House of Commons Hansard #250 of the 35th Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was c-7.

Topics

Canada Health ActPrivate Members' Business

11 a.m.

NDP

Bill Blaikie NDP Winnipeg—Transcona, MB

moved that Bill C-284, an act to amend the Canada Health Act (conditions for contributions) be read the second time and referred to a committee.

Mr. Speaker, I am in the happy position today of being able to report to the House that a great deal of progress has been reached on this issue since I introduced this private member's bill. I understand that a protocol such as this bill would have provided for is more than just in the works. There may even be a document outlining the protocol in circulation for comment, although it is hard to pin that down.

I thought the best thing I could do at this point is give a bit of a history of the development of this issue leading up to the present and a few words about where I think it should go now. I thank the hon. member for Hamilton West for seconding the motion.

Many members of the House will be aware that firefighters have been lobbying for a long time for a national contagious diseases reporting protocol. They have their annual lobby on the Hill and they meet with many members of Parliament. This is one of the three or four items they have been stressing for a number of years now.

Firefighters and other emergency responders have been concerned about developing a protocol so that they could be informed if they were likely to have been in contact with a contagious disease in the course of their work and provided with the appropriate medical treatment and counselling in the event of exposure on the job.

In February 1992 NDP labour critic Joy Langan, the former member for Mission-Coquitlam, introduced a private member's bill that found an elegant solution to the constitutional problem which had presented itself with respect to this issue; that this was regarded as being in the provincial jurisdiction.

Her bill would have amended the Canada Health Act to make it necessary for provinces to set up their own protocol if they were to receive federal health funding. The idea was to use the federal spending power in health to establish a contagious diseases protocol in exactly the same way the federal spending power was used to establish medicare nationally and to establish other conditions for the receipt of federal transfer payments for health care. In effect the establishment of this kind of infectious diseases protocol would have been another national standard, so to speak.

Although the bill was never debated in Parliament there was all-party support for the idea among members. After negotiations the NDP at that time managed to get the matter referred to the Standing Committee on Health and Welfare.

The committee held hearings in early 1993 and tabled a report in June of that year. The committee recommended, among other things, that the federal government "encourage the provincial and territorial governments to develop and implement within their jurisdictions a protocol for post-exposure management and follow-up of emergency response personnel exposed to airborne and blood borne diseases". It asked the government to report back to the committee in one year on the progress in establishing such a protocol. This amounted to a substantial endorsement of the principles of Joy Langan's bill.

Although it was too much to ask that the federal bureaucracy actually fulfil the one year deadline set up by the committee, in September 1994 the Liberal government did hold a national symposium on infectious diseases and emergency responders which I attended in part as an observer in my new capacity as the NDP labour critic.

The symposium brought together provincial and federal officials as well as a wide range of stakeholders among emergency responders. The symposium heard very good reports on the development of a protocol in the province of Ontario in which an NDP provincial government at that time, responding to firefighter concerns, had taken the initiative. There was a lot of enthusiasm for its development and application in other provinces and territories.

I say with some pride this was not the first time an NDP provincial government led the way on such issues. By taking the initiative and by doing the pilot project it put pressure on other provinces and the federal government to do likewise. While we are talking about the Canada Health Act this is how we got our publicly funded health care system in the first place, medicare, when the Saskatchewan NDP government of many years ago did a similar thing in the sixties.

I tried to add to the momentum building for a national protocol by tabling a private member's bill early in this Parliament. It was very similar to Joy Langan's but added a section that would have improved the privacy concerns about the release of private medical information. That was one of the concern's about Joy Langan's bill tabled last Parliament.

Even with all this momentum building toward a national protocol, the two private members' bills by NDP members, reports by a House committee and a national symposium and the Ontario protocol, it appeared that in May the government was backing away from a national protocol. I remember asking the Parliamentary Secretary to the Minister of Health about the government's intentions in this regard. She appeared at that time to be washing the government's hands of the issue and she answered me only that health was a provincial responsibility, and that was the end of the matter.

However, the International Association of Fire Fighters, to its credit, kept up the pressure and in June of this year a meeting was held between federal and provincial health officials and other stakeholders in which a national protocol was agreed upon. I have yet to see the final version but it is my understanding the International Association of Fire Fighters was very satisfied with the results of that meeting.

What I understand to have happened between then and now is the federal and provincial governments have agreed to a protocol that would allow emergency workers to learn of any health risks they may have been exposed to in the case of significant exposure to blood borne infectious diseases.

I understand the agreement has built-in protections for the confidentiality of patients' medical records, setting up a procedure through which emergency response personnel who have had significant exposure to blood can contact the local medical officer who in turn seeks information from the hospital on behalf of the affected emergency personnel.

In June the federal government said it would release a document by mid-October. I understand from conversations I have had with the firefighters as recently as Friday that this has not yet been done. I also heard from officials in the health minister's office that at least they think there is a document in circulation for comment.

At this point in the development of this issue there seems to be some confusion. Perhaps whoever is speaking with the knowledge of what goes on inside the government today can clear this up. People feel progress has been made. It certainly appears progress has been made. We had the successful meeting in June, the agreement on a protocol. Firefighters have an understanding of what that protocol will be like. However, there is still no document which outlines the details of that protocol so that firefighters and others like me would be able to respond with some knowledge of what has actually been agreed upon and what the details are.

It would have been nice if that document had been released and in an obvious and available kind of way in mid-October. On the occasion of debating this bill we would have been able to talk about the details of the bill. If there were some constructive criticisms to make they could have been made here or they could have been responded to here. However, we are not in that position now.

Unfortunately with these kinds of things we will not be in this position ever again because the bill will be debated only for this hour; it is not a votable bill. Frankly, given there is this kind of progress, unless we are all being mislead in some way there is really no need for the bill to go to committee or for it to proceed. We do have a protocol but we are not able to comment on the details at this time. I invite members opposite who may be in the know to say more about this.

I do not mean to single this out for special praise or commendation, as there are others, but it is an example of how through the private member's process an issue can be advanced, an issue can be pushed, an issue can be kept on the agenda. Eventually the government finds itself in a position to respond because it feels it has to or it finally becomes convinced of the need to respond or it is one of those mysterious political democratic things where at a certain point something becomes acceptable and doable that seemed very difficult to accomplish only a short time ago or yesterday, as one hon. member has said.

I am very glad to see there has been this kind of progress. It is preferable to have happened in this way. We are in a debate now about the imposition of national standards and conditions through the use of federal spending power through the Canada Health Act. It probably would not have been the preferred route given the current political and constitutional climate, shall we say, to have invoked the Canada Health Act as a way of achieving this. Although if push came to shove that procedure was there and that was a way to have the federal government seized of the issue and putting the government in a position where it could not say there

was nothing it could do because this was matter of provincial jurisdiction.

I think federal spending power ought to be used in areas where it is important to delineate and to enforce national standards. In that respect I am sure I have some disagreement with some of my colleagues in the House.

I am attached to the Canada Health Act. I was here in the House when it was passed in April 1984. I was a member of the health and welfare standing committee which studied the bill. There are amendments and phrases in the bill which I moved myself. In my political judgment, the bill owes its existence in part to the pressure which we brought to bear on the government between 1980 and 1984. In fact, in her book Medicare in Crisis Monique Bégin openly credits the NDP for the role it played in pressing the government to bring in the Canada Health Act.

I raise all of this because now there is a different third party in the House, our Reform Party colleagues. I often see a stark contrast between what we called for when we were the third party and there was a Liberal government and what the Reform Party is calling for. We said to bring in the Canada Health Act and to eliminate user fees and extra billing. Now the third party in the House is saying: "Get rid of the Canada Health Act and let us not have national standards any more. Let us permit the provinces to do what they will". There are two competing visions of what is a national government.

One of my concerns today as we contemplate the vote in Quebec, is that regardless of the outcome, if I hear the Prime Minister and others correctly, even if there is a no vote we are on the verge of major decentralization. I urge my Liberal colleagues, no matter what changes may be undertaken in response to a no vote by way of decentralization, that what we achieved together, the NDP and the Liberal government at the time, on the Canada Health Act and the notion that when it comes to health care there are values, procedures and standards we all hold in common as Canadians wherever we live from coast to coast to coast, be held up and not surrendered in the wake of a no vote.

Canada Health ActPrivate Members' Business

11:15 a.m.

Vancouver Centre B.C.

Liberal

Hedy Fry LiberalParliamentary Secretary to Minister of Health

Mr. Speaker, I rise to speak on Private Members' Bill C-284, an act to amend the Canada Health Act.

Let me say at the outset that I am extremely sympathetic and supportive of the plight and concerns of emergency response workers. Their devotion to preserving and protecting the lives of others often puts them unwittingly at risk of injury or exposure to disease. They are not aware of what the patient is carrying.

I understand and support the motive behind Bill C-284. Unfortunately, the Canada Health Act is the wrong instrument. The amendment is not within the scope of the act. The Canada Health Act sets out the broad principles under which the provinces are expected to operate medicare. An amendment dealing with the disclosure of infectious diseases is inconsistent with this purpose.

While the protection of health care workers from contagious diseases is an extremely worthwhile public health objective, the Canada Health Act is not the proper vehicle by which to achieve this. Let me explain.

Our health care insurance system is composed of 12 interlocking plans which are managed at the provincial and territorial levels. The federal health insurance legislation, which is what the Canada Health Act of 1984 is, establishes the criteria provincial plans must meet in order to qualify for a full share of federal health care transfers. Federal transfer payments may be reduced or withheld if a province contravenes the conditions of the act.

I will discuss these criteria, the cornerstones of Canada's health care system.

There is accessibility, which means access to medically required services regardless of ability to pay. That translates into no charges at point of service. There is comprehensiveness, which means a comprehensive range of medically required services. Universality means the coverage of all provincial residents must be given equally regardless of pre-existing conditions or diseases. Portability ensures that benefits go from province to province and abroad. Finally, public administration of medicare means that the plan must operate on a non-profit basis.

In addition to those five principles, the Canada Health Act requires that provinces provide medicare information to the federal minister when she needs it. In order to qualify for federal cash contributions, provinces also need to give recognition to the fact that the federal government does transfer payments.

The Canada Health Act also discourages extra billing or user fees. If this is broken, there will be automatic dollar for dollar reductions or withholdings of federal cash contributions to that province or territory. The threat that user charges and extra billing would erode accessibility to medicare was a major reason for the development of the Canada Health Act in the first place. It was enacted to protect those five fundamental principles of medicare I just spoke about. Nearly all provinces have committed themselves to upholding these principles even while making needed reforms to the system.

Canadians support the five principles and feel that medicare is a defining Canadian value. Results of a recent poll indicate that support for these national principles is higher than ever.

The Canada Health Act which defines medicare is close to the hearts of Canadians. It is something too risky to tamper with. The amendments to change the Canada Health Act as proposed in Bill C-284 by my hon. colleague cannot be supported.

The amendments ask that the name and nature of an infectious or contagious disease be disclosed to emergency response workers who may have been unknowingly exposed to that disease. While I support this objective, the amendments themselves affect the definition of hospital services. This will change the Canada Health Act criteria which deal only with the principles and funding of medicare. Rules are are set out concerning the non-compliance with the Canada Health Act and are part of the act.

In short, Bill C-284 asks that provincial and territorial plans impose a responsibility on hospitals to disclose to emergency response employees whether a patient to whom they are providing service has an infectious or contagious disease which is fine. However, it seeks to do this by making it a criteria of the Canada Health Act.

The disclosure of infectious or contagious diseases is a public health issue. It is not of the same nature as the principles and funding issues in the Canada Health Act. The protection of emergency response personnel is not even close to the purpose of the Canada Health Act.

Moreover, the act deals with the organization and delivery of health care services at the provincial and territorial levels and not with the regulation of internal operations of hospitals which falls under provincial and territorial jurisdiction. It would be intrusive to ask the federal government to impose on or intrude into the federal-provincial primary responsibility for hospital management which is a constitutionally protected right.

Moreover, Bill C-284 raises issues with regard to civil laws and rights and privacy laws in the provinces and territories. The federal government cannot really interfere in these issues.

What I am trying to say is that worthwhile though the member's intent may be, the Canada Health Act is not the proper place to regulate such matters which constitutionally fall under provincial jurisdiction and should be better handled at that level. The federal government cannot dictate to a province or territory how to run its health care plan, much less tell it how to run institutions. All it can do under the Canada Health Act is to place conditions on transfer payments to the provinces and territories.

At a meeting of health ministers in Victoria recently, provincial and territorial ministers reaffirmed their support for the principles of the act and agree to continue to collaborate in interpreting and applying its provisions. Provincial and territorial ministers agreed with the federal Minister of Health to work together to develop a vision for the future of medicare.

Contrary to the misunderstanding of certain parties, the Canada Health Act is not an impediment to the management changes which are needed to meet medicare's challenges. In fact, the flexibility inherent in the act has always been one of its strengths.

Since the enactment of the act in 1984, the federal government has attempted to work with the provinces in order to make the act a viable piece of legislation. The federal government recognizes that provinces and territories have primary responsibility for the management, organization and the delivery of health care services, including institutions and health care providers. Sufficient flexibility to operate and administer their health care insurance plans is obviously necessary if they are to meet the regional and local needs and conditions.

At the August conference, provincial premiers and territorial leaders were unanimous in their support of the publicly funded national health care system and reaffirmed their commitment to the principles of the Canada Health Act. It would be dangerous therefore, to tamper with those principles when they have received such wholehearted support. If we want medicare to survive, we must be vigilant against seemingly innocuous tampering as against more blatant threats such as user charges which as we know arise now and then.

I come back to the point that while the protection of health care workers is a serious concern and one which I share with the hon. member, the Canada Health Act is not the vehicle with which to address it. At the same time, the department has been involved with the prevention of infectious diseases and the protection of emergency response personnel for a very long time and is continuing to work with them on issues of concern. Let me give a few examples of our recent achievements in this area.

In 1994 a national symposium on risk and prevention of infectious diseases for emergency response personnel was held to explore the same question the member is talking about and to look at implementing where possible preventive and protective actions for those workers.

In June of this year a consensus conference was held with the objective of establishing guidelines the provinces and territories could use to develop and implement an infectious disease notification protocol for emergency responders. These guidelines are good examples of how the provinces and territories look to the federal government to provide a leadership and co-ordinating role in discussing issues related to health protection.

I have confidence in the ability of emergency response workers as the ones who are best qualified to seek solutions in conjunction with their provincial and territorial governments, health professionals and experts in infectious diseases. They have our support.

The Canada Health Act which protects our universal and comprehensive health care system agrees with that commitment. However, facing the challenges and finding solutions to problems which arise over the years took commitment as well and the commitment is still there today.

Today we can look back with pride on our past accomplishments, but we cannot be satisfied to rest on our laurels. The systems and the federal provincial relationships face many challenges and the issue raised by Bill C-284 is such a challenge. To this end, we as a federal Ministry of Health have taken the appropriate steps to support the concerns and efforts of the emergency response workers. At the same time the federal government cannot support an amendment which has no place in the Canada Health Act.

I encourage all hon. members to participate in the discussion of this issue with emergency response workers at the constituency level and to take appropriate steps to assist them in this important and worthy objective.

Canada Health ActPrivate Members' Business

11:25 a.m.

Reform

Sharon Hayes Reform Port Moody—Coquitlam, BC

Mr. Speaker, I am pleased to speak on Bill C-284 today, an act to amend the Canada Health Act, sponsored by the member for Winnipeg-Transcona.

The purpose of the bill is "to incite the provinces to make sure that the health care insurance plan of a province provides for the obligation for hospitals to disclose to emergency response employees who provide emergency medical or rescue services to a patient, the name and nature of an infectious or contagious disease that the patient might have transmitted to them". The essence of this bill is to ensure the safety of those who work in medical or rescue operations who are at risk of being exposed by an infectious or contagious disease.

The dedication of the people to whom this bill is addressed is to be commended and admired. I have talked with different emergency response workers and know their dedication and the risk they face each time they respond to an emergency. These professionals are police officers, firefighters, emergency medical technicians and paramedics.

I can agree with the intent of the bill. However, I disagree with the the means by which it seeks to accomplish and implement that purpose. Specifically, the bill seeks to amend the Canada Health Act by adding additional criteria to the list.

I must agree with the Liberal parliamentary secretary that the Canada Health Act is not the vehicle for this. I will go on to explain why.

Clause 2 of the bill amends section 7 of the Canada Health Act. Section 7 outlines the principles of the Canada Health Act. These are public administration, comprehensiveness, universality, portability and accessibility. The bill would add an additional criteria to that list and that is the disclosure of infectious or contagious diseases.

The Reform Party has consistently demonstrated how the Canada Health Act has allowed the federal government and others to play a carrot and stick game with the provinces. The carrot is the money that the federal government transfers to the provinces for medicare. The stick is the heavy handedness of the Canada Health Act that allows the federal government to financially penalize the provinces.

Sections 14 and 15 of the Canada Health Act allow the federal government and the health minister to financially penalize provinces if the minister has found that the province is in violation of sections 8 to 13 of the act. These sections deal with the five principles, as I have mentioned, of public administration, comprehensiveness, universality, portability and accessibility and finally, the conditions for the cash contributions or payments to those provinces.

The bill adds an additional criteria to a list that Reform members feel is intrusive already. It adds the disclosure of infectious or contagious diseases. By adding it to the program criteria of section 7 of the Canada Health Act, it would create another basis for the federal government to financially penalize these provinces. We have just gone through a recent example of how the federal government imposes its will on provinces with the issue, debated in this House, of private clinics in Alberta and other provinces.

Although the purpose and the intent of the bill is commendable, I disagree with the way it is designed to legislate that purpose.

Reform has a different and fresh philosophy to approach medicare in Canada. Our approach, and we call it medicare plus, contains the following: first, we reaffirm that the value of medicare is the best health care safety net in the world. Second, we would define medicare as Canada's comprehensive set of core national health standards, publicly funded, portable across Canada and universally accessible to all Canadians, regardless of their ability to pay. These are essentially the principles that now exist in the Canada Health Act.

We differ from the Canada Health Act and from the view of the government and the approach taken in this bill by removing the restrictions and the ability of the federal government to penalize provinces within these criteria. That is the plus of medicare plus and the third of our proposals. We would give provinces greater flexibility to administer and deliver the health services within their own respective jurisdiction. That is our general philosophy and our approach to federal involvement in medicare.

It would apply to Bill C-284 as well. We believe the provinces should decide whether or not to pass legislation on the disclosure

of infectious or contagious diseases rather than be compelled by a federal government through the Canada Health Act.

As my colleague mentioned today, in June there was a federal-provincial notification protocol established in this area. This dealt with blood borne diseases and took into account the confidentiality concerns and the procedures that would result. I commend the government for proceeding in this direction.

One question I have today of the government, as my colleague also had, is why this was not proceeded with and then the information given to the people discussing the bill today? Again this is a reflection of the inactivity in the House or the lack of proaction on real measures that need to be addressed within this place. This is unfair to Canadians, specifically to the emergency response personnel for instance within this very bill.

Bill C-284 illustrates once again the failure of the government to proceed with substantive steps in the proper areas where Canadians need things addressed.

Generally my philosophy would be that it is grassroots not Ottawa that must reform an ailing health care system in terms of the Canada Health Act. Bill C-284 speaks to increased federal control over a medicare system that is increasingly unaffordable at the federal level. Ottawa's share of our medicare system was originally 50 per cent and is now down to approximately 24 per cent or less. Its share will likely disappear within 10 to 15 years.

The symptoms that we see are bed closures. In my own provinces hospitals have closed. There are long waiting lists, up to seven to twelve weeks for procedures. There has been a de-listing of medical services so that each province may have a different base from which to work. There is reduced medical coverage for Canadians travelling abroad. As important as any of the others, there has been an exodus of some of our expert medical personnel from our land.

Reform says that the five program criteria should be maintained but we have to re-examine the definition of those program criteria. We have to allow room for provinces to exercise administrative jurisdictions over the funding and delivery of our health care system. The crisis in our country is not what is done but of federal government intrusion into provincial jurisdiction.

Today, we think of Canada as a grand old house that has fallen into a serious state of disrepair. Today I stand with great trepidation as I see the foundations of that house facing a great test. It is true that the house of our nation has an unsustainable mortgage. It has a cracked foundation. It has serious problems with some of the ways that the walls are fitting together and how the communications work within that house.

However, within the last few days I have seen many Canadians speak out with a great love and a newly discovered feeling of the importance of this country to them. This is all the more reason that I feel today it is time for the government to recognize that there has to be a new relationship within this House, new federal-provincial relationships outside the Constitution. Our own party has suggested 20 ways where we can bring provinces and the federal government together so that as a nation we can stand together today and tomorrow in order to make this country work.

Decentralizing those powers includes a medicare system that works for all Canadians, that is sustainable and that will be here today and tomorrow. I challenge the government to change at our medicare system so that it will work. I also challenge the government to look at many other things, as we have suggested, so that we have a Canada today and tomorrow.

Canada Health ActPrivate Members' Business

11:35 a.m.

Liberal

John Maloney Liberal Erie, ON

Mr. Speaker, I rise to speak on the subject of a private member's bill, C-284, an act to amend the Canada Health Act.

Under the Canadian Constitution the responsibility for health care falls primarily under the jurisdiction of the provincial and territorial governments. In other words, the provinces and the territories have a primary responsibility for the provision and delivery of health care services to the people of Canada.

This means that they act as planners, managers and administrators of their own health care systems. In practical terms, this includes negotiation of budgets with hospitals, approval of capital plans and the negotiation of fee agreements with medical associations. For its part the federal government by law is responsible for the promotion and preservation of the health of all Canadians. The Department of Health is responsible for bringing together parties on health issues of a national and interprovincial concern.

The federal government also assumes a responsibility for setting national policies and for providing health care services to specific groups such as treaty Indians as well as the Inuit.

It is appropriate when describing federal responsibilities in health care to note what the federal government cannot do. It cannot interfere in provincial and territorial responsibilities as defined under our Constitution. Nor can it be seen to be infringing on these responsibilities.

Bill C-284 attempts to require provincial and territorial health insurance plans to impose a responsibility on hospitals to disclose to emergency response employees whether a patient to whom they are providing service has an infectious or a contagious disease. I sympathize with the concerns of emergency response workers. They must be commended for accepting the fact that they are at

risk to exposure to diseases that may not be completely preventable in serving the public.

Indeed my wife and several members of my family are employed in the health care field as well as in the emergency response field. Therefore I understand and support the motives behind Bill C-284.

However, it is the provinces and territories that are responsible for all matters dealing with their hospitals. This represents what would be perceived as an intrusion on provincial and territorial responsibilities under our Constitution. It is not an easy solution as one would think. There is in this country a longstanding partnership between the federal, provincial and territorial governments with regard to health care.

The enactment of the Hospital Insurance and Diagnostic Services Act of 1957 and the Medical Care Act, 1966-67 established a framework for this partnership between governments. At this time the federal government provides a sharing of the cost of medically necessary hospital and physician services in return for the adherence of the provincial and territorial health insurance plans through the principles of a national program.

Federal legislation, the the Hospital Insurance and Diagnostic Services Act and the Medical Care Act recognized the constitutional position of provincial and territorial governments and left each with the responsibility of administering its respective plans.

Concerns over hospital user fees and extra billing by physicians led to the passage of the Canadian Health Act in 1984. This was achieved with all-party support. The federal government's aim in passing the Canada Health Act was to reaffirm its commitment to the original guiding principles expressed in earlier legislation. It was also to provide a mechanism to promote the provinces' and territories' compliance with the act's criteria, conditions and extra billing and user charge provisions.

In short, the Canada Health Act was intended to encourage reasonable access to necessary health care services on a prepaid basis for every resident of Canada. The provinces and territories have retained their responsibility of administering their health insurance plans under the Canada Health Act. They continue to be responsible for negotiations with physicians and hospitals.

Since the introduction of government sponsored health insurance, physicians have been free of the administrative constraints of managed care found in the United States and this continues under the Canada Health Act. Hospitals retain the freedom to charge for semi-private or private rooms and for meals and accommodations for chronically ill patients who are more or less permanently resident in hospitals.

The Canada Health Act's criteria are known to most Canadians and regarded as the defining principles of medicare. The principles of public administration, comprehensiveness, universality, portability and accessibility are valued and cherished by Canadians who will not accept changes to them. The results of a recent poll indicate that support for these national principles remain at an all-time high.

Provincial and territorial ministers of health share this support. On many occasions the provincial and territorial ministers reaffirmed their support for the principles of the act and their agreement to continue co-operation in interpreting and applying its provisions.

The Canada Health Act's criteria relate to the organization and delivery of health care services at the level of provincial and territorial health insurance plans. Bill C-284 proposes to add disclosure of infectious or contagious diseases to the Canada Health Act's criteria. However this addition deals with a hospital requirement, while the Canada Health Act pertains to provincial and territorial health insurance plans.

If such legislation could be enacted we would be concerned that it may give false assurances to emergency workers and their families that if they are not informed they are not infected. Unfortunately some diseases may not be detectable, at least using current methods, until some time after the infection. Solutions must be sought to meet this problem.

Health Canada has been involved with the prevention of infectious diseases and the protection of emergency response personnel for a very long time. Let me give a few examples of our recent achievements in this area. In 1994 a national symposium on risk and prevention of infectious diseases for emergency response personnel was held to explore the risks emergency responders face and the preventive and protective activities presently available.

In June 1995 a consensus conference was held with the objective of establishing guidelines the provinces and territories could use to develop and implement an infectious disease notification protocol for emergency responders. These guidelines are a good example of how the provinces and territories look to the federal government to provide a leadership role in issues related to health protection.

I also have confidence in the ability of emergency response workers themselves, as those who are admirably qualified to find solutions, to join with us to alleviate the risk of infection along with the provincial and territorial health departments, along with health professionals and experts in infectious diseases. Given the large burden for our health that emergency response workers carry, I am sure that provincial and territorial governments are sympathetic, supportive, and eager to co-operatively find solutions. I know I am.

The evolution of federal, provincial, and territorial relations in health care has maintained a distinction in federal, provincial, and territorial roles in health care, which is consistent with the Constitution's definition of jurisdiction. This is clearly stated in the preamble of the Canada Health Act:

that it is not the intention of the Government of Canada that any of the powers, rights, privileges or authorities vested in Canada or the Provinces under the provisions of The Constitution Act, 1867 (formerly the British North America Act, 1867), or any amendments thereto, or otherwise, be by reason of this Act abrogated or derogated from or in any way impaired;

Some would argue that to pass Bill C-284 would disrupt this historical distinction and balance and for this reason it cannot be supported by the federal government.

I encourage all hon. members to participate in discussions about this important concern in their communities in order to find a way to protect the emergency response workers whose job it is to protect us all. Few would argue the fact that the problem is serious. It is incumbent on all levels of government to hammer out a solution. The time is now.

Canada Health ActPrivate Members' Business

11:45 a.m.

Liberal

Stan Keyes Liberal Hamilton West, ON

Mr. Speaker, while I wholeheartedly endorse the spirit of Bill C-284, a private member's initiative moved by my colleague, the hon. member for Winnipeg Transcona, which I had the privilege of seconding, I cannot see where we can support his idea to put it through the Canada Health Act.

Perhaps what we have to do today is not talk about what we cannot do. I have to agree with the position taken by the parliamentary secretary. She very eloquently put forward the reasons we cannot put it through the Canada Health Act, as was proposed by the member for Winnipeg Transcona; rather, we should find a mechanism, a way to accomplish our goal.

Since I was elected in 1988, firefighters from Hamilton and across this great country have been lobbying legislators to set up a contagious disease protocol. They stress, and all of us who have heard their lobby agree, that it should be of national importance, which it is; that it must be co-ordinated nationally, and we agree; that we should establish national standards and conditions, which can happen. We need a way to administer the protocol that is being proposed.

The international association of firefighters has been meeting with provincial and federal representatives since June. They have had quite a bit to say about this. There have been some resolutions. Progress is being made. Maybe the amendments being put forward by the hon. member for Winnipeg Transcona are a worthwhile public health objective and need to be examined.

The purpose of Bill C-284 is to incite the provinces to ensure that the health care insurance plan of a province provides for the obligation for hospitals to disclose to emergency response employees who provide emergency medical or rescue services to a patient the name and nature of an infectious or contagious disease the patient might have transmitted to them.

As I said at the outset, maybe we have to look at what we can do. What we can do is search out a central organization that would work with the hospitals to create that information-sharing proposal. I wonder if the hon. member for Winnipeg Transcona has considered approaching the Canadian Centre for Occupational Health and Safety. That particular centre, which is located in my riding of Hamilton West, receives a government subsidy, although it has been cut back. To its credit, it has been sharing information with the private sector and actually selling a product to employees and companies, both here in Canada and in the United States, to obtain the money it needs.

I wonder if the hon. member for Winnipeg Transcona has approached the Canadian Centre for Occupational Health and Safety, which has created a database of infectious diseases, of products different companies across the nation use in their workplaces, et cetera. For example, the Canadian Centre for Occupational Health and Safety is there for the major corporations in product identification. It is also there for an individual employee, someone who may be working on the shop floor in Winnipeg when a drum spills over and some glop pours out. The employee can see that the barrel is marked XT-2000. He is not sure what XT-2000 is, so he calls the Canadian Centre for Occupational Health and Safety to find out what the product is and whether it will be harmful to his health.

I wonder if the hon. member for Winnipeg Transcona, in looking for a way to accomplish a very credible goal, has looked at the options. The parliamentary secretary to the Minister of Health made it quite clear today that it is not really in the domain of the federal government, but rather a central organization. This could address the opportunities the member spoke of, could satisfy the needs of the medical emergency personnel and rescue services people who are responding to the patient who might have an infectious or contagious disease.

Maybe we could use this opportunity to dovetail with organizations that by consequence are also today forming partnerships with the private sector. It is the private sector that understands that this database is beneficial. If the private sector finds that it is worth while, then it can share its information with the Canadian Centre for Occupational Health and Safety, which can also share its information with hospitals provincially.

Let us germinate the seed today. This is an option the hon. member for Winnipeg Transcona can look at. Having seconded the bill, I would be more than happy to sit down with him and get together with officials in Hamilton at the CCOHS to try to accomplish the very worthwhile goal this member and other

members of the House have been trying to achieve since I was elected in 1988 and even before that time.

I thank you for this opportunity, Mr. Speaker.

Canada Health ActPrivate Members' Business

11:50 a.m.

The Acting Speaker (Mr. Kilger)

Resuming debate.

Since there are no more hon. members left to speak and the motion has not been selected to be voted on, the time provided for consideration of Private Members' Business has now expired. Pursuant to Standing Order 96, the item is dropped from the Order Paper.

Canada Health ActPrivate Members' Business

11:50 a.m.

Liberal

Don Boudria Liberal Glengarry—Prescott—Russell, ON

Mr. Speaker, on a point of order, perhaps the Chair would suspend for about four minutes and then we could proceed to government orders.

Canada Health ActPrivate Members' Business

11:50 a.m.

The Acting Speaker (Mr. Kilger)

The House has heard the intervention of the chief government whip. Is there unanimous consent to suspend the House until 12 o'clock?

Canada Health ActPrivate Members' Business

11:50 a.m.

Some hon. members

Agreed.

(The sitting of the House was suspended at 11.56 a.m.)

The House resumed at 12 p.m.

The House proceeded to the consideration of Bill C-7, an act respecting the control of certain drugs, their precursors and other substances and to amend certain other acts and repeal the Narcotic Control Act in consequence thereof, as reported (with amendments) from the committee.

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

Reform

Grant Hill Reform Macleod, AB

moved:

That Bill C-7, in clause 60, be amended by replacing lines 13 to 15, on page 44, with the following:

"portion of an item, after the governor in council has consulted with those persons who will be directly affected by the amendment".

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

Liberal

Don Boudria Liberal Glengarry—Prescott—Russell, ON

Mr. Speaker, I rise on a point of order. I understand unanimous consent is being sought to debate the amendment, even though it was not moved previously. I indicate to the Chair that we do not have any objection to it. We concur, with the understanding that we will immediately go to third reading after the amendment is disposed of.

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

Reform

Grant Hill Reform Macleod, AB

Mr. Speaker, we are seeking unanimous support and agree to third reading going ahead with the same support.

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

The Acting Speaker (Mr. Kilger)

Is there unanimous consent?

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

Some hon. members

Agreed.

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

Reform

Grant Hill Reform Macleod, AB

Mr. Speaker, Bill C-7 has been a complex bill that has taken some time going through the House. There is some vast improvement in the bill by opening up choice in the health food industry.

However the power to make regulation is still flawed in relation to the bill. The particular clause we have zeroed in on is clause 60:

The governor in council may, by order, amend any of schedules I to VI by adding to them or deleting from them any item or portion of an item, where the governor in council deems the amendment to be necessary in the public interest.

I have a few words to say about that clause. I believe it is dictatorial, arbitrary and opaque. Other words that come to mind are words like behind closed doors. This ability should not rest in the hands of a few. The particular amendment suggested will address a significant flaw.

One of my colleagues will speak at length on the issue a little later.

Controlled Drugs And Substances ActGovernment Orders

11:50 a.m.

Vancouver Centre B.C.

Liberal

Hedy Fry LiberalParliamentary Secretary to Minister of Health

Mr. Speaker, I rise to speak to the third party amendment to clause 60 of Bill C-7.

I agree with the hon. member the bill is a complex and at times controversial bill. All parties were eventually unanimous in the substantive changes and amendments to the bill that improve the bill a great deal.

However I speak to the specific amendment of the hon. member to clause 60 that would read:

"portion of an item, after the governor in council has consulted with those persons who will be directly affected by the amendment".

The purpose of the amendment is to get the governor in council to consult with those who would be directly affected by a change in schedule made by the governor in council.

There is already in place a democratic process within the machinery of government that answers the particular concern the hon. member for Macleod brought forward. Government is required to consult with those who will be affected by the proposal and the public at large before making any changes.

The only exception to this requirement is where public safety is concerned and where on an urgent and emergency basis one needs to make a change to the schedule within 24 hours. Even then there

is a process wherein an emergency scheduling provision in the interests of safety of the public would allow it to happen.

Turning to the broader process the member is speaking about, the process provides for the machinery of government. Government is required to prepublish for a minimum period of 30 days in The Canada Gazette , part I, any proposal to change scheduling. The prepublication period may vary, depending on the nature of the proposal.

For example, if the proposal was to have international implications and would therefore have impact on GATT, there is an agreement in GATT that there would be a minimum of 75 days of prepublication to allow other countries to respond.

Not only would interested parties respond if this were done a national level. Any citizen at all could provide comments or suggestions about the content of the proposal and about their concerns on the proposal. Then the government is obliged to report to the governor in council on those consultations, the feedback or input from parties directly affected, from concerned citizens or from the public at large. Also it is to report on the proposed remedies to be brought forth to address concerns. If this amendment represents a major shift in the original proposal, and if the concerned parties that have had input want another shift, there is a requirement to prepublish once again to discuss the new shift.

All the bells, whistles and hoops have been jumped through in the process already so I fail to see what the hon. member's amendment would do to improve the process in any way, shape or form. It is already public. It is already open to disclosure. If disclosure requires change there is a requirement for further disclosure and for a further period of 30 days to discuss it. As I said before, internationally there is a requirement to prepublish for 75 days.

There is a fail safe mechanism already there to answer the hon. member's concerns about the issue.

Controlled Drugs And Substances ActGovernment Orders

12:05 p.m.

Reform

Leon Benoit Reform Vegreville, AB

Mr. Speaker, I am pleased to rise today to speak to the amendment to clause 60 of Bill C-7. It says that the clause should be amended by replacing lines 13 to 15 on page 44 with the following:

"portion of an item, after the governor in council has consulted with those persons who will be directly affected by the amendment".

The parliamentary secretary responded to the amendment by asking why we need it. We already have the proper bells and whistles in place to deal with the public consultation process.

The parliamentary secretary to the health minister is correct. The amendment will put in place the requirement for public discussion and public consultation on changes to the bill.

In many pieces of legislation the Liberals have succeeded in taking more and more power from the people by putting in place the ability to make changes to legislation through the governor in council. This is one such move on the part of the government. The most important example in Bill C-68, the gun control legislation, gives incredible power to the governor in council. Bill C-61 deals with several agricultural acts and gives the minister and the bureaucrats the power to impose fines of up to $15,000 with the onus on the people fined to prove their innocence. That is one negative point about the legislation. Another is the control given through the governor in council without debate happening in the House. That is not democratic.

Unfortunately the anti-democratic move in the bill that gives more power and ability to make more decisions through governor in council is not unusual. The government has shown in many ways that it does not want to make things more democratic in the House. We have seen through what has happened to members who dared to vote against their party line or against the government on bills such as the gun control bill, Bill C-41. I could name others. These members have been punished harshly for voting differently than the party position. They have been thrown off committees and the Prime Minister publicly threatened to refuse to sign their nomination papers. What kind of a democracy is that?

The amendment will at least ensure a small amount of consultation. Liberal consultation is different from the Reform's version of consultation. Reform believes that when we go to the people to ask for consultations we really want to hear what they have to say and to act on it. The Liberals have shown that is not what they see as consultation. For example, in the gun control bill the justice minister's idea of consultation was to have meetings to which people went by invitation only. Other interested people were not welcome. That was complete and utter nonsense. The amendment will in a small way give a bit of the power back to the people by requiring consultation.

I will refer to a couple of other amendments but first I will show that this amendment has in a small way dealt with the concerns of some of my constituents. I have found that Bill C-7 and the changes to the legislation are very important to people in my constituency. Many people have come to me in public meetings asking questions about specific clauses of the legislation, and this is one of them. People have written letters to me that refer to specific clauses of the legislation.

I will read a letter from one of my constituents. It is a form letter but personal comments are included with it. It represents the concerns of a wide number of people, often people who want access to herbs, spices or other traditional medicines. They do not want the pharmaceutical companies or the government to be able

to limit access to these products in some way. It is very important to them.

The letter states:

I'm writing to request that Bill C-7 be withdrawn.

That is what should have happened with the legislation. It should have been withdrawn, or at least large parts of it should have been withdrawn. It is an omnibus bill that deals with many parts of the act. It is so broad or wide ranging that I wonder how the House of Commons can be asked to vote on the bill. It would be far more useful to have more specific legislation dealing with similar concerns.

Not all parts of the legislation should be thrown out. There are many good parts. However, because it is an omnibus bill and deals with a wide range of issues, parts of it should certainly be thrown out. The letter refers to the parts this constituent feels should be thrown out. A good summary of the legislation is given:

Bill C-7, the Controlled Substances Act, combines the Narcotic Control Act with the portions of the Food and Drugs Act. Combining criminal law with regulatory health is inappropriate and puts my right to buy natural health products in serious jeopardy.

Bill C-7 is a Criminal Code framework which would implicate many common herbal remedies and natural supplements because of their "stimulant" or "relaxant" properties. I believe that public safety can be ensured without Criminal Code restrictions on food supplements-

Controlled Drugs And Substances ActGovernment Orders

12:15 p.m.

Liberal

Paul Szabo Liberal Mississauga South, ON

On a point of order, Mr. Speaker, my understanding of the rules of this place is that a speaker must speak to the subject matter before the House. We are now dealing at report stage with a specific amendment. The member is speaking about the whole bill.

Controlled Drugs And Substances ActGovernment Orders

12:15 p.m.

The Acting Speaker (Mr. Kilger)

With the greatest of respect, that is a matter of debate and not a point of order.

Controlled Drugs And Substances ActGovernment Orders

12:15 p.m.

Reform

Leon Benoit Reform Vegreville, AB

Mr. Speaker, I am surprised by the continual interruptions on the part of members opposite when we try to make a point on behalf of our constituents.

It is was important enough to my constituents to write this letter to me. That member does not want to let me rise in the House and read this letter and show how this amendment has at least in some small way dealt with this concern. That is anti-democratic. It is just one more thing. It is the Liberal way. It is not democratic and it is not what we expect in the House. I become upset when I have this type of an interruption.

The letter goes on to say:

Further, I object that the control of any bioactive components or synthetic analogues of natural herbs by Bill C-7 it will replace criminal sanctions to the herbs themselves.

Health Canada should not be allowed to seize, remove or illegalize safe products from the shelves of distributors or hold them at the border without clear and convincing evidence of a lack of safety or misbranding. Health Canada should bear the burden of proof.

I believe that natural herbs and health supplements do not belong in the Criminal Code. These products should be considered as dietary supplements and regulated as such. Natural substances should not be considered as drugs.

I expect that you will represent my interests and oppose Bill C-7.

We will of course oppose Bill C-7. If this amendment does pass, and I would be surprised if it did not, all it does is put in place a consultation process. There is nothing guaranteeing it will be a valid consultation process but it is certainly a move forward. The onus will be on the government to show that it has consulted.

If we as an opposition party ask the government to show us it has consulted, it will be forced to at least demonstrate that it has had some consultation with all interested parties.

Other things have happened with this bill; other amendments and really the deletion of one clause I think has been extremely important. I credit my colleague, the member for Macleod, for successfully having clause 3(1) removed. It is certainly an important change to this legislation.

Clause 3(1):

For purposes of this act a substance included in Schedules I, II or III shall be deemed to include any substance;

(a) that is produced, processed or provided by a person who intends that it be introduced into the body of another person for the purpose of producing a stimulant, depressant or hallucinogenic effect substantially similar to or greater than that of a substance included in Schedule I, II or III, and that, if so introduced, would produce such a substantially similar or greater effect; or

(b) that is represented or held out to produce, if introduced into a human body, a stimulant, depressant or hallucinogenic effect substantially similar to or greater than that of a substance included in Schedule I, II or III.

Again I congratulate my colleague for successfully having that clause thrown out. That is a substantial change to this bill and it will help. Unfortunately there are still so many concerns-

Controlled Drugs And Substances ActGovernment Orders

12:20 p.m.

The Acting Speaker (Mr. Kilger)

I regret the member's time has elapsed at report stage.

Is the House ready for the question?

Controlled Drugs And Substances ActGovernment Orders

12:20 p.m.

Some hon. members

Question.

Controlled Drugs And Substances ActGovernment Orders

12:20 p.m.

The Acting Speaker (Mr. Kilger)

Is it the pleasure of the House to adopt the motion?