MR. CHAIRMAN: I would like to welcome first our presenters here. Of course, it is nice to see our MLAs back. There are a couple I will have to re-identify, if I can comment on the new apparel or lack of on a certain member for Yarmouth, but more importantly we have an interesting issue to deal with here this morning. My name is Bill Estabrooks. I am the MLA for Timberlea-Prospect and I have the privilege of being the Chairman of the Public Accounts Committee. I would ask the MLAs, beginning with my colleague, the member for Halifax Fairview, to introduce themselves, please.
[The committee members introduced themselves.]
MR. CHAIRMAN: Thank you. I see that we have been joined by Dr. Smith, the MLA for Dartmouth East. If our witnesses could introduce themselves, please.
[The witnesses introduced themselves.]
MR. CHAIRMAN: Thank you. Prior to beginning, we have an opening statement and I would just like to read it into the record. It is something that we, as a committee, have worked on and it clarifies some of the events that will be happening here, as at each Public Accounts Committee meeting.
I remind our witnesses that, "Nothing that you say to us here today can form the basis nor support a cause of action, either civil or criminal. You are protected from interference, threats or legal proceedings on account of what you may say or do before this Committee. No evidence that you give as a witness before this Committee may be used against you or any other person in any other place without the permission of this House of Assembly except that, if false evidence is given by you under oath or solemn affirmation, you may be charged with perjury. You may be required to give your evidence under oath or solemn affirmation. You are bound to answer all questions that this Committee sees fit to put to you. If you are unwilling to answer a question, you may, after stating the reason for desiring to be excused from answering, appeal to me as Chairman of this Committee, as to whether, in the circumstances and for the reasons stated, an answer should be given. If you are not excused from answering, you may request that the whole or a part of your evidence be given in camera and not be published and the Committee will give consideration to your request."
I thank you for allowing a school principal to sound like a lawyer for a few moments. If you have any questions, of course, we can discuss those. I remind the committee that we are going to reserve the final 15 minutes of this session for correspondence. We have a couple of pieces of correspondence which we will be addressing so, hopefully, at 9:45 a.m., or thereabouts, we will be asking for our witnesses to be excused at that time.
We usually begin with an opening statement from one or all and, as I mentioned to you before, in the 10 to 12 minute duration would be acceptable. You may begin. Ms. Pike, I assume you are going first?
MS. MARILYN PIKE: Yes, thank you, Mr. Chairman. First of all, I would like to thank you all for inviting us here today. This is a timely opportunity for us in that - and I know you are aware of this - we have just released our first ever annual report and this gives us an opportunity to explain what is in that report, also to update you on the activities that we have engaged in over the past little while since that report was published, also to explain how we have delivered those services and something I know that you are very interested in, how much it is costing taxpayers to deliver that service. So this gives us another opportunity to be accountable to the public. We welcome that and we thank you for giving us that opportunity.
I would like to take about 10, maybe 12, minutes to walk through the annual report. I am not going to be reading what is in there. What I hope to provide you with are the highlights in each of the sections. Before I do that, I want to answer a question that might have occurred to you when you got the annual report last week. Where does this come from? Why is EHS publishing an annual report? This is as a direct result of the Auditor General's Report in 2000. In that report, the Auditor General recommended that EHS report performance in accomplishing planned objectives to the House annually. Again, the AG recommended that such a document be prepared annually and again, on Page 141 of the
report, the Auditor General states that an annual report should be prepared. So that's why EHS put the annual report together. As I say, it's our first one.
I would like you to turn to Page 1 of the annual report and if you don't have your copy in front of you, there are extra copies here. I would like to point out that the system is more than the ground ambulance vehicles that you see on the road, more than the helicopter. Those are the most visible pieces of the system. However, there is much more to the system than that. In fact, there are six components to our system. There is the ground ambulance, as I have already mentioned; the Communications Centre; there is medical oversight; there is an Air Medical Transport Program; a Trauma Program; and a Simulation Centre.
What is very unique about our system is the fact that each of these components, while separate, are also integrated. That doesn't exist anywhere else in Canada and, in fact, it doesn't exist anywhere else in the States where there is a province-wide or a state-wide system that actually integrates all of those components. So it is a unique feature and it is also a strength and it is recognized, and has been recognized, by other jurisdictions across Canada as well as internationally. In fact, Dr. Cain has just returned from a trip to Russia where he has consulted with the Russians on how best to go about developing their emergency health system.
I would like to introduce you, again, to the members of my team that I have brought with me today as I go through each of the programs just so you can put a name and a face to an area of responsibility. So, as you will see on Page 2, it starts out with ground ambulance. Derek Leblanc is the Coordinator of the Medical First Response Program for the province and he also provides administrative support to the ground ambulance contract.
John Ferguson works with EMC, Emergency Medical Care, and he is the Manager for the System Status Plan. John is responsible for determining, based on volume, where ambulances move throughout the province.
Tony Eden, some of you, I think, are familiar with Mr. Eden. He can't be with us here today but he also supports the ground ambulance piece.
In terms of the Communications Centre, the director for that is Grant Lingley. Unfortunately, he is ill today.
Medical oversight is under the direction of Dr. Cain and he is our medical director for the entire system.
In terms of the Air Medical Transport Program, the Trauma Program and the Simulation Centre, Paula Poirier is the director for those programs. She can't be with us here today because she is at a disaster planning exercise. However, I was responsible for those
programs up until a year ago so if you have any questions in relation to those, hopefully I will be able to answer them.
If you could look at Page 5, the vision and the mission for Emergency Health Services is listed there and the Auditor General, in his report, noted that EHS had a thoughtful and comprehensive strategic plan. Indeed, that has been in effect since 1996. It served us well because it has provided us with objectives and direction in terms of how we would go about becoming a centre of excellence. We update our plan yearly and we are always three years out.
Turning to Page 7, starting there, the various programs are described in more detail. I want to drill down a little bit more into each of those program areas, providing you with an update on what's happening there.
The first area, the paramedics; that's on Page 8. Certainly our paramedics are the backbone to the system. They're invaluable to the system. In 1998-99, we had 873 paramedics registered in this province. Of those, 94 were P3. Today, in the current registration, we have 833 paramedics, and 135 of those are P3s. We have stayed constant at 136, 135 over the past couple of years. We do have legislation prepared, paramedic legislation, that is ready to go. Hopefully it will reach the House in the fall of 2002. If you want more information on that legislation, Dr. Cain can certainly provide that.
We have a P3 program running in the province right now. It started in the fall. It's a collaborative effort between Holland College and the Nova Scotia Community College, and it's based in Truro. The next session will start in Sydney in the next couple of months. The session after that will be in Middleton, and the last session, the fourth session, will be conducted in Port Hawkesbury. The actual site is moving around to the various community colleges in the province.
We have 17 people currently enrolled in the P3 program right now. John is one of those people, so if you have any questions you want to ask about that program, certainly he can provide some of those answers. The hourly wage for paramedics by the end of March will reach an average of $15.52. You need to keep in mind that prior to 1995 paramedics were working around 100 hours, between 42 and 100 hours, and they were getting paid minimum wage. Those are just some of the highlights that are happening within the paramedic group.
In terms of the ground ambulance program component, which starts on Page 9, I just want to spend a few minutes going over why the system that cost $13.6 million pre-1995 now costs in excess of $50 million. I want to speak to that point in just a minute. However, before I move to that I would like to point out that both John and Derek were paramedics in the old system and they continue to be paramedics in this system. Dr. Cain was an emergency physician in the old system and continues to be an emergency physician in this system. I'm a nurse, I was a nurse in the old system and obviously I'm a nurse in this system.
I know that you've heard the background and where EHS came from probably many times over, but I think it's worth repeating briefly so that you do have an understanding or an appreciation of where we've come from so that you can understand why the system that cost $13.6 million pre-1995 now costs more than $50 million. Hopefully this handout that's in front of you will help to illustrate that point. As you know, in the pre-1995 system we did have 54 separate operators in the province. There were no standardized vehicles, equipment, supplies or personnel. It was generally a loss leader for funeral homes, and hearses and vans were used.
Currently we have one ground ambulance service and two small volunteer services. All ambulances are equipped like a mini-emergency department, so they have all the supplies that they need to take care of emergencies. The pre-1995 system was a level of efforts system, which means that there were no performance standards. You could call an operator and they could answer the call in 6 minutes, 60 minutes or not at all. That was up to them. The performance standards are identified in the current contract. The contractor needs to comply with those performance standards or they're penalized. They have 9 minute response times, 15 minute response times and 20 minute response times.
Pre-1995, it was generally an add-on to another type of a business, generally funeral homes. The care and the transport was provided by ambulance drivers and attendants. In the system today, we have doctors overseeing the system 24/7; that means there's a physician always readily available to the paramedics, if they need advice or direction. Paramedics now have to take a training program and need to be qualified as a P1, P2 or a P3. They also need to re-register every two years, and they need to maintain their competency.
The pre-1995 system was a transport service, this system is a medical service. In the old system the call and the dispatch frequently did occur from somebody's home. Ambulance drivers and attendants, as I mentioned earlier, worked 42 to 100 hours and were paid minimum wage. Currently we have dispatch from a medical communications centre with qualified paramedics able to give advice over the phone, so they can coach somebody through a choking or a cardiac arrest, some kind of an emergency. In the pre-1995 system we don't know for sure but we estimate there were about 65,000 transports; today there are 85,000 transports. The average cost per transport in the pre-1995 system was $186; currently it's $571. But those are the reasons for the increase in that cost.
I want to hasten to add that, because sometimes I think when we go over that description it sounds like everything was wrong and negative in the old system, and that's not the case. There were some very progressive operators who did an excellent job. They deserve credit for that. The infrastructure, however, at the time did not really support their efforts. Those are some of the reasons why the increase in cost.
I would like to move along now to Page 12, and I want to point out the response times. You'll notice the pie graph at the top of Page 12. Sixty-six per cent of emergency calls across the province - so this is a provincial statistic - are answered in nine minutes or less; 22 per cent of the emergency calls are answered in 16 minutes or less; and 10 per cent are answered in 30 minutes or less.
On Page 13, you'll note the description of the fleet. We have 142 vehicles in the fleet; 141 are part of EMC, one belongs to Pubnico. We have 142 vehicles in the fleet; 129 of those transport patients, three provide support and can give care but cannot actually transport a patient, and six provide support to the fleet. If something is needed in terms of actual vehicle or ambulance, there is a vehicle that can go out and lend that support. There are four support vehicles: one transports the simulator around the province, so it does education; one is for disasters; and two are administrative vehicles. So that's our fleet.
On Pages 16 and 17, those are two initiatives that were underway. They're current, they started in 2002. They are still underway. One is a vehicle safety program, that program is designed to develop a culture of safety within the paramedics. Both John and Derek can certainly provide you with more information in terms of that initiative. The Long and Brier project is something that we have going off of Digby in which we use paramedics who are not busy providing emergency care, they do one emergency call every 2.8 days on the Islands. During their downtime they are providing assistance to the community, within their scope of practice, but out in the community.
On Page 19, the Communications Centre. The communications centre is really the hub or the central link to the rest of the system. It provides support to every single component of the system. The communications centre will be accredited in the spring. It will be only the fourth centre in Canada to achieve accreditation. I need to stress that our communications centre is not 911, 911 downloads to us, just as it downloads to fire and police so we are not one and the same. Sometimes people are confused by that.
Medical oversight on Page 21 is described. I have already mentioned that we have physicians available to paramedics in the system 24/7 and what that means. You will notice there are statistics on the bottom of Page 22, those are cardiac arrest statistics. Dr. Cain can explain that in more detail to you but that indicates, that's one of our benchmarks in terms of how well we are doing. As you can see, we are progressing, we are improving.
On Page 23, the Air Medical Transport Program is described. When we started the Air Medical Transport Program in 1996-97, we did 250 missions per year. We're up to a little over 600 missions as of the end of December. The eastern region uses the Air Medical Transport Program the most, followed by western, followed by northern and central. We did four scene responses when we started that service in 1998-99 and we're up to 100 scene responses a year.
The trauma program - and that has been getting a lot of press, it got a lot of press last week with the release of the CIHI report. This program has a registry and it gathers data, in terms of trauma, across the province. So it provides us with data, with evidence, that we need to set our clinical standards and determine how we should care for these types of patients. It also is very much involved in injury prevention initiatives.
On Page 31, the simulation centre is described. The simulation centre provides educational opportunities for not just paramedics but nurses, respiratory therapists and physicians in the system. We did 10 courses in 1998-99, we are up to 118 today and this centre generates its own revenue through the courses so it is self-sufficient.
On Page 34, we have our financial summary. If you could turn to that for just a sec, I just want to point out a few things. It starts in 1998-99, the financial summary, and you'll notice that in 1998-99, the total budget for EHS was $58 million; $53.2 million of that was for the ground ambulance service and during that time, the private operators were purchased at a cost of $14.3 million. The bulk of the fleet was purchased at a cost of $6 million; - no user fees were collected at that time - and there were close to 82,000 transports. In 1999-2000, it was a $53 million budget with $46.8 million of that going to ground; user fees were collected so at that time we started collecting user fees and we collected $4.3 million during that time. As you can see, 83,000 transports, a little over that - sorry, you don't have that information, that is in the annual report closer to the front. I'm just repeating that.
In 2000-01, there was a $50 million budget, $48 million of that went to ground ambulance. The paramedic contract was signed so there were salary adjustments. User fees were collected, we collected $1.4 million more in user fees during that period of time and all program areas reduced their budgets by 2.4 per cent and we did about 84,000 transports during that year. In 2000-01, the salary adjustments represent most of the increase in that budget, it is $58 million again for 2001-02 so there is a salary adjustment contained there.
The last piece that I would like to speak to are user fees. I think that is probably an area of interest to everybody and certainly, I would like to speak to that for just a minute. First of all, I would like to make the point that this has always been a non-insured service. Ambulance service has never been an insured service under the Canada Health Act and that is true in every province across the country. So you will see wide variations in the fees that various provinces charge.
There have always been user fees in this province, always. I'm going to distribute . . .
MR. CHAIRMAN: Ms. Pike, I would like to ask you to wrap up if you could, please. We certainly look forward to that handout but I would ask you to wrap up within the next couple of minutes, please.
MS. PIKE: I will do that, yes. If Mora will just distribute that I will refer to this document probably later on so I think it is useful to have. You'll note in the document that, as I said, user fees have always been charged in the province. The private operators billed to the patient directly and they billed the government $13.6 million and that is where that figure comes from for the outpatient portion of the work. So when an individual was in an outpatient department and had to go to a hospital, the operator could bill the government for that service and that cost $13.6 million. All of the other invoicing was done directly to the patients so the province never did track or never did know how much was actually being paid for the service in years gone by.
The other document I want to distribute to you - and again, we can speak to it later - is a comparison of the rates across the country. Nova Scotia has the fourth lowest user fee rates across the country. The Yukon is the least expensive, they charge nothing to their residents for the service. Newfoundland is the next least expensive at $75; Ontario at $45; Nova Scotia at between zero to $85; New Brunswick at $120 - we are actually the least expensive in the Maritimes - and P.E.I. charges $130 per transport. So as I say, this has always been a non-insured service, Nova Scotians have always been paying for this service and that's where we fit across the country. As soon as Mora comes back, I'll get her to distribute this document to you.
MR. CHAIRMAN: Thank you, very much. Mr. Steele, it's 8:28 a.m., you have 20 minutes, 8:48 a.m. is your time limit.
MR. GRAHAM STEELE: I would like to start by saying, obviously a lot of good things are going on at EHS and EMC. I think the reforms to the system mean that we have what is a system that is among the best, not only in Canada, but in North America and the Fitch report which came out last month or the month before, certainly confirms that. It is the nature of the business we are in here in this committee that we tend to focus on the pressure points or where there is some controversy. Even though that is what I am going to focus on, I don't want that to detract from the overall picture of a high-performance but also a high-cost emergency health service.
One of the pressure points, of course, is user fees and I want to spend a little bit of time on user fees. I wonder if you could tell us - it may be in the document you handed out, it may not but any rate, just for the record - how much is expected to be billed for ground ambulance services in the current fiscal year, 2001-02?
MS. PIKE: The projection is that it will be $7.7 million billed.
MR. STEELE: That compares to for the last fiscal year, $5.86 million and for the year before that, $4.38 million so two years ago there was an increase of roughly 30 per cent and now there is an increase of roughly another 20 per cent in two years. Where is that money coming from? Is it coming from individuals or is it coming from third party payers?
MS. PIKE: Most of that is coming from the $85 invoicing so it would be in what you've just been distributed. The comparison of the new and the old rates, if you take a look at that, you'll see that there are two types of transports that are done most frequently, the interfacility transports and the home-to-hospital transport. You'll see those two sections. That represents over 90 per cent of the invoicing right there, and so the $85 charge represents the largest portion of that. Those are the easiest to collect as well.
MR. STEELE: When MLAs hear about user fees, it's typically somebody who's been charged $500 and feels that they should have been charged, at most, the $85. What process is available to people who are disputing their bill?
MS. PIKE: First of all, I'd like to point out that the policy is designed to charge the individual $85. The policy is designed to charge the insurance company or workers' comp, which provides insurance to workers, the $500 unsubsidized rate. No individual - although they get the $500 invoice directed to them, if they get a $500 invoice it's because of insurance. There should be insurance kicking in to cover that amount. However, if for some reason an individual feels that they need to have that reassessed or reviewed, there is a reassessment process. If that's still not satisfactory to that individual, we do have an appeal committee. The appeal committee will look at that invoice and determine if it is following policy.
MR. STEELE: You said there's a reassessment process, what is that? Who do people call?
MS. PIKE: People will call, they will start out with the billing supervisor at Emergency Medical Care. That's the first person. If that person cannot satisfy that individual, then it moves up to the CFO at EMC. Oftentimes the difficulties, the issues, are dealt with at that level. In fact, out of the 83,000 transports that we did last year, we looked at 37 appeals. Generally, in those two steps the issues are taken care of. However, if the individual is still not happy, it can come to me and I will take a look at it. If the individual is still not satisfied with the answer they are receiving, then it gets referred to the appeal committee.
MR. STEELE: The ones that seem to cause the most controversy are the ones where the person hasn't claimed under their insurance or insurance isn't available but EMC or whoever's doing the billing says, oh, but there should be insurance, even though there isn't, EMC says there should be and so they get charged $500. I have some specific examples here of calls the MLAs in the NDP caucus have received about exactly that kind of problem.
MS. PIKE: And I would certainly welcome that information so perhaps when we finish you can provide me with names and numbers, if you'd like.
MR. STEELE: Sure.
MS. PIKE: I can follow up on that. I'd certainly be very glad to do that. In terms of what you're describing, sometimes what happens is that people are not carrying motor vehicle insurance in the province, which is, of course, illegal. We are required to carry motor vehicle insurance. So that cannot be used as a reason for not covering that bill.
MR. STEELE: The cases that I have here don't actually involve that situation. I know my colleague, the member for Timberlea-Prospect, would like to discuss a particular case with you as well.
The Auditor General pointed out, in his report last year, well, rather than trying to paraphrase it let me just read it. This is on Page 139 of his report: "User fees are charged for ground ambulance and air medical transports. There is no legislative authority governing the levy of these user fees." There's no legislative authority for charging the user fees, it's not in legislation anywhere, it's not in regulation anywhere. In fact, some would say that under the principles of administrative law, it's illegal, that you can't charge a fee for which there's no statutory authority; not to mention the fact that because there's no statutory authority, it completely escapes the oversight of the Legislature. Does it concern you that the whole user fee regime is illegal?
MS. PIKE: Two points. First of all, legislation, which I would like to address, aside from the paramedic legislation we have also formulated the legislation that the Auditor General recommended. It's known and will be known as the EHS Act, and that is hopefully going to be to the House in the fall of 2003. So we certainly have addressed that.
In answer to your question more specifically, we did seek legal counsel on that issue. Respectfully, legal counsel suggested that since we were a division within Health, we enjoyed all the responsibilities and the privileges that come with being a department within Health, and we work through policy and are entitled to work through policy, like every other division. We get our legitimacy through the setting of policy.
MR. STEELE: This is not the place for a legal debate, but . . .
MS. PIKE: And I'm not a lawyer.
MR. STEELE: . . . I would say that that opinion is at the very least debatable, that simply because one is in government doesn't mean that you have free rein to set whatever fees and charge whatever fees one wishes. There are legal constraints on that. I know it's not usually possible to get legal opinions, but for $7.7 million to be resting on a policy that may not be legal, it seems to me that the department might want to be a little bit more forthcoming about the justification that it has. Would you be prepared to give to this committee a copy of that opinion?
MS. PIKE: In terms of the legal debate, that certainly is not anything that I can tackle or would tackle. I've heard the arguments on both sides. I leave it to the legal minds to make that final decision. I want to go back to a comment you made about the policy, and it has to do with it being - I forget exactly what your comment was, but - not well researched or far afield or some comment like that. I just want to point . . .
MR. STEELE: No. What I did say was that the opinion was at the very least debatable. That's what I said.
MS. PIKE: I want to move off the opinion and talk about the fact that the actual policy - free-reining, that was the expression that I think you used. It is not free-reining, in actual fact it was carefully researched, it's based on actual costs, and I think a fair formula is applied to the subsidy that individual Nova Scotians are going to be receiving, because the actual cost of the transport is $571. If you're carrying a health card, then you get the subsidized rate of $85. All of that was carefully looked at, and I would not agree that it's a free-reining type of a policy.
MR. STEELE: The question that I asked you was whether you'd be prepared to table the legal opinion on which the department is basing this program of user fees.
MS. PIKE: Certainly if I have that written I would have no problem presenting that to you. I can recall the individual lawyer who provided that advice, so if he's available he can certainly provide that to you verbally, as well.
MR. STEELE: I asked the question earlier about the amount of user fees that would be billed. What is the department's projection of how much of that amount will actually be collected this year?
MS. PIKE: It'll be around 79.8 per cent.
MR. STEELE: Of course a portion of the collections above 75 per cent are shared between EMC and EHS.
MS. PIKE: The formula is that, and I'll give you an example, if $10,000 in user fees is billed, then 75 per cent of that comes back to the Department of Health. That means that if EMC only collects $6,000 of that, they have to come good with the other $1,500. If however they do collect the 75 per cent, that all reverts back to Health. If they collect beyond that, so let's say they do collect 80 per cent or 85 per cent, or in my example if they collect 100 per cent of the $10,000 that was billed, $7,500 of it comes back to the Department of Health; the other $2,500 of that, $1,250 comes back to Health so we end up with $8,750 of that $10,000 and then $1,250 goes to the EMC. That is the formula.
MR. STEELE: I would like to change the topic, if I might, to the Fitch & Associates report which is dated November 2001 but, if I remember rightly, it was released some time in December.
MS. PIKE: That is correct.
MR. STEELE: There is a reference to the fact, and I will quote again, rather than trying to paraphrase, it says, "Unit hours . . .", in other words the availability of ambulances, ". . . could be significantly reduced in the following locations and EMC would still be able to achieve contractual response time requirements:". The 13 communities listed are: Annapolis, Arichat, Baddeck, Cape North, Liverpool, Lunenburg, Margaree, Musquodoboit, New Germany, Oxford, Pugwash, Sherbrooke and Wolfville. What is the current status of any plans or discussions or negotiations about carrying out that particular recommendation?
MS. PIKE: Just as you state, Mr. Steele, that was a recommendation made by the consultant. I know the government has been looking at that recommendation and they have not made a decision whether or not they are going to act on that recommendation. Obviously that's up to them, whether or not they choose to act on that.
If I could illustrate what that means in terms of a specific community. Oxford is on that list and I am going to use that as the example for what the consultant was saying because sometimes it's confusing to people. In Oxford, they do 131 emergency calls in that area over a year. So that is approximately one every two days. They currently have one ambulance in that area and a response time of under nine minutes for their emergency calls. So a call is answered in under nine minutes. The contract states that EMC has 60 minutes to answer those calls. Based on the population and the volume of calls in that area, EMC could answer those calls in an hour and still contractually be consistent with what the performance standards are.
The consultant is saying that if you move the ambulance out of Oxford and you put it in Truro or you put it in Amherst, it can make it to Oxford in 20 minutes and the contractor will still be meeting that performance standard. You can put the ambulance in Truro and it will be in Oxford in 60 minutes or less, still meeting the contractual requirements. However,
do you want to do that, because it is a degradation in service. While contractually it is consistent with the contract, it is a degradation in service.
So now the system status plan changes that are being considered are going to have an effect on the service in communities. The 12 changes that occurred since July 1999 did not result in any degradation of service. Now we are moving into changes that could result in a degradation in service. So government needs to be aware of that before it makes those decisions, if it's going to make those decisions at all.
MR. STEELE: Because of the way the contract is structured, the contract between the government and Emergency Medical Care, EMC actually has a financial interest in reducing services because any savings are shared between EMC and the government. If I remember the contract correctly, any savings below budget, 60 per cent go to EMC and the rest goes to the government. The problem that we have here is we have a user fee system that is structured in such a way that EMC has a financial interest in collecting as much as it possibly can.
MS. PIKE: An incentive to do that, yes.
MR. STEELE: It also has an incentive, if I may put it this crassly, to cut service. (Interruptions) Wait, I haven't asked a question yet, just a second. They have an incentive to cut service although they still have to meet the performance objectives. The message, I guess, the department is sending is you can cut service while still meeting the performance objectives. This all leads me around the user fee side and the cutting services side to the peculiar nature of EMC which is owned by a non-profit company, namely Maritime Medical Care, or they now go under the name Atlantic Blue Cross Care. It's a wholly-owned, for-profit subsidiary of a non-profit company, which is a very strange beast.
When you are talking about these incentives to boost collection of user fees and also to cut service, I mean the natural question comes up, how much money is EMC making out of this contract? What is EMC's profit, do you know?
MR. CHAIRMAN: Excuse me, Ms. Pike, before you answer that, Mr. Steele, you have two minutes remaining.
MS. PIKE: I know that the management fee that EMC collects as part of the contract is $975,000 and you sound like you know the contract well enough that you probably already know that anyway. In terms of the profit, I don't know what the profit amount is. I know what the revenue is, certainly, and that's public information that's in the contract but other than that . . .
MR. STEELE: One of the problems we have is we have this public service or a public utility - if you want to call it - contracted out to a private company that very closely holds its financial information, even though it only has the one job to do and it's a public job. We have no way of knowing how this issue of user fees and service cuts balances off profit. Does the department know what EMC's profit is and does it have the means of finding out?
MS. PIKE: I think I would like to answer that in a couple of different ways. First of all, at the outset when it was determined that the ground ambulance service would go to a private contractor, the performance standards were part of that contract, as you mentioned. The response times, the clinical care and also the cost-effectiveness, those were all performance standards that were built into that contract. If the contractor performs well, so they meet the response times, they provide the clinical care they are supposed to provide, and they do that in a cost-effective way, definitely there are rewards, there are benefits to the contractor. The contract can be extended. If they do those kinds of things, then they can be awarded a contract extension. Their reputation as an effective operator benefits all sides to this and certainly, that's an important plus, an important benefit to them and reasonable profit.
In terms of the second point or the profit question, what I would like to offer is EMC, if they announce their profit amount publicly, other than to their board, that puts them in an unfavourable position competitively. If they are going to bid on future work or even add additional work, it does put them in an unfavourable position, in terms of the bid cycle and in terms of being in a competitive position. They are in a one-down position if that is known, it makes it hard to compete.
I think Fitch has said quite clearly, emphatically, Nova Scotians are getting good value for their dollar, this is a cost-effective system, in fact, it is the most cost-effective system of all of the systems that are designed in this matter.
MR. CHAIRMAN: Thank you, Ms. Pike, Mr. Steele. It's 8:49 a.m; you have 20 minutes. Mr. MacKinnon, you are leading off for the Liberal caucus.
MR. RUSSELL MACKINNON: Thank you, Mr. Chairman. Ms. Pike, I guess my question would be more for EMC officials, a similar-type situation . . .
MS. PIKE: I would just point out that both Derek Leblanc and Dr. Cain are EHS and John Ferguson is with EMC. However, John is responsible for the system's status plan and really can't answer any other questions, apart from that plan.
MR. MACKINNON: Depending upon the type of question I have, we'll sort out who should answer it, certainly, on the question of value for dollar. My concern is whether the ambulance service that's being provided is - and I base it on a particular case where a lady had a small fender-bender and she had her two small children with her. She called 911, the ambulance arrived and she and her two children got into the ambulance themselves; they were
transported to the regional hospital in Cape Breton. Neither of the two children were checked at the time they were put into the ambulance, each one was given a teddy bear to soothe their emotions, I suppose. The mother was checked but she got into the ambulance herself and she got out of the ambulance herself. She signed herself into outpatients and had to wait for the triage to service her. Several days later she received a bill for $1,500.
My concern is whether we are providing a health service or is this ambulance service acting as a collection agency because $1,500, when they didn't even check the two children, one aged 4 years and one 6 years old, I was just wondering how you respond. What type of checks and balances are in the system for that? I know the lady did call the ambulance, EHS, and was given quite a verbalization on the phone as to why she would even question the bill, so I would ask if you could respond to that.
MS. PIKE: I'm going to hand it to Dr. Cain to respond, in terms of the clinical piece of that and then I'll take it back and explain the billing.
MR. MACKINNON: I can give you details in confidence, it's no problem.
MS. PIKE: Yes, I certainly would appreciate it, that would be great. So I'll hand it over to Dr. Cain, just to explain what would have gone on clinically in that situation.
DR. ED CAIN: I think in these cases the paramedics assess the patients as best they can in the field and that's a limited assessment, given where they are at and all of the circumstances. In their judgment if they felt the patient should go to hospital, then they would transport them to hospital. The patients have the right to refuse if they are competent but the paramedics in these cases, in trauma cases, would encourage the patients to go to hospital because sometimes it's not always evident of the injuries at the time and they may not show up for several hours, as we have seen in emergency departments before with patients coming in after an accident that they haven't been checked out for.
Once they get to hospital there is further assessment and triage that's done and according to that, treatment is either given or the patient is discharged. So the paramedics are basing the transport or non-transport purely on their assessment of the injury, that kind of thing and always erring on the side of safety.
MR. MACKINNON: In that case, wouldn't it have been prudent to at least check both of those children before you sent them a bill for $500 each?
DR. CAIN: I'm not familiar with the case but believe that the paramedics would have checked the children . . .
MR. MACKINNON: And if they didn't it would be only appropriate they be refunded $1,000, is that what you're saying?
DR. CAIN: I'm saying that I believe the paramedics would have checked the children because they would have to put them in a . . .
MR. MACKINNON: If the paramedics had not checked the children would it not be appropriate they be refunded the $1,000?
DR. CAIN: It's not in my purview to talk about the bills.
MR. MACKINNON: I'm talking in general, you're saying there are protocols and rules of engagement. If they didn't check the children, would it not be appropriate that they not be charged $500 per child?
DR. CAIN: I agree that part of the service is the checking over and management of the patient, so there is more than just the transport involved. There is a cost to the transport, I suppose.
MR. MACKINNON: But we're not running a taxi service.
DR. CAIN: Right, they're not.
MR. MACKINNON: Okay, I'd like to shift focus. Ms. Pike, back in March 2000, EHS issued a letter that the department was not responsible for providing air ambulance service for any of the activities in our offshore oil projects. I'm curious as to whether EHS does provide that service presently and what was the rationale for the change of policy?
MS. PIKE: Actually it kind of goes back, I guess, I'll link it to what Mr. Steele was asking and referring to, in terms of legal opinion. We didn't know whether we should be providing that service or not, so we sought legal opinion on that matter. Legal opinion told us that, indeed, we should not be servicing Sable Island, that that was not within our jurisdiction to do. We had further discussion on that within the department, and the decision was taken to not listen to legal counsel but to actually provide that service. Indeed we do service Sable Island, and we have been there on one occasion.
MR. MACKINNON: I see. Also, I noticed that the province took over from Star; without a lot of detail, I believe it's an issue that I questioned you on on a previous day.
MS. PIKE: Yes, I remember the phone call.
MR. MACKINNON: I'm looking at the estimates for 2000-2001, the cost of air ambulance, air medical transport, to summarize, $3.2 million. I believe the intent, when the province took over from Star, was that they were actually going to save money.
MS. PIKE: That wasn't the intent, but it certainly was a result.
MR. MACKINNON: If my memory serves me correctly that was one of the prerequisites, as I understand from our conversation - I could be wrong - that the province intended to save money. I don't seem to see those savings realized. I was looking, and it may be a bit unfair because the last annual report that was given by Star was 1999-2000, this is 2000-01, but their total cost was about $3.2 million as well. So there was really no difference between the province doing it and Star. Although, the big difference was with Star a large percentage of their revenue came from extraneous sources, like contributors, volunteers, that sort of thing; whereas now that's downloaded onto the backs of the taxpayers.
MS. PIKE: One critical difference is that when Star was here we were doing a little over 500 missions, we're now over 600 missions. That adds cost to the system. That would explain why you're not seeing that difference. The money that's been saved with Star's departure is being used to fund the additional missions. That's one thing. And the second point that you made, Mr. MacKinnon?
MR. MACKINNON: The source of their revenue, a large percentage of their revenue came from non-governmental.
MS. PIKE: In actual fact, they had a five year contract with us, and in the last three years that they were here they raised $30,000 a year in donated dollars. They had raised $90,000 while they were here, and that went to buy uniforms for the crew and a Propac monitor, those kinds of medical things, but in total they raised $90,000 over the last three years.
MR. MACKINNON: I'll turn it over.
MR. CHAIRMAN: You have until 9:09 a.m., Dr. Smith.
DR. JAMES SMITH: Mr. Chairman, I just have a couple of small points that we've been wondering about and haven't been able to get information on. Perhaps you can help us this morning. The issue of nurses travelling in the ambulance from one facility to another and returning, and being transported back by taxi, how is that handled financially now; who pays for that?
MS. PIKE: When we made the transition to the provincial ambulance fleet and deploying ambulances provincially, as you know, I am sure most people are aware, when a nurse was accompanying a patient on a transport and was returning home, they were going back on an ambulance, and we could never guarantee that we would start out here and deliver them to Sydney. We could never guarantee that because the ambulance could be redeployed to a train wreck in Stewiacke, to a Swissair, to any one of a number of incidents that occur in the province. So the poor individual nurse was left either at another institution, in some instances they were left in less than favourable conditions.
We decided that as an interim measure that we would actually pay to have the nurses returned. If that happened we would actually pay the taxi costs to have them returned to their home base. A year ago that cost us in the vicinity of $45,000 to $50,000 across the province. We were still getting numerous complaints with that system in effect, it just wasn't working. We honestly wanted to provide the nurses with safe transport but were at a loss for how to do it. So we worked with the different hospitals, actually, and I brought a group together, all of the hospitals were represented, the major users anyway, and we talked about how we could actually do this and provide a better service to these nurses.
The decision was to download to the various district health authorities, and they would take responsibility for that. They did an assortment of things, but a number of them did tender the work and did get cab companies, limousine companies who were willing to provide that service. Now the consistency is there, the reliability, and I'm told the nurses are feeling like they are being well served by that system.
DR. SMITH: Good, because it was an issue, so I'm pleased to see you have worked on it.
MS. PIKE: Absolutely, it was.
DR. SMITH: And the cost is probably being absorbed through the district health authorities, would that be the answer?
MS. PIKE: Correct.
DR. SMITH: And not EMC, it's not within the contract.
MS. PIKE: Right.
DR. SMITH: You said there are 833 paramedics, was that the correct number?
MS. PIKE: Currently.
DR. SMITH: Now is that full-time or would some be temporary . . .
MS. PIKE: That's all the paramedics in the registry. So yes, some would be casual, some would be part-time, most of them would be full-time.
DR. SMITH: And 135 P3s.
MS. PIKE: Yes.
DR. SMITH: Currently?
MS. PIKE: Currently, correct.
DR. SMITH: I don't have the figures, is that well within the contract now?
MS. PIKE: In terms of the progression?
DR. SMITH: Yes.
MS. PIKE: Yes.
DR. SMITH: Up to date?
MS. PIKE: Yes. Now it's difficult to track the progression. Fitch mentioned that as something we really need to improve on. Progression actually refers to - I am sure you are aware, Dr. Smith - every time the ambulance goes out it needs to have a P1 and a P3 on it. In the contract it's determined the percentages of those calls where that combination is supposed to occur. We have been unable to track that specific piece of information because of our computer system. The only way we could do that is manually, which is a horrific task. So we've upgraded the computer system. Starting on April 1st, we will be able to track that on the computer. We will be able to track a call that goes to you and see if that call is answered by a P1 and a P3 configuration.
DR. SMITH: It's not fully documented, and that was a weakness and that's why I wanted to get an update on that. Also, the Fitch report mentioned and there was some talk about that, that was one of the things that was picked up when the report was released, the response times and the paramedic qualifications being the performance indicators. If that was to be changed or the sites to be changed, what is your understanding? EMC can do that within the contract now, if it meets the qualifications of the contract, but do you think that would be a decision that would go to Cabinet? Would you feel that that would be done unilaterally? Would the department and perhaps Cabinet have input into that? Mr. Steele mentioned the numbers of sites or the sites possibly not going to be served directly by EHS.
MS. PIKE: Dr. Smith, are you referring to the 13 communities?
DR. SMITH: Yes, the 13 communities that Mr. Steele mentioned.
MS. PIKE: Yes. It is a public policy, a decision. It needs to involve government, so it would be government making that decision. For those 13 communities, it is not within the purview of Emergency Medical Care or Emergency Health Services to make those decisions. That will be a government . . .
DR. SMITH: The contract couldn't accommodate those changes. It would have to be outside of that.
MS. PIKE: Well, the contract could certainly accommodate those changes. Certainly the contractor, up until this point, has made those kinds of decisions, but where this now involves a degradation in service it's important that the government actually be the final call on that decision, not EMC and not EHS, but the three of us together.
DR. SMITH: When you say government, you would assume that would be a Cabinet decision; as administrator, you would expect that to go to Cabinet?
MS. PIKE: I would assume that.
DR. SMITH: Could you give me an update on the training program? I certainly was concerned when I heard it was moving out of the local area where you have the medical school, universities and health professionals of various orders, and the program is moving to Holland College, albeit, as you've mentioned this morning, the four sites. What's happening here, we have the simulator and those types of programs? What's the rationale behind all of that, to move it out of the Halifax community? Is it dollars and cents, is it to try to have a presence in the communities, or what?
I haven't quite followed that yet, and I'm really concerned because in some areas, some communities are strong. I know if you go down the list of Port Hawkesbury, some of them are fairly small centres and not well staffed, having their own problems of meeting their own health needs in those communities and not, maybe, a lot of strong leadership there that you would have in the medical school and the health professional schools. What's the rationale, and where are we going in all of this, and why Holland College?
MS. PIKE: I'm going to hand the question over to Dr. Cain, but before I do I just want to make the point that emergency health is trying to bring everything that it does, education, service, clinical care, to the communities that we serve. We are really trying to bring things out to all of these communities. The educational piece of this, you'll see the simulator travelling the road. It's been to Sydney several times, it's been across the province several times. We are trying to bring these educational resources out to where people live and where they work, rather than in the, shall we say, ivory tower here in Halifax. Anyway, I'm going to hand that question over to Ed.
MR. CHAIRMAN: Excuse me, Dr. Cain, before you begin that answer, you have just under two minutes. Dr. Smith.
DR. SMITH: Yes, if you could have a short one on this, because I'm talking about the resources. Some communities are well-resourced, health, medical and nursing-wise, and others are not. What's the goal here, basically the goal of moving this out from, you can call
it the ivory tower and I agree with you that its referred to as that, but we have a lot of expertise here that's needed at the roadside in emergencies.
DR. CAIN: The main rationale here is that we're trying to transition a fair number of the present paramedics from a P1 or P2 into a P3. The largest concentration of P3s right now is in metro. We have a good number, a good cadre here in metro, so the idea was to give the paramedics in other regions of the province a chance, while still working, to upgrade their status to a P3. Therefore, it was important to take it out to these communities. We will use other clinical sites, other than just in the communities, because that's very important, and they will come to Halifax, a lot of cases, to do their practicum or their ride-ons in order to be in a high-volume, high-acuity area. We're well aware of the concerns of having it in a smaller place, but the major reason for that was to allow these paramedics in these other areas to continue to work and not have to travel to Halifax or live in Halifax.
DR. SMITH: So you have a relationship with the medical school or someone, and why Holland College?
DR. CAIN: We have no relationship with our medical school here per se . . .
DR. SMITH: But you bring them back into the city, you said, is that the QE II or . . .
DR. CAIN: To ride along with the ambulances, because we have the P3s here, they have to ride along with a P3 to do their practicum in order to practise their skills.
DR. SMITH: So you're not connected with the trauma team there?
DR. CAIN: The only way they'll be connected to the trauma team is when they bring a trauma in, they'll learn how to recognize the criteria for calling the trauma team. They'll see the trauma team in action at the QE II.
MR. CHAIRMAN: The government caucus, you'll have until 9:30 a.m. Mr. Carey.
MR. JON CAREY: My first question is, in the old system you said paramedics were working in excess of 100 hours a week, what are they working now?
MS. PIKE: Currently they work 42 hours or 46 hours.
MR. CAREY: The follow-up to Dr. Smith's question regarding P3s, at the present time I think you said you had 135.
MS. PIKE: Correct.
MR. CAREY: What is the objective of the department? Is it to have all P3s?
MS. PIKE: No, not at all. By the year 2006-07, we're hoping to have between 70 to 75 calls answered by a P1-P3 combination and 25 per cent of the calls answered by a P1-P1combination. Actually, I should defer to Ed.
DR. CAIN: The goal is 75 per cent of all calls or unit hours eventually to be done by a P1-P3 crew and then the other 25 per cent by a P1-P2 crew.
MR. CAREY: I guess not to get into too much detail but this would seem that as we train people we will be losing them because we'll reach a maximum level of people and then we want to keep our P1s. What type of program is in place to keep our people and to use them to the best positions and so on?
MS. PIKE: Again, we've recognized this as an issue. It is not an issue at the moment but we are looking into the future and recognizing that what's going on with nursing currently, what's going on with other disciplines within Health will also come to roost in the paramedic group.
There are several strategies that are underway to try to deal with this proactively. One is that in terms of retention and recruitment, one of the features of the program that I mentioned earlier, or the system that I mentioned earlier, was its integration and because that's so unique in the system and paramedics have the opportunity to move through that system, so they might be travelling in a ground ambulance today but they could have the opportunity to be flying eventually, once they get experience under their belt. That's not something that's available in other systems, so the integration allows that to occur. I think we need to promote that more and more. People who understand that are attracted by that.
Working and living in Nova Scotia with the Long and Brier project underway and hopefully because that will, I think, prove to be successful at the end of the 18 month stint, that's another attractive feature to paramedics. That's something that is quite innovative and it's something that they would be very interested in doing. We're also pulling a committee together shortly to actually look at what else we can do to retain the paramedics and attract paramedics to the system.
MR. CAREY: Further to the Brier Island experiment, from what you are saying, I would make the assumption that that's going very well. What does the medical profession think about expanding this? Are there obstacles? We realize there is a shortage of doctors all over rural Nova Scotia so is it possible this will be expanded? You were talking about some places only having a call every two days or something, that these people could be providing some type of care for outpatient type situations. Is that progressing or what state are we at now?
MS. PIKE: I'll hand that question over to Dr. Cain in just a second. I just want to make a point and that is on Long and Brier, the paramedics that are there - and you are correct - they are doing one emergency call every 2.8 days. That is a skilled resource, a wealth of information and a resource to that community and that community is under-resourced, as I'm sure you are aware. For a paramedic to be able to do a glucose check, or check a blood pressure, to make sure that a person is taking their pills, or do any of those kinds of things, is certainly an enhancement to the system down there. Certainly, I'm not trying to paint a picture that everything has been rosy, there have been issues. We've had several challenges that we've had to deal with but at the end of the day I think that people are understanding that this is an innovative initiative that allows an under-resourced community to have additional resources available to it. Dr. Cain.
DR. CAIN: This service is not meant to replace or displace any medical service that would be already there and in the case of Long and Brier Islands there was very little available to them. This is meant to integrate with whatever is in place in that community. So when the paramedics do a blood pressure check or a glucometer check, they would report back to the family physician and send a document back to the family physician, updating on how their patient is doing.
If you have an elderly patient who is not very mobile with very little access to transportation and therefore to their family doctor, who may be an hour and a half away, they may let their blood pressure checks slide, or their sugar slide, et cetera, and the paramedics can pick this up early and hopefully prevent the emergency from happening before it does and call to the family doctor if it is urgent, or send a note to the family doctor to let them know how their patient is doing. This is not meant to replace anybody.
MR. CAREY: Just to touch on Mr. MacKinnon's situation of having three people transported, how often do you think this might happen? In my constituency I have a couple of situations where, at a car accident, four people were not seriously injured apparently but they were all transported in one ambulance and were billed $2,000. Whoever is responsible for billing, would their directive be $500 per person? If a call is $500 per ambulance, how could this type of thing happen?
MS. PIKE: Again, I'll hand it over to Dr. Cain to answer the clinical part of that and then I'll take it back and answer the billing piece.
DR. CAIN: I can only address the clinical part and again, the motivation for the paramedics is, do they feel the patients need to be checked out and must they be transported individually or if they are from the same family, is it best to keep them together if their injuries are not that acute.
MR. CAREY: I'm not questioning what the paramedics did, I'm questioning the billing aspect of it.
MS. PIKE: In answer to that, every time an individual enters an ambulance there is a requirement that a patient care record be completed - a PCR we call it in the field. That PCR has a number attached to it so those PCRs are actually tracked through the system and are submitted at various points in a day or a week to Emergency Medical Care. Emergency Medical Care then processes them for a number of different things: quality assurance to see that the care has actually been conducted according to standards and also for billing purposes.
As soon as there is an admin number and a patient care record that is put together and it's a motor vehicle accident that is transported to the hospital, the rate is $500. It is presumed that care has been provided to those - in the case you're describing - four individuals, as Dr. Cain had described and so care has been provided to those individuals.
MR. MACKINNON: Plus the teddy bears.
MS. PIKE: Do you want one of those? You keep bringing it up.
The transportation is not the cost here, it is a small portion of the cost. Where we have moved to a medical system, all of the pieces that are part of the medical system are what contribute to the cost and that's how we arrive at that bill, that invoice.
MR. CAREY: It just seems to me that this would be a cost-driver for the insurance companies or for whoever has to pay when you do this type of thing. One ambulance charging $2,000, and I realize mileage is not a factor - in this case it was about a mile and a half - seems excessive, but at any rate.
MS. PIKE: Just a couple of quick points there. The total billing to the insurance companies - and there are 130 of those companies in this province - is $1.2 million, so it's $1.2 million spread out over 130 companies. The other point is that the insurance companies do build that into their premiums, so what they're charging us right now for motor vehicle insurance, the premium is built into that, they know what the cost of this is going to be when they charge you your rate. Before you jump to increased rates and this is the reason, in fact, we have the Insurance Bureau of Atlantic Canada sitting on our advisory group and these invoices are not considered to be a cost-driver as far as they're concerned, it's the soft tissue damage and the follow-up in terms of soft tissue damage that is actually contributing to the increased insurance costs.
MR. CAREY: The air medical situation, to have that program in place, if it wasn't used at all, what's the cost?
MS. PIKE: If it wasn't used, if it didn't fly one single . . .
MR. CAREY: Daily or hourly, however you work it.
MS. PIKE: I'm sorry, say that again. If it just sat on the ground . . .
MR. CAREY: Just to have it in place. You have to pay for the helicopter, its maintenance, whether it flies or not, and the pilot and the staff.
MS. PIKE: That would be, if we're just paying that cost, $150,000 a month.
MR. CAREY: When a helicopter is requested, what's the cost per hour?
MS. PIKE: If we do one mission, it would still be $150,000 a month; if we do 20 missions or 30 missions in a month, it's still $150,000 a month. There's a flat fee.
MR. CAREY: So, in fact, the helicopter being called out when it wasn't necessary is not an added expense to the system?
MS. PIKE: It isn't if it doesn't exceed 500 flight hours. We've already paid for 500 flight hours. If we exceed 500 flight hours, then there is an additional cost. If we use one of those flight hours, it's the same cost as using the 500 flight hours.
MR. CAREY: I'm not sure how well this has been explained to volunteer fire departments and so on, because I know there are situations where the fire chief or someone has to make the decision at a car accident or whatever the situation may be where this program is used. They are very reluctant to call it because they have been told that it's a charge of about $2,500 an hour to put these people in gear. Has this been explained to the people involved, the Emergency Measures people and fire services and so on?
MS. PIKE: Obviously not well enough.
MR. CAREY: Who makes the call for a helicopter, at a scene?
MS. PIKE: If it's within a facility, it's generally a physician. You need to keep in mind that all the calls are screened by our medical control physicians. If you are making that call, then the call goes into the communication dispatch centre. They get in touch with a medical control physician, so it wouldn't be Ed but it would be like Ed. The situation is described to that physician. It's the physician's call whether or not the helicopter goes. Based on criteria, the medical control physician decides if it warrants the air medical transport service.
MR. CAREY: So actually someone in Bedford-Sackville makes the decision from information they're provided from the scene?
MS. PIKE: Correct, although the physician wouldn't necessarily be in Bedford-Sackville, they could be anywhere. When they're on call, they make that determination.
MR. CAREY: But the person at the scene doesn't make the call?
MS. PIKE: No. They make the call, they don't make the decision.
MR. CAREY: They make the actual telephone call, the request, but the decision is . . .
MS. PIKE: Yes, yes, that's correct.
MR. CAREY: You said that this company, program tries to be planning ahead at least three years in their projections and so on. This program is now costing, ballpark, $60 million or a little less. Where is it going in the next three years?
MS. PIKE: I think we're going to probably stabilize. We're going to try to consolidate the kinds of things that we've done, try to really streamline some of the things that we've been doing. We want to maintain our position as a centre of excellence, so we're going to really concentrate on some pretty innovative research projects that we have currently, we're just starting up.
I think you're going to see the focus stay, in terms of maintaining the system that we have right now but getting more efficient at doing that, and then probably we're going to be engaged in a lot more research. We are going to be getting this news out there to the public, to the rest of Canada. I think we're one of the best-kept secrets around.
MR. CAREY: I appreciate what you've said, but where's it going dollar-wise?
MS. PIKE: Hopefully it's staying right where it is right now, other than - I want to add this caveat - salary adjustments. Obviously that will play - 75 per cent to 80 per cent of the amount you see on that page is for salaries, so that is a major cost-driver. Obviously I can't predict where that's going to go.
MR. CAREY: Just to go back to finish up on my questions on the air ambulance, how many hours do they normally fly? You said you pay basically for 500 hours.
MS. PIKE: Yes.
MR. CAREY: Last year, what would have been used?
MS. PIKE: They would have used all 500 flight hours. I'm sorry I don't have the exact amount there, but I would say probably they flew another - I'd have to check my records - 60 to 80 additional hours.
MR. CAREY: And when you go over the 500, they bill?
MS. PIKE: They do.
MR. CAREY: At what rate?
MS. PIKE: It's $1,670 per flight hour.
MR. CAREY: So my $2,500 was off but it's $1,600 or $1,700 for an hour, if you're actually paying.
MS. PIKE: Yes, that's correct.
MR. CAREY: Back in the operation of the ambulances, in the information we received we were told that approximately $37 million is the operating costs for salaries and so on and the vehicles, but it wasn't broken down, what it costs to operate the vehicles. Is that number available?
MS. PIKE: It is. I don't have it on the top of my head, but I can certainly provide you with that. In terms of the $37 million, can you tell me . . .
MR. CAREY: That was just part of when we met with the Auditor General, we received information on various costs, and included in salaries and so on I think $37 million was part of the package that included a lot of things, and in that package was the actual lease payments and maintenance of the vehicles and so on. The operating cost didn't appear to be available in the information we had. There seems to be a benefit to operating efficiently and keeping the maintenance up from one side of the equation, and the other side, maybe there isn't a benefit, it depends on which side of the fence you're sitting on in this business.
MR. CHAIRMAN: Jon, I'm sorry, I didn't mean to cut you off. You have under two minutes. Ms. Pike, I'm sorry to interrupt your answer. Go ahead.
MS. PIKE: What I'm looking confused about is I've never actually seen that figure anywhere. The base that we started with several years ago was around $29 million, then the base was increased because of salary adjustments to $42.3 million, I think. Any of the figures that I have, in terms of what ground ambulance is costing, I'm just not familiar with that figure, so that's why I'm looking somewhat puzzled.
MR. CAREY: What I was interested in was what the actual operation of the equipment, the vehicles themselves, is. We don't seem to have that number anywhere, and the auditor didn't have that number.
MS. PIKE: I can certainly get that for you.
[9:29 a.m. Mr. James DeWolfe took the Chair.]
MR. CHAIRMAN: Thank you, and time is up for that session. We'll now direct your attention, at 9:30 a.m., to Mr. Estabrooks from the NDP. We will have five minute intervals.
MR. WILLIAM ESTABROOKS: We, of course, all receive calls as MLAs about appeals and concerns. I can bring to your attention, and I've been given permission by this family, the Valee family of 1102 Prospect Bay Road. When the three children are brought in because of an emergency situation concerning the fact that I believe one child was the concern, but you keep the family together. They make the run into the hospital and then, of course, after that received the bill. I guess my question should be, and I don't know if either Mr. Ferguson or Mr. Leblanc want to answer this question, but you're not in a collection agency mode there but you're providing transportation, the family is in a stressful situation, and you put the family in as a unit and away they roll.
I don't know if those people are aware of the fact that for that particular service which they're receiving at the time, not just the medical service and, not to get sarcastic, the taxi service, they are going to be charged. Is there any obligation on behalf of the attendants to say, if you put these other family members in here, they are going to be charged?
MS. PIKE: Did you want either Mr. Leblanc or Mr. Ferguson . . .
MR. ESTABROOKS: Anyone can answer. These are the men who are on the spot, I understand, or the women who are on the spot.
MS. PIKE: Certainly I can hand it over to either one of them to tell you what really happens in the field. I can tell you that we do not direct paramedics to let people know that they are going to be receiving a bill. It's the care that comes first. Certainly they are not told. If they are booking an ambulance for something, if it's prescheduled, they are told that there is a cost and what the cost will be. In an emergency situation, to my knowledge, paramedics are not telling people that there will be a charge.
MR. FERGUSON: Mr. Chairman, there's not really much I could add to this. Again, it's not exactly my area of expertise, so I wouldn't be doing anybody a favour by speaking to it. Again, I would just have to concur with Dr. Cain's earlier statements in terms of the
paramedics' assessment of the mechanism of injury and what the patient may present with in the hours and days to come. With respect to the type of billing issues, I'll turn it back to Marilyn, who is ultimately responsible for the working group that is, again, responsible for the development of user fees.
MR. ESTABROOKS: Under no circumstances - I want to be clear that the service was exceptional and the people who responded did so appropriately. The bill arrives however for $85 per child. The concern then begins. They call their MLA, I place calls and receive a very prompt reply from a Paul Maynard, Supervisor of Billing and Collections. Billing and Collections are Mr. Maynard's responsibility. I also received a draft reply, it says draft at the top, so I'm interested in that particular thing.
A couple of questions. First of all, I'm not talking about the actual formal appeals that actually arrive at your desk, Ms. Pike, I'm talking about the number of inquiries or the reaction initially that would be directed to, I assume, Mr. Maynard's number. When you receive the bill, there is no notification in here at all about the fact - and I have the copies of the Valee family bill - that there is a right of appeal, that you can question this. How many calls - I don't expect a specific number. I'm aware of the fact that there are probably a lot of responses initially of, "what's this". You said there were how many appeals, earlier?
MS. PIKE: Thirty-seven.
MR. ESTABROOKS: Do you have any record, in terms of how many individual requests Mr. Maynard would have to handle without the formal appeal status coming forward?
MS. PIKE: I don't have that on the top of my head. One point I would like to make, however, is whether it's an $85 bill - well, if it's an $85 bill actually - individuals, if they can't afford to pay that, EMC will arrange a repayment schedule based on what they can afford. If they can afford $5 . . .
MR. ESTABROOKS: But, Ms. Pike, that's not explained to these people, and that's why they come to us, and that's why we get into it with conflict resolution being the problem.
MS. PIKE: Certainly when Mr. Maynard is contacted or Mr. Sapien, which is the next step, or even myself, if I'm contacted, I do indicate that to people. If this is financial hardship that we're talking about, then EMC is more than willing to arrange a repayment schedule that fits into the finances that you have available, whether that's $5.00 a month or $1.00 a week.
MR. CHAIRMAN: Now we have to turn our attention to the Liberal caucus. Dr. Smith, five minutes, please.
DR. SMITH: We have just a few brief minutes, and there are so many topics and so much history and such an excellent service. If we get cut off, I would like to congratulate you all, the team's sticking together and achieving this high level and such a great report from the Fitch report, as well. I guess we all knew that, but it's nice to have someone from outside say that. It's been very positive. I think that we've gotten where we are today, it's just simply amazed me in watching it develop over the years and how we did achieve so well. I think it was the will of government and a lot of people who were very committed to the process that has ensured quality.
I am concerned, and the only concern that I have - maybe it's because I don't understand - is the Holland College issue. I just want to return to that briefly. I'm really concerned that as new technology evolves, state-of-the-art, that we keep doing what we're doing, that that sucking chest wound is treated well from the site of the injury and it's not delivering people into hospitals with something that should have been corrected. I use that as an example of one of the few ways that sometimes you can save a life. We have the medical community here, the medical school and the tertiary care hospital that I think is the best east of Montreal, obviously. So we move away to Holland College.
As Minister of Justice, we were concerned, we had complaints about programs there. I know, personally I had pressure from the Premier's Office over there to maintain a program in justice, the training of police officers, that was controversial. Who made the decision to go to Holland College? And, why would we go to a college outside of the Province of Nova Scotia? We are less than 1 million people, we are sort of a fairly small province, well-connected, why did we go to a college outside for training that, to me, logically would be done here, in the centre of Halifax? Everybody in Nova Scotia loves to hate Halifax, but it's still where the action is.
MS. PIKE: As I'm sure you're familiar, there was a P3 program that was coming out of the QE II. The QE II decided to get out of that business when the rest of their schools moved over to the university setting. We were left without a home for the P3 program. That generated some interest in a number of different agencies, actually, to provide that service. We asked them to submit a proposal as to how they would go about actually providing P3 training, and we had four agencies that actually submitted a proposal. Then we asked them to come in and provide a presentation to us. At the end of the presentations, and there was a large group, Dr. Cain was part of that group, and actually there were probably four other physicians that were part of that group, the determination was made that two of the agencies would be appropriate for P1 training, and two would be appropriate for P3 training. The two agencies that would be appropriate for P3 are Holland College and the Nova Scotia Community College.
We had discussions with both of those agencies, and we decided that since Holland College was already accredited and since the Nova Scotia Community College was not, and would just be embarking on this as a new venture and could not get that accreditation for at
least three to four years, and we didn't want to wait that long, that it would certainly be a good marriage if the two could get together and provide this P3 training. The paramedics who are currently in the program would be graduating from an accredited program. We could have moved ahead with just the Nova Scotia Community College, but the paramedics who are currently in the program would not have graduated from an accredited school.
The plan is - and this is a two year transition period - that at the end of the two years, the Nova Scotia Community College will be in a position to be accredited. Once that occurs, then the training will be done out of the Nova Scotia Community Colleges across the province, and Holland College will be providing training to other people but not in Nova Scotia.
DR. SMITH: Thank you very much and that gives you a regionalization too, with your community college system.
MR. CHAIRMAN: We will turn the final round to the PC caucus, five minutes. Barry Barnet.
MR. BARRY BARNET: There are three distinct areas that I want to talk about and if I could get brief answers because I only have five minutes. The Auditor General in his 2000 report raised a number of issues, one of which surrounded the purchase of the private ambulance operators in 1997. My question is what process was put in place to evaluate the purchase price of either the shares or the assets of the private ambulances that were purchased at that time?
MS. PIKE: As I think the Auditor General mentioned in his report, the documentation is not there to answer those question and I, although I was responsible for the air program, the trauma program, and the Simms Centre at the time, I was not privy to any of those discussions or any of that piece, so I have no answer for you.
MR. BARNET: So we'll never find that out. The next question is what process was put in place to determine whether or not the Province of Nova Scotia was receiving fair value, in terms of its agreement with EMC? Was there a shadow-bid process put in place or some form of evaluation of other jurisdictions, to determine whether or not we were getting fair value for our dollar?
MS. PIKE: I fear that this will be a short answer as well in that once again, I was not part of any of those discussions or part of the process at that time, so I really have no information to provide you.
MR. BARNET: That's too bad again. Certainly, that would be something, I think, the people of Nova Scotia would like to know. They would like to know whether or not we got fair value for our dollar at that time in both regards, with respect to the agreement that we
entered into with EMC and as well, the agreement that EMC entered into and EHS at the time, with the individual private operators. There were 33 agreements, the Auditor General raised a number of issues about verbal agreements subsequently becoming written agreements and then a sum of $13 million being divided among those operators of, I think it was, the ambulance association and then others. To me it would make perfect sense, at least as a business perspective that there be some formal record of how that was done, what type of evaluation was used, and it is disappointing not to have that.
My final point is with respect to Clause 8.5 of the agreement between EHS and EMC which provides for a fee or a penalty for response times in excess of certain times in certain jurisdictions based on a formula. Who reviews whether or not these fees are applied or ought to be applied and have we ever collected on any of these things in the past?
MS. PIKE: We actually track that on a daily basis, we track it on a weekly basis and by we, I mean us, the regulators, EHS because we are the regulators in the system. We do receive reports in relation to response time, as I say, on a daily basis, a weekly basis, a monthly basis and that is provided actually by Mr. Ferguson and his team from EMC.
I am pleased to be able to say that there have been no response time penalties because EMC has maintained the contractual requirement, in terms of response times, so there have been no penalties there.
MR. BARNET: Have there been any penalties with respect to the provision of the agreement that provides a $50 per incident charge for missing data?
MS. PIKE: There have been and in total, $500.
[9:43 a.m. Mr. William Estabrooks took the Chair.]
MR. BARNET: I am going to pass to my colleague, Mr. Chairman.
MR. CHAIRMAN: Mr. DeWolfe.
MR. DEWOLFE: Mr. Chairman, I know I only have a few seconds but the Auditor General did indicate the need for a dispute resolution process for disagreements on the condition of EHS vehicles. Currently, contract provisions - it was brought to our attention by him - do not require EMC to comply with government procurement policies. In the remaining seconds I just want to mention that currently, three year lease agreements are not acceptable with the 200,000 kilometre provision, because I drive 200,000 kilometres in three years. They're penalized, big time, for this and it is a win-win situation for Tristar, obviously, because the vehicles have to be in excellent shape, including the tires, when they get them back and my understanding is that they sell them at full rate overseas. That is an area of cost- saving that we have to deal with, you have to deal with in the future.
MR. CHAIRMAN: Mr. DeWolfe, I would like Ms. Pike or whomever to respond to that and then I'll give you a couple of minutes for a wrap-up, please.
MS. PIKE: The government actually does benefit by that, in that when the ambulance is returned to Tristar - and there are three conditions that have to be met when those ambulances are returned - the maintenance records have to be there, it has to be brought up to normal wear and tear and the kilometres have to be not over 2,000 kilometres. However, when those ambulances are returned, the government will get $11,800 returned to the government on each of those vehicles. I'm pleased to be able to say with the single contractor that we have now, one contractor, we haven't lost one rebate on any of the ambulances that have gone back. The lost rebates that occurred in the past were because operators were returning the vehicles, minus the maintenance records and we could not track those, we could not get those maintenance records. So as a result, we did not meet one of the pre-conditions and we lost the rebates. However, that is no longer the case.
MR. CHAIRMAN: Thank you for that explanation. Do you have any further comments or do any of your associates have any comments, Ms. Pike?
MS. PIKE: Again, I would like to reiterate though that we really did welcome the opportunity to be here today. It does give us another avenue whereby we are demonstrating and are accountable to the public we serve. Thank you.
MR. CHAIRMAN: Thank you. We will adjourn briefly so we can pay our respects for you being here and then we have to reconvene with a couple of pieces of correspondence.
[9:47 a.m. The committee recessed.]
[9:48 a.m. The committee reconvened.]
MR. CHAIRMAN: If we could reconvene, we have a couple of matters of business, of correspondence. Perhaps I would ask Mora, if she could, to just bring us up to date with the structure of meetings that it looks like we have on the horizon.
MS. MORA STEVENS (Legislative Committees Coordinator): Next week we'll be doing the briefing session on the Chignecto Central Regional School Board. The week after that there is a scheduling conflict, so there will not be a meeting. The week following that, which is February 20th, there will be the Auditor General's Report briefing to us. Then the week after, February 28th, we will have the school board in. What I'm going to do is write this schedule out and send it out to the committee members so they have it for the month of February.
MR. CHAIRMAN: Just to clarify, next week we will be in camera with Mr. Salmon and his staff. Matters of correspondence, I would like to do them just as they have arrived. I would direct your attention to the January 11th letter from Ms. MacDonald, the NDP MLA for Halifax Needham, and I will turn the floor over to Mr. Steele.
MR. STEELE: Mr. Chairman, on behalf of my colleague, the member for Halifax Needham, her letter is a request to this committee to consider putting on its agenda the matter of the liver transplant program at the QE II Health Sciences Centre. Just as I think everybody in Nova Scotia can be proud of the high-performance ground ambulance service that we have, we can also be proud of the high-level surgery programs, like the liver transplant program. Unfortunately, in recent weeks and months it has fallen apart in some disarray, allegations and counter-allegations.
It's a very important part, I think, of the health service and the Public Accounts of the Province of Nova Scotia. It seems to me and my colleagues in the NDP caucus that this is very much worthy of the attention of the Public Accounts Committee.
MR. CHAIRMAN: Other speakers on this topic? Dr. Smith.
DR. SMITH: Mr. Chairman, I just want to support the member for Halifax Fairview on this initiative. I guess we are referring to Maureen MacDonald's letter. We have an additional name that we would like to submit there. My main concern in all of this is there are two issues here, the issue of Hinrich Bitter-Suermann and his relationship with the university and the hospital appointments is one thing. I think, so far it's clouded a very important issue.
There is the issue of liver transplants being done in Nova Scotia. It's unconscionable to me that this would be a cancelled program and I only hope it is returned. It's a question of value of dollar, the cost of sending these people, and in humane terms, the impact financially and on human terms it's just difficult to understand that a province such as ours would have to cancel this program. We have the names of Dr. Peltekian and Dr. Tom Ward that we'd like to submit to come before. If it's the wish of the committee to address this issue, we'd like to add those two names.
MR. CHAIRMAN: We have those names, Ms. Stevens? Mr. DeWolfe.
MR. DEWOLFE: Mr. Chairman, first of all, I would like to mention that I certainly feel that Hinrich Bitter-Suermann, defeated MLA, has no responsibility for the cost of recruiting new doctors or the cost of sending Nova Scotians out of the province or the financial justifications and pressures, those concerns don't relate to him personally, they are internal matters. Currently the liver transplant program is under review, and it would not be appropriate at this time to move forward on this issue. I would suggest that until the review is over that this matter be put on the back burner and we will deal with it at a future date.
MR. CHAIRMAN: Mr. Steele.
MR. STEELE: I am disappointed by the response of the government caucus. Just as we said yesterday in the Human Resources Committee, it's worth bearing in mind that this is the Public Accounts Committee of the Legislature, not the Public Accounts Committee of the government. Just because something somewhere is going on inside government, it's not a reason for this committee not to look at such an important issue. If that's the best the government can do, then I'm sorely disappointed.
MR. CHAIRMAN: Point made. Mr. DeWolfe, do you wish to reply?
MR. DEWOLFE: I'd just reiterate that the transplant service is currently under review and it would not be appropriate to move forward at this time.
MR. CHAIRMAN: I'm going to recognize Dr. Smith.
DR. SMITH: Mr. Chairman, this program has been disrupted for about a year now and we don't need that long for a review. This is an urgent matter. I agree, I don't care to see Dr. Bitter-Suermann come before this committee, I think he gets far too much media attention and it's taken the issue away. This is a very important issue. It has nothing to do with his personality and how he may be treating medical students or residents who don't want to have him as a teacher. I don't want to give him a platform within our committee. Having said that, this liver transplant program is extremely important.
It will cost $82,400 to go out of province, plus all the family expenses. We know there is a backlog, there is only half the number being sent out that were being done previously. We have people sitting in Nova Scotia, in their homes today getting sicker and sicker, and they are going to die. This is going to cost lives in Nova Scotia. There isn't anything else like this going on in the health care system. It's dollars. It's going to cost $82,400 out of province, it's around $25,000 to do them in-house, in Nova Scotia. It just totally baffles my mind.
We talked about a system here today. You talk about the commitment of government to do something and fix the EHS services in this province, and we've done that. And this government can't commit to maintain a program like this, it's not only financial disaster, it's a human disaster for these people who are dying in Nova Scotia of liver disease and their families who are trying to support them. It's an urgent matter that should come before this committee.
MR. CHAIRMAN: The question has been called for. Further speakers? Mr. Steele.
MR. STEELE: Very briefly, Mr. Chairman, the member for Pictou East says that the program is under review. If that's the reason that the government caucus is going to offer for
voting against this proposal, then it seems to me that the member needs to explain to this committee who is reviewing it, with what terms of reference, under whose authority . . .
MR. CHAIRMAN: Mr. Steele, I'm not into question and answer here. I apologize for cutting you off on that. If the member wishes to speak again I'll recognize him, but I don't want to get into a Q & A on this.
MR. STEELE: Mr. Chairman, I'm making a statement in the form of a question. That is that if the government caucus is going to offer that as a reason, surely they owe it Nova Scotians to explain the nature of the review process, what the deadline is, who it's going to report to, because this Public Accounts Committee shouldn't have to wait for some process that we know nothing about.
MR. CHAIRMAN: Do you wish to reply? Mr. DeWolfe.
MR. DEWOLFE: I do not. As I indicated, it's under review. We will deal with it at a later date, when it's more appropriate.
MR. CHAIRMAN: The question has been called. Would those members who support Mr. Steele's request, seconded by Dr. Smith, please say Aye. A recorded vote has been called for, and I will ask the members to stand in their place. Those in favour of the motion, signify by standing in their place.
Mr. Steele Mr. DeWolfe
Dr. Smith Mr. Barnet
Mr. MacKinnon Mr. Carey
MR. CHAIRMAN: The motion is defeated.
I will turn to our next item of business, the January 22nd letter from the MLA for Clare, the interim Leader of the Nova Scotia Liberal Party, Mr. Gaudet. I would assume that a member of the caucus - Mr. MacKinnon, do you wish to speak to this?
MR. MACKINNON: This is a rather complicated issue. It is one that is twofold in its purpose. One is obviously dealing with environmental issues, but that's really not what the purpose of this committee is for. It's really the issue of value for dollar. This particular company, Mark-Lyn Construction has received a considerable amount of money from the
Department of Economic Development, and it involves a number of government agencies. In fact, there's evidence to indicate that cash disbursements were made. There doesn't seem to be any trail of accountability. Our Leader has requested, rightfully so, that this issue certainly be brought before the Public Accounts Committee.
It's an issue that I raised in the House of Assembly in the last session, hoping that the respective ministers would respond accordingly. It's certainly just looking at the issue of value for dollar. I think there are some serious concerns with the way the government has treated this particular contractor, in terms of the expenditure of taxpayers' dollars. Without belabouring or getting into too much detail, I certainly ask for the support of members of the committee to endorse this. It's an extremely important issue.
MR. CHAIRMAN: Mr. DeWolfe.
MR. DEWOLFE: If that was in the form of a motion, then I will indeed second it. I agree that this is indeed an agenda item that we can move forward on and should as a Public Accounts Committee. My only recommendation would be that we include someone from Economic Development as well as Environment and certainly the contractor so that all questions can be answered by those departments and the owner.
MR. CHAIRMAN: Mr. MacKinnon.
MR. MACKINNON: I am certainly in support of that because Economic Development is really the lead agency here. The environmental issues, they are issues of a different measure and it is important to have them there. Transportation and Public Works were also involved so there is some latitude there. The general thrust of the motion is to bring this issue before the Public Accounts Committee and we are open in terms of ensuring that the proper powers to be speak to the issue.
MR. CHAIRMAN: Thank you, Mr. MacKinnon. Mr. DeWolfe.
MR. DEWOLFE: Just for clarification, I think Transportation and Public Works, their only role in it would be the fact that they administer industrial parks. So would it be necessary to include them in this?
MR. CHAIRMAN: Mr. MacKinnon.
MR. MACKINNON: Well, we are not going to get too hung up on it but the fact that perhaps whatever department comes to speak will at least give some assurance that they will have the appropriate information from the other department because I do understand
Transportation and Public Works played an active role at one time but that may have fizzled a bit in favour of the Department of Economic Development.
MR. CHAIRMAN: Mr. Steele, I believe, has a comment.
MR. STEELE: Yes, just briefly, that getting to the bottom of this issue depends very much on getting the right people, I think, before the Public Accounts Committee and no doubt the Parties can agree on who that should be and if we can't, there can be some further discussion at next week's meeting of the committee, I would think. I would think that between us now we can probably agree on who should be called.
MR. CHAIRMAN: So I sense some consensus here. Can I call for the question? Would all those in favour of the motion please say Aye. Contrary minded, Nay.
The motion is carried.
Fine, we will be discussing this as part of our in camera session just in terms of who is actually going to appear next week.
I recognize Mr. Hurlburt, which I find hard to believe, but I recognize him.
MR. RICHARD HURLBURT: Mr. Chairman, I would like to have some clarification, where it is my first day on the Public Accounts Committee. When somebody is summoned to come to this hearing, it is mandatory that they show up?
MR. CHAIRMAN: We have been through that a couple of times, Richard, and I believe - well, Mora, you can answer it better than I so why would I even try to fudge it?
MS. MORA STEVENS (Legislative Committee Coordinator): What we standardly do is we issue the invitation. If it is to someone on the outside of government, what happens is they receive a specific letter saying they are being asked to voluntarily come before the committee, however the committee does have the right to subpoena them if they feel it is necessary. What has traditionally happened is people have said, yes, I will come, because they know we can subpoena. If they would say no, that issue would then come back to the committee and the committee, as a whole, would decide whether they wanted to subpoena a particular person.
MR. HURLBURT: Why I asked the question, Mr. Chairman, I just find your opening remarks very intimidating and I am sure that it puts a little fear into the witnesses who are appearing before this committee. I just ask, maybe we could relieve some of the opening remarks. I just find them very forceful, I guess maybe is the term I want to use.
MR. CHAIRMAN: Thank you, Mr. Hurlburt, but on that topic, I want you to know that these comments were available to - we received information and advice from Mr. Hebb. We then turned it over to the caucuses and they had the opportunity to review these comments. This was decided upon after some fairly lengthy discussions, myself as the chairman, but each caucus was aware of the suggestion that Mr. Hebb brought forward. There was an opportunity for input earlier but I appreciate you bringing that up but that is something that we have talked about a number of times on the committee and all caucuses had the opportunity for input on whether they believed that this was an appropriate statement as advised by Mr. Hebb. I recognize you again, Mr. Hurlburt.
MR. HURLBURT: Mr. Chairman, I do not want to belabour this but I just think that it seems like it is iron-fisted. If we could just maybe fine-tune it a little bit. It has to be very intimidating for people who are coming in as witnesses.
MR. CHAIRMAN: Richard, if I may, we are open to review this process but I would assume that your caucus provided copies of what Mr. Hebb provided to the committee and then we heard back from and discussed at a number of our meetings about these comments that I read from. This was the first time we used it today but, I want to be clear on this, this is something we have had the opportunity for input on and that would be something that I would advise you, if you feel about this, then you talk to Mr. Olive, your caucus chairman and he bring the concerns to me, as the Public Accounts Chairman. On this topic, Dr. Smith?
DR. SMITH: Yes, I know it's late, Mr. Chairman, but this was my first morning here for a long time. I was quite taken aback by - and nothing to the chairman, yourself personally, obviously this has been the consensus of the caucuses. I would wonder - in support of Mr. Hurlburt's remarks - whether those who come of their own free will, without being subpoenaed, have something different read to them, an introduction, I don't know what the proper word is, almost like a warning, I guess, it's been. Now if someone is subpoenaed and we know that they are a witness who may be hostile or non-co-operative and they have to be subpoenaed and that is the decision of the committee that we subpoena them, then I would see them being read something stronger like this here this morning. People who come of their own free will and maybe even look forward to coming here, to be almost accused of - we're going to be watching you to see if you lie or not - and I know it has been all in good legal advice and with good intentions but I just wanted to share with you my impressions here this morning. I thought it had been done routinely, I didn't realize it was the first morning that it had been done.
MR. CHAIRMAN: I recognize a number of speakers on this topic. Now we could discuss this at another time but I have at this stage, Mr. MacKinnon, Mr. Barnet and Mr. Steele. I don't mean to cut the conversation off but I'll recognize those three and then perhaps we can move on. Mr. MacKinnon.
MR. MACKINNON: I'll be quick, Mr. Chairman. Obviously this was an issue that we all caucused and it was mutually agreed by the committee and if the tone seems a little heavy we could always tone it down a bit. But it is like everything else, you won't know unless you try a process. There are four different issues that came on previous days, where witnesses gave undertakings and never ever followed up. We had the ones from the museum. She gave an undertaking to give financial statements - not forthcoming.
Also the issue from the Deputy Minister of Health on the doctors - information undertaking, no information forthcoming. The lady who came before the committee gave an undertaking to provide information on the criteria, pre-1998, for seniors going into nursing homes, financial criteria. We still can't get that information, despite the fact that the committee was given an undertaking. We have another day where on March 21, 2001, Mr. Poole from Service Nova Scotia came here and gave an undertaking to provide the list of recommendations that were made to P&P for a number of matters - still refuses to provide that information. It is an important issue, I recognize the sensitivity and the question of intimidation but people coming in here giving undertakings and not living up to their legal obligations, it is starting to make the committee look a little toothless, to say the least and questions the value of its purpose.
MR. CHAIRMAN: Thank you. Mr. Barnet, then Mr. Steele.
MR. BARNET: Mr. Chairman, aside from the points raised by the previous speaker, there were a number of us on the committee who felt a particular incident that happened at committee, where a member of the committee requested someone appearing before this committee take an oath on the Bible, was somewhat discriminatory, where we hadn't done that in the past. It is my understanding that by reading this into the process it eliminates the need to cherry-pick or to single out one individual to take an oath. It is felt by many that this is a lot less intimidating than simply on a case-by-case basis, any member picking one presenter and asking that individual to take an oath. Frankly, as intimidating as it is, I think it is better than the alternative.
MR. CHAIRMAN: Mr. Steele.
MR. STEELE: Actually, Mr. Chairman, what I was going to suggest was that it is an important discussion that perhaps we should pursue next time when we have the committee's legal counsel here. That, of course, is a representative from the Office of the Legislative Counsel, whether that is Mr. Hebb or someone else, because, as Mr. Barnet has just pointed out, there were reasons why we got here but I will readily acknowledge Mr. Hurlburt's point
that it is possible to say these things without doing it in what sounds like a heavy-handed way. In order to refine this, perhaps what we need to do is talk to our legal counsel, to hear what we gain and lose by changing the words that he has provided to us because let's not forget he provided those words at the committee's request in order to deal with the other side of the coin which is that witnesses were coming before this committee unclear about their rights and obligations and we were trying to help them out by making clear to them what their rights and obligations are. There are many different ways of saying the same thing and perhaps we can talk this over at our next meeting with Mr. Hebb. That is my suggestion, at any rate.
MR. CHAIRMAN: Thank you. I will take that under advisement. We have a meeting, of course, that is in camera. I know Mr. Salmon has some important points to bring to our attention and if it is appropriate and we can get it on the agenda and Mr. Hebb is present, we will discuss it at that time. Again, perhaps if those members who have expressed those concerns want a copy of what was read into the record and would like to bring it to your individual caucuses prior to our next meeting, that would be fine. Mr. Hurlburt, are you okay with that?
MR. HURLBURT: Yes.
MR. CHAIRMAN: I would, at this stage then, ask for a motion of adjournment.
MR. MACKINNON: So moved.
MR. CHAIRMAN: The meeting stands adjourned. Thank you.
[The committee adjourned at 10:12 a.m.]