two occasions the minister and the acting minister have been asked in this House about measures being taken by the Ontario government to isolate certain new types of highly infectious diseases which may be introduced into Canada by travellers, in particular about the extremely virulent West African disease, Lassa fever, which kills 30 per cent to 50 per cent of those who contract it and for which there is no known cure.

On one occasion, the minister replied that “negotiations are under way concerning the use of the National Defence Medical Centre in Ottawa” which, in any case, can only accommodate three such cases. What is Ontario going to do? The answer apparently is nothing.

It is difficult to believe in your good intentions even in your understanding of the problems in health care, when you react as you did on another occasion, on Thursday, June 10, 1976, when I asked you the following question:

“Mr. Dukszta: A couple of weeks ago 12 monkeys died suddenly at the Metro Zoo. I want to ask the minister a three-part question about this. Does he know what the monkeys have died of? Has he isolated the virus? If not, what would he have done, if it was a Marburg virus, to isolate the 20 or 30 people who were exposed who would have been in need of treatment, in view of the fact that the ministry doesn’t have any preparations and there is capacity only to isolate about three to four people?

“Hon. F. S. Miller : I didn’t realize the member is expanding my field. [And then you went on to joke] Mind you, Mr. Speaker, I have been dealing with them across the House for some time.”

It obviously appeared very funny to you that I would ask you about the death of the 12 monkeys, and you riposted like a clever school boy. The point was of course that the Marburg virus infects both humans and monkeys. The Marburg disease virus is related to the Lassa fever which, as I have just said, is fatal to 30 per cent to 50 per cent of human contacts.

The minister should also bear in mind -- and obviously doesn’t -- that diseases of this kind are particularly dangerous to health workers. The morbidity and mortality rate for Lassa fever is especially high for nurses and lab technicians. While modem techniques for reducing risks to health workers from such diseases exist, the government hasn’t even considered introducing them. This kind of failure to protect health workers is symptomatic of the Conservatives’ general failure to act in the areas of occupational health and safety, which in turn is due in part at least to its reactive model of health care.

Let me contrast how the preventive model and the medical model work when it comes to an occupation-caused disease. Mesothelioma is a rare but very dangerous form of lung cancer. If we accept the medical model approach, prevalent now both in organized medicine and in the Ministry of Health, then early detection and treatment can be provided within our system.

When an affected individual has a complaint, pain, discomfort or cough, the individual sees his doctor, a diagnosis is made and the individual enters the medical system; or possibly a regular x-ray test detects the turnover on a routine screening and the individual again enters the smooth, efficient medical system of diagnosis and treatment.

But mesothelioma, although rare, is now recognized as having a causal relationship with asbestos. You don’t have to work with asbestos to get it; you just have to be around asbestos. A study conducted at the London School of Hygiene into 76 cases of mesothelioma showed that nine out of 45 cases had not even worked with asbestos, but lived in the household of an asbestos worker. A further 11 lived within half a mile of an asbestos factory.

Dr. Irving Selikoff, of Mount Sinai School of Medicine in New York, in his address to the Ontario NDP convention on June 12, 1976, gave examples of people developing lung cancer who never worked with asbestos: “One was a daughter of a plant manager who used to bring his company’s products home. Another used to bring her husband meals at the asbestos factory where he worked.”

We can prevent mesothelioma, if we control the process of producing asbestos. This would not only reduce the incidence of mesothelioma but reduce significantly both the human suffering and the financial cost of dealing with the disease once it is established.

To give another example, money spent on purifying drinking water when dealing with typhoid is a far more humane and thrifty use of health care dollars than to simply wait for people to be struck down by typhoid and then to treat the disease.

To sum up, the ministry reacts to health problems, again and again, only when they actually occur and when they lead to public outcry. This is why the ministry is not dealing at the origin level with the problems of coke oven emissions, uranium, lead, vinyl chloride, arsenic and other noxious substances which significantly affect workers’ health.

Instead, what should be done? An active, carefully planned and thoughtful attack on these problems -- a proactive attack, rather than a reactive one -- would begin with a three level approach to prevention:

1. The primary level of prevention can be defined as an exhaustive analysis of all present and future industrial products, and control of immediately dangerous substances before they produce both short and long-term problems.

2. The secondary preventive level consists of a vigorous clinical system of detection, supervision, monitoring and treatment of health problems once they occur.

3. At the tertiary level, rehabilitation, retraining, compensation and income maintenance must be provided for the worker and his family, or the family alone if the worker is killed.

The government of Ontario fails at the primary level, where the provincial system of monitoring industrial products is minimal. We have no estimates of workers at health risk from occupational hazards in mines, factories or the construction industries, or from radiation, airborne contaminants, noise, toxic substances and direct physical hazards such as occur in construction work.

You, the government of Ontario, fail dismally at the secondary level. We lack a general reporting system in Ontario. Hence, we have no adequate data base for analysing, preventing and dealing with health problems, particularly occupation-related ones.

One obvious source for such information which is not being used by the government would be OHIP data. For instance, 8.9 per cent of separations from hospital are from accidents, poison and violence, a rate of 15.3 per 1,000. In order to accurately assess occupational health risks, what we need to know is what proportion of these accidents is due to injury or hazard at work, and what proportion of other, non-accident diseases can be attributed to conditions of work.

If OHIP subscribers were coded as to workplace and occupation, these rates could be determined for a specific workplace. Then it would be a simple matter for an employer with an unusual incidence of injury and health problems to be investigated and taxed for his failure to protect the safety and health of his employees.

One result, then, of this passive model of health care adopted by the ministry has been that the province has in effect left major decisions about industrial pollution up to private industry, and within the ministry concern for such problems has been assigned to doctors or to ministry experts -- experts who are totally involved in the passive medical model which allows only for dealing with the incidence of illness once it occurs, and not its prevention. Ontario’s government, in fact, though clearly entrusted with the responsibility for occupational health, has failed to deal with this lack of any reporting system. Each ministry passes on the responsibility to someone else.

Again, without an efficient centralized reporting system there can be no co-ordination of the workers’ own doctors. Workers from the same plant often see different doctors. Their physical problems are reported individually and thus are never seen as a collective problem arising from the work situation. At the treatment level the workers are also separated, and it is assumed that the problem is uniquely that of each individual worker and not connected at all with that worker’s environment. In this way asbestos becomes the problem of the worker in the asbestos factory and not of the management of the factory.

This tendency is aggravated and augmented by the way the ministry generally views health, that it is the individual’s problem rather than a social one. Then it naturally follows that individual causes for these problems are sought. Thus, in the face of massive evidence to the contrary, we should still not be surprised that the present minister has consistently espoused the view of patients that they are careless, greedy, and lazy. He obviously holds to the concepts of accident proneness and employee carelessness as a way of explaining work-related accidents.

The Workmen’s Compensation Board are particularly enthusiastic exponents of this attitude. An injured worker is initially and automatically assumed to be at fault. The burden is on the worker to prove he was not at fault, even when, as is unfortunately often the case in our province, working conditions are so primitive as to be unspeakable. All too often in fact it is easier to shift the blame from the working conditions to the worker. The primary result of this approach is to guarantee that the Ministry of Health and the Ministry of Labour will never have to deal with conditions in industrial plants.

At the tertiary level of prevention, Ontario’s system of rehabilitation, refraining, compensation and income maintenance is grossly inadequate.

Let us now look at some horrifying statistics of the incidence of industrial-caused disease. In a study of male laryngeal cancer patients at Toronto General Hospital in May, 1974, researchers found that 23 per cent of the victims had been exposed to asbestos at some time in their lives. A report issued by the Mount Sinai school of medicine after a two-year study of conditions at Thetford Mines in Quebec showed that 61 per cent of asbestos workers with 20 years or more service were suffering from lung abnormalities and 52 per cent were afflicted with asbestosis.

The asbestos industry reacted by denial, public relations campaigns, dissimulation, dissembling and outright lying. Characteristically, attempts were made to blame workers’ smoking as the reason for lung problems. Canadian Johns-Manville Co. Ltd. recently closed an asbestos mine in northern Ontario, because the company stated it found it impossible to comply with weak provincial guidelines as to maximum permissible exposure to asbestos fibres.

In the US the National Safety Council has reported mining and agricultural work as being among the most hazardous occupations in terms of deaths or accidents. In Ontario, which has a higher proportion of workers in these areas, we have hardly begun to recognize the implications of this, much less to deal with them. The amount of money the government spends on occupational health is minuscule in comparison with the majority of European countries, even those without progressive or socialist governments.

A recent study published by the US Department of Health, Education and Welfare showed there are at least four million workers in the US who contract occupational diseases every year, with the number of on-the-job injuries exceeding 20 million per year and the number of deaths reaching approximately 28,000. If we extrapolate to Ontario, since data is not available here, the equivalent figures would be 133,000 people who contract occupational diseases every year, with the number of on-the-job injuries approaching 660,000 per year.

In 1974 there were 1,415 workers killed on the job in Canada. Many, if not most, deaths and medical problems do not come under the Workmen’s Compensation Board or the occupational branch of the Ministry of Health because there has been no calculation of the correlation between illness and occupation. If in Canada statistical data were available which would enable us to include deaths from occupation-related causes, we would find the number of deaths for Ontario alone would reach near that figure of 1,415 for the whole of Canada.

[11:00]

The Pilot Study for Development of an Occupational Disease Surveillance Method, conducted in 1975 by the department of environmental health of the University of Washington, showed that out of a total of 1,116 cases with medical conditions reported, 346 cases were probably occupational diseases and 113 had a suggestive history of being occupation-connected. For instance, out of 122 cases studied with hearing loss, 96 were connected with the patient’s occupation. Out of 128 cases with skin conditions, 64 were occupation-related; 31 cases out of 74 of conjunctivitis and other eye conditions were occupation-related.

I will just give one more example of what is happening to our occupational health field. When you compare the number of lost man-days due to injuries at work with the number of lost man-days due to strikes and lockouts here in Canada, the figures are quite startling. Twice as many man-days were lost due to work-related injuries, excluding fatalities, as were lost through strikes and lockouts; 18 million man-days of lost production due to work related injuries compared with 9.3 million lost man-days due to strikes and lockouts.

The extent to which public health and the continuous health risks endangering workers and their families are underemphasized can be understood within our social situation as being a class issue. The infinitely greater incidence of morbidity and mortality in the working class is due to the health hazards to which they are exposed at work. This, in turn, is closely related to the fact that priorities in our health spending are established by a health care system attuned much more closely to the middle, professional and corporate classes.

These more fortunate classes do not suffer from occupation-caused health problems but from general health problems that beset all humanity. To cure their problems, the middle, professional and corporate classes extract much more than their fair share of the health tax dollar. For example, the health insurance division reports that 35.3 per cent of all OHIP claims are generated in Toronto, which has only 29.4 per cent of the population, while in Sudbury 5.0 per cent of OHIP claims are generated by 7.5 per cent of Ontario’s population.

It becomes perfectly understandable why in Canada neither the Liberal government in Ottawa nor the Conservative government in Ontario is prepared to study occupational health problems. To do so would compel them to collect the information which would clearly show the correlation between occupation and danger to health at work and the increased morbidity and mortality rates of the working class. The Conservatives have demonstrated they are not prepared to deal with the realities of occupational health hazards for the working class, for ultimately any such measures will only jeopardize the cause of their corporate industrial benefactors.

The way this government deals with this unpalatable data can be shown by its behaviour with the Toronto lead pollution problem. Two recent reports on the causes, extent and health hazards of lead contamination -- the report of the Environmental Hearing Board on lead contamination in the Metro Toronto area and the report of the lead data analysis task force -- clearly show that the government places the profit of the private sector over the health and well-being of its people.

The Environmental Hearing Board ignores the conclusions of its own commissioned research -- conclusions long since come to by the workers and local residents -- that proximity to lead smelters is a primary cause of elevated blood levels and resulting health problems.

While concluding that the lead smelting industry is the culprit, the Environmental Hearing Board makes recommendations which leave the monitoring and control of lead emissions in the bands of the guilty party, the lead smelters. Such a distortion of the facts involved is reprehensible, especially when one considers the manifest danger to the health and well-being of workers and local residents, which could have been stopped and can be stopped at the source. A strategy of primary prevention would avoid much needless suffering and expense. But it will not happen.

The failure of Ontario to protect the health of its workers is highlighted by the efforts of other provinces in this area. A number of provinces have enacted occupational health and preventive health measures to protect better their workers from industrial disease and injury. The most important and far-reaching measures have been enacted in Saskatchewan under, I might say, an NDP government.

Mr. Warner: Long-standing too.

Mr. Conway: I hope it is not spreading east.

Mr. Dukszta: The Occupational Health Act, 1972, as amended in 1974, together with sections 68B and 68C of the Labour Standards Act, is the core of a new, worker-oriented approach to health and safety at work. The new Saskatchewan Occupational Health Act which is now being introduced will combine these two measures and will correct technical difficulties which have made for problems of enforcement. This new Act will impose a duty on the employer to actively promote the health and well-being of the worker.

The key to implementing such occupational health and safety measures is to establish both acceptable and safety standards and enforcement procedures. To integrate all these diverse and administratively separate parameters a specific occupation, a health and safety division has been set up under the Saskatchewan Ministry of Labour.

Mr. Laughren: What a difference.

Mr. Dukszta: The need for such integration becomes quickly apparent when one realizes that in Ontario the Ministries of Labour, Health, Natural Resources, Environment, Consumer and Commercial Relations and Community and Social Services all deal with various aspects of the problem, six independent ministries, each with its own individual, water-tight jurisdiction.

Mr. Laughren: Non-operative accord.

Mr. Dukszta: The key to the Saskatchewan legislation is two-fold. Firstly, there is the

section of the Labour Standards Act which gives the worker the right to refuse to continue work where he or she believes that conditions are unusually hazardous or dangerous to health and safety (68C):

“An employee may refuse to do any particular act or series of acts at his place of employment where he has reasonable grounds for believing that the act or series of acts is or are unusually dangerous to his health or safety.”

Mr. Warner: That’s essential.

Mr. Dukszta: Secondly, there are the provisions calling for the mandatory establishment of health and safety committees in places of employment. These committees are to be composed 50-50 of workers and management and are to be established at each place or work or shop. These two provisions are coupled with others which prohibit the employer from retaliating or discriminating against an employee for exercising his rights under these provisions.

The proposed Act not only extends these provisions but prescribes stronger penalties for employers not obeying them. Moreover, it establishes a general responsibility for employers to protect the health and safety of their workers. The possibility that workers could walk off the job with pay compels the employer to clean up the place of work.

These two key provisions of the Saskatchewan legislation are essential anywhere if an occupational health and safety act is to have any meaning: (1) the mandatory establishment of health and safety committees with 50 per cent of workers on them; (2) the empowerment for workers to walk off the job under hazardous conditions without penalty. They are also the most contentious provisions, for management and corporate owners will fight tooth and nail to avoid this encroachment on what up to now has been considered the rightful and legal prerogative of capital.

Both Alberta Bill 39 and Manitoba Bill 83 have now adopted the Saskatchewan mode in word if not in deed. Neither of these two provinces, however, has actually written in sections similar to Saskatchewan

section 68(c), allowing the worker to walk off the job.

There are a number of reasons why the workers should have the right to monitor their own environment, in addition to governmental and management monitoring. It would provide a useful check on the unreliable monitoring by management; it would involve the workers directly in the safety of their own workplace; finally, it would begin to establish the important principle that the place of work, whether an industrial plant or a smaller shop, is equally owned in the full legal and moral sense by all people who work there.

An occupational health and safety act, like that of Saskatchewan, is a good place to begin worker participation in this society, just as the community-run health centre is a good place to start returning health to its owners. It is the embodiment of the principle that those who pay the cost of health care and are served by it must play a major role in shaping it. Unfortunately, you, the government of Ontario, don’t believe in that.

Mr. Laughren: The minister is cowering.

Mr. Dukszta: In the words of the Leader of the Opposition (Mr. Lewis), there is an unbridgeable intellectual, political, ideological and human gap between us -- you as a conservative, and me as a socialist. Your apotheosis of the profit motive and private health care provision for the select few will always blind you to the overall human situation and the ideals of human equality and public well-being.

In

summary, there are three major points that need to be emphasized again. The health care system administered by you is expensive, wasteful and organized on an inappropriate medical model, a restricted, professional and acute illness model. Importantly this system does not deliver health services equally to all the people in Ontario and fails to provide for the safety and well-being of thousands of workers at work. Criminally, it condemns many workers to wasting diseases and death from occupational diseases while wantonly spending public money on unnecessary surgery and lab tests.

I will not tolerate the continuance of this antediluvian model of organization, with its inefficiency and inequality in the provision of care. I will not tolerate a health care system in which one class bears the burden of injury, suffering and expense and another reaps the profit. I will not tolerate a health care system which blatantly denies the right to health of workers in the mining, construction and manufacturing industries. The people of Ontario will not tolerate this health care system which does not serve their interest or protect their well-being. You and your government have faded.

Mr. Warner: Resign.

Mr. Dukszta: Only the New Democratic Party has the knowledge and the will to restructure the health care of Ontario and to provide the people of Ontario with what is their right.

Mr. S. Smith: I have quite a number of remarks that I would like to make but some of them will have to be saved for later on in this afternoon’s debate since I have a long-standing engagement at another city that I have to get to. I do wish to make some general remarks, however, in response to the minister’s opening comments. The minister in addition to his own private ordeal, has had his ministry come through an ordeal the like of which we haven’t seen before and I hope we shan’t see again.

Never before has one department bungled so thoroughly and destroyed the general patterns of expectations and reasonableness that people have come to expect in the conduct of their every-day affairs in this whole health system. Hospitals are a shambles. People within hospitals are hesitant even to talk to you for fear that the numbers will be misinterpreted one way or another. The so-called regression analysis which was done has not only brought the Health ministry into disrepute, but it has brought the whole field of statistics into disrepute because of the absolutely ham-handed and inaccurate way in which these figures were dealt with.

The people throughout the province have been shocked to find that a Ministry of Health can, by directive from Queen’s Park, close hospitals with no thought in mind other than how many dollars have to be spent at that hospital and without any consideration for the organic role which hospitals play in communities. But we have been through all this before. Although one can without much difficulty raise quite an emotional lather about this, and with justification, I feel that when time is precious, perhaps we shouldn’t spend too much time on it going over old ground. That ground, however, does demonstrate one of the fundamental difficulties of the government.

Although this particular minister may be one of the better ministers in the government, he is obviously not immune from that particular difficulty. In fact, it is one which afflicts, I suggest to you, the Treasurer (Mr. McKeough) more than anybody else. That is this notion that decisions than can be made at the centre by an elite group of so-called knowledgeable people and imposed on people throughout the Province of Ontario.

This is the concept behind regionalization, behind restructuring and behind the kinds of bigness that are constantly having hymns sung to them by the Treasurer of Ontario. This is the notion that people can’t be trusted ever to make a tough decision on their own behalf, that things have to be rammed down their throats and that a gun has to be held to the head of a community before it will make any kind of sacrifice whatsoever in the common good. That notion is the very opposite of the notion that caused me to enter politics.

I suspect a good many other people in this House in all parties entered politics believing the very opposite of what the Treasurer and the Minister of Health have demonstrated.

It is possible to get regional health councils to make tough decisions if you sit down with them and point out the fact that they have been spending more money than they should in comparison with their neighbours in other counties. It is possible to get hospitals to get together and share the burden of sacrifice, provided you don’t, first of all, name one as the one on which the guillotine is going to fall and then expect the rest of them to put their heads voluntarily under the axe.

[11:15]

This fundamental lack of understanding on the part of the ministry has been one of the great downfalls of the whole minority government situation. Certainly I’m not here to place personal blame one way or another but I’m afraid it has to rest with the Minister of Health because of the fact he holds that position. I think the Ministry of Health has conducted itself disgracefully and I say that without my usual hyperbole.

On the so-called savings from the closing of psychiatric hospitals, I hope the minister will admit this is a bookkeeping game which is going around. Basically, because of the federal government’s willingness to share rather generously the costs on mental retardation but it’s unwillingness, rather foolishly, to share the costs of psychiatric hospitals, the saving is a lot greater on paper than it really is in terms of dollars and cents to the taxpayers of Ontario.

On the so-called savings from the labs, how the minister could keep a straight face when pointing out how much money he saved by closing the labs, following it up five minutes later by explaining this new policy of 16 regional boards which are going to try to rationalize the private lab sector in the province by shifting more of that work to the public labs and the hospital labs, is simply totally beyond me.

First of all, to shut down public labs and then go about the province trying to find out how you can increase the workload in the public labs so as to take it away from the inefficient or over-used private sector is something which only the minister, with this ability to keep a straight face while saying things that are outlandish, can possibly comprehend.

It was obvious that the private labs system was the part of the system that needed looking at. It is obvious from the fact that its expenditures over the past five or six years have gone up from $4 million a year to approximately $70 million a year this year. Even though the minister constantly avoided my questions and his replacement during his unfortunate illness did the same the fact is the ministry has had reports as far back as August, 1970, which I have here.

There is just one report after the other warning the ministry of the fact that money was going to be poured into the private labs in an uncontrolled way, that it was an invitation to abuse and that money was bound to be wasted with the way in which the private labs were set up.

I have a number of documents and I’ll quote from them later when we get to that particular vote. These documents indicate that the cabinet was considering the grave difficulties in that area as far back as 1971 and that in 1972, as was pointed out by the Leader of the Opposition and I, regulations were approved giving the government all kinds of scope to do the things the minister now says he’s about to bring in regulations to do.

There is already a regulation prohibiting certain classes of people, and it leaves it totally open to the ministry to make that decision, from owning shares in private labs.

Now he says he’s going to bring in something to do with conflict of interest. He could have brought this in long ago. The idea that certain practising physicians should not be allowed to own parts of the private labs could easily have been implemented long ago. He was warned of this years ago. I’m not impressed, I’m afraid, with his present determination as he expresses it in his opening statements.

With regard to occupational health, that is another area where the government, I’m afraid, has conducted itself disgracefully. Comments were made by my colleague from Parkdale who holds a view of medicine I do not share -- namely, he wants a totally socialized model and I don’t agree with him on that -- I do agree with him when it comes to occupational health.

I think it simply staggers belief that in this century we, an industrial province of this kind, can have half a dozen or so inspectors supposedly safeguarding the health of our working people at a time when we’re adding 500 to 1,000 new potentially toxic chemicals to our industrial processes each year, frequently with no knowledge of what harm these can do. How it is that we can sit here and allow the United States and other countries to invest enormous sums in doing proper investigations of each of these chemicals? We sit here and sort of shrug our shoulders and say we’ll wait for the results.

I think that’s fundamentally immoral, Mr. Chairman. It’s something I can’t accept as a member of this Legislature.

I come from an industrial city, and it’s just inconceivable to me that the working men and women should go off to work every day and be shortening their lifespan by the inhalation of various substances which we already know in many instances to be lethal and in other instances we don’t know but we have reason to suspect might turn out to be such. I think this is fundamentally immoral. It’s something I can’t accept.

When we brought up these matters -- and certainly the New Democratic Party, to my right, has done excellent work in bringing them forward as well -- the answer we got from the Ministry of Health, and in private chats I got the same impression, was that they felt that a proper system of inspection would be akin to a police state. If I may quote his exact words, “There would be an inspector at every desk, sitting there all day.” That’s absurd. The fact is that we need a proper system of inspection. I want to know why it is that the minister has not answered the letter of Dr.

Newhouse, who I can assure you is not a political colleague of mine. I don’t even know what his politics are, but I can guarantee you he is no associate of mine in that sense.

Mr. Lewis: Nor indeed of ours.

Mr. S. Smith: I don’t even know. Frankly, I have no idea what his politics are.

Mr. Nixon: He could be a Conservative.

Mr. S. Smith: He could be; I don’t know.

But he asked these questions on May 14:

“How many inspectors there are for industrial health protection; how often each business employing more than three or four employees is inspected with respect to safety in the workplace; how many firms in Ontario are not being inspected on a regular basis and are using hazardous materials; and what legislation is available to assure that the penalty for this sort of contravention of threshold limit values is severe enough that the industries themselves will want to find out what hazards exist in the workplace and do something about it.”

These are not unreasonable questions. The man deserves an answer. And yet a month or six weeks have passed and he hasn’t received an answer. He is very upset about that.

I bring this up to point out that the ministry is going off totally in the wrong direction. The indication that the ministry has given us is that they are going to have industries responsible for policing themselves. They feel that is the way to avoid a police state or something like this.

Presumably, there is some merit in the idea of industries policing themselves if they have powerful unions with enough technological expertise to make sure that this policing and monitoring is done properly, but for the vast majority of workplaces in the Province of Ontario no such unions exist and no such expertise is available. The ordinary working man and woman have to depend on the government to have a proper set of investigations, a proper set of monitoring devices and data available that can be understood and translated into language that people can know.

It is unthinkable that in 1976 we should expect working people in this province to subject themselves to hazards without even knowing what those hazards are. Surely people have a right to know what it is they are subjecting themselves to. I suggested back in November that we should have a form of organization similar to the Food and Drug Directorate so that anybody who wanted to bring in a new process or a new industrial chemical had to have it approved, and the burden of proof would be on them to show that it was not harmful.

I’ve also said that we should have the kind of thing in this province that they have in the National Institute for Occupational Safety and Health in the United States.

For instance, when they found that there was a higher incidence of birth defects where people lived around a certain type of plant -- I think it was synthetic rubber plants -- or that leukemia was higher in places that were making synthetic rubber, what they did was looked at each of the employees who had been employed for the last many years in any of these plants, plus people who lived in the neighbourhood, tracked them down all over the United States of America, got hold of their medical records and compared the incidence of various illnesses that these people then suffered from with the incidence for the population as a whole.

That is the kind of study we should be doing in Ontario, but we don’t have the facilities for that kind of work. None of the private universities can do this on their own. We have only one direction to go in: We must set up a real institute of safety and health which has enough money to do the job and frankly, I think it could be centred on places like McMaster University, the University of Toronto and possibly others.

Mr. Shore: Western.

Mr. S. Smith: No, no. The point is that, particularly in the industrialized cities, the universities could be part of this. I think it is really shocking that the ministry has simply not seen fit to move ahead in that area. And if they are going to leave it to industry to police themselves, then that really is entirely hopeless.

I want to make a few comments about Browndale; but that’s a subject we should go into at some length and I’m afraid the time doesn’t permit me to do so. I do want to say that the report given to the House this morning by the minister doesn’t do too much to reassure me. As far as the houses in Don Vale, in which $368,810 was spent, it is not clear to me from whom these houses are being leased. I would like to know, for instance, whether the houses were being leased from Browndale interests or from the interests of people who themselves were instrumental in setting up Browndale.

I think it’s also important to know about this management contract, which is sending close to $1 million a year into Browndale interests. Why should such a contract be acceptable here in Ontario and not acceptable in places like Illinois? It seems to me inconceivable that the government should be paying a per diem to an organization that farms out its management. I don’t think we’ve heard proper answers on this.

I’d also like a little more about the audit itself, how far back it went, whether it dealt with the 1973 situation, in which the salaries were listed for creating the per diem rate -- and a number of other issues?

I would like to read the letter that Karl Jaffary -- who, as you know, is certainly not a member of our party -- wrote to the Globe and Mail, in which he said:

“Browndale is a non-profit corporation which leases houses it occupies from companies controlled by the original promoters of Browndale. The houses are frequently bought specifically for the purpose, and the result has been that the principals of Browndale have been able to buy very expensive real estate holdings, which have been paid for out of the rents that are in turn a part of the $7.3-million a year paid by the taxpayers to Browndale. If that is the consistent method of operation you’ll appreciate the reasons for the delay --”

And he was going on discussing the delays in relocating the children.

We have now, of course, the Haliburton situation where there has been a mass resignation. I wonder if the ministry is planning to let that excellent staff carry on on its own in a separate situation and take over the Browndale quota in that area?

I also wonder if we can be guaranteed that Browndale will be given no increase in its per diem and how the minister can stand and say that $65 is a bargain when Youthdale can get away with $36, or it’s in the middle -- or whatever. Youthdale can get away with $36, and Community and Social Services have many places that have people just as disturbed as the ones in Browndale, getting just as good care for half of the $65.

So basically, I’m afraid the minister’s opening remarks raise more questions and answers, and I hope later on in the debate to go into great detail in each of these areas that we’ve touched on. But with these particular remarks I’ll conclude my comments for this morning.

Mr. Deputy Chairman: Does the hon. minister wish to reply before we go into the vote by vote?

Hon. F. S. Miller: Mr. Chairman, I could, and yet I suspect that each of these points brought up by the speakers or the critics of the Health ministry in the other two parties will come up during the votes, and it’s perhaps better than me taking a lot of time now to deal with them as they are specifically mentioned. I have made a number of notes.

I would say just to the member for Parkdale that, really, if I am to keep a totally serious face at all times, then I think all of us would have to abide by the same rules. We’d have a very strange House if there wasn’t a bit of repartee here from time to time. I don’t think any one member or any one party has the corner on making the odd humorous comment. While I made a humorous comment on monkeys, the fact remains I took the time to get a very thorough reply for you, and I can gladly read that into the record when the time comes.

Mr. Deputy Chairman: Before we start the vote by vote scrutiny of the ministerial estimates, I would draw to the hon. member’s attention that the Minister of Health did provide each member of the committee a breakdown of the areas of responsibility as far as the moneys for each vote are concerned. Consequently, while I realize there will be some policy discussion under the minister’s office, item 1 of vote 3001, I would hope the members of the committee would attempt to direct their remarks on the spending of the various areas as outlined by the minister’s paper, which he circulated to the members of the committee this morning.

[11:30]

Mr. Dukszta: Mr. Chairman, on a point of order, I’ve discussed the question of estimates with the leader of the Liberal Party and within our own party and, if you can bear with me for a minute, we thought we could divide it into two hours for the first item, 2½ hours for the second item and 2½ hours for the third one so that we will make an attempt to cover as much as possible of the health estimates in the limited time we have. I’m just mentioning it -- I’m not sure whether you agree -- that we have two hours for the first, 2½ for the second item and 2½ for the last one.

Mr. Conway: Mr. Chairman, that certainly is the understanding we have. Given the fact that we are now 1½ hours into the first section, I think it probably advisable, given the fact there are a considerable number of speakers, that with half an hour left we consider all the items in the first vote together, if that does not --

Mr. Deputy Chairman: Is it the intention of the committee, tentatively, to take half an hour on the first vote and divide the remaining time between the two votes equally? Agreed?

Mr. Dukszta: Mr. Chairman, we have another half an hour for this whole vote, 3001, and 2½ hours for votes 3002 and 3003.

Mr. Deputy Chairman: I would draw to the hon. members’ attention that I assume this doesn’t limit any debate from any of the government members; they can take part.

Mr. Breithaupt: I am sure they are welcome to join in, Mr. Chairman.

Mr. Haggerty: Mr. Chairman, if you will permit, for clarification, where do I find occupational health in the minister’s estimates? Is it listed there this year?

Mr. Deputy Chairman: Which vote does occupational health come under? I think that’s item --

Hon. F. S. Miller: Vote 3003, item 3, I think.

Mr. Deputy Chairman: Yes.

On vote 3001:

Mr. Deputy Chairman: Is it the wish of the committee that we take the vote in its entirety?

Agreed.

Mr. Swart: Mr. Chairman, I want to make a few comments, very briefly, on item 2, specifically the Ontario Drug Benefit Plan, and perhaps solicit a reply from the minister on this. There are just two comments, really, which I want to make. The first is, I would ask the minister if he would consider -- I believe the government can do it by regulations; it may well not he his ministry -- extending the drug coverage to spouses, aged 60 to 65, who get the federal spouses’ allowance.

I suggest there is a very real need there, first of all because the total income of the couple when one or the other is aged between 60 and 65 is less than when both are over 65. If they don’t get the drug coverage there is real hardship.

Secondly, many of these people receive drug coverage from the social services department of the region or the local municipality until this year but because of cutbacks in the money, the assistance, from the province to the municipalities, the municipalities have in turn cut off many of these benefits. There is greater difficulty, greater hardship, in the situation now than there was a year ago.

Therefore, I suggest the minister should give consideration to that extension. I suggest we can afford it. If we can afford to waste the money we have wasted on private labs -- or that the government has wasted on private labs -- if we can afford to pave the Spadina extension, if we can afford a quarter of a million people unemployed in this province, we can afford the few million dollars to extend drug coverage to spouses between the ages of 60 and 65.

The second point I want to make is one pertaining to administration. I admit quite frankly I’m confused about the administration of the drug plan. Apparently it is paid out by the Ministry of Revenue while the legislation is under a welfare Act -- it’s a longer name than that but it’s a welfare Act -- yet apparently the Minister of Health has final jurisdiction over it. Maybe it’s this complication of administration that is causing the problem.

First of all, there is a one-month delay. The drug cards are supplied in the month following the month in which they get their first old age security cheque. I understand from inquiries in the ministry that they get a computer list from the old age security department and they supply the cards on the basis of that list. However, there is a breakdown because, the computer list is apparently compiled sometime during the month and after that list is compiled cheques are issued manually.

Those do not come through to the provincial ministry and as a result those people who get the manual cheques do not get the drug cards in the following month. We have found there are a large number of these in our area. Perhaps the great majority of them are never heard from, but there are a very large number who come to us.

If there is some foul-up and a person doesn’t get his old age security cheque for three months, while it is retroactive the drug benefits are not retroactive. There is a real difficulty in trying to get retroactive payments. Most of those we have had have been’ refused. Even though by the regulations they are entitled to payments for the drugs, they are refused.

I would suggest to the minister that if he’s unaware of this problem he should check it out fairly thoroughly and make some sort of liaison with the OAS so that these foul-ups in the administration do not occur. I suggest to him this is not just the odd case. If he wishes, I can give him names and times to prove this is taking place in a large number of cases. I would ask him to investigate it thoroughly and to comment on it.

Hon. F. S. Miller: Mr. Chairman, I am just wondering how the members want their answers. It sometimes is easier to discuss quickly the points brought up by a specific member than it is to let them pile up and lose track of them. Also, I realize that it may well be that some of these members have to be somewhere else today too.

Mr. Breithaupt: Oh, yes, please do.

Hon. F. S. Miller: If I may, I will just quickly try to summarize the points brought up.

Mr. Deputy Chairman: Agreed.

Hon. F. S. Miller: Certainly one of the areas we have to consider for expansion of the drug benefit system is to the spouses of those who are under 65 when one spouse has reached that age. As you know, OHIP has always covered that spouse for general benefits. Right now with so many restrictions on my budget, it’s a difficult time to add a benefit. I certainly am not going to rule it out as either being unfair or unlikely. I’m just pointing out that it’s not a year in which I’m looking for ways to spend more money.

Mr. Swart: It is the year in which they need it worst.

Hon. F. S. Miller: One can argue that. In the fall, the general welfare recipients, I’m told, will start getting drug benefits. I think I mentioned that in my original statement so that those who have been dropped perhaps by municipalities will end up getting the Ministry of Health coverage.

As far as the cards go, I’m sure every member of the Legislature has faced this kind of problem from some constituent who has not received a direct card on time. Without duplicating an enormous staff in Ottawa, we are dependent upon them for the eligibility criteria. There are ways and means by which we can speed up the process and get a person a card when he may not otherwise get one. I’m sure many members have called our ministry to get a temporary card for a person.

Retroactivity is a little different thing. I suspect a number of plans don’t have a retroactivity clause. I think Canada Pension is a good example. I believe if you don’t apply on time you just don’t get it. I believe the old age pension is the same way, if I am not wrong. If you miss your first date of application or don’t fill the papers out soon enough, I don’t believe you get retroactive payments.

Mr. Gaunt: Yes, for a year.

Hon. F. S. Miller: Up to a year? In any case, retroactivity is something that would have to be considered very cautiously before we agree to it.

Mr. Swart: Can I just pursue that one question further? Would it not be possible to get a supplementary list from Ottawa up to the end of the month? Those cheques, and there are a large number, that are issued manually don’t come on that computer list and they lose their benefits for one month. I wonder if there wouldn’t really be some simple way of working this out so they don’t lose that month’s benefit.

Mr. Conway: I have just two or three very brief comments arising out of the first vote and the minister’s opening remarks. One is moved, in a sense, to compare what the minister has said on this day, in June, 1976, with what he said in November, 1975, in the concluding portion of his estimates for that year.

In his opening remarks at that time he found it wise and useful to begin by pointing to the success of the negotiations of the Ontario Nurses Association in the public health nursing field. I wonder, today, how the minister feels about talking about the success or the obvious lack of it with respect to the ONA negotiations and the complete breakdown in the public health field as a result of that?

It was interesting too at that time that he signalled the institution and the impending success of the Council of Health as a senior advisory body to the Minister of Health. One wonders today, six or seven months later, how this particular body has been able to react to the significant changes in this particular regard. The third point the minister made at that time was the relationship to the impending institution of an occupational and environmental health establishment. I would wonder, given his commitment of seven or eight months ago, how he feels about that at this particular time.

I would have just these few comments by way of comparison. There was one thing he said then that perhaps is most significant. In that debate the hon. minister said something in response to an urging from my good friend from Parkdale. This relates to the general administration and to the way in which this ministry has been doing its business. On Nov. 12, 1975, in response to something said by the member from Parkdale, the Minister of Health said:

“To show the openness of my ministry, I think you must admit that we never try to deny you any information you want, do we?”

I think it is truly regrettable that the indictment of the past six or seven months is simply that this government, and particularly this ministry, has chosen to operate in the fashion it has with respect to the hospital closings and I realize that that is an item for the second vote, 3002, but I would like the minister reflect upon that at this point in time.

I think it was interesting too that four or five days following that remark in the emergency debate on the Chesley Hospital closing you were urged to comment in response to a point made by the member for Grey-Bruce (Mr. Sargent) and you said:

“I have no intention of seeing the 24 hospitals closed. The member asked me how many were on the list. Each one in turn will be told in negotiation if it is being considered. Each one will have the option and the opportunity to discuss the merits of closing with me and they will learn it in order only after I have decided there is some good reason for the action which we take.”

I think that clearly there must be some explanation, not necessarily on the specifics of the hospital closings, but on the manner in which this ministry has decided to conduct its business. I would particularly like some comment from the minister in that regard.

I would also like to take this opportunity to ask a question under the heading of item 1, the policy co-ordination secretariat, with respect to the document released, I think two days after the conclusion of the Health estimates in November 1975 -- and I refer to the report of the special programme review which makes in a series of 20 or 25 pages a number of most interesting statements and suggestions. I wonder how the minister and his policy secretariat are interpreting and perhaps moving to the implementation of the recommendations with respect to health care in Ontario made by the special programme review?

[11:45]

Hon. F. S. Miller: On the first point of the nursing negotiations, any time two parties to negotiations fail to get their own way and a strike results there is a great temptation to demand government intervention at once. Because a negotiated agreement wasn’t arrived at before a strike took place it does not imply that the system doesn’t work in most eases. It does.

I was struck by the paradox last week of the members of the public health nurses’ association, members of the ONA, coming down here and, in effect, demanding compulsory arbitration and removal of the right to strike when really one of the major issues, I guess, CUPE was facing the next day was the right to strike and its reluctance to be forced into a position of compulsory arbitration. It’s a question of how you see your particular problem on a given day.

People who haven’t got the right to strike feel denied a privilege which society has given to most people. Those who do have it often feel it isn’t a potent enough weapon to get their way in negotiations. We’ve talked about alternatives to the strike and I would dearly love to find one but to date it has been the ultimate weapon of the employee if negotiations break down with the employer.

Those nurses were exerting their rights last week. I didn’t like them being on strike. Some management is exerting or using its rights this week by locking them out and I don’t like that. I clearly told the association of the health units last week that I would recommend, and so did the Minister of Labour, that they not lock out employees. This would escalate the whole situation.

Mr. Haggerty: Appoint new members to those boards. You can do that much.

Hon. B. Stephenson: They are elected.

Hon. F. S. Miller: Listen here, let’s not start appointing people arbitrarily to boards which, in the main, have represented their areas well. In most cases they have been named by either municipalities or people at large and I think they have done a pretty good job of --

Mr. Nixon: Representation from the government on each one, is there not?

Hon. F. S. Miller: Yes, there is. There is always representation but it’s a very minor --

Mr. Nixon: That is what he is talking about; he’s not talking about replacing the board.

Hon. F. S. Miller: It’s usually a question of one or two members on each board who represent the province depending upon the area they serve in.

Mr. Haggerty: They carry out your policy.

Hon. F. S. Miller: I would suggest to the hon. gentleman who interjected that if any board member has been given policy to follow, I would like to know about it. We leave those gentlemen and ladies there to act as independent members on that board. They do not have to follow government policy and they are not told what government policy is to follow.

On the Council of Health, I lost the import of your question altogether. The Council of Health is alive and well and able to give me advice whether I solicit it or not.

On the institute on occupational and environmental health, I think I answered a question in the House this week from the Leader of the Opposition when he asked me what point we had reached on that. We did ask for the advice of the advisory council. That advisory council did give us a recommendation on the formation of an institute and that’s been in my hands for only approximately 10 days. It would appear, I think, to be reasonable advice and probably will be followed.

Mr. Lewis: When would it happen?

Hon. F. S. Miller: I don’t know that it has to wait for any particular school year; in other words, I think one could organize a base in a university or two quite quickly. I suspect, as I think I mentioned that day, the University of Toronto, in looking forward, had decided to make certain organizational changes so that it could offer a package. I don’t know whether any other universities did. Do you know of any?

Mr. Lewis: I think McMaster is one.

Hon. B. Stephenson: I think McMaster is trying.

Hon. F. S. Miller: McMaster is trying, I am told.

Mr. Lewis: Are we heading for the fall?

Hon. F. S. Miller: I would like to think so. It is an area in which we are very anxious to get that kind of advice. I’ll get into occupational and environmental health when we get to the note on it and I certainly want to stress how important it is to me. I think that’s really all I would like to reply to on this member’s comments right now.

Mr. Nixon: Mr. Chairman, there are just three things that I want to deal with in the first vote and I guess the first one might as well be the institute to which the minister was referring. I, too, want to urge upon him as strongly as I can the establishment of something of an advanced research basis, to university level hopefully, which will mean that on not so many occasions will the attention of the minister be brought to matters that have arisen in other jurisdictions, perhaps by members even of this House.

There is quite a frightening feeling sometimes that the whole thing is moving so quickly. It really gets considerably beyond the membership of this House, perhaps even including the Minister of Health himself, to understand and grasp the importance and the ramifications of these matters. I thank my lucky stars that I live out in South Dumfries township with only a hog farmer living to the west of me who uses a liquid manure process. Maybe there ought to be a question on what the long-range far-reaching effects of that are to human and other organisms.

I simply want to urge upon the minister the establishment of some kind of an organization which is going to be on top of these changing aspects.

I don’t know who it was -- it may very well have been the Leader of the Opposition -- who said that the politics of environmental health is going to be one of the most important aspects of our responsibility during the next decade and perhaps much longer than that. It’s obviously very much a fact of our existence here when every question period includes questions to the minister on some little-known or unheard-of organic chemical which may, in fact, have tremendous effects and influences on our environment and to the individuals living within it.

I would like to join with others who urge the minister to take definite action in this regard and I can assure him of strong support in this connection.

The second thing I want to put to the minister is the continuing problem which I am experiencing as a member of the Legislature. In his opening statement he referred to the history of the establishment of hospitalization and a programme of universal health care. The minister knows that while it’s almost universal, it is, in fact, not universal. The people do not have to belong to it and every now and then somebody will come to me too often for my peace of mind who is not a member of this or their membership has lapsed because of some problems in the transfer of premium responsibility.

I would hope that we could pass a statute making it quite clear that everybody living in this province is a member of our medicare programme and that there is no possibility that anyone is going to go to the doctor or go to the hospital and not be properly covered. We all know it is not possible for an individual to go into one of our hospitals in this province and pay for any reasonable care himself in any way. It may be that the advisers to the minister wish to keep it this way so that there is some compulsion or some pressure on the individual, particularly in the pay-direct field, to pay direct and on time. But I believe we are approaching it in the wrong way.

My own experience is that you can usually give some kind of justification for the lapsing of the coverage and I don’t recall anybody ever having to go into the hospital where they had to pay for it themselves when they didn’t feel that they could do so. But I believe we should have a universal programme here and I would hope that we move in this Legislature to accomplishing that.

The last point has to do with the legal status of the hospitals which were visited by the minister in that great tour across the province some months ago. We are waiting for the Supreme Court of Ontario to tell us whether or not in their legal opinion the government acted properly and legally. I would not expect the minister to make any predictions as to what might come about but could the minister give us some predictions as to the actions that the government might take? I have heard that the minister or representatives of the ministry have said that whatever the outcome, whoever wins this reference, it will go to the Supreme Court of Canada.

Really, I am not so sure that it’s sensible for the government of Ontario to take it beyond the Supreme Court of Ontario. The remedy, if they feel they have to have it, is a clear one and that is a reference to this Legislature which is open to them at all times. There is a small political problem, that we are all aware of, that probably they could not get the authority to close the hospitals from this Legislature. But a reference beyond the Supreme Court of Ontario by the government, it seems to me, does not seem to be a sensible procedure. The government should surely have accepted the ruling of the divisional court in the first instance, and either --

Mr. Bullbrook: Right, exactly right.

Mr. Nixon: -- decided not to go forward with this policy, which is extremely unpopular and wrongheaded in my view, and has been turned down by the courts, or to take the other remedy that is democratically open to them.

I would also like to ask the minister if he would comment on the present negotiations with the hospitals which are on this formerly black list and now kind of a greyish-pink list. For example the hospitals that I know of -- Willett particularly -- is continuing to function as an active treatment hospital. I feel the board there is acting most responsibly and it has been dealing with the minister’s deputy and others, trying to find some common ground.

But I really would hate to think the ministry is simply putting off the Willett board and the other boards until such time as the cudgel is restored to its quivering fingers, and they can beat the hospitals into submission once again. I believe the boards of the hospitals have been acting most responsibly. They have not been assuming that they are not going to have to at least discuss a change in their present powers and responsibilities.

More and more I am getting the impression that this thing is being left in abeyance, without definite answers forthcoming from the officials in the ministry charged with this affair until such time as the good old reliable majority government powers are restored. In that case we will be back to the bad old days when the government would act in an autocratic and high-handed manner. I would hope the minister could give me some assurances in that regard, that I can pass on to some others who are concerned as well.

Hon. F. S. Miller: Mr. Chairman, there is one thing I want to point out. Inadvertently I have read some wrong figures into the record in my opening statement. As soon as I have them corrected I will correct them for the record. I had my statement being revised this morning and, in the rush to get here at 10 o’clock -- whether the press knows it or not -- I picked up the wrong copy of my statement. I had it edited --

Mr. Lewis: No, that is not true. You just had one regression analysis and then you got another and they conflicted. Happens to the ministry all the time. Perfectly predictable.

Hon. F. S. Miller: Well, I have some errors in it, apparently. In any case the moment I get the correction --

Mr. Nixon: Who is to say which is wrong?

Hon. F. S. Miller: -- on the arithmetic I will give it to you.

Mr. Lewis: Depends how much you regress.

Hon. F. S. Miller: It was caught just this morning.

Mr. Breithaupt: We will accept your regrets.

Hon. F. S. Miller: The hon. member for Brant-Oxford-Norfolk talked about making OHIP compulsory. I suppose that is a valid point. Yet we do have people who choose not to join and they choose knowingly, not in ignorance.

Mr. Nixon: I don’t think they should have that alternative.

Hon. F. S. Miller: That, I think, is an honest difference of opinion. To date this province has used a premium system for part of the costs --

Mr. Nixon: We need their premiums to provide an overall programme.

Hon. F. S. Miller: No, I don’t think so. We are getting five-sixths of the money from them anyway in taxation. In many cases they are the people who are contributing a heavier amount toward the overall plan than the rest of us.

Mr. Nixon: Don’t worry about Gordon Sinclair.

Hon. F. S. Miller: You and I both know that if a person is at the low end of the income scale, it is an academic argument -- they get the care under any circumstances. If they are at the well-to-do end of the scale and they go to hospital and have to pay it and they haven’t paid their OHIP premiums, tough luck.

Mr. Nixon: You used the word “universal” and that is incorrect.

Hon. F. S. Miller: All right, as long as you have a premium as a requirement for coverage then it is very difficult to make it compulsory. We could do it. I simply say that I think there are some people in this province who still feel they have the right to make that choice. The percentages are a very minuscule number. As a matter of fact every time I’m given the total number of registered people on OHIP it exceeds the population of the province.

Mr. Nixon: It does?

Hon. F. S. Miller: It does.

Mr. Lewis: That speaks to the accounting within OHIP.

Hon. F. S. Miller: No, it doesn’t. What it speaks to is the fact that we cover all members of a family automatically without having them go through a registration form, simply by using the family coverage number and going to see the doctor. Very often we have discovered people are inconsistent in their own use of names. They may have three names and chose to use two on one day and two on another day and unfortunately they will be enrolled under those separate names. It is interesting. But in any case the family member is covered, whichever name he or she chooses to use when they go to see the doctor.

[12:00]

Mr. Godfrey: Fortunately most people have only got one appendix.

Hon. F. S. Miller: Yes, or you would have found a way to take out two.

As to the group action or the government action, at least, in response to the court, I touched on that briefly in my opening statement. I really don’t feel that this government would want to go to the Supreme Court of Canada if we lost the next round.

Mr. Shore: Why didn’t you go in the first place?

Hon. F. S. Miller: I’m speaking personally now -- there’s not a government policy formulated on this basis. I think at that point we have to face our responsibility, if we lose in court.

Ms. Lewis: That’s right.

Hon. F. S. Miller: Now that responsibility, in my opinion, is to come back to this House with legislative changes -- if we lose.

Mr. Lewis: You won’t do that, I am sure.

Hon. F. S. Miller: I’m quite prepared to.

Mr. Lewis: Excellent.

Hon. F. S. Miller: On the other hand, that is not a decision, as you know, that the Minister of Health will take all by himself.

Mr. Lewis: That’s true.

Hon. F. S. Miller: I will be guided by my colleagues in cabinet --

Mr. Conway: And Eddie Goodman.

Hon. F. S. Miller: No. I’ll be guided by my colleagues in cabinet.

Mr. Nixon: Who will be guided by Eddie Goodman?

Mr. Lewis: Who will be guided by the last survey?

Hon. F. S. Miller: I suspect you have some surveys yourself.

Mr. Lewis: We don’t. I wish we did.

Hon. F. S. Miller: If, on the other hand, we win in court I suppose there is always the right of the hospitals to consider the appeal process. Again, we’ll be faced with a decision: Should we wait for an appeal or should we consider clarifying what may have been deemed an unclear law?

Mr. Bullbrook: It is not a question of winning or losing. You missed the point. You don’t win that case or lose it.

Hon. F. S. Miller: In the case of the hospitals such as the Willett in Paris, we are continuing to finance them and I think it’s very unfair to talk about their long-range plans until such time as we’ve really clarified the whole issue of their future. In your case, it’s compounded by two things: (

a) they are not a party to the case in court; (

b) there is a long-term-care study going on in your area to help us decide what the chronic needs are in your area.

Mr. Nixon: It surely has nothing to do with it. Didn’t the Premier say it was the policy of the government to treat all of those hospitals the same, whether they were party to the legal reference or not?

Mr. Breithaupt: I believe so.

Hon. F. S. Miller: We continue to fund them, as you know, and we’re going to keep on funding them.

Mr. Nixon: Of course, you are not in the same group.

Hon. F. S. Miller: There’s no argument about the need to fund them. There are all kinds of ways of being nasty in the meantime while the court cases went through. The fact is --

Mr. Nixon: They were not open to this minister.

Hon. F. S. Miller: They were open to me if I wanted to use them. I’m simply saying --

Mr. Nixon: Not to this minister they were not open. You are not a mean person.

Hon. F. S. Miller: -- we felt they should be funded on a normal basis until their future was determined either by the courts or this Legislature. That is the basis I want to keep it on.

Ms. Gaunt: Mr. Chairman, I would like to make a few brief comments on this vote. We’ve talked in a general --

Mr. Acting Chairman (McCague): Order, please. I understand there was agreement that the debate on vote 3001 would conclude at 12 o’clock. Could we follow that agreement?

Mr. Gaunt: All right, Mr. Chairman. I am quite agreeable to that. The remarks I had actually referred in a general way to the hospitals which come under another vote and I can make those remarks at that time. I wanted to tie that in to the hospital insurance, the general OHIP insurance programme, which comes under this vote but I can do it under the second vote with your permission, sir.

Mr. Nixon: Stay on your feet. He’ll put it right up and you will be right in order.

Hon. F. S. Miller: On a point of order, Mr. Chairman, I think OHIP doesn’t really come under this -- just the doctors’

section of it does; the medical --

Mr. Gaunt: I wanted to talk about the doctors’

section but I can tie it all up, I am sure, in the second vote.

Hon. F. S. Miller: I am sure you can.

Mr. Acting Chairman (McCague): Shall vote 3001 carry?

Vote 3001 agreed to.

On vote 3002:

Mr. Angus: I would like to refer again during these estimates, as I did last time, to the ambulance services, particularly those services which are not yet paid for by the ministry under OHIP; those which my constituents find themselves in the unfortunate circumstances of having to use; those which my colleagues, any of the northern members, or their constituents find they must utilize just to get basic medical services. I am referring to the air ambulance service which will allow a doctor to transfer a patient from a hospital to a hospital in an emergency situation, but will not allow OHIP to reimburse the parents or the patient for returning to the community they come from.

I’d like very briefly to read into the record, just to make my point, a letter I received from a constituent of mine who like myself, had the circumstances to travel to the Hospital for Sick Children for treatment services for a child:

“I am writing concerning an

article that was in the newspaper last November. It stated that you were in favour of the government paying for parents in Ontario who had to take their children to the Hospital for Sick Children in Toronto. I agree with you 100 per cent because my husband and I have gone through it. We had a child last February who was born with congenital heart disease. He was flown to Toronto two days after birth, which social services at the hospital paid for. He was there for a month-and-a-half. We couldn’t afford to be down there with him, and when the time came to go and get him we had to pay for the trip there and back.

“In October he had to go back again. The doctors here were certain that he would need heart surgery then because he was doing so poorly. We had been saving for six years for a down payment on a house, and because of this money I couldn’t even get my way paid to Toronto. I went to social services at the hospital, the welfare office and Kiwanis, but no one would help. Therefore, we ended up paying again. If everything would have gone all right I would have only had to stay there 10 days, but complications set in and I was there for five weeks, all of which we had to pay for ourselves.

“Although they have places down there for $5 a day, it is only for mothers. If the fathers come it would mean staying at a hotel. That is why we are still renting and almost back to where we started from.

“Parents who have children with heart problems or any defect that they have to go to Toronto for have enough problems and worries without being concerned about a gigantic bill. It’s not their fault that they had children born with things wrong with them, and most of the problems have no known reason for happening. I have great concern for these parents. Although it wouldn’t do us any good (our child passed away in November), I hope something can be done to help pay the expenses for parents who have to go to Toronto.”

That is not an unusual case. In fact, unfortunately, it seems to be more the rule than anything else.

We talked about this before in estimates and I realize that your concern is for preventive care, or at least at that time that’s what your concern was. I would like to add again a request that your ministry undertake the examination of this situation with a view to paying for transportation costs whether it is for children or adults who must leave their home community and fly to Toronto or to Hamilton or to any of the other major centres in Ontario to obtain the medical services that they require to survive or to function.

I’d like to change my approach just to a certain extent and offer you a proposition. I think if you have the OHIP computer working these days, or if you can get it working, that you instruct your staff over the next three or four months to pull out -- I’m not sure how they would do it but I’m certain the programmers would find a technique -- to enable us to understand how many people we’re talking about. How many people from northwestern Ontario are travelling to Toronto, whether it’s to the Hospital for Sick Children or to any of the other major hospitals?

Have them pull that out of the computer and have your own staff run a check as to the length of time that those patients are in Toronto hospitals or are in other hospitals in this province or elsewhere in Canada or the United States.

I think once we can understand, in terms that this House will accept, in dollar figures, the cost for providing this service, the cost of ensuring that everybody in the Province of Ontario has equal access at equal cost to the medical services that they need to survive, then I think we’ll be doing something for the people of Ontario. As your staff are compiling this -- and I hope, Mr. Minister, you will accept this suggestion -- I would also ask them to take a look at why so many patients find it necessary to travel to the United States for medical services; services they don’t feel they can obtain in Ontario or obtain competently in Ontario.

I leave those two requests with you. I know that the Thunder Bay District Health Council will be more than happy to receive the basic data, to be able to pull it together and to assist your ministry in ascertaining the extent of the problem and in providing some costing.

Mr. Conway: I would like to add one brief footnote to the ambulance question, and perhaps the minister could answer my query in addition to that of the member for Fort William.

In the November debate I brought to the minister’s attention a particular problem that my people in the Deep River area were experiencing with the ambulance review study that was under way. At that point in time I was informed by the minister through his staff that that study probably would be prepared and presented within six to eight weeks, meaning that we could have expected it at the end of January.

I was called this morning by some very concerned officials at the Deep River and district community health organization, and at this point they still haven’t heard what is going to happen to the ambulance situation in their particular area. I am just wondering, in answering the general question about ambulance services raised by the member for Fort William, whether the minister might direct specific attention to the problems of the people living in the Deep River area and what, if anything, we can expect by way of the report presently being prepared.

Hon. F. S. Miller: Mr. Chairman, on the first point, I suppose it is like almost all government plans, where does one draw the line and what are your priorities? The very fact that we have an air ambulance system, and that we have a tremendous ground ambulance service in the Province of Ontario, puts us leagues ahead of many jurisdictions. I hope the hon. members recognize that. That doesn’t mean it covers every conceivable need.

Think of what these people would have been involved in if they were in the States of New York or Vermont. I know personally, because we had an accident in that state. I had to take my wife, who had two broken legs, 60 miles in the back seat of a car, because there wasn’t even a for-hire ambulance available, let alone one paid for by the state. It is only when one runs into this kind of problem elsewhere that one appreciates the Province of Ontario’s excellent service.

It is a question of priorities. Under what circumstances do you pay for the transportation of other people? Under what circumstances do you pay for pretty expensive return of a patient by air? What could you have used those dollars for in other parts of your programme? These are the kinds of sawoffs and decisions you always have to make.

I can’t offer the member any encouragement that we are suddenly going to become more generous. We are looking at the overall problem of transportation of the physically handicapped as well as the transfer of people with other problems to centres of treatment.

I have no idea of how many people are involved in this way. I am sure there are quite a few. I know that in a riding like my own, 150 miles from Toronto, there are lots of people transferred here for care and the families often are quite busy running back and forth to visit them. Again, I can speak to that fairly personally.

The hon. member for Renfrew North asked me about Deep River --

Mr. Angus: Before you go on to that, could I just reiterate a couple of my requests?

I appreciate the fact that we don’t know how many people there are and that we really don’t know the dollar figure we are talking about in terms of what it would cost to provide free transportation for medical services. But what I was asking you before was, would you be willing to instruct your people who handle the OHIP computer to draw up a programme, over the next three or four months, that will provide us with that information -- at least in terms of the numbers of people, the lengths of stays and the home origin.

In that way, in the fall, we can have that information and we can send it out to the regional health councils and ask them to cost it as to their particular area. Then we will know, at least a dollar figure, what we are talking about and then you, as the minister, and your ministry, can assess it, in the words that you use, in terms of priorities and in dollars.

[12:15]

Hon. F. S. Miller: One of the things we can tell you, on any given population base, is where they are getting their health care. For example, when we went to the hospitals that were closed, we were able to say in the town of Bobcaygeon, to be specific, 22 per cent of the people who entered hospitals from the village or area of Bobcaygeon go to the local hospital; and 78 per cent go to other hospitals. We were able to say these are the hospitals they go to, these are the days of stay they have and within Bobcaygeon the following people came from elsewhere, etc. etc. That kind of data is available.

We have to adjust every population base for a hospital to reflect the true references to it. Rather than saying four beds per thousand people, we have to say four beds per thousand referred people, not resident people. This