Selected Ontario Legislative Assembly Hansard
April 2000

This page contains selected debates on health care issues in the Ontario Legislative Assembly. For more information, please contact Karen Lee, Corporate Information (OMA). The entire Hansard discussion is available at the Ontario Legislative Assembly's Hansard Homepage at:
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Mr Kwinter moved second reading of Bill 2, An Act to amend the Medicine Act, 1991 / Projet de loi 2, Loi modifiant la Loi de 1991 sur les médecins.

Mr Monte Kwinter (York Centre): I'm pleased, for the third time actually, to rise in this House to debate this bill, and I want to read the bill, which is sublime in its wording but profound in its impact.

It only has 68 words, and it says: "A member shall not be found guilty of professional misconduct or of incompetence under section 51 or 52 of the Health Professions Procedural Code solely on the basis that the member practises a therapy that is non-traditional or that departs from the prevailing medical practice unless there is evidence that proves that the therapy poses a greater risk to a patient's health than the traditional or prevailing practice."

This bill was first introduced on Thursday, May 8, 1997, as Bill 126. It was again introduced on October 29, 1998, as Bill 2. The genesis of this bill is really the World Health Organization's 1989 Helsinki agreement. It was signed on behalf of Canada and, by definition, on behalf of all the provinces and territories, by the Minister of Foreign Affairs at the time, and this is what it says:

"A registered practitioner shall not be found guilty of unbecoming conduct, to be found to be incapable or unfit to practise medicine or osteopathy solely on the basis that the registered practitioner employs a therapy that is experimental, non-traditional or departs from prevailing medical practice, unless it can be demonstrated that the therapy has a safety risk unreasonably greater than the prevailing treatment."

That is almost verbatim to the wording in my bill, a bill that was signed by the international World Health Organization.

Notwithstanding that, and after this bill received unanimous consent in this House on May 8, 1997, the College of Physicians and Surgeons, in their annual report to members as published in their Members' Dialogue, stated, and the headline says, "Bill 126--Monte Kwinter Private Member's Bill: Executive received an update in June on this bill, which received second reading in the Legislature and was referred to committee. Executive agreed that while the college has already made clear its opposition to the bill, we will prepare to speak out strongly against it again should it be called before the committee for further consideration."

Notwithstanding that, the College of Physicians and Surgeons established an ad hoc committee to take a look at the issues, and what happened? The ad hoc committee on complementary medicine, which studied the issue of regulating physicians who provide non-traditional diagnostic methods and remedies, met for two days of public hearings. The College of Physicians and Surgeons committee report concluded that patients have every right to seek whatever kind of therapy they want. In addition, the committee stated that regardless of the kinds of therapies or practices they choose, physicians are accountable not only to their patients but also to the college, and ultimately to the public at large. I have no quarrel with that; I agree.

Since my bill was introduced, another interesting thing has happened: The Ontario Medical Association has given permanent status to a section on complementary medicine.

Other things have progressed since the first debate on this bill. The United States Congress passed legislation that's going to change the face of health in that country forever. What they've done is pass legislation that allows for the Office of Alternative Medicine at the National Institutes of Health to be changed from being an office to a centre, which means it gets $50 million worth of funding. In addition, the legislation provides $1 million to support the establishment and operation of a White House Commission on Complementary and Alternative Medicine to study and make recommendations to the Congress on appropriate policies regarding research, training, insurance coverage, licensing and other pressing issues. Again, a very significant step forward.

"Almost two thirds of traditional US medical schools now teach alternative therapies, including chiropractic, acupuncture, herbal remedies and mind-body medicine, a survey found. With millions of Americans visiting alternative practitioners yearly, educators have no choice but to respond to this relentless challenge to evolve. The survey of 125 medical schools found that, of the 117 reporting, 75 of them now include in their curricula alternative medicine."

In our own country: "A new acupuncture program has been launched at Mount Sinai Hospital in conjunction with the Michener Institute and is heralded as the first of its kind in Canada. The program, part of the hospital's pain clinic, will be an important bridge between traditional Chinese and western medicine, said Michener Institute president Renate Krakauer."

Also, interestingly enough, there was a conference on traditional healing to treat menopause in Toronto. A researcher from Columbia University's medical school in New York stated that this is a process that has been tried for centuries and is something that mainstream doctors are now getting hold of. An interesting comment she made was, "In Europe, St John's wort, a botanical used to treat mild to moderate depression, another common complaint of premenopausal women, is outselling Prozac by leaps and bounds."

Another very interesting development is the statement by Dr Russell Joffe, the man behind McMaster University's proposed $100-million centre for complementary medicine. Joffe said, "The centre will do something quite unique for a western university faculty of medicine, amalgamating research into western and eastern treatments while investigating the roles lifestyle, diet and stress play in keeping Canadians healthy. ... Nearly 50% of Canadians are using some form of alternative therapy, so it's important to better understand how it works and its place in the health care field."

An Angus Reid poll, which asked about Canadians' attitudes towards alternative medicine, found that the majority, 66% of Canadians, feels that the government should be advocating the use of alternative medicine and practices in order to potentially reduce the costs to the health care system.

I want to enter into the record a letter I received from Dr Linda Rapson, the president of the Ontario Society of Physicians for Complementary Medicine. She says:

"I wish to thank you for bringing Bill 2 ... before the Legislature.

"Your bill comes at a time when there is even more urgent need to improve the knowledge and experience of the medical profession in the area of non-traditional medicine. The public will be best served by a medical profession that can take a careful, objective look at various forms of 'alternative' medicine, to best advise our patients. Our long-range goal should be to critically evaluate complementary therapies in the same way we are assessing traditional medicine, in order to provide the safest, most cost-effective and beneficial treatments. This would ideally be accomplished through interdisciplinary co-operation and collaboration, bringing the best of traditional and non-traditional care to the Ontario public.

"We are convinced that the sort of protection for Ontario physicians provided by this bill is urgently needed to ensure that all Ontarians receive safe, beneficial and cost-effective treatment."

It's signed by Dr Linda Rapson.

This is an issue that has been before this House twice. It has had unanimous consent twice, but there has been a dramatic sea change since this was first introduced. I read the quote from the College of Physicians and Surgeons, which was opposed to it. They have been silent. There has been no opposition to this at all.

It's also interesting to note that the current Minister of Health, in a letter to a constituent, wrote: "I want to assure you that this government supports freedom of choice for patients for a range of care options, as long as people are not put at unnecessary risk. This includes physicians who use non-traditional treatments, as long as they maintain the standards of the profession and have the skills, the education and training necessary to provide such treatments."

That's exactly what this bill does. The time has come to move forward. The citizens of Ontario and of Canada are far ahead of the government. I think it's important that this provision be enshrined in the Medicine Act because what it will do is provide doctors with the freedom of choice and, more importantly, patients the freedom of choice to take a hand in the treatment they receive and to be able to access not only traditional medicine--and this is not a substitute; this is complementary--but to access treatments out there that are not necessarily mainstream but have been shown to be effective, safe and, in all cases, part of what the population seems to want. I encourage my colleagues once again to support this--this is the third time. If I can prevail on them, I'd like to get third reading today. Notwithstanding that, let's take one step at a time.

Ms Marilyn Churley (Broadview-Greenwood): I'm very pleased to stand today in support of Mr Kwinter's bill. Today it feels like déjà vu all over again to me. I can only imagine what it must feel like to Mr Kwinter. He must be very pleased, even from the last time we debated this bill in this House, that we've moved even more forward. The public is ahead of us and it's time to move on. I don't think we should be in a position ever again in this House to have to begin this debate all over again. It's really good that we have this opportunity to have the debate once more and to discuss the merits of it and possible problems, but it really is time to move on.

As was pointed out the last time around, Statistics Canada says that 3.3 million Canadians see non-traditional practitioners, and the number is growing. I'm one of the statistics that I mentioned here and have been for a number of years, and so are a number of people in my riding. They're quite anxious to see me support this bill again and they're quite anxious for this Legislature to take ownership of it, particularly the government, because they have the power either to move it forward into committee or take over the bill itself, which I'm sure Mr Kwinter would not object to. His goal is to get this thing through. The government should take a stand today and do one or the other. Some amendments, I believe, would need to be made, and that could be done through the process of committee hearings or the government making it their bill.

We've been talking for some time now in this House, certainly before this government and when the NDP was in government, about new, integrated medical systems, the way we deal with all forms and types of medicine, not only after the fact when we're sick, but preventive medicine. This is an opportunity to deal with that in a planned way, so that it becomes part of what we're talking about, part of the system; so that the safeguards we need to see in place are there and the regulations to protect people are in place. That's the kind of thing that people who use alternative medicine have been crying out for, for some time.

When the NDP was in government from 1990-95, I remember working with our ministers of health, Frances Lankin and Ruth Grier. We were, as governments before us, a part of regulating midwifery and nurse practitioners. We can all recall a time when a tradition that was with us many years ago became almost outlawed from the system and doctors took over. It took a while again for us to say that midwives have been around for eons doing that job and they can do it very well and it's time to bring them back into the system. It took a very long time before, I have to say it, the OMA and others agreed that it made sense in terms of cost-cutting and also in terms of the skills that midwives can bring. The kind of attention they can bring to their patients is really beneficial--to a woman when she is giving birth, to the family and to the whole process. It has become more and more accepted now. Midwives are back in the system; nurse practitioners are back in the system. There's still a lot more work to do but we've all agreed as a community that there's a very important place for them in the system. We have to move in that direction now.

I think it's urgent now because so many people use alternative medicine and have been for a long time. I commend the Toronto Star--I saw it in the weekend paper--for doing some work on testing some of the alternative medicine that's out there. I don't think a newspaper should have to do that. I think all of us who use alternative medicine would like to know there are more regulatory rules in place so that when we buy some of these alternative medicines we feel we're protected, that what it says on the label is actually in that bottle. That's an important step we have to take.

In closing, I want to say very strongly that today is an opportunity for all of us to say not only that we're going to support this resolution but that we're going to be done with this initial aspect of the debate, which we've had three times in this House now, and we're going to move it into committee or the government--I know the Minister of Health is very busy and I'm not suggesting that ministers have a lot of time to come to--

Mr George Smitherman (Toronto Centre-Rosedale): She's creating new ads.

Ms Churley: Yes, creating new ads, but I'm trying to be non-partisan this morning. It's possible at times, depending on what the government members say, of course. I was a minister once and I tried to come on Thursday mornings. But I wish in this debate that the Minister of Health could be here to participate in this and give us her assurances that she indeed--

Mr Garry J. Guzzo (Ottawa West-Nepean): Anybody comment on your absence?

Ms Churley: I'm not commenting truly on the minister's absence; I'm really not. I'm trying to be fair and say how difficult it is for ministers to have the time available to come to private members' hour on Thursday morning. This is an issue that I hope the minister is paying some attention to and that she will give us her views on where she intends to take it. I believe she could have a lot of influence on the members of her cabinet and caucus in where they should go in terms of supporting this bill.

I would ask that everybody support this bill at the very least today and that it go into committee so we can take it to the next step and make it the law of the land.

Mr David Tilson (Dufferin-Peel-Wellington-Grey): I would like to make some remarks on the member for York Centre's bill. I agree; I think this is at least the third time it has been presented to this House and I have supported that bill on the former occasions. I congratulate the member and provide my admiration for him in his determination to bring this issue forward. You refer to the "Kwinter bill" and everyone knows what you're talking about.

I'm here as well, for the former speaker's information, as the parliamentary assistant for the Minister of Health, and I'm probably going to speak out of both sides of my mouth at the same time. I intend to support your bill, but obviously I have an obligation as the parliamentary assistant to express some of the minister's concerns, although it is private members' hour and I'd be voting in my personal capacity. I believe, as I hope members all around this province will, that the public supports the general principles of what the member has been saying.

I might as well get out of the way what the minister's concerns are. They give you these notes that you have to read and I'm not going to do that, but I will comment on some of them.

Ms Churley: He's rebelling. He's breaking free.

Mr Tilson: No, I'm not rebelling, because I think it's fair that members should know the ministry's position on this. You've read part of what she has said in a letter to her constituents and that's fairly accurate.

The ministry has worked with the College of Physicians and Surgeons of Ontario to ensure that physicians using alternative complementary treatments would not be the subject of quality assurance investigations solely based on their use of these treatments. The College of Physicians and Surgeons quality assurance regulation now has many procedural safeguards for these physicians. Finally, the minister has asked the Health Professions Regulatory Advisory Council to advise her on regulatory issues related to naturopathy and she will consider their advise carefully as it is received next year. Therefore, it is the position of the ministry, at least, that she cannot support moving forward with legislation in the absence of the Health Professions Regulatory Advisory Council's advice.

The member indicated that he would ask for third reading today. He may be right, because it has been debated in this House so often. Because of a comment of the minister, however, I would hope he'd suggest it go to a committee and we would have again an opportunity to discuss it, perhaps have the College of Physicians and Surgeons representatives to come forward to the committee and provide their comments. There are concerns with the bill.

"The ministry believes that the physicians and other health care professions who use the alternative or non-traditional treatments should be able to practise as long as they maintain the standards of practice of the profession, work within the scope of the practice, have skills, education and training for their practice and do not cause serious physical harm or put their patients at unnecessary risk."

I'm sure the member agrees with that. If it's safe, absolutely. If it's safe, if you're practising something, if there's some sort of regulation to make sure the public understand it, or if you're selling some sort of herbs or whatever--I don't want to appear too off on this--but if materials are sold, you want to know for sure that those people know what they're doing. Doctors tell me: "Well, if I have my patient under medication for something or I'm aware that my patient has some ailment and someone else prescribes something else, whether a treatment or some sort of medication, it could conflict. It may be something completely related, and we could have a tragedy." I'm sure the member agrees with that as well.

"The bill would enshrine in legislation professional misconduct guidelines which have historically been dealt with through regulation." I don't know whether that's a fair comment, but that would be up to the member to comment on that.

Finally, and this is an interesting point, "The minister is of concern that no regulated health professional legislation has these guidelines in legislation." I guess that's a fair comment. We're now putting into legislation what other professions have by regulation. This is the first time this has been put forward that I know of. He may know some other professions, but normally these sorts of things are not enshrined in legislation.

She goes on to say, "The College of Physicians and Surgeons has the mandate to regulate the practice of the medical profession to govern the members in the public interest." We're varying from that a little bit as well.

I didn't hear the member comment on the fact that the word "solely" does not appear in this legislation, whereas it appears in the other piece--

Mrs Lyn McLeod (Thunder Bay-Atikokan): It does.

Mr Kwinter: You're wrong. It says so. I read that today.

Mr Tilson: It does? OK. I apologize to the member. That's what I was led to believe.

Those are the concerns of the Minister of Health. Personally, as other members have spoken, we're into other things. We're into nurse practitioners. We're into midwives. My daughter gave birth to a little girl back in September.

Interjection: Congratulations.

Mr Tilson: Thank you very much. She lives in California and she had a midwife. In California, I understand, it's common practice, and it's gradually becoming more popular here.

There are many things that our health system simply can't afford. More importantly, there are people who completely support these alternative ways of dealing with things. I had a woman come into my office who had arthritis. She literally couldn't move her hand for fear of pain. Well, she took some sort of treatment, treatment that's being recommended in this amendment to the--is it the Medicine Act? Now she's fine; she's not perfect, but she's a lot better than she was.

So I believe, in my constituency at least, my people support that as long as it's safe. I will be supporting this legislation notwithstanding--and I hope the members realize that--the reservations of the Ministry of Health.

Mrs McLeod: I am pleased to participate in this debate in support of the bill that's been put forward by my colleague from York Centre, as indeed has been mentioned a number of times already this morning, the third time that this particular bill has been presented.

The bill does continue--I want to stress this fact, given the comments that the member for Dufferin-Peel-Wellington-Grey made on behalf of the Ministry of Health, who may have misread the third iteration of this bill--to contain the change that was brought in the second time when the member for York Centre, who was then the member for Wilson Heights, presented this bill, and that is to include the word "solely," so that it clearly states, "A member shall not be found guilty of professional misconduct or of incompetence under section 51 or 52 of the Health Professions Procedural Code solely on the basis that the member practises a therapy that is non-traditional or that departs from the prevailing medical practice ... ." I did believe at the time the member made that change in his second presentation of this bill that it was an important change and I'm pleased to see that he has continued with that in this third presentation of the bill.

It was important, and the member for York Centre read a letter from Dr Linda Rapson, the chair of the complementary medicine section of the Ontario Medical Association, when he presented the bill the second time. I'm going to reread it again because I think it's important to be sure we recognize the importance of including the word "solely." "By adding the key word 'solely' to the bill, we believe you have gone a long way to answer the sincere concerns of some individuals and organizations with respect to the potential for this bill to weaken the traditional public protection we have come to expect from the College of Physicians and Surgeons of Ontario." I certainly do not believe that it's the intent of the member for York Centre or the intent of any member of this House to indeed weaken in any way the protection that Ontario citizens have from duly regulated health care practitioners.

The bill was unanimously supported in this House on the two previous occasions that it was presented. I suspect it will be supported unanimously again, and that leads me to say that it is time--past time, probably--for the Ministry of Health to bring this bill forward. If, as the member for Dufferin-Peel-Wellington-Grey has suggested, it's the preference of the Ministry of Health to see the intent of this bill incorporated within existing health professions regulations legislation rather than stand as a separate piece of legislation, they have had ample time, and probably have ample time ahead of them, to bring forward the appropriate changes to the health professions regulations legislation. In fact, this is an extremely timely point at which to be revisiting this issue and to be opening up a debate about the regulation of alternative medicine and alternative therapy practices, because the entire health professions legislation is under review as we speak.

I believe that the government needs to open an even broader discussion on the issue of alternative medicine and alternative therapies than is dealt with in this particular bill. This bill deals with physicians, and solely with physicians. It opens the door for physicians who are conscientious and responsible users of alternative therapy, who are trained practitioners of alternative therapies, to have that as an option they can present to their patients. The bill really doesn't go beyond that at this point.

I think it's important that physicians recognize they have a responsibility to respond to their patients. Patients come into physicians' offices and ask about alternative therapies. They need to have answers from their physicians. I think it's a concern that so many Ontarians are using alternative therapies, seeking out alternative therapies, using alternative medicine products, and are hesitant to speak to their physicians about them because they believe the physician would disapprove or would not even be legally able to make any recommendations regarding these alternative medicines because they're not within their defined scope of practice now. I believe that the bill essentially allows physicians to accept a responsibility to respond to patients' interest in alternative therapies. This bill is really just one step towards the regulation of alternative therapies that are increasingly used by Ontarians.

I want to take just an extra minute or two and stress the fact that I think it's essential, given the reality of the demand for alternative therapies, that the government act in a way that consumers of health care have some protection against irresponsible practice and some guarantee of quality in the services and products that are offered.

Probably the issue that stands out most clearly as one which demands regulation is the practice of acupuncture. We know that currently in Ontario virtually anyone can practise acupuncture. There are no regulations, there are no controls, there are no limitations. We know the practice of acupuncture has demonstrated its benefits when it is carried out by well-trained, conscientious practitioners. We also know it is a highly dangerous practice when carried out by people who are not adequately trained.

In order to get past the horror stories that start to emerge about the practice of acupuncture, for example, we have to have regulation. Good regulation obviously requires scientific evidence of the benefits of the practice, as well as a clear understanding of where there is potential harm. I think it is imperative that the Health Professions Regulatory Advisory Council review the need for the regulation of alternative medicine and alternative medicine practitioners and determine what can and cannot be regulated and how it can best be done.

I acknowledge that these issues are not easily dealt with. I know that the advisory council studied acupuncture for two years back in 1996. We have never seen the results of that report publicly. We know it's now under review again. We know there is a report on acupuncture expected yet again this spring. It is not easy to deal with it, and I don't think we want to avoid the most stringent criteria in terms of the evaluation of what is responsible and what is credible practice. But I think the greatest danger, the greatest potential harm to consumers of health care, is to ignore the issues altogether or to avoid dealing with them.

Where there are benefits, then the Ontario public should be able to access alternative therapies with confidence in the quality of care that they will receive. Where there is potential harm, the Ontario public must be made aware of it. Where untrained practitioners are posing dangers to the health of the population, they must be stopped from their dangerous practices. One of the great strengths of the bill that is presented today is that it opens the doors to addressing these very real issues in a responsible way.

Mr Carl DeFaria (Mississauga East): I am pleased to rise today in support of this bill. I am supporting this bill mainly because of the demands I have had from my constituents for alternative medicine and options in health care during the past five years. My position is that patients should have the freedom of choice from a range of care options. We should signal that, and I think this bill does that.

What is important is that physicians and other health care professionals who use what is called non-traditional treatment--it's non-traditional here, but it's traditional in many cultures of peoples who make up Canadian society today. What is important is that there is a standard of quality, a standard of practice, a standard of care that is maintained and that is similar to other standards in health care, and that the people practising have the skills, the training and the education to carry on the practice that they are carrying on.

I recall particularly a situation where one of my constituents was suffering from cancer, and he was in constant pain. He used to contact my office all the time, asking me to assist him because he needed acupuncture to help with the pain. He had constant pain. He just wouldn't be able to survive without it. He had to pay out of his pocket for this treatment, and it was very costly. He pleaded with me until his death that we look into ways of helping people with some sort of financial help to be able to pay for these kinds of alternative treatments that he required. He passed away a few months ago. The suffering that I saw in this constituent made it just so clear that there are other methods of treatment and other ways of treatment that we should look into. Especially now that we are looking at ways of easing the cost of health care, sometimes a lot of the non-traditional treatments may be less costly than the treatments that we have in our traditional health care system.

I want to applaud the member for York Centre for pursuing this matter. I want to indicate to him that I'll be voting in support of his bill, and I'll be doing that with the support of the constituents of Mississauga East. I am pleased to support this bill today.

Mr Alvin Curling (Scarborough-Rouge River): I too want to thank my colleague from York Centre for bringing forth for the third time this bill, which I think is extremely important. I will emphasize the importance in a different light than many people have done. But I want to also commend my colleague from Thunder Bay-Atikokan, who has expressed most of the concerns that I sometimes hear expressed outside, and again emphasized it in a way that takes care of all those concerns. I have seen no other bill brought before this House that people have shown such interest in, not only inside but outside. But there is one other aspect of it. Let us move it along. I've seen the passage of quite a few bills in this House, and I think it's a comfortable way to move that process into place.

As you know, health care is one of the largest budgets that we have in our system and takes the biggest piece of the Ontario budget pie. I'm sure that looking at ways in which we can address health care in an efficient way will always be the largest and longest debate in this House, and I think this is a solution that can come to it.

One of the main things I want to emphasize is the fact that, especially in my constituency, we have quite a diverse cultural community that uses alternative medicine, and I can say to you that they feel very strongly about it because they have used this in their old country for thousands of years. There are billions of people in Asia, Africa and China, and people here in Canada, who have used what we call "alternative medicine." As a matter of fact, I don't even like the name "alternative medicine." It is medicine in those countries, and may be alternative here, but it has been around longer than the traditional medicine that we talk about here. I think it has been proven in many respects that this medicine not only would help the cost of medicare here but also has proven itself over the years and can be applied successfully in treating the citizens of this country.

We have seen also that almost 70% of Canadians feel that this could be supported and paid for by the government. I think that's one of the grave concerns. But we can see that sometimes this non-traditional medicine, if you want to call it that, can be introduced, and maybe at far less cost than traditional medicine. I know there's concern. A colleague from the government side stated that we've got to make sure this is safe and all that. Of course. The government must have regulations, and people who are practising this medicine must be educated in the field and of course follow procedures that can be monitored.

As my colleague from York Centre stated very well, although he should be disappointed that it has not progressed enough, he and many of us have learned many things that can make this bill a better bill. This is now ready to move forward, because the longer we keep this out of the system, I'm quite sure there are people who will be deprived of proper treatment. We'll remove the fear so that when they go forward to get these medicinal treatments they don't feel that they are breaking any law and those who are administering it don't feel they are breaking any law. I think the government must act in a responsible manner and say, "Let's make sure that we move forward."

As a matter of fact we now have seen that marijuana, which was completely outlawed at one time, today is legalized. That would be considered to be alternative medicine because it has been proven today to help those who have cancer and relieving the pain of those with other treatments. In the past, one would not only be charged with possession but charged with smoking marijuana itself. There are many areas, and I'm not only looking at marijuana but at many other things.

We also know that our parents have given us alternative medicine, and one would have questioned their authority a long time ago, whether they are able to administer that in any way. I've been healed by my mother's alternative medicine, and it did not come to light that she was doing anything illegal. But again, look how healthy I look and look how healthy millions of people around us look--very healthy. I would give that praise to my mother, who has practised alternative medicine--rest her wonderful soul, she made such a wonderful son--but again she did it in a way to look after me with her alternative medicine. There are many ways it has been applied. I'm just saying that we are prepared and poised in our society here in Canada, blessed by the fact of that diversity, that we can have hands-on individuals who have seen the practice of alternative medicine and who can institute that.

I know my colleague wanted to say a word, and I will leave a minute or so if he comes back.

Mr Tony Martin (Sault Ste Marie): I want to, as others have in this place this morning, offer my congratulations and support to the member who has brought this bill forward this morning, recognizing that it is the third time he has made the effort, and say that I'm happy to be speaking on it again. I spoke to it when he tabled it in May 1997 and I'm happy still to be here and willing and able with my caucus to support its intention, both in principle and in fact, and will be indicating this in the vote that will happen here later this morning.

I want to offer him some comfort in that I've had a bill before this House three times now, you'll note, my bill on franchising that I've worked through the system. We're at a point now with the government where we may have something. It won't be everything I've asked for. As a matter of fact, it will probably fall quite short of everything the people we've talked to at the public hearings we've had on this bill called for, but we will have something. I think that's always a step forward. In this place we make gains incrementally. We don't always get everything we want, but if we get something, if we move the goalposts forward a distance in our time of service here, we feel we've done something for the general public and for the public good. I suggest that what has been proposed here today by Mr Kwinter is in the interests of the public good, will serve us all well and will move the question of how we deliver health care in this province forward quite substantially and significantly. It's an issue we've been looking at for quite some time. I think it's time to take some action and stop dithering and to ask some of those very important questions that need to be asked. Get out there, do a bit of a public consultation, hear what the public have to say about it and then ultimately get on with it.

I just want to put on the agenda today probably three things, some comment on three areas that concern me where this bill is concerned and where the whole agenda of this government is concerned.

One is the question of who's driving the agenda. Always, when things come before us in this place, I think it's important for us to ask the question and to understand, if we can at all, because it becomes quite confusing at times as you try to sort it out, who's driving the agenda? In whose interests is the government acting? Who is being served and, ultimately, at the end of the day, is the common good of the community of Ontario front and centre in the decisions we make? I suggest that if it is for the common good of the people of Ontario, and there's a desire to provide the best of health care, and to make an offering to the citizens of Ontario that is safe and well regulated and understandable and accessible, then we've done our job here; we've done our duties. I don't have any answers to that question, but it's something we all have to think about as we consider the subject before us today and as we vote: Who's driving the agenda? In whose interests are we acting? Why are we making the decisions that we're making?

The second thing that we have to take a look at in this instance and again in other instances as we work our way through different pieces of business before this House is, who is giving leadership around this place? It is no more important or obvious who is or isn't giving leadership than where we consider the question of the reform of health care and the reform of primary health care in this province.

I suggest to the members of the House and to the public out there who are listening that if this government had any real interest in moving the health agenda forward in this province, they would be doing a whole lot more than simply negotiating right now with the Ontario Medical Association a very narrow and, I would suggest, limiting set of proposals that will not do anything to further the agenda of the reform of primary health care or the presentation of different forms of health care to the public out there that will be preventive in nature and promote health in the province so that at the end of the day we don't have to spend the kind of money that is worrying so many as we look at the budget of health care in this province over a number of years now. As we look ahead to what the cost of health care will be as we consider the aging of our population and the number of diseases we're discovering as each day goes by that are new and responsive to some of the things that we're doing, sometimes, because we haven't thought it out and we haven't allowed into the action more of the players who might have something to offer by way of understanding and alternative approaches, we've not been able to stem the tide or understand or get a handle on some of the new challenges from the health care perspective that confront us.

The question that needs to be asked, that we all need to be considering here this morning as we look at this piece of business, is, who's giving leadership? Where does responsibility for this lie? Ultimately this morning, we can give some leadership. We can take it upon ourselves, because this is private members' public business, to give some leadership, to ourselves indicate to the government by supporting this bill that we think they should be moving today in this way to recognize the contribution that so many of the alternative health care providers out there, or alternative processes in health care, can provide to the delivery of health care in this province.

We only have to look back over not a very long period of time to some of the changes that have come about that have recognized the contribution of professionals who for the longest time in this province for some unknown reason were not allowed to exercise the ability and training and concern they had in their particular profession. I only have to mention a couple: nurse practitioners and midwives. The progress that has been made over the last 10 years in this province has been quite exciting and phenomenal. There is no reason why we can't move forward in this area as well to recognize the contribution that can be made by alternative medicines so that they become part of the mainstream, so the people of Ontario who now are actually voting with their feet and taking advantage of some of these medicines can do that and know that it's regulated and safe and that what they are accessing is the best that's out there.

The third thing that I want to put on the record this morning is the real concern of this, which is the government's concern that if we pass this, it will cost them more money. Over the last five years, they have given all the money away. If this government had sat back, taken a deep breath, taken a sober second thought and considered the impact of their tax breaks to their rich benefactors and friends and how that would impact their ability to be government and offer services in this province over the long haul, they probably would not have done what they have done and impacted in such a negative way our ability as a government to offer the kinds of services that this member this morning is proposing we support here today. I will be supporting it.

Mr Joseph N. Tascona (Barrie-Simcoe-Bradford): I'm pleased to join the debate with respect to Bill 2. Certainly Ontario health consumers deserve reliable access to competent doctors who offer safe, beneficial and low-cost alternatives to conventional medicine.

That brings me to the point I'd like to make. I believe that consumers in our province should have choice. I note that in a pamphlet distributed by Citizens for Choice in Health Care, they claim that Alberta and eight American states have enacted legislation that protects consumer access to complementary medicine provided by physicians. So what we're talking about here is choice, and alternative medicine is clearly an option that people should have access to in our province.

What I'm concerned about, however, is that the bill makes absolutely no reference to the issue of ensuring that doctors who would be practising alternative medicine would have the appropriate training and necessary background to administer that alternative medicine. We know that traditional Chinese medicine and acupuncture is an entirely different system of medical science. Complete training in the profession of TCM and acupuncture, for example, requires four to eight years of full-time study. What I'm concerned about here is that we would have western doctors simply moving into the area of practising alternative medicine without appropriate training. Bill 2 makes absolutely no mention of any training requirements, and I believe it would be absolutely essential that the training component be addressed. I look forward to participating in that discussion through the committee process to ensure that we address that.

Support on this side of the House would be in principle for the bill, based on the fact that the current legislation and regulations already allow alternative practitioners to practise within Ontario, and they can practise without the fear or perceived fear of reprisal. I believe that physicians and other health care professionals who use both traditional and alternative or non-traditional treatments should be able to practise as long as they maintain the standards of practice of the profession and work within the scope of the practice; have the skills, education and training for their practice; and do not cause serious physical harm or put their patients at or in unnecessary risk. Bill 2 would enshrine in legislation professional misconduct guidelines that historically have been dealt with through regulations.

Let me turn my focus to the College of Physicians and Surgeons of Ontario. The college has the mandate to regulate the practice of the medical profession and to govern its members in the public interest. The college decides what, if any, changes they want in their own bylaws, and it is the College of Physicians and Surgeons of Ontario which, if it still has concerns with Bill 2, may be affected with respect to the inclusion of the word "solely." Because what we're dealing with here is a procedure, in terms of what the member wants: "A member shall not be found guilty of professional misconduct or of incompetence under section 51 or 52 of the Health Professions Procedural Code solely on the basis that the member practises a therapy that is non-traditional or that departs from the prevailing medical practice unless there is evidence that proves that the therapy poses a greater risk to a patient's health than the traditional or prevailing practice." That's what we're talking about here.

The bill still places the burden on the College of Physicians and Surgeons of Ontario to prove negligence. There is a lack of research available today to evaluate the safety and efficacy of many alternative therapies--

The Acting Speaker (Mr Michael A. Brown): Thank you. Further debate?

Mr James J. Bradley (St Catharines): I join in supporting the bill by my colleague Mr Kwinter. It is a bill which is an adjunct to a previous bill he brought forward to allow more options for people to look at in terms of medical treatment. It has in it the safeguards that are necessary to alleviate some of the concerns that others might have.

I know that if he had time to put it in the bill, he probably would have talked as well about funding for the whole health care system and how next week in the provincial budget we will no doubt see the government forget about their latest tax cut and instead put the money into health care, because that option is there. When I hear the Premier say there is no money for health, it reminds me that some of the other provinces are giving tax cuts at the same time they say they have no money for health care.

I remember my friend from Peterborough nodding in agreement with me a few weeks ago when I mentioned in the House that the problem with transfer payments was that the provincial government would get the transfer payments and give them away in tax cuts instead of putting them into additional money for health care. I know my colleague from York would be concerned that, in addition to passing this bill, we would also want to see appropriate funding for health care, because at the present time we have people who have to go to the United States to get treatment; for instance, cancer treatment, radiation treatment and a number of other treatments. We have a long list of people waiting for heart bypass operations.

We have a lot of areas where money could be invested into the health care system, and that money will be there. The provincial Treasurer will get up and say that, for the first time since 1989, the last Liberal government budgetary surplus, they will have a surplus here. That money can be invested in paying down the debt. That money can be invested in health care, which everybody is concerned about. I'm convinced that the member who brought this bill forward would also want to see the provincial government forgo unnecessary tax cuts and invest that money in health care where it belongs.

The Acting Speaker: The member for York Centre has two minutes.

Mr Kwinter: First, I want to thank all the members on all sides who participated in this debate for their support. I gathered from everything I've heard that even though there are some reservations on the side of the government, they're going to support it.

I just want to address those reservations. Number one, this bill addresses the medical profession. It's an amendment to the Medicine Act and we're only talking about licensed medical practitioners. They have the same responsibility to the cause of physicians and surgeons as they have in every aspect of their practice. A doctor who is not qualified to be a surgeon does not start performing brain surgery. It's the same thing when we talk about alternative or complementary treatments. The doctor will still be responsible to the college for the way he practices medicine.

Those who want to investigate these complementary treatments will certainly have to get the necessary educational qualifications and take responsibility for it. It's important to know that this legislation is already in place in Alberta. It was given first, second and third reading on the same day. I'm hoping I can get third reading today. It is in place in several jurisdictions in the United States. Most importantly, it was signed by Canada in the Helsinki agreement of the World Health Organization with the exact same wording. Effectively, Canada is a signatory to that provision.

All this does is build a platform. It's a very small step but a very important step to allow freedom of choice for the doctor, and most importantly, freedom of choice for the patient. The idea that they can go to a licensed medical practitioner to discuss their concerns about their own personal health and the possibility of alternative--

The Acting Speaker: The time for debating this ballot item has now expired.
 

Mr Monte Kwinter (York Centre): On a point of order, Mr Speaker: Can I move approval for unanimous consent for third reading.

The Acting Speaker: Mr Kwinter, you may ask for consent that the bill be ordered for third reading immediately. Is that what we're asking for?

Mr Kwinter: Yes.

The Acting Speaker: Mr Kwinter has asked for unanimous consent that the bill be ordered for third reading. I'm afraid we don't have it.

Pursuant to the standing orders, this bill will be sent to committee of the whole House.

Mr Kwinter: Mr Speaker, the general government committee.

The Acting Speaker: Mr Kwinter has asked that this bill be sent to the standing committee on general government. Is it the pleasure of the House that that happen? Agreed.
 

If you called the 1-800 number in response to the first $3 million worth of ads, you could get your name put on a list to receive the plan when it was ready in, we were told, three to six months.

Somebody in the government's highly paid PR department must have pointed out that it might be a good idea, if they were going to run another $2 million worth of ads, to actually have a plan they could send out to the few people who might not be convinced by seeing, "We have a plan," spelled out on their television screen several times a night in prime time.

So the current round of multi-million-dollar ads do indeed show a plan, and you can ask to have one put in the mail, which might seem to be an improvement over the blatantly false advertising of the first round. You might think so, unless you look at the plan: the same plan that was sent out just before the last election, also at taxpayers' expense, with a couple of interesting changes. Last April the government said they would move towards a four-week maximum waiting time for cancer treatment. They didn't hit the target, so they just removed that from the plan. The document they sent out last spring before the election said they would improve ambulance access to hospitals. Well, we've had more emergencies on critical care bypass than in the history of this province, so they dropped that out of the plan too. And guess what else? They left out the graph showing the federal government was increasing spending for health care.

So the advertising continues, but is this advertising really about health care?
 

Ontario's capital, Toronto, has a plan to improve health care for Ontario's citizens. All we need is the $1.7 billion that the Liberals have cut on an annual basis since 1995. Ontario's nurses, doctors and hospitals agree with this position.

Canada's capital, Ottawa, on the other hand, has responded with a feel-good television ad depicting Canada as some kind of jigsaw puzzle. Despite the fact that the little girl in the ad is obviously well qualified for membership in the federal Liberal caucus, the fogginess of the message bears a distinct resemblance to the Ottawa Senators' trap. You'll remember the trap strategy in the Battle of Ontario. Although the details of the trap are best left to hardcore hockey fans, suffice it say that the trap's purpose is to induce a kind of stupor in opponents and fans alike.

Despite their best efforts, the trap did not work for the Ottawa Senators, and it won't work for the wannabe senators in the provincial and federal Liberal caucuses.

Canadians want hockey, not hypnosis, and Ontarians want their health care dollars back now, not hackneyed Liberal symbolism.

One more thought: Go Leafs, go.

Mr Howard Hampton (Kenora-Rainy River): My question is for the Acting Premier. For months we've been asking you what is going on in your closed-door negotiations with the doctors at the Ontario Medical Association. We now understand that within the last 24 hours a deal has been reached. We'd like to know the details. In particular, we'd like to know, does the deal continue the inadequate status quo where more and more communities, more and more families, don't have a family doctor, or are we going to see some real primary care reform? Are we going to see greater utilization of nurse practitioners? Are we going to see doctors, nurse practitioners and nurses working in teams, not on a fee-for-service but on a salary basis where we optimize all the skills? In short, we want to know, will the doctor now be in for all the people of Ontario and not just for some of them?

I expected an announcement today. Will you confirm that there is a deal with the Ontario Medical Association and will you tell us what the details of that deal are?

Hon Chris Hodgson (Chair of the Management Board of Cabinet): We are continuing to negotiate. I'm not aware of what he alleges to be true. My information is that we're still in negotiations and we will continue to negotiate for the best interests of the people of Ontario. We share your concern. We want to make sure that doctors and nurse practitioners are available to the public right across Ontario, not just in the urban centres. That's what we will be negotiating, to make sure our health system continues to improve and provide better service to the people of Ontario.

Mr Hampton: I want to ask the Acting Premier to re-examine his information, because we have been told that a deal has been signed. I'm going to ask you in particular here to either confirm or deny that. My fear is that we're not going to learn about this agreement here, that we'll learn about it on the next series of television ads during the next hockey playoff game, because that's been the pattern of your government.

But the particular issue is this: Three years ago, your Premier and your Minister of Health made a lot of noise about primary care reform, how you were going to change the system, move from the status quo, move to a new primary care system where more families would have a family doctor. It didn't happen. In fact, what's happened in three years is this: We've gone from a situation where there were 100 family doctor vacancies in 68 communities to one where there are 415 family doctor vacancies in 100 communities. Even your expert, Dr McKendry, says the situation is going to get worse if you don't make some changes.

So tell us the details, please. What is in this deal? What have you signed?

Hon Mr Hodgson: The information I have is that there is no concluded agreement; negotiations continue. That's the information I have and that's what you directly asked me.

I think the record speaks for itself. We do share the concern of Ontarians; we want to see more people serviced by doctors and nurse practitioners. We set up the pilot projects for the primary care, and the record is quite clear. In 1992, the NDP government reduced entrance spaces to medical schools by 10% and reduced post-graduate training positions by 10%. This means fewer doctors are graduating now. We recognized that we inherited a mess and we're trying to negotiate to make it better.

The Speaker: Final supplementary.

Ms Frances Lankin (Beaches-East York): Acting Premier, it will be interesting to see how these negotiations come out and whether in fact we do make it better. I suspect one of the reasons this is being downplayed is because you're going to fall way short of what everyone knows is needed in terms of primary care reform.

One of the first problems you have is that it doesn't just deal with doctors and you've buried the whole issue in negotiations with the OMA. We heard today from Ontario's nurses. Over the next 10 years, we're going to be 60,000 to 90,000 nurses short. There's a crisis coming if you don't take action now. They've said the time for real change is now. That means changing the way we deliver primary care so that we can better utilize the skills of nurses and other health care professionals so we can focus on keeping people well instead of only treating them when they're ill.

Minister, your own commission developed a six-year plan to reform primary care. Your minister and your Premier keep saying: "We're not going to go down that road. It's only going to be voluntary." It may be our only way of truly sustaining public medicare. Perhaps that's why you're not interested. I think, once again, you've sold out the public on primary care reform. If I'm wrong, prove it. Table the deal. Tell us if it's been signed. If you don't have the information, get it before you go out to the scrum, because Ontarians deserve to know whether this government has protected their interests, reformed primary care, or sold them down the river one more time.

Hon Mr Hodgson: As I mentioned before, my information is that we are continuing to negotiate with the OMA. In regard to the nurses, we agree with the Registered Nurses Association of Ontario. In fact, we helped fund their study--$500,000--on ways to improve the condition in Ontario for nurses and with more nurses. Some of the recommendations have already been implemented. The facts speak for themselves. We've invested $375 million to hire 12,000 new nurses. We've announced new mandatory four-year baccalaureate degrees in nursing, and we've allocated $22.6 million in implementing new standards for nurses. We agree we want to see more nurses, and we agree with improving it.
 
 

Mr Monte Kwinter (York Centre): Tomorrow during private members' hour we will be debating Bill 2, my private member's bill, which provides that a licensed medical doctor shall not be found guilty of professional misconduct or incompetence solely on the basis that the said doctor practises a therapy that is non-traditional or that departs from prevailing medical practice, unless there is evidence that proves that the therapy poses a greater risk to a patient's health than the traditional or prevailing practice.

This will be the third time this bill is debated at second reading. On two previous occasions, the bill was given unanimous consent but, unfortunately, on both occasions the bill died on the order paper.

Many positive things have happened since I first debated second reading of the bill on May 8, 1997. The College of Physicians and Surgeons of Ontario established an ad hoc committee on alternative medicine which made 14 recommendations in its report. One of the key conclusions is: "In essence, we believe that physicians be allowed a reasonable degree of latitude in the kinds of therapies they offer to their patients. We also believe that patients have every right to seek whatever kind of therapy they want." The Ontario Medical Association has also decided that the probationary section on complementary medicine should be granted OMA sectional status.

In the United States, more people seek alternative treatment than conventional treatment. That trend is also occurring in Canada. The time has come to ensure freedom of choice for the doctor and freedom of choice for the patient.
 

In the face of this inequity, northern Cancer Care Ontario officials decided to lobby this government for a northern program, like the one in place for southern Ontario cancer patients. They want 100% of travel accommodation and food costs covered too. In December 1999, Gerry Lougheed Jr, chair of Cancer Care Ontario's northeast advisory committee, met in Sudbury with northern Ministry of Health staff and was clearly told that such a proposal would be developed. He was promised he would have it by Christmas.

It's four months later, and nothing has come from the Ministry of Health. It's as if the meeting and the commitment made in December never occurred, and so this government continues with its blatant discrimination of northern cancer patients. Not only do northern patients suffer the emotional trauma of cancer treatment, but they face additional trauma wondering if they can afford to stay in Sudbury or Thunder Bay to be treated. There's no excuse in Ontario, in 2000, for northern cancer patients to suffer a financial burden in trying to access cancer care. To the government: Pay these costs now.

Mrs Karen Adams is in the gallery today, and I would like to describe her struggle in trying to donate an organ. Karen is a potential match to donate a kidney to her sister-in-law. Because her husband is receiving a disability pension, your government claws back all she earns at her part-time job except for the first $160 a month. If she donates, during her eight-week recovery every penny of her unemployment insurance will be deducted. Mrs Adams cannot pay her bills without this extra income. ODSP suggested that the organ recipient should reimburse her for the money.

Minister, why did it take a fear of bad publicity for ODSP to make a one-time-only exemption? For $320 your government was prepared to block an organ donation. Why is your government not making it easy for someone to donate?

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): I will refer that to the Minister of Community and Social Services.

Hon John R. Baird (Minister of Community and Social Services, minister responsible for francophone affairs): Obviously, our objective in setting up the Ontario disability support program is to provide a good income support program to people with disabilities. We're always concerned when we hear of cases like the one the member opposite described. I would certainly commit to look into the issue and to make a policy change if it is warranted. Obviously, the case of someone experiencing that kind of trouble is of great concern to anyone, and we would certainly be prepared to look into it.

Mr Parsons: That was somewhat of a wishy-washy answer. Not only has the surgery been delayed because of your government's policies, but now Karen is told that there will be no doctor available until at least the end of summer. Not only that, but the surgery may not happen at all, because the recipient family must first prove they can pay for the anti-rejection drugs for the rest of their life.

Minister, the recipient spends nine hours every night, plus lunch hour, hooked up to her dialysis machine. This operation would improve her life and that of her family. Your organ donor program appears to be tied directly to family income. Why is your government not supporting Karen's and similar families, and will you commit to meeting with Karen after question period to hear her story first-hand?

Hon Mr Baird: As I indicated to the member opposite, I would certainly be prepared to look into this issue. I regularly get suggestions from members on both sides of the House on how we can provide better programs for people with disabilities.

The member opposite read a scripted answer, saying he didn't like the answer to my question. It was obviously written before question period. The member opposite may have a difficult time taking yes for an answer, but we would be pleased to look into the issue and see what can be done.

With your permission, Mr Speaker, I'd also like to introduce Nick Shkordoff, my co-op student from St Stephen's Secondary School in Bowmanville.

Recently in my riding of Durham a number of my constituents had the privilege of listening to Minister Frank Klees speaking about his impressions of the historic turnaround in this province witnessed since we formed the government in 1995. Minister Klees identified a number of problems to which we found solutions. While our proven track record was certainly a hit with the audience that evening, the most overwhelming response came when he used the simple comment: "We did what we said. We kept our promises."

Minister, our record of keeping promises has not only contributed to the revitalization of Ontario but I think it has also helped the public's perception of politicians themselves.

Interjection.

The Speaker (Hon Gary Carr): Stop the clock, please. The member take his seat, please. Member for Durham, come to order.

Interjections.

The Speaker: Member, come to order. It is not funny. We are now waiting for the NDP, who will miss their question if the time runs down, and it's not funny. When I stand up and say the time is over, it is over. The member had a little over a minute and it is now the minister's time. I would appreciate it, when I stand up--it's not funny to stand up and continue on. The NDP will lose their question. It's very important. They are sitting waiting quietly and we can't have the clock run on.

Minister of Health for the answer.

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): When it comes to the Healthy Babies, Healthy Children program, I am very pleased to say that our initial investment into the Healthy Babies, Healthy Children program was $10 million. Based on--

Interjections.

The Speaker: Minister of Health, take her seat. Order. Stop the clock, please. I'm going to watch the clock. I thank all members on both sides for their support. I said we would have 10 seconds. Before, we said we were going to wait 10 seconds before it starts. If the member had heard that, had waited 10 seconds and then it starts, that's why the question was coming. Quite frankly, it's to give the opposition members more time, so I don't know what he is complaining about.

Mr Dwight Duncan (Windsor-St Clair): On a point of order, Mr Speaker: My understanding is the clocks are in here so we can all see the time. The clock was not running while the question was being answered and--

The Speaker: Member, take his seat. I explained to the members what happened. It is easier to wait 10 seconds when I put the time on the clock. The reason I am putting time on the clock is we are not going to miss a supplementary for 10 seconds because of foolishness going on on both sides with the official opposition and the government members.

The members of the third party don't get much of a chance under the new standing orders, and I'm determined to get down to that question. When games are played on both sides to run the clock down, quite frankly, it isn't going to go on.

I said there would be 10 seconds put back on the clock. It is easier to not start the clock than it is to add it, so we were doing it. That's the way it can be done, and in the future it will be done that way as well.

Minister of Health.

Hon Mrs Witmer: I am very pleased to say that our government has demonstrated its commitment to the welfare and well-being of all children in the province of Ontario. We announced our Healthy Babies, Healthy Children program with an investment of $10 million; that was in 1997. I am very pleased to say that last week I made an announcement indicating that we were increasing the amount of funding to a total of $67 million, which means that every child now born in Ontario will be screened to determine if they are at any risk and, if so, they will get support.

The Speaker: The minister's time is up. Supplementary.

Mr O'Toole: Thank you, Madam Minister, for that response. I know that to Durham this means in excess of $925,000, which certainly will go a long way to helping our children get a good start in life.

Minister, these are real changes. Could you share some of the other reforms that you have made working with the federal Minister of Health for all citizens of Ontario?

Hon Mrs Witmer: Yes, we certainly have made some very significant reforms in the province of Ontario, not only to the Healthy Babies, Healthy Children program, but we're also moving forward with primary care reform. We have expanded home care; in fact, our funding is the highest per capita in all of Canada. We continue to expand our drug programs to make sure they are accessible for those who don't have the funds to support them.

Unfortunately, despite the tremendous reforms that have been implemented by not only the Ontario government but governments throughout Canada, whether in the provinces or the territories, there has been absolutely no reaction and no response from the federal government. Of course, as you know, they continue to refuse to restore the federal transfer cuts.

The Speaker: The Minister of Health's time is up.

Hon Norman W. Sterling (Minister of Intergovernmental Affairs, Government House Leader): On a point of order, Mr Speaker: I would like to ask unanimous consent to allow the NDP to ask their principal and supplementary questions and extend the question period accordingly.

The Speaker: I've heard some noes, but we will attempt to get to it.
 
 

This shortage is so severe that vital CT scans and MRIs are simply not taking place when they should. The lack of anaesthetists has meant that desperately important surgeries are being cancelled. People cannot even get X-rays done because of the shortage of radiologists in Thunder Bay.

While all this is going on, the Ministry of Health makes funding announcements, as they did last week related to genetic screening programs for hereditary cancers, and leaves northwestern Ontario out of the funding loop.

This government needs to understand the gravity of the situation and to recognize that it has reached crisis proportions. With that in mind, I'm calling on the Premier to make time during his trip to Thunder Bay tomorrow to sit down with area physicians so that they can explain to him, face to face, the grim reality of health care in Thunder Bay. It is not often that the Premier visits our region. It is therefore crucial that he use this time in my community to deal with the most pressing issue we are facing in our region. Peoples' lives are increasingly being put at risk as this crisis deepens, and we need the Premier's direct involvement and support.

Fundraising dinners are part of the political process, and I respect that, but quality health care is vital to our survival. Premier, make time tomorrow to deal with this crisis and meet with our area physicians.
 

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): I rise in the House to introduce a very important piece of legislation that will mean better treatment for people with serious mental illness and safer communities across our province.

Brian's Law is named for Brian Smith, the Ottawa sportscaster killed in 1995 by a person suffering from severe mental illness. At the inquest into Brian's death, the jury recommended a comprehensive review of Ontario's mental health legislation and the introduction of community-based treatment programs to ensure that people with serious mental illness who pose a danger to themselves or others get the treatment they need. Today we are introducing legislation to fulfill those recommendations, recommendations that have been echoed too many times in too many inquests since 1995.

Brian's widow, Alana Kainz, has been a strong advocate for these changes to Ontario's mental health legislation, changes that will save lives and prevent other tragedies. I am honoured today to have Alana and members of Brian's family with us in the visitors' gallery. I would like to thank Alana for her efforts on behalf of all the people of this province, and I would like to express to her my profound respect and sympathy.

With the introduction of Brian's Law, our government is responding to the strong recommendations of coroners and juries, the expert advice of mental health care professionals, and the voices of many families who have felt helpless in the face of their loved ones' suffering.

Our government is committed to balancing the rights of patients with the safety of our communities, and Brian's Law will help us to fulfill that commitment by making sure that families and health care professionals are able to provide care and treatment to their loved ones and patients. The changes included in this bill enable community treatment orders for people with serious mental illness, and expanded grounds for committal to psychiatric facilities. They facilitate access to treatment by streamlining hearing and appeal rules and removing barriers to mental health care and treatment.

This legislation is critical to the reform of the mental health system. This bill is the culmination of 18 months of listening to the people of Ontario and experts from around the world, and there will be further discussion during debate and committee hearings.

I would like to acknowledge the work of my parliamentary assistant, Brad Clark, who consulted with people across the province on these changes. His work was informed by Dan Newman's June 1998 report 2000 and Beyond: Strengthening Ontario's Mental Health System, which called for review of Ontario's mental health legislation to support our reform efforts.

I would also like to thank my staff, particularly Lori Turik, and the Ministry of Health staff.

We have received important advice and guidance from many individuals and organizations and we are very honoured to have some of those people here with us today in the visitors' gallery: Mr Ted Fielding and Ms Janice Wiggins, of the Schizophrenia Society of Ontario; Dr Stephen Connell, of the Coalition of Ontario Psychiatrists; Barb LeBlanc, of the Ontario Medical Association; the Honourable Justice Douglas Carruthers; and Ontario's chief coroner, Dr Jim Young. I would also like to recognize at this time the efforts of Mr Richard Patten, the MPP for Ottawa Centre, who has been a strong advocate for these changes to the Mental Health Act.

Today we are responding to all of these voices and to the needs of those individuals who are caught in the storm of serious mental illness. I would also like to acknowledge a family that has suffered a tragic loss and is here with us today to witness the introduction of this important legislation. Lori and Tony Antidormi lost their son, Zachary, in 1997. Again, Zachary was killed by a person who was suffering from serious mental illness. On behalf of all the members of this House, I offer our profound sympathy to the family and assure them that Zachary is in the hearts and minds of all of us today.

For Zachary and for Brian and for all the families and the individuals who have experienced the terrible effects of serious mental illness, we are introducing Brian's Law. Enormous strides have been made in the last century in mental health. Today I can confidently say that we are lighting the way for the new century with this landmark legislation.
 

There is growing concern among doctors and patients that this significant issue is not being addressed by these bureaucrats. Recent investments in this area, such as the provincial hip registry for $2 million, while laudable, seem to place dollars at the wrong end. Preventing hip and wrist fractures is far more cost-effective than treating them or tracking them after the fact. In 1996, Ontario spent $394 million on osteoporosis fractures, 98% of these dollars going to acute and long-term care. Given that these therapies, such as Evista, cost only $570 per patient per year, an investment in prevention of fractures rather than costly treatment of fractures makes sense both from a human and cost factor.

We are today calling on the Minister of Health to take action, provide our women with access to Evista in order to lessen their pain and at the same time save taxpayers' money now.

It hit home personally last winter when my little grandson, James, had a terrible asthma attack which hospitalized him for a week. I can't tell you how worried his mother, father and I are, looking toward more smog this summer.

Those health effects pose a burden on the health care system through increased emergency room visits and increased hospital admissions. Regrettably, this scenario will likely be a repeat of previous years.

We can, however, take concrete steps to avert this health and environmental disaster. Yesterday, my colleague Shelley Martel asked the Minister of the Environment to ensure that the conversion of Lakeview generating station from coal to natural gas be made a condition of sale. The minister spoke platitudes about the environment but did not answer her question about Lakeview.

This generating station is the single largest polluter in the GTA. According to Jack Gibbons of the Ontario Clean Air Alliance, Lakeview operating at 80% capacity creates a smog equivalent to roughly one million cars. I would ask the minister to get on this and make the announcement today.

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): I'd like to go back to the cancer care issue and just let you know, because there was no broken promise, as you very well know, that our government has undertaken steps on an ongoing basis to ensure that the needs of cancer patients in this province are addressed. In fact, this morning I launched a $3.8-million genetic screening program to detect the risk of hereditary breast, ovarian and colon cancer. I can tell you that this will have a tremendous impact in the saving of lives among the women and the men of this province, who will have the opportunity to have the genetic testing if they have a history of this in their families.

We are moving forward. We are the only province in Canada to set up this program and an advisory--

The Speaker (Hon Gary Carr): I'm afraid the Minister of Health's time is up. Supplementary.

Mrs Pupatello: I'd like you to answer this question. I'm going to tell you about Rachel Ross. Rachel Ross is one of 12 mothers from Toronto--she's from Caledon East--flown to the Ottawa General Hospital in the last 12 months to deliver babies. Rachel was the first-time mother of twins. She went into labour after 26 weeks of pregnancy on March 17. That was last month. First, she went to Brampton Memorial. She was told there were no neonatal beds available in Toronto or Hamilton. She had to make a choice: Ottawa or Windsor. She chose Ottawa because she has some family there. Then she was told she would have to go by land ambulance, but the doctor wouldn't allow the five-hour drive there. After several delays she was airlifted by helicopter and told that an obstetrician and paediatrician had to go with her. There was no doctor on that helicopter ride to Ottawa. Her husband wasn't allowed to fly with her; he had to buy his own airline ticket.

Could you please explain how today in Ontario you could possibly let this happen to expectant mothers?

Hon Mrs Witmer: As the member knows, we have been expanding the system in the province to ensure that these deliveries can be delivered as close to home as possible. We have put the program forward to you where we are expanding the capacity within the system, and that is ongoing and that is happening. Any decisions that are made concerning these issues are clinical decisions that are made by physicians who are in the best position to know what is going to be the most appropriate level of care that is going to be required for patients they're dealing with.

Mrs Pupatello: Minister, here's what you said on December 17, 1998: You vowed no other women would be turned away and sent to another city. That was your promise. In this case, the doctor said the twins were ready to be moved back to Toronto in a week. They spent two weeks at the Ottawa General because there were no neonatal beds available in the largest city in the nation. As the mom, she was out of the hospital after four days. She stayed two weeks in Ottawa. She was given a one-way ticket to Ottawa and had to find her own way home when it was time to come home.

Minister, please explain to Rachel Ross and every other expectant mother in this province how you could allow this to happen in the province today after the promises you made a year and a half ago.

Hon Mrs Witmer: The member might be pleased to know that unfortunately this was a problem that existed under your government and under the NDP. For more than 10 years in the province we have not had enough NICU beds--

Interjections.

The Speaker: Minister, take your seat. Order. Member for Windsor West, come to order. You can't ask a question and then yell at the minister when she's trying to answer it.

I will say this: When I have to stand up, it gives the cabinet ministers a lot of time to answer, notes get sent in. It's in your interest to let them answer the question, because quite frankly, if we need to stand here, we will do that. You can't ask a question and then yell at the minister when she's trying to reply.

Interjection.

The Speaker: I say to the member for Windsor West, this is your last warning. We can't continue to go on. You've got the question asked and you cannot shout at the minister after you've asked the question. This is your last warning.

Minister of Health.

Hon Mrs Witmer: As I began to say, although the previous two governments chose not to address the issue, our government acknowledged that there was a need to increase access to neonatal intensive care services. Presently, in the city of Toronto, neonatal intensive care beds are available at three hospitals. We are working to expand the capacity at these hospitals: Women's College, Mount Sinai and the Hospital for Sick Children.

There was $10 million annually set aside to fund 18 new bassinets at these hospitals; 14 are already up and running, with the others to come on board shortly. There was an additional $4.1 million put aside for equipment purchases, training and minor renovations. We are fast-tracking 14 additional beds at the Hamilton Health Sciences Centre.

The Speaker: The Minister of Health's time is up.

While you negotiate with the Ontario Medical Association, while you have the authority and the capacity now to ensure that the doctor is in for all the patients in the province and that nurse practitioners and nurses are in, what are you doing and what have you done in situations like poor little Cody's?

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): Our government has recognized that there is a need to ensure that we have the appropriate distribution and supply of physicians in the province of Ontario. As you know, we originally asked Dr McKendry to take all of the information available, and he has reported. As a result of his report, we have expanded the number of foreign-trained doctors into Ontario. We are making available spaces within our program here for people who want to return from the United States. We have expanded the number of nurse practitioners. In fact, it was our government in 1998 that made it possible for legislative changes to take place, and we are presently funding approximately 226 nurse practitioners, although I know there are more practising in the province.

We recognize that people need--

The Speaker (Hon Gary Carr): I'm afraid the minister's time is up.

Mr Hampton: Minister, your government has been in charge now for five years, and for five years the situation has gotten worse and worse and worse. I could take you to the city of Kenora, where the same situation prevails, or I could take you to literally dozens of communities across this province. The fact of the matter is, you're negotiating with the doctors, with the Ontario Medical Association right now. For five years, you and your Premier have said that you believe in primary health care reform; you believe in a system where doctors would have a roster of patients, where they would be available full-time; where nurse practitioners would be available; where nurses would be available. But for five years, nothing has happened, and this little boy has to go outside the province just to see a physician.

You are negotiating with the OMA right now. What is going to come out of the Ontario Medical Association negotiations that's going to help this little boy and literally hundreds of thousands of patients across this province? Are you going to do anything, or simply blame governments of the past?

Hon Mrs Witmer: I would remind the leader of the third party that it was unfortunately his government that cut medical school enrolment by 10%. We, of course, have been moving forward. I am pleased to report that the number of specialists in Ontario has increased since 1995 by 450. We have recruited 115 specialists for designated underserviced areas in northern Ontario. According to CIHI, the Canadian Institute for Health Information, the total number of active physicians in Ontario has increased by over 260 since 1997. So certainly there are increased numbers of physicians in the province, there are more in northern Ontario, and there continues to be more that we need to do.

We have moved forward. We did introduce the primary care pilots. We started with four and we have now expanded to seven. We want to continue to evaluate and make those available to all people.

The Speaker: I'm afraid the Minister of Health's time is up. Final supplementary.

Mr Hampton: Let me get back to real people in real communities. Two doctors have left Dryden in the last year, two more are leaving this year. If you go down the highway to Kenora, a similar situation: More physicians are leaving.

Minister, this comes back to the choices you have to make as Minister of Health. We've seen how you've mismanaged the system. You cut $800 million from hospitals. You discover you made a mistake so you put $600 million back in. You boast about laying off nurses--the Premier calls them Hula Hoop workers-- then you discover you can't run the health system without them, so you start rehiring nurses.

Right now you've got two choices: You can continue to go down the road that you're on, which leads you to a Ralph Klein style of privatized health care, or you can have a serious set of negotiations with the doctors and begin to change in a serious way the delivery of primary health, the access to nurses, nurse practitioners and doctors. It's in your hands right now. Are you going to keep on mismanaging the system until we have more of these or are you going to take the doctors on and change the system?

Hon Mrs Witmer: Our government has undertaken the moderization and the strengthening of this health system. I have said on many occasions that we were the first government to do so and the last province in all of Canada.

I would just remind the leader of the third party that in the last full year of your government there were 345 doctors who left Ontario. In 1997, that rate had been reduced by a third. It was your government that reduced entrants to medical schools by 10% and reduced postgraduate training positions by 10%. It was your government that saw the greatest decline in nursing supply: It went down 8.9% from 1993 to 1995. We are having to deal with the consequences of your actions, and that's why we're moving forward to ensure there are appropriate physicians everywhere in the province and that we hire 12,000 additional nurses.

I want to refer specifically to an organization that provides long-term care to Polish seniors. Copernicus Lodge in my riding has been waiting for many, many months and they are in the same position as many non-profits. In the first round of choices by this government, they gave funds to private companies and omitted these important community needs. There are whole communities with frail elderly people who aren't getting the services they require.

In addition, the chronic care hospital in my area, Runnymede, has been extended in its funding for one year. Again, a government is forgetting about frail and chronically ill people by making them wait, by making them not know what the future is.

The hardest thing for families is not to have a secure future. This government for some reason, after the election, has forgotten about that, has forgotten these people. Today, I hope we will remember them and I hope the government will act very soon.

Minister, this is your strategy. It's your plan and your policy that is causing this turmoil and is putting services to some of the most vulnerable citizens of Ontario at risk. What are you going to do to fix the turmoil you have created?

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): The leader of the third party knows that during the time our government has been in office, we have concentrated significant efforts to ensure that those who suffer from mental illness are indeed getting the additional services they require. In fact, we have been undertaking consultations, first with Mr Newman, and more recently we have had the new PA undertake that responsibility. We are building a continuum of care that starts with prevention, goes through to the community and ends up with hospital care. We have invested more than $150 million in community- and hospital-based services. We have $19.1 million and 140 new beds for community-based mental health services. We have set aside $45 million for supportive housing for the mentally ill.

The Speaker (Hon Gary Carr): Order. I'm afraid the minister's time is up. Supplementary.

Ms Frances Lankin (Beaches-East York): Could we for a moment focus on the Centre for Addiction and Mental Health. Please understand that three years ago, when the order for the merger and amalgamation took place, your assistant deputy minister at the time, Ron Sapsford, made a commitment to members of the community, to the staff and to the professionals that there would be put in place a monitoring program to safeguard patient treatment at Queen Street and the community of mental health facilities that were being offered through that facility. What everyone in the community is saying now is that through the restructuring and through the merger, those safeguards weren't put in place. In fact, resources are being taken away from patient treatment and being focused on research, which meets a national and international agenda but does nothing for mentally ill patients on the streets of Toronto who need those facilities.

Two examples: The Lakeshore outpatient program was recently shut down and reallocated back to Queen Street, supposedly because of building renovations. Renovations have been done for a month; the services have not been committed to be reopened. There's an indication they're going to be moved out to Peel. A rehab program at Queen Street, the DARE program, and a couple of others have been shut down without any consultation or notice.

Minister, the three people who resigned were patient community advocates. Surely you're concerned, surely you've talked to them about why. What are you going to do?

Hon Mrs Witmer: Again I would say to the third party that our government has worked to ensure that there are community services in place. As the member well knows, we have expanded community-based mental health services. Today we have 51 assertive community treatment teams that are available to help people in the communities. We've set aside $19.1 million. We have enhanced the court diversion programs, we now have psychogeriatric outreach, we are doing case management and we are providing crisis support services. So we have moved forward to ensure that more and more individuals can get the support that is needed in the community. Certainly we have seen an amalgamation of services within the city of Toronto, but I can tell you that today, based on the information I have just provided, there are more community services available 24 hours a day than ever before in this province.

Ms Lankin: One more time: the Centre for Addiction and Mental Health. Will you talk about that institution? You've merged the services of the former ARF, the Clarke, Donwood and Queen Street. In that, you promised to safeguard patient treatment within that facility. Everybody in the community is telling you that what has happened through that merger is that resources are being put over to the research side and that patient treatment is going by the wayside. You have now had three very prominent, high-profile patient community representatives on the board of directors who've resigned, two of them publicly saying it's because patient treatment is not getting the right attention and they're not getting the proper information and accountability from the administration of the centre.

This is your responsibility. Please talk to people in the community. Talk to the heads of psychiatric departments in every hospital in downtown Toronto. They'll tell you they're getting the spillover. I'll tell you what people are saying out there, and it's not very nice. They're saying that within that centre right now, the patients at Queen Street are being used as guinea pigs for research. Minister, you need to step in and show who's managing the mental health system and who's in charge of these services at this institution and bring some accountability back to the process.

Hon Mrs Witmer: I think we need to take into consideration that the board of directors at the Centre for Addiction and Mental Health is in full operation and they are proceeding with their role in governing the hospital according to the mandate they are attempting to fulfill. There is a new chair and they are certainly moving forward. We have committed and directed over $136 million there in 1999-2000 in support of the Centre for Addiction and Mental Health and we do believe they are meeting the governance of the CAMH and they're meeting the legislative requirements of the Public Hospitals Act.

In Ontario there have been many organ transplants performed with similar successful stories that have given hope to people of all ages. The donors and the recipients come from many diverse backgrounds, but they all have one thing in common: the gift of life, whether they are giving or receiving it.

Premier, it has been six months since your advisory board on organ and tissue donation was established. Can you please tell the members of this House what the advisory board and this government are doing to increase public awareness for organ donations?

Hon Michael D. Harris (Premier): I appreciate the question because I haven't had many good questions this session, and I appreciate the member's interest.

As I indicated, the advisory board on organ and tissue donation was announced in the throne speech last October, and it is chaired by Don Cherry. They have an expert panel of those who have a great interest. Don Cherry, as I think many members would know, not only has an ability to reach a lot of people but he has a vested interest. He has said many times his son Tim would not be alive today were it not for his sister Cindy who donated a kidney.

So I have asked the panel, which includes many other experts and great spokespeople like Tie Domi and Muggsy Bogues from the Raptors, who have agreed to help us spread the word, and we are doing a lot of that. We expect a final report by the end of May. We will make that report public, and we hope those recommendations will assist us to correct a record that we're not real proud of in Ontario on the number of organ donors.

The Speaker (Hon Gary Carr): The Premier's time is up. Supplementary.

Mr Stewart: We all know that we could need a donor organ someday. In fact, right now there are 1,200 adults and children waiting for kidneys in Toronto alone, with 200 more across the province waiting for other transplants. The unfortunate fact is that many will die waiting.

Premier, there are no two ways about it: We must increase Ontario's organ donation rate. What is being done to make this happen?

Hon Mr Harris: We are trying to raise awareness and we are awaiting recommendations. This government has taken action. We have put over $2 million into donation awareness campaigns. We've spent almost $4 million since taking office for organ transplant programs. But I want to say it is clearly not enough; he's right. We have a serious obligation to do all we can to increase the number of organ donations in this province, and also to look at any other barriers that are there, once they are donated, to getting them to those who need the donation.

Our millennium challenge was to double Ontario's organ donor rate over the next five years; it's not just to invest in programs, it's awareness. Undoubtedly some dollars are going to be required as well.

I can tell the member we look forward to the recommendations at the end of May. We're not waiting to help raise awareness and we will act quickly to substantially increase--

The Speaker: I'm afraid the Premier's time is up.

You said yesterday, Minister, that you had to take into consideration concerns that had been expressed nationally and internationally that are compelling you to take a cautious and measured approach. But the recommendation for a provincial program in Ontario was based on a thorough study that was done by the expert panel that you put in place. The members of the panel looked at the cost of the program and they weighed that against the lives that would be saved with the screening program, and they recommended a provincial screening program for all individuals over 50 years of age. They specifically recommended against the pilot program that you're proposing.

Minister, your own expert panel said clearly: "It is unlikely that a significant decrease in mortality, morbidity or direct/indirect societal costs will occur in the absence of clear, specific guidelines aimed at the majority of individuals at average risk for colorectal cancer."

Colorectal cancer is expected to kill 2,300 Ontarians in this next year alone. Your pilot project might save one or two. But I ask you today what you'd say to all the others whose deaths might have been prevented with a full provincial screening--

The Speaker (Hon Gary Carr): Time is up.

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): Our government has invested over $155 million in cancer services and cancer care since 1995. In fact, we have been moving forward in order to ensure that the appropriate screening programs can be put in place. As you know, we have breast cancer screening programs, we're doing cervical screening programs and we will be continuing to make announcements in future months indicating movement in the area of prevention. We are certainly working collaboratively with not only Cancer Care Ontario but others in the province who have a keen interest in ensuring that the incidence of cancer decreases. Unfortunately, the incidence of cancer continues to increase, but in specific response to the member's question--

The Speaker: I'm afraid the time is up. Supplementary.

Mrs McLeod: You're not working collaboratively with Cancer Care Ontario on this particular program. They're recommending a full provincial screening program. They thought you agreed. They say you're stalling and backing off what you were prepared to support. You can't use concern about evidence as an excuse for inaction.

Again from the report, the recommendations of your own expert panel are supported by the Canadian Cancer Society, the Canadian Society of Colon and Rectal Surgeons, the Ontario Association for Gastroenterology and the Ontario Association of Pathologists.

There is only one reason why you're refusing to put in place a full provincial screening program and the reason is you're not prepared to pay for it. You said as much yesterday when you said you had to take into consideration the high cost of the program, and yet you are probably paying more for the treatment of this cancer in its advanced stages than you would be paying for the screening program.

Minister, I don't understand your government's action on this. I don't understand a government that can spend millions of dollars advertising its concerns for health care and yet refusing to put in place a screening program for a cancer that kills 2,300 Ontario men and women every year. I guess all I can ask is, how does your government place a cost--

The Speaker: I'm afraid the member's time is up. Minister of Health.

Hon Mrs Witmer: As I indicated yesterday, we are awaiting the Canadian Task Force Report on Preventive Health Care. They have yet to endorse the colorectal cancer screening. As you know, no other country in the world has undertaken that type of screening program. What we have said to Cancer Care Ontario is that we want them to embark on a pilot program, as they are doing in England and Scotland. There are still some concerns that have been expressed, both nationally and internationally, about a population-based approach to colorectal screening. Until such time as those concerns are dealt with, we are suggesting that they move forward with a pilot program, as is being done in other countries.

Dr Sinclair, a family doctor, works an average of six days per week, and he reached his cap four months before the year-end. My question, Minister, is this: How much work do you expect out of Dr Sinclair for free?

Hon Elizabeth Witmer (Minister of Health and Long-Term Care): As the member knows, we do take the issue of physician distribution and supply very seriously. As a result, we had Dr McKendry do an initial review of the situation. His findings have been provided to Dr Peter George and the expert panel. They are now providing us with a long-term plan to ensure that as we move forward we will know precisely the number of specialists and family physicians that are going to be required throughout the province of Ontario and we can ensure that they are placed into communities where they are needed.

In response to the McKendry report, we did make some very short-term recommendations. Those are being implemented right now. As you know, we are increasing the number of foreign students in our programs. We are encouraging people to come back from the United States. I might add, over the past few years, between 1997 and 1998, the rate of physicians leaving Ontario has actually decreased--

The Speaker (Hon Gary Carr): Order. The minister's time is up.

Mrs Pupatello: Dr Sinclair in my riding says this: "I have continued to work well past the cap because I refuse to close my doors to people who did not want this situation any more than I did. I've lived up to my oath and I'm exhausted."

Minister, despite all the reports, there is no denying we have a shortage. You gave us the designation. You know there's a shortage. We have 30,000 to 40,000 people without a family doctor. He applied for the exemption and he was denied. I am asking you to review this case. Please review this case and help all the people in my riding who do not have a family doctor. Reports aside, the issue is real and it's there today. You can make a difference to help the people in my riding. I am asking you today to undertake to look at this application and provide an exemption for Dr Sinclair.

Hon Mrs Witmer: As the member knows, certainly there is always the opportunity to appeal. Again, I would emphasize the fact that our government has taken unprecedented steps to address the issue of physician supply and distribution. It is an issue, unfortunately, that has gone on for many, many years in Ontario. We now have in place a panel which will develop, for the first time in the history of this province--no other government undertook to do this in the past--a long-term plan to ensure that we have the appropriate number of family physicians where they're needed, to also identify what kinds of specialists are going to be needed in the future, particularly in response to our aging and growing population, and let's make sure those specialists are located where they need to be.