April 10, 1957

PC

William Gourlay Blair

Progressive Conservative

Mr. W. G. Blair (Lanark):

Mr. Speaker, before the adjournment for the dinner recess the minister spoke and he gave me the impression-indeed the suggestion was made- that 90 per cent of the costs of mental hospitals in the province is paid by the provinces themselves. I want to point out to the minister that a person who is mentally ill-and let us have this point clear in the beginning -is suffering from an illness comparable with any other illness to which the human body is heir. It is just as important to consider mental illness as it would be to mention carcinoma or cancer, pneumonia or any other disease. The patients going into those hospitals are paying their bills; they are not all indigents. In fact, the proportion of indigents in mental hospitals in my own province is not any higher than the proportion of indigents in the ordinary general hospital. The only people who might be classed as indigents in those hospitals are those that have been there for a long time and have exhausted their finances as a result of long treatment.

I want to point out that when a patient goes into a mental hospital a form is filled out by the bursar of the hospital and inquiry is made into the patient's assets. His whole financial condition is analysed. I am going to point out various extracts I read from the mental hospitals act, Revised Statutes of Ontario, various extracts to prove my point that patients going into mental hospitals are paying their fees in a way comparable with that of patients admitted to general hospitals. I will read these extracts. I want to prove to the minister that patients going into hospitals are obliged to pay fees. I therefore read from section 16, paragraph 2, of the mental hospitals act:

(2) The charges of such hospital treatment shall be paid by the patient unless he is an indigent person, in which case the charges shall be payable in the same manner as charges for indigent patients are payable under the public hospitals act . . .

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That is clear; there is no difference there. Then I read section 16a of the mental hospitals act:

16a. The minister,-

That would be the minister of health of the province of Ontario.

-out of such moneys as may be appropriated by the legislature for the purpose may contribute toward the cost of treatment in public hospitals of indigent patients transferred thereto under subsection 1 of section 16 in such amounts, in such manner and under such conditions as may be prescribed by the regulations.

But I go on with this proof. There is the question of the liability of the municipalities, and I read from section 57 of the same act;

57. (1) The necessary costs and expenses incurred under sections 23 to 29 and section 35-

That is a further reference.

-in determining the mental condition of any person including a fee not exceeding $10 and a travelling allowance of ten cents per mile of each medical practitioner who issues a certificate-

Those are charges. Then we come to the question of admission of a patient, and this is extremely important. This is section 60:

60. (1) Upon due application for the admission of any person the superintendent and steward of the institution shall make a full and thorough inquiry respecting the estate, either in existence or in prospect, of the person and of its sufficiency, free from all claims of his family, to supply the means necessary for his maintenance and clothing in the institution as provided by the regulations.

That is maintenance. Do not forget that this is the beginning of the section where they deal with maintenance. If that were not enough we find this:

(2) The superintendent and steward shall where possible require from the person liable for maintenance of the patient an agreement or bond to secure the payment of the patient's maintenance, either in whole or in part, and the agreement or bond shall continue in force so long as the patient is maintained in any institution.

Then it goes on, of course, to point out:

(3) Where the obligation is for a limited period nothing herein shall extend the liability beyond the period limited.

And then we find this:

(4) The giving of an agreement or bond shall in no way release the estate of the patient from its obligation to maintain and clothe him in the institution as hereinafter provided.

If funds are not forthcoming otherwise, they will be taken from his estate. Further we find this:

61. Every patient admitted to an institution who has at the time of his admission or subsequently comes into the possession of property shall be liable for his maintenance.

Then there is a section with respect to his wife:

62. Every person whose wife is a patient shall be liable for the maintenance of such patient.

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Then further:

64. (1) The steward of an institution shall send a written notice on the first day of each of the months of January, April, July and October to the person liable for payment of the maintenance of a patient, giving the date of the patient's admission to the institution and the amount which is due and owing for his maintenance . . .

And so on. It is clear that patients are paying in the mental hospitals in Ontario. Now we come to the powers of the public trustee. Directly a patient is admitted into a hospital within a province the public trustee, from the time of his admission, takes over control of his estate. I therefore read into this record chapter 77 of the same statute:

77. The costs, charges and expenses of the public trustee and any money advanced by him for the patient or for the maintenance of the patient's family shall be a charge upon the property of the patient, . . .

That is clear; there is no doubt about that. I further read into the record section 83 which is as follows:

83. The public trustee shall, out of the money in his hands belonging to a patient for whom he is statutory committee, pay the proper charges for his maintenance in the institution in which he is a patient, and he may also pay such sums as he may deem advisable to the patient's family-

The public trustee has control of the patient's money and he pays the hospital bills out of the patient's estate, the administration of which is under his control. I mentioned the fact that upon admission of the patient to the hospital inquiry is made and a financial statement given-actually it is called the blue form. I shall read extracts from that form.

The minimum rate for which a patient or his estate or the person liable for his maintenance shall be liable in the general wards of any institution-

I understand that varies from $7 to $10.50 per week.

-in cases where the patient's condition requires special care and treatment, such further charges may be made as the superintendent may determine.

This illustrates that extra charges may be made when the patient is in the hospital. One has to consider that under present conditions and new forms of treatment that are being used now, tranquilizing drugs may be included. The cost of these tranquilizing drugs is very heavy and may run from $20 to $40 per week. Nevertheless it says in this form that in cases where the patient's condition requires special care and treatment, an additional charge may be made.

I am going to cite some of the questions asked on the blue form by the bursar of the hospital when the patient is admitted. I have seen this happen quite often in my own province of Ontario, and I may say that every possible opportunity is given to lower

the fee as far as possible. However if there is a charge, certainly there will have to be payment by some person responsible. A member of the family may go and help fill out this blue form or it may be filled out by the solicitor who has charge of the estate. Questions like these are asked under the mental hospitals act:

Real Estate:

Give the number of the lots, concession, township, and county; the number of acres, whether leased or freehold; the name and address of mortgagee, if any, and the market value of the property.

There are a lot of questions about property. Then if the property is rented there are many questions concerning who is receiving the rent. Inquiry is made into life insurance. They ask the name of the company; the number of the policy; the amount of insurance; who has the policy at the moment and who is the beneficiary under the policy. There are questions also about the personal estate and personal property. In the case of a farmer, they ask the approximate value of his farm implements; his stock in trade: livestock; farm produce; and other property, if any. They ask about moneys secured by mortgage. Then, there is this sentence:

What suggestions do the relatives or friends make for the guidance of the public trustee?

The rate of maintenance is then set, and as I said in any case in which I have participated these people have been most helpful in trying to put that fee down as low as possible. There is no doubt on that score, that the public trustee does keep very close track if a person is declared incapable. If he has an estate, they certainly have to pay for the patient's maintenance out of that estate.

Then I come to form 30. I am only trying to prove to the minister that if a person is declared incompetent to handle his estate, payment is made. Form 30 of the regulations under the mental hospital's act is a bond for the maintenance of the patient in the hospital. I feel that that proves beyond all doubt that patients going into hospital pay their hospital bills. I have stated that the number of indigents in these hospitals is at a rate comparable with the number of indigents in general hospitals.

Before the dinner recess I heard the minister mention what the federal government had done by way of providing beds. He pointed out what was happening in the city of Ottawa. Let me say to you that there are insufficient beds in the city of Ottawa to cope with this program. The civic hospital is going to put in 40 beds. There will be 80 beds in the city of Ottawa for mental patients. In so far as the hospital at Brockville is concerned, I am not aware of the number of patients in that large

hospital but I would say that 300 or 400 of the patients in that hospital come from the Ottawa area and not entirely from the Ottawa valley.

Let us look at the regulations as they stand. In answer to some of the questions that were put to him today the minister pointed out with a degree of pride that we are going to take care of mental patients in general hospitals. There is no doubt that is the case under this bill. However there is no restriction on the length of time which a patient may be in that hospital. Remember that when a case of mental illness occurs, no doubt the relatives will want to have the patient put in a general hospital rather than in one of the Ontario hospitals. It is only normal and natural that they would want to do that. I want the minister to pay particular attention to this, that they would have a further incentive to do so because the care of such patients is free in general hospitals and if they go to the Ontario hospitals they will be charged. It is going to come out of their estate or some place. Payment has to be made.

As I said the other day, I feel this is a retrograde step. You are not really recognizing the problem of the number of mental patients in Canada. The amount of money you are giving under the health grants does not begin to cope with this problem of hospitalization. As my leader has said, even if the province of Ontario or any other province is paying a large percentage of these costs there is this drag on the province's finances. After all, taxes have to be paid and the financial agreements that are made between the province and the dominion under this bill are of some help, but the provinces are having their own troubles in trying to finance other things. There is no doubt of that.

To recapitulate, I think I have clearly proven that patients going into mental hospitals in my own province are paying their bills. I do not believe this figure of 90 per cent the minister has mentioned. If they are not paying their bills, they might be classed as indigents, but there is a very strong inquiry made under the regulations. In cases where the estate is taken over, the hospital bills are paid. There is a percentage of indigents in these hospitals. If long-term treatment is required and it is certainly expensive, a small estate might easily disappear.

It is not sufficient to say that the cost of caring for the mentally ill will put up the cost of caring for the others. There was some suggestion that there might have to be an additional tax levied under the present 82715-214

10, 1957 3389

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scheme in order to take care of mental hospital facilities. As my leader has said, I feel that this should receive further consideration. There are 10,000 more people in Canada suffering from mental disease than there are in all the general hospitals put together. Some people do not understand that. They have taken the minister's statement that the provinces are paying 90 per cent of the bills.

Let me say this to you, sir. These are sick people the same as anybody else. If they are to be ignored under this scheme, then we shall arrive at this situation. We will pay for pneumonia, yes; that is fine, but we will not pay for mental disease. We are not giving recognition to one of the greatest problems that the minister has to face in the whole of Canada. If you are to face up to it, then some place, somehow additional funds must be provided for the care of these people. You should not set them aside and say that it is the duty of the province to look after them.

The minister made the statement this afternoon that the province is looking after 90 per cent of the mental patients. Their bills are being paid but there is no greater percentage of indigents in those hospitals than in other hospitals. We must look at that. Let us take a second look at this; let us inquire into it and do something to help this population which is growing in Canada.

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CCF

Stanley Howard Knowles (Whip of the Co-operative Commonwealth Federation)

Co-operative Commonwealth Federation (C.C.F.)

Mr. Stanley Knowles (Winnipeg North Centre):

Mr. Speaker, my intervention at this point will be very brief. I admit also that what I will say will inevitably be by way of repetition of things that have been said before. I feel, however, that we must indicate our whole-hearted support of the proposal now before us, which is in line with the contention that we have made right from the start, that reconsideration should be given to the government's insistence that mental and tuberculosis hospitals be excluded from this plan.

As the hon. member for Lanark (Mr. Blair) has just indicated, the incidence of diseases in these categories is very great, and if we are to have a hospital plan that is worthy of the name it should include all the diseases that affect our Canadian people in all of the provinces of this country.

What we do not like about the government's attitude toward this matter is that it is giving the impression it is coming into hospitalization on a 50 per cent basis when in point of fact it is coming in on a basis of about 30 per cent or 35 per cent when you consider all of the illnesses in Canada that require hospitalization. We feel that is not good enough.

I rise also to protest once again against the times without number the minister tries to

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repeat the argument that the federal government is doing only what is done in some of the provinces. Mr. Speaker, let me say it again, despite the fact that I have said it half a dozen times already, in provinces like Saskatchewan and British Columbia particularly, where they have gone the farthest in this field, all hospitalization is taken care of by the state whether it be in general hospitals on the one hand, or in mental or tuberculosis hospitals on the other. It is paid for out of two different accounts; in Saskatchewan, for example, out of the insurance account in one case and out of the general account in the other, but it is taken care of for all the people of Saskatchewan by the state as represented by the provincial government with, in some instances, assistance by the municipalities. The federal government, on the other hand, proposes to get into the field of hospitalization and proposes to limit its participation in that field to hospitalization in general hospitals.

I deny to the minister the right to use the argument about the insurance principle because so far as the federal government's contribution is concerned it is to come out of the general revenues in the same way that the payments made by Saskatchewan and British Columbia for mental and tuberculosis hospitals come out of the general revenues of those provinces.

Again, I say to the minister that his argument about not being ready to subsidize the provinces with respect to some of their responsibilities does not stand up at all. This whole legislation is a recognition of the fact that the time has come for the federal government to get in and help share certain responsibilities that the provinces are now carrying. We contend that it should get in with both feet and not just with one foot. We support wholeheartedly the suggestion that is contained in the amendment that is now before the house that this bill should be referred back to the committee of the whole for the purpose of reconsidering the question of extending this coverage to hospitalization of all kinds.

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SC

George William McLeod

Social Credit

Mr. G. W. McLeod (Okanagan-Revelstoke):

Mr. Speaker, I should like to say a few words at this time on this bill. I am satisfied that the majority opinion in this house favours the bill in principle. Throughout the long history of this measure, for almost a year and a half, in committee and wherever it has been studied, I have personally been a consistent supporter of it. Since the bill has been brought forward we have noted a few of the regulations concerning it which will make it very difficult for the province of British Columbia to work its scheme in accordance with this legislation. At all times

1 have been impressed by the words of the minister that this bill would be set up in complete co-operation with the provinces and that no stumbling blocks would be placed against it. I believe the difficulties which I shall mention later can be worked out by regulation, and I have every confidence that within the understanding that we have been given on so many occasions by the minister sponsoring this legislation that will be done. However, at this time I should like to draw to the attention of the house the difficulties which we are facing.

In order to save time I shall immediately move a subamendment, seconded by the hon. member for Fraser Valley (Mr. Patterson);

That Bill 320 be not now read a third time, but that the said bill be referred back to the committee of the whole for the purpose of considering clause

2 (e) and inserting after the words "2 (e)" the

words "2 (f), clause 8 (1) and clause 4 (a)

thereof".

The whole amendment would then read:

That Bill 320 be not now read a third time, but that the said bill be referred back to the committee of the whole for the purpose of reconsidering clause 2 (e), clause 2 (f), clause 4 (a), and clause 8 (1).

I shall try to state simply my reasons for bringing this to the attention of the house briefly. In the province of British Columbia we have a system under which every resident, if he is in that province for one year, is automatically insured. We have no registration and we have no signing up and there is no record of policyholders in the ordinary accepted sense of insurance plans. One of these clauses refers to in-service treatment, for instance. There are many smaller hospitals which are quite efficient and serve the purpose in small communities but they are not able to provide all the services which are required under the particular regulations to which I have referred.

It is required that the province shall make monthly returns showing the number of policyholders, or insured persons in the province. I think you will see, Mr. Speaker, that under the system being operated in British Columbia that would be a very serious problem to us and it would be almost impossible for the province to furnish any such returns to the federal government, because we have no record whatever of insured persons. Every person in the province is automatically insured. To comply with the regulations it would mean that you would have to have perhaps a census of the province every month in order to get the total. It is apparent therefore that this regulation will need some clarification or change.

Concerning the matter of residence I believe this bill sets forth a stipulation that every person shall be immediately covered.

That is another feature which is contrary to our provincial set up. In the province of British Columbia it is necessary to have been a resident of the province for one year before you become eligible for hospital insurance and I think when you examine the situation you will agree there is nothing seriously wrong with that provision.

Under all other insurance schemes I know of, either private or provincial, the premiums are payable in advance at which time the insured person is covered, but in British Columbia the premium is not paid until you have lived in the province for one year. During the time you are resident there you pay 2 per cent in the form of sales tax on the purchases you make and this represents your contribution to the health insurance fund. I believe that these points should be given further consideration. I am sure it will be the desire of the minister to cooperate fully in seeing that these difficulties are ironed out.

British Columbia was the first province to signify its willingness to accept the federal scheme in principle, but now that the bill has come forward and a careful study of it has been made it is found that it will be impossible under the system now in operation in British Columbia to comply with the regulations attached to the federal proposal as this would involve a complete change in our provincial system. I therefore suggest that the subamendment I have just read be presented for the consideration of the house and that these matters be given further serious consideration.

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Marlin:

I can assure my hon. friend that the points he has mentioned with which I am familiar could be arranged in the regulations through negotiations that we will have with the province.

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SC

George William McLeod

Social Credit

Mr. McLeod:

Mr. Speaker, I want a vote on it just the same. The one vote will cover them all. It will not make any difference in the time consumed. We appreciate the words of the minister and I am sure that such will be done. We may as well cover it all in the one vote.

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LIB

William Alfred Robinson (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

Mr. Deputy Speaker:

Is the house ready for the question?

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Fleming:

Mr. Speaker, I wish to raise a point of order. I contend that this proposed amendment is not a proper amendment to the amendment that is now under debate. It could be introduced as a separate amendment after my amendment is disposed of but in my submission it is not a proper amendment to the amendment.

The amendment that is now under debate relates to a particular subject, namely, the 82715-2144

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definition of "hospital" contained in the bill and the debate has proceeded very clearly within the confines of that subject, the inclusion of certain kinds of hospitals and the exclusion of other kinds; but the amendment introduced by the hon. member for Okanagan-Revelstoke (Mr. McLeod) proposes to take in three other subjects dealt with in the bill which have absolutely no relation whatever to the subject of the amendment I moved.

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

I think the hon. member for Okanagan-Revelstoke did not mean to do that. I appreciate what the hon. member for Eglinton is saying. We might deal with his amendment first. I do not think the hon. member for Okanagan-Revelstoke meant that we should not deal with them separately.

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Fleming:

Whatever his intention was he certainly introduced his amendment as an amendment to my amendment. Either the hon. member must withdraw his amendment or, in my submission, it should be ruled out of order, Mr. Speaker.

The three matters that he proposes to add to the specific reference contained in my amendment include clause 2(f) which is the definition of "in-patient services", a quite different subject matter from the hospital institutions that are excluded; the next matter is section 4 subsection (a) which relates to the basis of federal contributions under the whole scheme-

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

Mr. Speaker, may I intervene at this point. I have just spoken to the hon. member for Okanagan-Revelstoke and he agrees that the amendment of the hon. member for Eglinton should proceed first. The hon. gentleman will withdraw his amendment for the time being.

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Fleming:

If the hon. member for Okanagan-Revelstoke is withdrawing his amendment I do not need to say any more because section 8 deals with the regulations and is still further removed from the subject matter of my amendment.

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LIB

Louis-René Beaudoin (Speaker of the House of Commons)

Liberal

Mr. Depufy Speaker:

I have read the

amendment proposed by the hon. member for Okanagan-Revelstoke. I understand that the hon. gentleman wishes to withdraw his amendment.

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?

An hon. Member:

He has not said so yet.

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SC

George William McLeod

Social Credit

Mr. McLeod:

Mr. Speaker, we wish to

comply with the rules of the house. I was simply adding the contents of my amendment to the amendment moved by the hon. member for Eglinton. It was not my intention to destroy the hon. member's amendment and I was just adding to it. However if you rule

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against my doing so we are prepared to withdraw my amendment and move it later as a separate motion.

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LIB

William Alfred Robinson (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

Mr. Deputy Speaker:

Has the hon. gentleman unanimous consent to withdraw this amendment?

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Subtopic:   AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND
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?

Some hon. Members:

Agreed.

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?

Some hon. Members:

No.

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SC

Ray Thomas

Social Credit

Mr. Thomas:

Mr. Speaker, the understanding is that if you rule against this as a subamendment then the hon. member for Okanagan-Revelstoke is willing to move it as an amendment after this one has been disposed of; otherwise, if you do not rule against it, we leave it as a subamendment.

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PC

Donald Methuen Fleming

Progressive Conservative

Mr. Fleming:

Mr. Speaker, it is either withdrawn or it is not withdrawn. The hon. members must make up their minds.

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LIB

Paul Joseph James Martin (Minister of National Health and Welfare)

Liberal

Mr. Martin:

I think the situation is that my friend the hon. member for Okanagan-Revelstoke does not want to interfere with the amendment moved by the hon. member for Eglinton. He recognizes the merit of what the hon. member for Eglinton has said on the procedural question and for the time being withdraws his amendment.

be followed and hon. members introducing such matters ought to know that they should be brought in by way of a separate amendment and not by way of being tacked on to an existing amendment to which their amendment has no relation whatever.

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April 10, 1957