March
7, 2017
HOUSE OF ASSEMBLY PROCEEDINGS
Vol. XLVIII No. 64
The House met at 1:30 p.m.
MR.
SPEAKER (Osborne):
Order, please!
Admit strangers.
Today, I welcome to our public galleries 10-year-old
Wendy Dalton, who is joined by her mother, Patricia, and father, Don Dalton.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
Wendy is the subject of a private Member's statement.
As well, we welcome to our public gallery: Mayor Paul
Pike of St. Lawrence, town clerk Andrea Kettle, and councillors Ernie Lundrigan,
Mike Stacey, Rodney Doyle, Amanda Slaney and Jack Walsh.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
We
would also like to welcome to our public galleries: Port Saunders Mayor Tony
Ryan and Councillor Peter Kennedy who are in St. John's for meetings.
SOME HON. MEMBERS:
Hear, hear!
Statements by Members
MR.
SPEAKER:
For
Members' statements today we have the Members for the Districts of Conception
Bay South, St. George's Humber, St. John's Centre, Burin Grand Bank,
Lewisporte Twillingate and Harbour Main.
The hon. the Member for the Conception Bay South.
SOME HON. MEMBERS:
Hear, hear!
MR.
PETTEN:
Thank you, Mr. Speaker.
Mr. Speaker, I rise in this hon. House today to pay
tribute to the Kiwanis Club of Kelligrews on the occasion of their 60th
anniversary. I recently had the pleasure of attending their anniversary dinner
celebration. They have worked tirelessly serving the needs of those in
Conception Bay South.
The Kiwanis Club of Kelligrews has had a significant
impact on the community over the last 60 years. To see an example of its many
contributions, one only has to look at the minor softball field located next to
the club, and their commitment to the youth of the area is very evident.
With projects ranging from developing the Sgt. Thomas
Ricketts Memorial Park and long-time hosting of the annual Santa Claus parade
and the infamous annual Kelligrews Soiree; the Kiwanis Club of Kelligrews is
committed to bringing the exceptional services to our community.
Mr. Speaker, I ask all Members of this House to join me
in congratulating the Kiwanis Club of Kelligrews on 60 years of service to the
Town of CBS, and wish them all the best in their future efforts to assist the
people in our community.
Thank you.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. George's Humber.
MR.
REID:
Mr.
Speaker, I rise today to recognize Alex Henniffent, a business administration
student at Grenfell campus who was recently recognized at the Global Student
Entrepreneurs award ceremony.
While only 20 years old, Alex already has seven years'
experience as an entrepreneur and is a client of the Navigate Entrepreneurship
Centre in Corner Brook.
The Global Student Entrepreneur Awards program is
designed for undergraduate students who own and operate their own businesses.
Young entrepreneurs can learn to promote their business and its value
proposition by competing with other business owners.
Participation in local, regional and online
competitions will result in worldwide media coverage for the entrepreneurs and
their businesses. Students can also meet and benefit from the experience of
fellow entrepreneurs, the VIP judging panel and industry representatives from
the Entrepreneurs' organization.
Alex placed first in the Atlantic Canada's region of
the international contest series for 2016-2017. The value of the prize he
received was $30,000, which includes transportation to Vancouver, a trip to
anywhere in North America, business training, a website creation package and
$5,000 in cash.
Mr. Speaker, I ask all Members of the House join with
me in wishing Alex well in his future endeavours and congratulating him on this
prestigious award.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. John's Centre.
MS.
ROGERS:
Thank you, Mr. Speaker.
Many people are doing wonderful work in my District of
St. John's Centre and today I recognize Susan Gillingham.
Susan is the pharmacist owner of Shoppers Drug Mart on
Lemarchant Road, one of the largest methadone dispensaries in the province,
serving over 270 patients.
Susan is participating in a fantastic study aiming to
increase access to HIV care. The APPROACH study is led by a team at MUN's School
of Pharmacy. APPROACH stands for: Adaptation of Point of Care Testing for
Pharmacies to Reduce risk and Optimize Access to Care in HIV.
Clients request a test verbally or discretely on a
piece of paper. The screening test is similar to a blood-glucose test with a
finger prick and results are ready in less than two minutes.
Susan and her team have received extensive training in
not just the physical aspects of the testing, but also in counselling for
delivering test results in a safe and caring manner. Positive results come with
a bloodwork requisition and people receive further testing.
This study is also in partnership with the AIDS
Committee of Newfoundland and Labrador. I thank Susan Gillingham and her team
for their leadership, improving our community, for their passion and their
compassion.
Thank you very much, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Burin Grand Bank.
MS.
HALEY:
Thank you, Mr. Speaker.
I rise today to recognize Chief Petty Officer Second
Class Scott Osborne of the Royal Canadian Navy. Originally from Little Bay East
in my District of Burin Grand Bank, Scott is now stationed in Halifax.
Scott was in Ottawa yesterday where he was presented
with the Military Merit award by the Governor General, Mr. Speaker an award
given to service men and women who have demonstrated dedication and devotion
beyond the call of duty.
He has served on six naval ships, including HMCS
Toronto, which nominated him for this
award; has been twice an instructor at the Canadian Forces Naval Operations
School; and has been posted to CFS St. John's.
Anyone who knows Scott will be struck by his energy,
his positive attitude and his willingness to go above and beyond. His parents
Bill and Rita Osborne, sister Gail, brothers Ross and Ron, and indeed the whole
family can rightly be proud of him.
I ask all Members to join me in congratulating Chief
Petty Officer Scott Osborne on this award. He is a shining example of the more
than 700 Newfoundlanders and Labradorians currently serving in the Canadian
Armed Forces.
Thank you.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Lewisporte Twillingate.
MR.
D. BENNETT:
Thank you, Mr. Speaker.
I rise in this hon. House to recognize an outstanding
gentleman from my District of Lewisporte Twillingate, Mr. Victor Baker
better known as Uncle Vic.
On March 3, I had the privilege of attending Uncle
Vic's 100th birthday. The celebration started with Victor being picked up by
horse and carriage at Pleasantview Manor in Lewisporte, where he now resides. He
travelled to the United Church where a full house of family and friends awaited
his arrival for a surprise birthday party. The afternoon was filled with stories
of Mr. Baker's life, along with song and dance, in which this youthful man could
not stay seated, and danced and sang to nearly every song.
Mr. Baker is such a pleasant and caring man. He
appreciates everybody and everything. And people love him for that. When asked
by reporters what was his secret to living 100 years, he said the key was to
watch your diet and stay active. And as a testament to his humour, he told
another reporter that the key to being 100 years was being born in 1917.
Mr. Speaker, I ask all hon. Members to join me in
congratulating Mr. Victor Baker on his 100th birthday.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. Member for Harbour Main.
MS.
PARSLEY:
Thank you, Mr. Speaker.
I am honoured today to rise and recognize a special
constituent of mine from the District of Harbour Main. In October, nine-year-old
Wendy Dalton was selected as Mattel: You Can Be Anything contest winner, which
allows young girls to live out their dream career for a day. Wendy chose to be a
pilot; a profession that is male dominated.
In collaboration with the Gander Flight School, Wendy
was sent to Gander via limo with her mother Patricia and father Don. She was
given a tour of the flight centre, was taken through pre-flight checks and
shortly after took to the skies above Gander to fulfill her dream.
Working alongside flight instructor, Heather Philpott,
Wendy operated the various controls inside the cockpit and learned about the
importance of the instruments that keep a plane on course. Once back on the
ground at Gander International Airport, Wendy no doubt was elated by the
experience.
I believe she serves as an example to young girls
everywhere that no matter what profession you choose in life, whether it be male
dominated or not, with dedication and hard work you really can be anything.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
Before proceeding to Statements by Ministers, we would also to recognize in our
public gallery today, Deputy Mayor Todd Strickland and Town Manager Melvin
Keeping from the Town of Port aux Basques.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
Statements by Ministers.
Statements by Ministers
MR.
SPEAKER:
The
hon. the Member for Education and Early Childhood Development.
MR.
KIRBY:
Mr.
Speaker, I rise today to acknowledge the committed efforts of the Premier's Task
Force on Improving Educational Outcomes. The task force was launched in November
as one of more than 50 initiatives included in
The Way Forward, which is our government's vision for sustainability
and growth in Newfoundland and Labrador.
The task force includes four distinguished education
experts: Dr. Alice Collins, Dr. Marian Fushell, Dr. David Philpott and Dr.
Margaret Wakeham.
From January 30 to March 2, public consultations were
held throughout the province which included meetings with teachers, high school
students, members of the public and various stakeholder groups. In addition,
there is an online option for submissions which will be available until March 20
at
www.ptfnl.ca.
Mr. Speaker, the task force is examining the
kindergarten to grade 12 education system and considering a number of priority
areas in education, including: early learning; mathematics; reading and
literacy; inclusive education; student mental health and wellness; multicultural
education; co-operative education; indigenous education; and teacher education
and professional development.
The Premier's Task Force will provide recommendations
to assist government in developing an Education Action Plan which will guide and
support 21st century learning and educational opportunities for students in
Newfoundland and Labrador.
Mr. Speaker, as a government, we are committed to
providing the best possible education system for our students and we will
continue to work collaboratively with our stakeholders to improve student
performance.
I ask all hon. Members of this House to join me in
thanking everyone who has taken advantage of the opportunity to share their
opinions during these consultations, and also in recognizing the members of the
task force for their dedicated work.
Thank you.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
Thank you, Mr. Speaker.
I thank the minister for an advance copy of his
statement. I would also like to acknowledge Dr. Collins, Dr. Fushell, Dr.
Philpott and Dr. Wakeham. I've had the pleasure of working with some of these
individuals in the past and I hold their experience in the highest regard.
While I have a great deal of faith in the task force,
the same cannot be said for the group to which they will report. I would hope
the Minister of Education will listen more intently to the task force than he
did with other stakeholders such as the NLTA, the association of school
councils, administrators and teachers, parents and students as it relates to
improving education in our province.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. John's East Quidi Vidi.
MS.
MICHAEL:
Thank you very much, Mr. Speaker.
I, too, thank the minister for the advance copy of his
statement. I'm delighted to acknowledge the task force, in particular, for their
efforts. They've had a huge task to perform and they have a long road to travel
at the hardest time of the year.
I'm very much looking forward to their report and have
great hopes, but I urge the minister once he has received the report, to work
closely and work with all stakeholders in ensuring that all the task force's
recommendations get implemented. I trust what they're going to say.
Thank you, Mr. Speaker.
MR.
SPEAKER:
The
hon. the Minister of Advanced Education, Skills and Labour.
MR.
BYRNE:
You
got that right.
Mr. Speaker, I would like to inform this House of a
far-reaching advancement that our government believes will have a very positive
impact on post-secondary education in our province and on the economy of our
province.
At the end of February, I was very pleased to join the
Premier at the College of the North Atlantic's Corner Brook campus to announce
the establishment of a new Workforce Innovation Centre. This is an extraordinary
development, made possible by $1.8 million in funding from the
Canada-Newfoundland and Labrador Labour Market Development Agreement.
The Workforce Innovation Centre will fund a variety of
initiatives to help create sustainable employment and serve as an incubator for
new ideas and projects that will help our province prosper. Eligible
organizations, Mr. Speaker, such as municipalities, Indigenous organizations,
and post-secondary education institutions, can and will apply for funding
following a public call for proposals later this spring.
In The Way
Forward, we commit to have College of the North Atlantic and its 17 campuses
serve as local and regional economic generators and hubs. This centre represents
a giant leap in that direction. By harnessing the renowned creativity of
Newfoundlanders and Labradorians, we can, as the Premier said, set our province
on a new path of discovery.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
Thank you, Mr. Speaker.
I thank the minister for an advance copy of his
statement. The Workforce Innovation Centre is a very positive initiative which
we all hope will produce positive results for the people of our province. This
is an initiative that was worked on heavily by the previous administration. I'm
pleased to see the partnership with the federal government came to fruition.
The Canada-Newfoundland and Labrador Labour Market
Development Agreement can only be truly successful when a government actually
focuses on the province's economic climate and recognizes that fostering an
environment for sustainable employment and innovation is a step in the right
direction.
At a time when the Liberal government has done so much
to discourage economic growth in our province, it is nice to see something that
offers our communities and young people a glimpse of hope.
Thank you, Mr. Speaker.
MR.
SPEAKER:
The
hon. the Member for St. John's East Quidi Vidi.
MS.
MICHAEL:
Thank you very much, Mr. Speaker.
I too thank the minister for the advance copy of his
statement, and this is great news. I'm really glad to see it. It will definitely
help our growing unemployment issue which, as we all know, is a serious problem.
I have one it's not so much a concern, but a question
to the minister because it wasn't clear to me. Is this a one-time grant? How
many years is this going to cover? What is going to sustain this centre over
many years? That wasn't clear from his statement.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
Further statements by ministers?
Oral Questions.
Oral Questions
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
Mr. Speaker, the Premier hand-picked a former Liberal
leadership candidate and a Liberal financial donor to the highest, non-political
position in the public service the Clerk of the Executive Council.
So I ask the Premier today: Do you think it's
appropriate to have a politicized Clerk of the Executive Council?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
With all positions, certainly within government, what's
important is we get the right people that can do the job, Mr. Speaker, and the
person that we have in place right now has a very stellar record. As a matter of
fact, he had a lengthy career in public sector workforce in this province, Mr.
Speaker. Mr. Coffey, for those that would know him as the current Clerk of the
Council, the head bureaucrat in our province is doing a great job on behalf of
Newfoundlanders and Labradorians.
Mr. Speaker, one of the most encouraging things that I
know since I became Premier of this province is the number of Newfoundlanders
and Labradorians who unselfishly are stepping up to key positions in this
province to help work with us through the current situation that has been left
by the previous administration, a record of mismanagement and poor planning, I
say, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
As we all know, the Clerk is supposed to be the most
senior, non-political office in government. This is another backtrack on the
Liberal's promise to take the politics out of appointments.
So I ask the Premier: Are you and your Clerk, Mr. Bern
Coffey, attempting to politicize the public service?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
For the question there, I would say to the Member
opposite, not at all. What we're trying to do, Mr. Speaker, is get this province
back on track.
SOME HON. MEMBERS:
Hear, hear!
PREMIER BALL:
We're very fortunate that the former Clerk is now working with the Newfoundland
and Labrador Housing Corporation doing a great job, Mr. Speaker. So this is not
about replacing people or putting people there for political reasons. This is
about making sure we have people that can actually do the job that we've asked
to do.
Again, I say, Mr. Speaker, it's about people that are
willing to step up. Step up from very great careers that they've had, both in
the public sector and the private sector, willing to help and step up for our
province, Mr. Speaker. We've seen it with the new CEO at Nalcor, who has a
stellar record. We know that he's making a great difference at Nalcor, and
helping us right now in the current situation, as I say, Mr. Speaker.
The Member opposite raises the question here; if you
look at your own record, political appointments that they have put into place,
like John Ottenheimer who was a leadership candidate just weeks prior to the
previous election, Mr. Speaker. They were decisions they made for political
reasons.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
Just to be clear to the Premier, I'm not questioning
qualifications of the Clerk. I'm questioning the promise that this government
made, that the Liberals made to take the politics out of appointments, and
putting Bern Coffey in such an important position is putting politics in to the
most senior position in government.
So I ask the Premier: Can you tell us and identify,
explain to us the process that you followed when you hired former Liberal MHA
Perry Canning to the Assistant Deputy Minister of Mines and Natural Resources?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
What we've had with Mr. Canning and his appointment,
Mr. Speaker, again, it's another example of a Newfoundlander and Labradorian
who's now back in our province and willing to step up and support the
initiatives that what we need to do in this province, Mr. Speaker.
When you look at the past, and we look at how far we've
advanced this since we've taken government, Mr. Speaker, we need not go back too
many years when you look at elections in our province. When Len Simms would one
day be the CEO of Newfoundland and Labrador Housing Corporation, the next day he
could be leading a Progressive Conservative campaign, and then he'd go back when
that was finished and go back into the same position again. Mr. Speaker, that is
politics. What we are doing is not politics.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
I heard some of the comments over there, and I just
reiterate, I'm not questioning the qualifications of Mr. Canning or Mr. Coffey.
My question was what was the process, and the Premier hasn't told us yet.
So I'll ask him this question: Premier, can you explain
to us what was the process you followed when you hired former Liberal candidate
Lynn Sullivan to the Assistant Deputy Minister of Royalties and Benefits in the
Department of Natural Resources?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, once again, Ms. Sullivan had a great record
working within an agency or within a public sector workforce within our
province. Ms. Sullivan did a great job. Again, I would if you look at the
qualifications, in her case, Mr. Speaker, she came back and took a pay cut to
come back and try and help this government tackle the mess that was created by
the Members opposite.
I would say, Mr. Speaker, that when you look at the
process that we had used in attracting the people to work with this government,
it was a much better process that was used by the prior administration. And the
former premier himself knows that he reached into the RNC to put his own deputy
chief in staff, I say.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Deputy chief.
Well, Mr. Speaker, once again, this is not about
qualifications or capabilities of people, this is about the process. The
Premier's not providing the information. A very clear question is what is the
process they followed? In the case of Ms. Sullivan, it appears she didn't even
know what job she was going into after she was appointed. She had to find out.
So I ask the Premier this: Can you tell us what process
was used when you hired former Liberal political assistant Tony Grace to the
position of Assistant Deputy Minister of Lands in Municipal Affairs?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, to the Leader of the Opposition, you know, I take
exception to the fact that we've had people here with long careers within
government. To bring someone like Tony Grace, who has been around government
circles through the past administration Mr. Speaker, he worked there for many,
many years. It's been a continuous years of service in public sector within this
province, I say.
So he's qualified for the job, Mr. Speaker. He stepped
up to the job and doing a great job, I would say, in some of the restructuring
that we've seen within government.
These are people that have been inside the government
for a long, long time. When the opportunity came and the positions were
available to them to continue the great work that they were doing on behalf of
people, Newfoundlanders and Labradorians, they stepped up to the task and the
challenges that was offered to them.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
I say the opportunity didn't come, they created the
opportunity because it was only last fall that the Premier and his ministers
stood and talked about how all the deputy ministers and assistant deputy
ministers positions and people they eliminated, very qualified people they threw
out, and then they appointed their own Liberal friends to all these many
positions. Tony Grace was no different. While they were terminating others, they
were moving him in.
So the Premier still hasn't told us what the process
was, so I'm going to ask him again, Premier, if you can identify the process
used to hire your former Liberal Party executive member Ted Lomond to the Deputy
Minister of Tourism, Culture, Industry and Innovation. Can you tell us what
process was used for that political appointment?
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, the process that was used when you go out and you
put management people in situations, you look for qualified leaders; that is
exactly what you do. You put the best people that you have available to you to
go into those key positions.
Mr. Speaker, what I would like to know, in some cases,
what process was used by the former administration to actually take some of
those very qualified people out of the positions that they were in to.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
The question was very simple, and I've asked several
times now and we still don't have an answer. I've asked the Premier: What is the
process he used to hire these people? He took good public servants out of jobs,
people who have served government for many, many years, he put them on the
streets, he eliminated them. They talked about all the jobs they eliminated and
then they backfilled them with Liberal friends.
So I'll ask the Premier again: Can you tell us the
process you used to hire former Liberal candidate Paula Walsh to the Assistant
Deputy Minister of Justice and Public Safety?
MR.
SPEAKER:
The
hon. the Premier.
SOME HON. MEMBERS:
Oh,
oh!
MR.
SPEAKER:
Order, please!
PREMIER BALL:
Thank you, Mr. Speaker.
I have to be honest with you, it's pretty sad in this
House today when you look at a woman, a young woman who's had a tremendous
service and a stellar record again within the RNC in our province and through
Labrador and throughout this province, to even question the fact that she would
not be qualified for the job that she's been asked to do, that she stepped up to
do. It is a bit disheartening, especially tomorrow when we look at PMRs in this
very House when we'll be discussing things like pay equity and so on for young
women and women who are willing again, Mr. Speaker, to step up.
The former premier of this province, the current Leader
of the Opposition, is willing to question someone of their record, which Paula
Walsh has put in place in this province, it is very hard to stand up here and
answer a question about an individual who's doing such a great job on behalf of
this province.
SOME HON. MEMBERS:
Hear, hear!
SOME HON. MEMBERS:
Oh,
oh!
MR.
SPEAKER:
Before I recognize the Leader of the Opposition, I hear banter back and forth
across the floor. The only individual I wish to hear from is the individual
recognized to speak.
The hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
There is a lot of noise coming from across the hall
here today. I think they're a little bit sensitive over the line of questioning
today.
To the Premier's answer to the last question, not one
time today have I questioned the qualifications of any of these appointments.
I've asked repeatedly what the process was. The Premier wants to try and
grandstand and make it about qualifications or questioning someone's background.
It's not about that, I say, Mr. Speaker. It's strictly about qualifications.
I'll ask the Premier this because he has not yet told
us once what the process he used was. He campaigned on taking the politics out
of appointments his words: taking the politics out of the appointments. Their
signature bill was about taking the politics out of appointments.
So I'm going to ask the Premier, you appointed a
long-time, Liberal, strong supporter with very close ties to people within the
Liberal Party, a former political staffer, Carla Foote, to the most senior
communications position in government.
I'll ask the Premier: What process did he use to
appoint Ms. Foote to the most senior communications, non-political role in
government?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Wow
thank you, Mr. Speaker.
When you think about that position and who was actually
filling that position that Ms. Foote is now into, I find the line of questioning
rather bizarre in some ways.
Mr. Speaker, I want to go back to one of the questions
that was asked about Mr. Lomond, Ted Lomond. In that particular case we had in
many of the cases that I talk about here, there were vacant positions that were
available for people to step into. So, Mr. Speaker, it was as simple as that.
It's important for any government, for any team, to put
the best available people that they have around them. That's what these
decisions were based on, making sure that we have strong Newfoundlanders and
Labradorians in the positions often that were vacant that required good, strong
Newfoundlanders and Labradorians to step into these leadership roles.
Mr. Speaker, I'm very proud, not of the work that's
being done even today, but also the work that's been done in the past as well.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
He did fill a vacant position because the government
opposite created these vacancies in these positions by putting long-standing,
qualified, hard-working senior executive members of government on the streets.
Mr. Speaker, the Premier has been asked several times
to provide the process used to make these political appointments when he
promised to take the politics out of appointments. He hasn't answered yet what
process was used, so I'm going to ask him: What process was used when he
appointed the former Liberal candidate, a long-time party supporter, a
significant financial contributor to some of their campaigns, Mr. George Joyce,
to the position of Assistant Deputy Minister of Labour Relations.
I ask the Premier: What process did you use to choose
Mr. Joyce?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, the former premier, and now the Leader of the
Opposition, is asking questions about process. With Mr. Joyce, and I'll go by
memory on this, but he was hired by a former I'm guessing it was a PC
government in the '80s, by Minister Blanchard at the time. So the process of him
being hired and coming into government was done, you know, many decades ago, I
say, Mr. Speaker.
And likewise with Tony Grace, you'd have to ask the
former Premier Williams because that was the guy that actually hired Mr. Grace
in the beginning.
SOME HON. MEMBERS:
Oh,
oh!
MR.
SPEAKER:
Order, please!
PREMIER BALL:
So,
Mr. Speaker, the former premier is asking questions about a process of people
like Tony Grace, or people like George Joyce. These processes were established a
long time ago by the individual hires that he's asking about.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
So if I understand what the Premier said, the closest
time that it came to a process, the process was that he was formerly hired by a
PC government so that made him right for the assistant deputy minister position.
So, Mr. Speaker, I want to ask the Premier this because
we've asked this question about process over and over today, given him numerous
opportunities to talk about what process he used to make sure that he took the
politics out of appointments in all of these positions. There is right now a
process going on with government whereby managers and directors in government
are competing for restructured positions within the public service.
I ask the Premier: Will the competition that you
currently have underway within the public service where people are competing
against each other for jobs, will it include interviews or will ministers simply
handpick those positions as you've done with all these others today?
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Minister of Finance and President of Treasury Board.
MS.
C. BENNETT:
Thank you, Mr. Speaker.
The process for the individuals that have been impacted
by the decisions and the announcement we made on February 22 is a process that
has been agreed to with the public sector act in mind, in consultation between
the HRS department as well as the Public Service Commission.
All impacted applicants are to submit by the end of
business on March 6 their applications for positions. Applications should
include a recent copy of the employee resume, as well a summary of why the
employee believes he or she possesses the necessary educational skills and
experience for the position.
Mr. Speaker, the deputy ministers are responsible then
to do the screening and make a recommendation on the somewhat, I think 60 to 65
positions that are posted, and we look forward to seeing successful candidates
receive those positions.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
Well, the names and the positions that I went through
today during Question Period is just a small sample of political appointments
made by the Premier and his government. They politicized the Clerk, the highest
position within government. It's never been politicized like this in the history
of our province before; the highest communications position. They are moving to
politicize other positions. They politicized deputy ministers and assistant
deputy ministers. They're moving to politicize Access to Information, and now
they're making efforts to politicize positions in the public service.
I ask the Premier, people of the province do not trust
you and your government: Are these moves that are going to instill trust? Why
have you broken another promise to take the politics out of appointments when
you've made all these very clear political appointments?
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
If you remember, for the people of the province, Bill 1
in this particular Legislature was the Independent Appointments Commission.
Where we had Chief Justice Wells, we had Shannie Duff, certainly not someone who
is known to be a Liberal, we had Zita Cobb, we had Derek Young and Philip Earle.
These are individuals that stepped up to put, for the first time in this
province, a non-political appointments commission. Mr. Speaker, they've done a
great job. They've been able to put key people in place; politics completely out
of it, I would say, Mr. Speaker.
What we've done, for the first time in the history of
our province, is put indeed a very formal Independent Appointments Commission, I
would say, Mr. Speaker, and the former premier certainly did not have the
courage to do that.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
Can
the Minister of Education outline the process used to hire his former running
mate as the director of communications position in his department?
MR.
SPEAKER:
The
hon. the Minister of Education and Early Childhood Development.
MR.
KIRBY:
Mr.
Speaker, I don't know what political system the Member his headspace is in.
There are no running mates that I'm aware of in our political system. So I'm
sort of at a loss to even comment on what he's referring to. I have no idea what
the Member is talking about.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
Thank you, Mr. Speaker.
I should remind you that you were both running
candidates when you were a Member of the NDP Party.
In April of last year, the Minister of Education stated
that the 2016 Liberal budget would not cause undue hardship for teachers. Well,
the teachers have spoken.
Does the minister now still stand by that statement?
MR.
SPEAKER:
The
hon. the Minister of Education and Early Childhood Development.
MR.
KIRBY:
Thanks for the political history lesson from the Member for Bell Island, Mr.
Speaker.
Last year, we implemented a number of changes for a
very unfortunate reason, and that's because the previous administration over the
course of their term of office drove this province up onto the rocks, raided the
Treasury and basically ran for the hills afterwards, and continue today to take
zero responsibility for the financial mess that they want the next generation of
Newfoundlanders and Labradorians to have to deal with.
We made decisions last year that were very difficult to
make. We made them based on the best research evidence available. We had the
courage to make those decisions, unlike the previous administration who doesn't
even have the courage today to admit responsibility for the mess they made.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
So
your courage included cutting 217 teachers out of the education system.
Educators, parents and students have expressed concern
about the inclusive education model.
Will the minister confirm that pushing through full-day
kindergarten was at the expense of inclusive education resources?
MR.
SPEAKER:
The
hon. the Minister of Education and Early Childhood Development.
MR.
KIRBY:
Mr.
Speaker, at the expense of repeating myself for about the hundredth time,
perhaps, there were 73 positions reduced through the teacher allocation formula
last year, not the number that the Member seems to come up with a different
number every time he stands here in the House of Assembly.
To a person I have been to closing in on a couple of
dozen schools so far in this year, in 2017. I was in several dozen schools last
year. I have spoken to kindergarten teachers and I have spoken to parents. To a
person, they have praised full-day kindergarten. The only person I hear
criticizing full-day kindergarten and saying that he doesn't want it is that
critic over there.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
This critic over here has never said he didn't want all-day kindergarten. It was
this administration who designed the process for all-day kindergarten, but we
were not willing to do it at the expense of the rest of the mainstream school
system, Mr. Speaker, and the inclusive process.
To quote the minister: We have to make adjustments to
inclusion, because if we don't, we will be failing our children.
What are these planned adjustments to the inclusive
program?
MR.
SPEAKER:
The
hon. the Minister of Education and Early Childhood Development.
MR.
KIRBY:
Mr.
Speaker, again, I thank the Member for the question he asked me last week. As I
said, we stood in Opposition for a number of years calling attention to issues
and challenges associated with the inclusive education model that that
administration brought in, I believe it was 2009, with zero consultation with
teachers and the education sector. Drove it in, imposed it upon the education
system, never consulted with anybody, never put in a dime of additional
resources.
When we were running for election, the Premier said he
would establish a task force to review the education system. That was the
subject of my Ministerial Statement today. One of the key areas that they are
looking at is inclusive education. We are acting where they failed to act.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Conception Bay East Bell Island.
MR.
BRAZIL:
Two-hundred-and-seventeen needed teachers removed from the school system last
year, Mr. Speaker.
The minister likes to talk about the past. Well, in the
past that minister actually condemned government for failing to, and I quote:
invest in new public libraries, stating they are such a crucial resource for
families with young children.
Will the minister tell us: What is holding up the
release of the consultants that you hired on the closure of libraries?
MR.
SPEAKER:
The
hon. the Minister of Education and Early Childhood Development.
MR.
KIRBY:
Mr.
Speaker, I'm pretty sure the Member was here in the House of Assembly last week
when I said that that report was going to be released in the spring. And that
hasn't changed since last week when the same question was asked by the
Opposition.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Mount Pearl North.
MR.
KENT:
Mr.
Speaker, following Question Period yesterday, the only thing that the Finance
Minister could say in response to my questions over and over again was he's
wrong, he's incorrect, he's wrong.
So I ask the Finance Minister a simple question: Has
any direction on targets for cuts been given to departments?
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Minister of Finance and President of Treasury Board.
MS.
C. BENNETT:
No.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Mount Pearl North.
MR.
KENT:
Mr.
Speaker, that's not even believable, and answers like that contribute to the
lack of trust that people have in that Finance Minister and administration.
According to Statistics Canada, 16.8 per cent of people
in Newfoundland and Labrador were unemployed in January 2017. That's over double
the Canadian average. This government has put the economy into a tailspin with
heavy taxes and a lack of a plan, and it has negatively impacted consumer
confidence.
I ask the Minister of Finance: Is there any plan to
address the negativity and the hopelessness created by you and your government?
MR.
SPEAKER:
The
hon. the Minister of Finance and President of Treasury Board.
MS.
C. BENNETT:
Mr.
Speaker, I'm glad to have the opportunity to stand up again and answer a
question from the Member opposite who yesterday made a choice to speak about
information that he had not validated, he had not had facts. He never picked up
the phone and asked me the question, but he saw fit to come into this House of
Assembly and provide information to the people of this province that's not based
on fact, and by doing so created anxiety.
Mr. Speaker, I would ask the Member opposite to take a
long look at the tone of the questions that he asks in this House of Assembly in
the context of his contribution today and in the past to the economic realities
that our province faces, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. John's Centre.
MS.
ROGERS:
Mr.
Speaker, last week the Premier said, when referring to Muskrat Falls power
rates: In just three years, we will see double. That means people now paying
$300 a month will be facing a staggering $600 for their power bill.
I ask the Premier: What measures is the Premier
planning now to help homeowners, businesses and institutions prepare for these
skyrocketing power bills?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, thankfully someone in this House had the
wherewithal to ask a question about what is indeed a very pressing issue in this
province.
SOME HON. MEMBERS:
Hear, hear!
PREMIER BALL:
I'm
not expecting the Official Opposition to be asking these questions. I wish they
would.
Mr. Speaker, I did say in this House last week about
one of the biggest challenges that we will face as a province is the doubling of
electricity rates as a result, or mainly as a result of the Muskrat Falls
Project.
We've put in many measures already. We talked about the
sale of surplus power. We made that commitment for many years now. We lead that
discussion when the Official Opposition refused to even go down that road. It
took them a few years to get there when they started realizing the impact that
this was having.
We're a few years away. We're going to look at whatever
mitigating efforts. We know there will be things that will have to be done, Mr.
Speaker, to deal with this, what is indeed a pressing issue.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. John's Centre.
MS.
ROGERS:
Mr.
Speaker, the people of the province are waiting for those plans.
Mr. Speaker, Nova Scotia's UARB acted decisively in
protecting the people of Nova Scotia from their excessive power bills, just as a
regulator is supposed to do.
I ask the Premier: Why won't he give this province's
PUB oversight of the Muskrat Falls Project so it can begin to protect the people
here in Newfoundland and Labrador?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, the UARB in Nova Scotia and we're seeing,
obviously, lots of interest in provinces like Ontario as well, Currently, right
now in our province we are just over 11 cents a kilowatt hour. So we are very
competitive as it exists today. We know that mitigating efforts will have to be
put in place in the future, but we're not quite there yet.
In terms of bringing the PUB into this process right
now, this project is nearly 80 per cent either done or committed to at this
particular point right now. So the PUB will have to be involved at some point in
terms of rate setting, as they always do. But when you look at the legislation
that we've sat through, both Bill 60 and 61, and the impact of Muskrat Falls,
with a power purchase agreement that is in place for the supply and purchase of
power from Muskrat Falls, there's very little that could actually be done right
now because of the measures that have been put in place. We have a contract that
is in place with Emera. There is a federal loan guarantee commitment.
So we will be there for the people of Newfoundland and
Labrador who deal with this issue.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. John's East Quidi Vidi.
MS.
MICHAEL:
Mr.
Speaker, a recent Emera document revealed it has a 59 per cent partnership
capital in the Muskrat Falls transmission line. I ask the Premier, is this
accurate and, if so, what are the financial implications for the people of this
province?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
Well, I think that the document that the Member
opposite is talking about is some information that was put forward on a blog
right now. But when you look at the way the financing was put in place, the
structure was put in place by the prior administration, not by me not by me at
all, but by the prior administration and we've inherited this situation that
we're currently into. When you look at the Emera investment in terms of the
overall project, there are responsibilities. Because it was a prior
administration that said for 20 per cent of the project, they would get 20 per
cent of the power, Mr. Speaker.
So the final determination on what the percent would be
have yet to be determined, Mr. Speaker. And we are very concerned very
concerned of many missed opportunities for people in Newfoundland and Labrador
as a result of this project.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for St. John's East Quidi Vidi.
MS.
MICHAEL:
Thank you, Mr. Speaker.
I ask the Premier: Could the people of this province be
on the hook for some of the costs to Emera for the two-year delay in Muskrat
Falls and, if so, how much? Because they've paid for the Maritime Link; it's
done. What's it going to cost us, that delay?
MR.
SPEAKER:
The
hon. the Premier.
PREMIER BALL:
Thank you, Mr. Speaker.
The project itself, when you look at the Emera
component to it, it's a publicly traded company. As I said, the terms that were
outlined in the contract by the prior administration is what they are. As a
matter of fact, Mr. Speaker, Emera will get access to power once a third
generating station or a third turbine actually starts producing power.
That is kind of where the contract is, Mr. Speaker. One
of the astounding things that we see in that contract is that it is the people
of Newfoundland and Labrador, because of the contract that was put in place by
the prior administration, could potentially be on the hook for overruns on the
Emera portion of this project.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
time for Question Period has expired.
Presenting reports by Standing and Select Committees.
Tabling of documents.
Tabling of Documents
MR.
SPEAKER:
The
hon. the Minister of Finance and President of Treasury Board.
MS.
C. BENNETT:
Thank you, Mr. Speaker.
On February 22, our government made an announcement
about changes to the management positions in government. At that time, I
indicated both to the media and to Members opposite in the House of Assembly
that when those employees who have been impacted by this change had all been
spoken to, I would table a departmental breakdown of those numbers.
Mr. Speaker, I'll be tabling that information today
based on the decisions and the announcements we made on February 22.
Thank you.
MR.
SPEAKER:
Further tabling of documents?
In accordance with the
House of Assembly Accountability, Integrity and Administration Act I
am pleased to table amendments to the Members' Resources and Allowances Rules
subordinate legislation to the act. The amendments arise from the
recommendations made by the 2016 MCRC and were first approved the House of
Assembly Management Commission on February 27, 2017.
The amendments are being tabled in the House as
required under the act. As a copy is being distributed to each Member, I ask the
Members do I have the consent of this House that these amendments are considered
as read into the record?
AN
HON. MEMBER:
Yes.
MR.
SPEAKER:
As
required, these amendments will be posted on the House of Assembly website and
will be brought to the next meeting of the House of Assembly Management
Commission for final approval.
Further, in accordance with section 19(5)(a) of the
House of Assembly Accountability,
Integrity and Administration Act, I hereby table the minutes of the House of
Assembly Management Commission meetings held on November 30, December 7, 2016
and February 1, 2017.
Notices of Motion.
Answers to Questions for which Notice has been Given.
Petitions.
Petitions
MR.
SPEAKER:
The
hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
To the hon. House of Assembly of the Province of
Newfoundland and Labrador in Parliament assembled, the petition of the
undersigned residents of Newfoundland and Labrador humbly sheweth:
WHEREAS emergency responders are at great risk of
post-traumatic stress disorder;
WHEREUPON the undersigned, your petitioners, humbly
pray and call upon the House of Assembly to urge government to enact legislation
containing a presumptive clause with respect to PTSD for people employed in
various front-line emergency response professions, including firefighters,
emergency medical service professionals and police officers not already covered
under federal legislation.
And as in duty bound, your petitioners will ever pray.
Mr. Speaker, this is a mater and a very important one
that I've raised in the House last year. I've discussed it publicly and I can
tell you I met with a number of stakeholders over recent months and look forward
to meeting with more to discuss this.
PTSD goes beyond just what the prayers of the petition
here are asking for, which is a presumptive clause for PTSD. PTSD is being
better understood, better known, a much clearer understanding of the nuances and
what's involved in PTSD, the causes, the response, how people are impacted by
PTSD and their families. It's being better understood now than ever before. One
of the problems with a personal PTSD is their ability to apply for assistance or
to talk about what had caused the PTSD or the workplace stress injury.
Currently, under the rules of the Workplace Health,
Safety and Compensation Commission, or WorkplaceNL as it is now, an injured
worker, a person who becomes injured with PTSD, especially front-line responders
in our province, have to be able to establish what event caused the PTSD. What's
known now, more than ever before, is that PTSD is often not caused by a single
event but by a series of events or many years of workplace trauma or exposure to
significant events.
What the petitioners here are asking for is a
presumptive clause for people in those particular professions. As well, what's
needed, Mr. Speaker, is not only just the presumptive clause for people in front
line but also other people who have the risk and exposure to PTSD in other
workplaces.
The legislation should be updated. The legislation
should be improved. There should be other actions that government can take to
help assist and promote early intervention of those who are regularly exposed to
difficult and traumatic events so that the onset of post-traumatic stress
disorder and workplace stress injuries can be reduced, better understood by
those who are exposed to them, and then reduced lost time and also the impact on
the workers.
So, Mr. Speaker, I'm pleased today to table this
petition. It's another one I have on PTSD. I have tabled them in the past. I
expect to have more that will be looking for other aspects of improvements in
legislation to have a positive impact on workers throughout our province when it
comes to post-traumatic stress disorder and workplace injuries.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Mount Pearl North.
MR.
KENT:
Thank you, Mr. Speaker.
To the hon. House of Assembly of the Province of
Newfoundland and Labrador in Parliament assembled, the petition of the
undersigned residents of Newfoundland and Labrador humbly sheweth:
WHEREAS Members of the House of Assembly are elected to
represent the interests of their constituents; and
WHEREAS recall legislation would increase democracy in
our province by making Members of the House of Assembly more accountable to
their constituents;
WHEREUPON the undersigned, your petitioners, humbly
pray and call upon the House of Assembly to urge government to introduce recall
legislation into the House of Assembly.
And as in duty bound, your petitioners will ever pray.
Mr. Speaker, this is an issue that I've spoken about at
length in this Chamber in the past. In fact, I presented a private Member's
motion just last year, and it read: BE IT RESOLVED that this hon. House
supports the introduction of legislation for the recall of elected Members of
the House of Assembly, similar in principle to the legislation in effect in
British Columbia, where a registered voter can petition to remove from office
the member of the assembly for that voter's district provided the voter collects
signatures from more than an established percentage of voters eligible to sign
the petition in that electoral district.
So this is not a new concept. It's a concept that has
worked in other places in Canada and has worked in other places around the
world. I understand the sensitivities associated with it, particularly for
Members opposite, but I think it would be when we talk about the need for
democratic reform, I think it would be a step in the right direction.
Recall legislation is not a new idea. It was on the
books in Alberta in 1936, in one of the US states back as far as 1908. And it's
not a rare idea. Most US states have had recall at some level of their
democracy. In Canada, Alberta has had it in the past, and British Columbia has
it today. So it doesn't destabilize a democracy. Many would argue it strengthens
a democracy.
So given that all three parties in this Legislature
have talked about the need to modernize this institution and promote democratic
reform, recall legislation seems like an easy step. There's precedent for it.
There are jurisdictions where it's working quite well. It's a multi-step
process.
For instance, as I mentioned when I read the previous
resolution, a petition has to be signed by a specific percentage of the
electorate. There has to be a vote on whether to recall the Member, and there
are all kinds of checks and balances along the way. So it's not something that
could simply be done flippantly or in response to a broken election promise or a
bad budget or whatever the case may be.
This would be a positive step in the direction of
democratic reform. There are a lot of people out there who would like to see
recall legislation of some form come into our democracy. Unfortunately, that
private member's motion last year was defeated, but there's a lot of support for
it among the public. It's an issue that I'll continue to raise, and I hope other
Members in this hon. House will raise as well.
Thank you.
MR.
SPEAKER:
The
hon. the Member for St. John's Centre.
MS.
ROGERS:
Thank you, Mr. Speaker.
To the hon. House of Assembly of the Province of
Newfoundland and Labrador in Parliament assembled, the petition of the
undersigned residents humbly sheweth:
WHEREAS government has removed the provincial point of
sales tax rebate on books, which will raise the tax on books from 5 per cent to
15 per cent; and
WHEREAS an increase in the tax on books will reduce
book sales to the detriment of local bookstores, publishers and authors, and the
amount collected by government must be weighed against the loss in economic
activity caused by higher book prices; and
WHEREAS Newfoundland and Labrador has one of the lowest
literacy rates in Canada, and the other provinces do not tax books because they
recognize the need to encourage reading and literacy; and
WHEREAS this province has many nationally and
internationally known storytellers, but we will be the only people in Canada who
will have to pay our provincial government a tax to read the books of our own
writers;
WHEREUPON the undersigned, your petitioners, humbly
pray and call upon the House of Assembly to urge government not to impose a
provincial sales tax on books.
And as in duty bound, your petitioners will ever pray.
It's rather ironic, Mr. Speaker, when you think that
our own writers here in Newfoundland and Labrador, that everybody across Canada
will pay less to read their books than the people of Newfoundland and Labrador
will. Because we will be we are the only province in the whole country that
imposes a 10 per cent tax on books. It's rather ironic really. It reminds me of
no, I won't go there. I simply won't go there, Mr. Speaker, but it is so
incredibly ironic.
Now, it's not only the effect on the people
individually in terms of the extra financial burden on books and again, we
have to constantly remind the Members of government who support this that we do
have the highest illiteracy rate in the province. We have the lowest literacy
rate in the province. But we're not affecting only individuals' ability to buy
books, but also we're really harming individual booksellers here in the
province.
For instance, Amazon only started collecting the taxes
since January 1, when they are importing books, selling books to individual
people here in the province. Chapters and Indigo started collecting the second
week of January, after Matt House, who's an independent bookseller here in the
province, complained to the Finance Department. But there are still maybe
hundreds of retailers who do online sales, who aren't collecting the tax. So
that means they are selling the books at a much cheaper rate than our own
booksellers are able to sell them here, because they're not charging the obliged
10 per cent tax.
So the Finance Department says no, it's not our
responsibility, it's a CRA matter. So our own Finance Department is not doing
anything about it, and CRA doesn't have a system through which it can monitor
the destination of online sales. So, Mr. Speaker, this is negatively affecting
the people and businesses of Newfoundland and Labrador.
Thank you very much.
MR.
SPEAKER:
The
hon. the Member for Conception Bay South.
MR.
BRAZIL:
East Bell Island, Mr. Speaker. Sorry to correct you on that.
MR.
SPEAKER:
My
apologies. Conception Bay East Bell Island, sorry.
MR.
BRAZIL:
Thank you, Sir.
To the hon. House of Assembly of the Province of
Newfoundland and Labrador in Parliament assembled, the petition of the
undersigned residents of Newfoundland and Labrador humbly sheweth:
WHEREAS government recently cut vital funding to many
of the province's youth organizations; and
WHEREAS the cuts to grants to youth organizations will
have a devastating impact on the communities, as well as its youth and its
families; and
WHEREAS many of these organizations deeply rely on what
was rightfully considered core funding for their day-to-day operations;
WHEREUPON the undersigned, your petitioners, humbly
pray and call upon the House of Assembly to urge government to immediately
reinstate funding to the province's youth organizations.
And as in duty bound, your petitioners will ever pray.
Well, Mr. Speaker, we talked about multi-year funding
here and it was a good piece of legislation that we all supported, and that we
want to move forward as quickly as possible; but it does bring up concerns when
only a few months ago, without proper notice, a multitude of organizations,
particularly youth organizations, were cut substantial parts of their core
funding. And it ranged from 40 per cent to 60 per cent and has had a devastating
effect on some of these organizations.
We're hearing some organizations having to layoff some
employees, some having to reduce hours of operation, some having to reduce what
programs they offer and we all know, and I attest and I would suspect most
Members in this House of Assembly have been part of some youth organization that
has received some form of government funding over the years. If it's the Boys
and Girls Clubs, if it's Big Brothers Big Sisters, if its Girl Guides or Scouts,
or if it's a number of the organizations that particularly service young people
in this province, they see the value.
From an economic point of view, the value here, and the
business community will tell you, they generate tens of thousands of dollars for
the economy because the ratio of the dollar invested in comparison to the dollar
that they themselves leverage is, in some cases, 3-1, 5-1. In some cases, some
organization leverage 20-1 the money that's put in by government.
So to cut that, not only are you cutting directly that
dollar figure but if you can quadruple that, in some cases, that's what is lost
to the taxpayers here. That is what is lost to our local economies, particularly
all these organizations that are in rural Newfoundland and Labrador. Outside of
that, it's the program money, the investment we're getting by the amount of
money being put into the economy, but the service is being provided.
If government tried to provide those services, it would
be hundreds of millions of dollars. So we're getting tens of millions of dollars
invested in our economy, but we're getting hundreds of millions of dollars of
program delivery services. So that's a positive for the people of this province.
So, Mr. Speaker, I do ask that the Minister of Finance
and the Cabinet go back. It's a minimal saving, and I mean a very minor saving
in comparison; but the impact it will have on young people, the impact it will
have on our society, next year, five years down the road and the next
generation, it's going to be irreversible. So I ask, go back, reassess this, put
back the core funding. If you're going to move that way, it's a good move. Do it
right at the beginning.
Thank you, Mr. Speaker.
MR.
SPEAKER:
The
hon. the Government House Leader.
MR.
A. PARSONS:
Yes, Orders of the Day, Mr. Speaker.
MR.
SPEAKER:
Orders of the Day.
Orders of the Day
MR.
SPEAKER:
The
hon. the Government House Leader.
MR.
A. PARSONS:
Mr.
Speaker, I would call from the Order Paper, Order 3, third reading of Bill 68.
MR.
SPEAKER:
The
hon. the Government House Leader.
MR.
A. PARSONS:
Thank you, Mr. Speaker.
I move, seconded by the Minister of Service
Newfoundland and Labrador that Bill 68, An Act To Amend The Highway Traffic Act
No. 5, be now read the third time.
MR.
SPEAKER:
It
is moved and seconded that Bill 68 be now read a third time.
Is it the pleasure of the House to adopt the motion?
All those in favour, 'aye.'
The hon. the Leader of the Opposition.
MR.
P. DAVIS:
Thank you, Mr. Speaker.
I'll only take a few minutes today. Yesterday, in
Committee, I asked the minister and we had a discussion after the House as well
and his answers yesterday, he was going to give some thought to three matters
that I raised. One was discussion about why age 22. Statistics reflect ages 16
to 25, so I asked the minister yesterday why not 25 versus 22.
Also, the length of impoundment for vehicles; officials
have provided information that the first impoundment would be three days. We
know other jurisdictions have seven days. The minister was going to reflect on
that too, if I remember correctly. And thirdly regarding impoundment, indication
was that impounding of vehicles would only occur when a person has a
blood-alcohol content of over 80 milligrams or refuses a demand provided by a
peace officer.
So in a case of a person over 22 has a blood alcohol
content between 50 and 80, who receives a suspension, my understanding is that
in that case the impoundment would not happen; or, if a person under the age of
22 who had a BAC of between zero and 50 milligrams, they would receive a
suspension and, in that case, the vehicle wouldn't be impounded either.
Anyway, I just remind the minister of those and ask him
if he's got any further information or comments to offer on the legislation
before we finalize third reading.
MR.
SPEAKER:
The
hon. the Minister of Service NL.
MR.
TRIMPER:
Thank you, Mr. Speaker.
I thank the Member opposite for the chance to further
comment. Before I say anything further, I'd like to acknowledge again the
presence of Patricia Hynes-Coates and Amanda Hynes-Coates who are with us and
watching our deliberations with MADD Canada.
As the Member indicated, I did have a good discussion
with him yesterday and reflecting back on the discussion and the debate in the
House over two full afternoons, two full sessions, a variety of media, numerous
commentary that we've received in our office, I've received personally, it's
been dramatic to see that, frankly, the province is telling us that as we move
forward with the passing of this bill, that they're looking for as stringent a
set of regulations as possible to implement and association with the passing of
this bill.
I met with my staff this morning and received assurance
that they also have that desire to do same. So what I'd like to offer as an
overview comment to the Member opposite is that we have that determination. We
will be continuing to work with other jurisdictions to look at the various
parameters that he's indicated, plus others, frankly, and we will be looking for
the toughest, most stringent mechanisms and mitigation measures that we can
apply in association with this bill.
The specifics around his questions if I could just
take a second in terms of why age 22, it's clear that some jurisdictions
certainly I indicated that Quebec and Ontario do reference this less than age
22. As I indicated in my remarks, it does provide one six years. Assuming you
become a new driver you've got six years to be under the scrutiny of a strong
environment of separation of alcohol and driving. That's it. We did have further
discussion on this point this morning and our staff are going to continue to
consider that. At this time, though, our position is less than 22.
In terms of the length of impoundment, and I believe
that this question and the Member can correct me if I've got it unclear but
it was from the perspective of a peace officer and making it clear that when a
peace officer encounters an impaired driver, making sure that they've got clear
direction.
In speaking with officials this morning, I can provide
the following clarification that it will now be mandatory for that peace officer
to impound the vehicle on two situations: One is if the driver refuses to
provide a breath sample; or secondly, if either the roadside test or a
subsequent test back at, for example, a police station indicates that the driver
is driving at an impaired level.
There is some discussion still, I will assure the
Member opposite, around the aspect of whether or not that level should be
dropped to 0.05. And I'm going to assure this House that we will continue to
look at this matter and if we can, we will certainly move forward on that point.
I believe that captures the scope of it, but I guess,
in summary, I would like to reassure the House that we are determined to make
our roads and our highways safe again. By passing this legislation with the
support of MADD, and frankly with the support of the entire province, it's been
quite overwhelmingly to see the response. I'm looking forward to, in about six
months from now, releasing these regulations after a thorough education, a
thorough revision of the structures that need to be put in place to move and
tighten up the way Newfoundland and Labrador looks at drinking and driving.
Thank you very much.
MR.
SPEAKER:
The
hon. the Member for St. John's Centre.
MS.
ROGERS:
Thank you very much, Mr. Speaker.
I also would like to commend the folks from MADD, and
we know that we wouldn't be here today doing this work, were it not for the
leadership, the passion and compassion of the people in MADD and the teams that
work together in MADD Mothers Against Drunk Driving.
We know that often, often it is folks in civil society
who push us to do the right things. And I'm very grateful for their leadership,
for the work that they have done, and for the insistence and persistence,
because that's what brings us to do often we need that push in order to be
able to do the right thing and to work together.
Now, yesterday in Committee of the Whole, I asked the
minister why the province hadn't looked at implementing the recommendation of
0.05 for the alcohol-blood concentration that MADD had recommended. And the
minister had said well, because it's a
Criminal Code matter. However, we know that in most territories and
provinces in the country that there is an aspect of administrative laws for
drivers. I'm not exactly sure, I haven't had a chance to go back to our law,
whether or not we have that ability within our province, but I believe we
probably do.
The minister responded to me and said, well, no, that's
a Criminal Code matter; not in our
jurisdiction. In fact, it can be within our jurisdiction if it's administered
under the administrative laws for drivers, and there are a number of actions
that can be taken, if in fact the blood concentration level is over if we
lower the rate as recommended by the Mothers Against Drunk Driver. There is
everything from licence suspension from a few hours to seven days, or again,
different provinces and territories have other suspension programs for repeat
infractions. It could be vehicle impoundments, education and remedial programs,
ignition interlocks.
So I would like again for the minister to consider
that, to consider looking at the potential under own laws for administrative
laws for any infractions that, in fact, we can take that recommendation from the
Mothers Against Drunk Driving to reduce the level for blood-alcohol
concentration. So I would hope that the minister would consider that, that the
Department would consider that. I believe that it is a really good
recommendation. All the recommendations from the Mothers Against Drunk Driving
are solid recommendations, and I believe this might firm up what we are doing
here in this bill.
Thank you.
MR.
SPEAKER:
The
hon. the Minister of Service NL.
MR.
TRIMPER:
Just a short comment, Mr. Speaker, I'd like to say as I said previously, that I
appreciate the suggestions, the recommendations. As I said and I want to assure
the House again, we are feeling an awakening in this province in terms of the
seriousness of this problem. The level of conversation is such that we realize
we need to get tough on this problem. Following an excellent meeting with all
senior officials in my department this morning, I can assure the Member of the
Third Party that that zeal is there, and we are going to do our best with these
regulations to honour the request, frankly, of this House and the entire
province.
Thank you very much.
MR.
SPEAKER:
Is
it the pleasure of the House to adopt the motion?
All those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
MR.
SPEAKER:
All
those against, 'nay.'
Carried.
CLERK (Barnes):
A
bill, An Act To Amend The Highway Traffic Act No. 5. (Bill 68)
MR.
SPEAKER:
Bill 68 has now been read a third time and it is ordered that the bill do pass
and its title be as on the Order Paper.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Government House Leader.
MR.
A. PARSONS:
Thank you very much, Mr. Speaker.
I would call from the Order Paper, Order 6, second
reading of Bill 70.
MR.
SPEAKER:
The
hon. the Government House Leader.
MR.
A. PARSONS:
Mr.
Speaker, I move, seconded by the Minister for Health and Community Services that
Bill 70, An Act Respecting Patient Safety And Quality Assurance In The Province
be now read a second time.
MR.
SPEAKER:
It
is moved and seconded that Bill 70 be now read a second time.
Motion, seconding reading of a bill, An Act Respecting
Patient Safety And Quality Assurance In The Province. (Bill 70)
MR.
SPEAKER:
The
hon. the Minister of Health and Community Services.
SOME HON. MEMBERS:
Hear, hear!
MR.
HAGGIE:
Thank you very much, Mr. Speaker.
I'm pleased to rise in this hon. House today to open
debate on Bill 70, entitled An Act Respecting Patient Safety and Quality
Assurance in the Province. This bill is actually one of a kind in this country.
Many provinces have brought together elements of patient safety through various
acts in their legislatures. It includes quality assurance in some, but there is,
however, no other province in the country that has a single comprehensive
statute with all of the elements found in this bill. Indeed, we have been lucky
in some respects to come towards the end of the pack because we've been able to
learn from others who've gone before us.
To put this bill in context, I think it would be first
important to actually decide what constitutes patient safety. There are many
definitions and there's a whole raft of literature, but I think the simplest
working definition is that patient safety is the reduction and mitigation of
preventable harm in the health care system.
The fact that preventable harm actually occurs is
disturbing to some, but effectively every day in this province health care
providers engage with the people of this province with the goal of providing
them with the best possible care. As a former health care provider myself, I
know that providers choose their professions because of a desire to help, not to
inflict harm. Indeed, my own profession has its ethos summed up through the
Hippocratic Oath, which can be paraphrased as first do no harm.
In actual fact, however, whilst in the majority of
cases, patients do traverse the system with good quality care and more often
than not favourable outcomes, there are occasions where that isn't the case.
Despite best efforts and intentions, patients are sometimes harmed as a result
of care that was actually intended to help them.
In Newfoundland and Labrador our health care system is
actually administered directly by four regional health authorities, each of whom
are responsible for ensuing quality services are provided to the people of the
province predominately on a geographical basis, but in the case of some health
authorities they assume a provincial or even a super-regional service.
One way of enhancing patient safety is for the RHAs and
health care providers to participate in a consistent approach to quality
assurance activities. Again, quality assurance may require a little definition
but, essentially, it has several elements to it. These activities provide or
involve the assessment or evaluation of the quality of care provided. So they're
metrics. They process metrics. They look at numbers. They look at percentages of
people who have problems associated with disease and try to separate those from
folk who would have problems that may be associated with the processes of care.
So it also, therefore, involves the identification of
problems or shortcomings in the delivery of care. Unfortunately, the nature of
health care and its personal involvement often means that problems with health
care actually end up in MHA's offices and on the floor of this House when they
would be more properly dealt with by actually going to the front-line providers
and managers.
Part of the quality assurance activities is to try and
have mechanisms to identify problems with delivery. Once you've identified the
quality of care and shortcomings, or potential shortcomings in delivery, you
need to then design activities that might overcome those deficiencies like a gap
analysis.
Finally, once you've identified where those gaps are
and put remediation in place, you then need to ensure that there's some
monitoring to keep an eye on your corrective steps. You cannot manage what you
do not measure, is a simplistic expression but it does actually help in this
context.
In the context of this bill, quality assurance
activities may actually focus on reviews of a particular event after it's
occurred or it could actually include a broader systems review. And as my
narrative progresses, I hope to highlight some of the areas where those would
occur but also to emphasize those areas where it doesn't delve. This is not
about clinical competence and it's not as much focused on the individual as it
is on the system.
The intent to Bill 70 is to actually provide a legal
framework for quality assurance activities. These would be undertaken by the
RHAs and the Department of Health and Community Services. It also, therefore,
would be a two-way communication.
It would provide direction to the RHAs to achieve that
consistency by enabling both the department and the RHAs to set standardized
requirements. Those standardized requirements would be around things like
reporting, how you actually conduct quality assurance activities and also an
element figured prominently, both in Justice Cameron and in the wider literature
and societal discourse, which is the concepts and practicalities of disclosing
information to patients and their families.
So the bill itself covers four major areas related to
the umbrella themes of quality assurance and patient safety, and to do that it's
divided into sections. One will be on reporting investigation and release of
information, the second will be on quality assurance committees and patient
safety plans, the third will focus on a provincial patient safety and quality
advisory committee, and the final part will lie around patient disclosure.
The RHAs will be required to report to the department
on specific safety indicators. These will be determined from time to time and
can be altered in the regulations that will be crafted under the act.
And I'm going to talk a little bit about handwashing,
nothing too gory for my colleagues here who are of a sensitive nature in the
field of patient care.
AN
HON. MEMBER:
We
appreciate this.
MR.
HAGGIE:
You
may be surprised that I'd pick something like handwashing. You'd think that was
a fight that was long since over, but in actual fact it isn't. And of all the
things that health care providers and individuals can do to prevent the spread
of infection, washing of hands is probably the single easiest and most
important. It's something that we're taught as children and grandchildren, yet
it's surprising how often it lapses; it's slipped from areas in professional
life.
The commonest way of transferring bugs for want of a
better word viruses, micro-organisms that cause health care associated
infections is on the hands of health care workers during patient care. Everyone
thinks about wearing gloves but really that isn't always practical and, where it
is, there are still flaws with the concept that a single technique by itself
produces a solution to the problem.
The cross-infection and infection control literature is
very dogmatic. Hand hygiene is still considered the most single important way to
reduce health care associated infections, but compliance is poor. People rush,
they go from one room to another, there isn't a sink handy. The hand sanitizer
dispenser is broken or fallen off the wall, or simply empty from overuse and it
gets skipped.
It is actually quite frightening when you do these
audits and spray areas of door handles, for example, and phones, telephones. You
really don't want to know what's growing in the handset of the average
telephone. Stop! You don't want to know, that's right.
Paradoxically even the plug socket, the plug holes in
showers and tubs. So really, handwashing and hand hygiene is your final barrier
for yourself as well as the next person with whom you interact.
Shaking hands may be very sociable, generally accepted
western way of greeting but there are some people for whom that is probably not
a good idea.
The results of monitoring of handwashing within RHA
operated health care settings would actually become a publicly reported, open,
transparent, easy accessible indicator. It's one of many interventions that
actually educate, and by educating starts to change behaviour. A lot of people
will skip that or forget it simply because of forgetfulness. It's an error of
omission, not an error of commission. And it's simply just the busy world in
which they find themselves.
Public reporting encourages transparency and
accountability and allows people to see the effects of interventions from such
processes around quality assurance to see how they're working with time. So the
results would then feedback to improve health care worker understanding and
compliance, and maybe even identify deficiencies in current policies. So that
kind of information, in addition to others, would then assist the RHAs as those
organizations mandated to actually deliver health care with the effectiveness of
infection prevention and control and allow them to make future further
improvements.
As an aside, this is becoming even more important with
the declining effect of antibiotics with other quality assurance issues in the
system, the number of bacteria who are developing multiple resistant, becoming
so-called super bugs, is actually getting to the point in some jurisdictions
where it's going to affect the ability for people to undergo straightforward
routine surgery, putting joints in and having caesarian sections and these kind
of things. You're going to put the clock back to the 1930s. Handwashing will
mitigate against some of that, simple, low tech, very effective.
So as part of the reporting mechanisms, the RHAs would
be required to notify the department of specific occurrences and adverse health
events. If you had a cluster of infections and notice that your hand-washing
numbers weren't right, you may be able to tie the two together. These would then
become something that would be flagged at the provincial level again,
awareness and education.
The bill also defined adverse health events in section
2. The logic behind this is again to provide a constant, consistent lexicon so
everyone's talking about the same thing. There were reports in 2008 and 2009 as
a result of provincial inquiries. There was an Office of Adverse Health Events
established, but the definition was not one of regulation or legislation, it was
one of usage. I think to have consistent definitions would be very helpful. So
the bill and the definitions are actually included in your draft.
It defines adverse health events as an occurrence that
results in an unintended outcome which negatively affects a patient's health or
quality of life. It's a fairly standard, fairly well-validated definition. An
occurrence is an undesired or unplanned event that does not appear to be
consistent with the safe provision of health services. So it's something
outside the norm.
The bill then specifies that certain adverse health
events and occurrences must be reported to the department, as the department is
ultimately responsible for the oversight of the RHAs and the province's system.
It would be important that this information is shared up the chain.
So every RHA would also be required to establish a
process for review, what we would call close calls. They're defined in the bill
as a potential occurrence that did not actually occur due to chance, corrective
action or timely intervention. This close call is a concept borrowed from other
fields of engineering, the nuclear industry and aviation have pioneered these
kind of concepts and actually have a whole literature about systemically
identifying errors and close calls and ways to document, track and reduce them,
ultimately.
The RHAs would then have to establish a process for
reviewing and investigating occurrences and adverse events. This would be done
under direction from the department to the RHAs through regulation, as to what
processes they should utilize at analyzed specific events. The importance of
this is at the end of it you have a standard framework. Whatever is happening in
Lab West is subject to the same processes, the same standards as whatever is
happening in Gander or in the Health Sciences Centre.
So the regulations would be drafted to support the
bill, if the House sees fit to pass it. Work on those regulations could begin
immediately. I'm advised by staff, both within the department and the RHA, that
it would take no longer than six months to get those regulations into place.
Changing tact ever so slightly, I'm sure, Mr. Speaker,
that all Newfoundlanders and Labradorians are familiar with the Commission of
Inquiry on ER/PR receptor laboratory testing, often shortened by the name of the
Commissioner, Madam Justice Margaret Cameron. Her report was presented to
government in 2009 and contained a number of recommendations for reform. It
actually followed on the heels of the Task Force on Adverse Health Events, which
was government initiated and led by the then Clerk to the counsel, Mr. Robert
Thompson. This was completed in 2008 and had numerous recommendations as well.
So it's not like the department started from cold, and
much work has been completed in addition to those within the department and the
RHAs on implementation of the recommendations in both of those.
There were changes recommended, particularly by Madam
Justice Cameron, about the disclosure of information to patients, which actually
required some legislative change. Whilst I can't speak to what happened between
2009 and 2015, my department has worked hard to make sure that the various
interests and stakeholders have had sufficient input to have their views
reflected with Madam Justice Cameron's in this draft bill.
So section 17 of the bill requires a positive
obligation on the part of the RHA to disclose certain information related to an
adverse health event to a patient and/or his family. That is not an option; it
is a responsibility written in law, not regulation, that falls upon the RHA. And
basically, the disclosure has to include the facts of the adverse health events
and any new or otherwise unknown facts as they become known. So you can see from
the way this is worded, this is probably just not a single conversation.
Secondly, the consequence to the patient, as they
become known, because this may be something that evolves over time; the details
of the health services provided to the patient as a result of the adverse health
event so this is what they had from health care that they would not have
otherwise required had this event not happened and finally, any
recommendations from a quality assurance activity undertaken to review the
adverse health event.
This deals with the concerns of Madam Justice Cameron,
as well as patients and their families. How could this happen, what does it
mean, and are other people likely to suffer a similar problem in the future?
These four points detail a positive obligation on behalf of the RHA to actually
meet those requests, and do it proactively. The bill also requires that the
information provided to the patient be noted on the patient's health record as
had by the RHA.
Currently, each RHA does have a policy which addresses
disclosure, but Bill 70 imposes a positive duty on the RHAs by statute to ensure
that patients who are impacted receive the same type of information regardless
irrespective, rather, of whether they live in Lab West, Nain or downtown St.
John's.
Mr. Speaker, this will be the first time in this
province, the first time the patients and their families who've been impacted by
an adverse health event will have a statutory right to recommendations that come
out of a quality assurance activity into the event that impacted their family.
There was another recommendation from Madam Justice
Cameron recommendation 34 and I'll come back to this a little bit later
but she recommended that there be no restriction on the right of access of a
public inquiry into the quality assurance information and its process. In
accordance with Bill 70 we have followed that recommendation, and public
inquiries will be able to access quality assurance information.
I will loop back to other elements of access to
information later, because it's not quite as straightforward as that. For those
of you who follow these things, you may recall that after the Cameron inquiry
there was a flurry of activity from regulators looking to have access to quality
assurance information, and this ended up going to court and there was a ruling
sought as to whether or not two pieces of legislation applied to quality
assurance information, and both of them were competing.
The judge of the day, in the way judges sometimes do,
actually ducked the question by saying the information requested wasn't quality
assurance information, go away and sort out the law at your own pace. So there
will be another piece to this public disclosure and access to information that
I'll allude to shortly.
It is acknowledged that there is a risk perceived by
health care providers in permitting commissions of inquiry to have continued
access to quality assurance information; however, a commission of inquiry is
created in response to major, significant events. And it's important,
particularly in the light of current societal views I think on other issues,
that these public inquiries are and are seen to have the access they need to do
the job to address the question for which they're constituted. These are not
everyday events, hopefully and fortunately. Certainly, if you look in the health
care field, Madam Justice Cameron's inquiry was a two-plus decade event.
It's hoped that the possibility of a commission of
inquiry accessing quality assurance information won't actually produce a barrier
to health care provider's participation in the quality assurance process. But at
the end of the day, that is a hope, and it's set against society in the public
inquiry, the rights of a public inquiry commission to do the things that it is
mandated to do.
Traditionally, you see, documents related to quality
assurance have been treated as highly confidential and not shared even within a
regional health authority, let alone between it. The legal protection of quality
assurance information has been regarded as a fundamental underpinning to the
process. It is felt to be essential to ensuing an open environment where health
care providers are more likely to share opinions and make recommendations.
This august House, in May of 1991, had a two-day debate
on access and rights of access to quality assurance information. When it passed,
in those days, what became the amendment to the
Evidence Act, section 8, that stated as amended after that debate,
which involved figures of the like of Hubert Kitchen, Lynn Verge, Paul Dicks and
the former Minister of Justice, I think at the time, was the father of the
current Minister of Justice. It was quite a debate.
Basically, once the amendment was passed, it stated the
quality assurance information and those individuals who participate in those
activities are not compellable in legal proceedings. Mr. Speaker, not
compellable is a term that has significant legal connotations. It means that
information gathered during the activity cannot be disclosed in a court and a
person who participates in a quality assurance activity cannot be compelled to
testify about what occurred in that quality assurance activity. That protection
only occurs for a quality assurance activity.
I think it's worth sharing some insights from my own
perspective about what quality assurance activities actually are like. They can
vary from the boring and anodyne to the openly hostile and vitriolic. And the
stuff that's said in there is said set against the background that it stays in
the room. It is, if you like, a health care provider's equivalent of a sandbox
where a computer programmer can deal with deleterious code and not kill his
computer system. It's done in a way that allows the outcome to be better than it
otherwise would have been.
It is felt, if that protection under the
Evidence Act is removed, that kind of
level of discourse and the quality of output will fall. So the bill amends the
Evidence Act and the
Public Inquiries Act to clarify the
relationship between the two, between legal proceedings in which quality
assurance information can be disclosed and those where it cannot.
The definition of a legal proceeding has been clarified
in this act and in a consequential amendment contained in this act to the
Evidence Act to include a proceeding
before a committee or a person under the authority of an RHA mandated to review
the clinical competency of a health care provider.
Legal proceeding also includes proceedings before a
committee of a governing body of a regulated health profession. What that does
with the protection, is quality assurance information is not to be produced
during a legal proceeding. So individuals who participate in quality assurance
activities cannot be required to testify in relation to those proceedings at a
legal proceeding.
It's not a blanket protection. What it does, though, is
it specifies that a legal proceeding before a regulator is included in this
protection. So to clarify, the output of the committee is public. The fact the
committee met is public. What goes on inside the committee is protected from
disclosure in disciplinary and legal proceedings in a civil action in a court of
law.
What it doesn't mean, though, is that anybody who
wants, for other reasons, to engage in a legal proceeding in a civil action or a
regulator who wants to find and establish the facts of the case, they have no
impairment of their ability to go and subpoena or request people to testify. All
it means is they cannot ask them about the speculations in the room. They can
ask them as to the facts. They can ask them as to the details of their direct
knowledge, but they can't ask them about the hearsay of what goes on in a room.
Quality assurance information is defined in Bill 70,
and means information that's generated or provided for a quality assurance
committee activity. So it will not include, and specifically excludes, anything
in the patient's clinical record, a hospital chart or a medical record, anything
that's maintained for documenting health care. That is accessible to anybody, as
it is currently.
When a quality assurance activity is being conducted,
however, if it appears that the actions of a health care provider don't meet a
standard of care and a review of the skill, knowledge or competency would be
undertaken, that falls outside quality assurance. A switch is tripped. Whatever
went on in quality assurance remains protected but the issue of competency and
skill is referred to an outside process through the regulator, or through
whatever mechanism the RHA feels is appropriate as a first step. That review
would be separate, not part of the quality assurance activity and once it's
identified as such and taken outside is not protected.
At the conclusion of an accountability review into the
competency of a health care provider so this is a separate process, if that
were a concern the RHA can impose its own disciplinary measures or change
their practice scope within the ability, or register a complaint of misconduct
to the relevant professional regulatory body.
It's important to note that information generated for
or produced in the context of this type of individual accountability is not
protected. So this is not a blanket protection for anyone who participates. It
doesn't hide the unsafe practitioner, if that's what people are worried about.
Information generated for this kind of a review, i.e. a
competency review, can be released in legal proceeding and can be released to
the health regulators. This clarifies what can and can't, and at the moment
there's such an element of doubt, that in particular my understanding is it's
the nurse regulators who've been besieging the health authorities looking for
information from a quality assurance process, feeling they have a legal right to
get it.
Our government appreciates and values the role that
regulators have, but it recognizes that there is some protection of process
needed for true quality assurance. One of the ways that regulators fulfill their
statutory mandate is through the disciplinary process, and this comes into play
when a regulator receives an allegation of professional misconduct about a
health care provider. They currently have the authority to obtain the
information necessary to process allegations and currently a lot of this comes
from the RHAs. That again is not impaired or constrained by anything recommended
in this bill.
It does, however, clarify that while they're not
entitled to quality assurance information, as regulators, they are entitled to
everything else: patients' records, patients' charts, RHA policies and any
public information about what may come out of a quality assurance process in the
future.
Quality assurance information only includes information
created for or produced in the context of a specific quality assurance activity.
It will, as I say, not include patients' charts and it doesn't cover areas of
skill, knowledge or clinical competency. That information can all be released.
Regulators are also entitled to speak to the
individuals involved and the only limit is that they cannot compel an individual
to divulge what was said in that box, in that sandbox during a quality assurance
process. Similarly, human resource divisions of the RHAs, when investigating an
issue about a clinical competency matter, will not be able to access quality
assurance information.
The idea of protection of the information under quality
assurance is to maintain the integrity of the process which is of the most value
to the systems when health care providers who are involved in it feel they can
participate in an open and honest and frank manner without their musings and
hearsay being hauled up in a court in legal matters.
Without such protection, and the uncertainties that
have existed since Cameron, and the decisions of Justice Diamond for example in
2014-15, the quality assurance activities that used to happen in the RHAs have
really chilled. They're frozen. And it's felt that this clarity will help to
re-establish that process, because a lack of quality assurance has been shown to
have a significant negative impact on patient safety.
Mr. Speaker, we sought the input of the health
profession regulators who would like us to have less protection. We've sought
the opinions of the professional associations who would have liked us to have
had a lot more protection for their individual members. And we've spoken widely
with advocates and representatives in drafting this bill, and I would appreciate
and like to acknowledge here their efforts and insights.
As I say, some groups say that Bill 70 doesn't go far
enough, and there are some that say it goes too far. Maybe that balance is
struck just simply by that fact alone. It does attempt, as a bill, as a
comprehensive piece of legislation, to achieve a balance in the protection of
quality assurance information so that only that is necessary for the quality
assurance systems issues will be protected. The objective, again, is to promote
full, open and candid discussion within that protected area, unimpeded by risk
or perception of risk.
While most of my remarks have focused on the area of
quality assurance, there are a number of other provisions in the bill; I've
simply emphasized these because I'm aware that they have been significant
sources of contention with special interest groups. The bill provides a
structure through which quality assurance activities will be conducted one
that currently doesn't exist at the moment in any cohesive way.
It will require each RHA to establish a QA committee
which will monitor, report and make recommendations on the quality of health
services to its health service board. It will also feed in and provide direction
to RHAs as to how to conduct a quality assurance activity. Some of the smaller
RHAs, particularly, have had challenges around these. There was a knee-jerk
action in 2009 and 2010 for any quality assurance activity to automatically
mandate bringing in outside specialists and consultants. This is overkill and
not necessary, but it was done because of a lack of clarity in the system at the
time.
The quality assurance committee within each RHA would
be responsible for overseeing processes in the RHA and may actually convene
subcommittees from time to time. So with a larger RHA, such as Eastern Health,
they have a QA, a regional committee, but it may have, for example,
subcommittees to look at cardiac program, subcommittees to look at mental health
in a community, these kinds of things.
Also, the RHAs will actually be required to develop
patient safety plans. These are plans that would focus on improving safety and
removing preventable negative occurrences which could impact a patient's ability
to get out of hospital. I'm thinking of initiatives in hospital now like falls
and medication errors and those kinds of things.
These plans would be the means through which each RHA
would tailor to its own priorities, but the provincial mechanism I'll allude to
in a minute will allow those plans developed, say, in Central or in Western to
be available for input or perusal by other RHAs, so they're not perpetually
reinventing the wheel.
As a provincial mechanism, Mr. Speaker, we felt a
provincial patient safety and quality advisory committee would be the way to go.
It would be established with representatives from the department, the RHAs, and
as well would have public members able to represent the voice of the patient, if
you like.
The committee's mandate would be to measure, monitor
and assess patient safety indicators, and the overall quality of health services
in the province. It would use those indicators and those quality measures to
make recommendations on gaps and how to improve things.
We have, for a long time, measured process
enthusiastically but poorly. What I am hoping with these is that we can look at
those process indicators that we can show are clearly linked to positive
outcomes or removing negative incidents. I think that fits very well at a
departmental and a provincial level with the thrust of where this government
wants to go in terms of outcomes and indicators and using evidence to feed back
into the system to tweak it, to make it better.
So to summarize, Bill 70 aims to achieve the following
objectives and I believe it meets those aims and does achieve these
objectives. Firstly, to standardize quality assurance processes and reporting;
to impose a positive duty on RHAs to provide patients, their families, and the
public with information relevant to the care provided within the health care
system. This is a significant first and was very popular with the public groups
and advocacy groups we saw.
Thirdly, it would create a mechanism whereby learnings
related to close calls, occurrences and adverse health events are actually
shared. Too often the smaller RHAs struggle and aren't aware that other of their
neighbours have actually had the same problem, dealt with it and fixed it. And
we found that out with incidents both small and large over the system in my
short tenure in office.
Finally, and the bit I spent probably the most, in
terms of time, talking about, it provides legal protection and legal certainty
around what is protected and what isn't, that does not currently exist. In that
void we have uncertainty, and in that uncertainty we have had a distinct lack of
ability to do some of the quality assurance work that I think professionals
would really like to get involved in, but they've been fearful because they
didn't know where they stood.
The intent of the bill is to provide a framework
through which policies and procedures adopted in the area of QA actually get the
force of law, because underneath this act will be regulations. It will be
through these regulations that we will have standardized committees,
standardized terms of reference mandate and we will start to homogenize policies
across RHAs and across themes. So if you're a patient receiving surgical care in
Happy Valley-Goose Bay, the patient safety framework, the quality framework is
exactly the same as if it was in the Health Sciences Centre.
It will provide legal support to the activities that
are already being undertaken by the department and the RHA. They've been doing
them through policy without regulatory framework or without a legal background.
It will provide direction as to the expectation of QA activities within the
regions and provincially.
There is no expectation. So any quality assurance
activity can be set at the moment by its mere existence to meet the standard,
because we don't have a standard.
This bill, however, is not and I would emphasize at
this stage is not about protecting people who should be providing health
services to an appropriate standard and who are not. They are not covered. This
may make them easier to spot, and, quite frankly, I think they represent a very
small fraction of the people who work in health care in this province.
To go away thinking that we have a health care system
that doesn't have people who go to work every day determined to do the best job
they could, I think would be a misapprehension I'd want to correct at this
point, because that's certainly not my personal experience. It's certainly not
been the experience I've got travelling around the province here in the last 14
months going from facility to facility. Universally, I've been met with
enthusiasm, dedication and a preparedness to do more than their simple job
description and time sheet would suggest.
What this bill is about is it's about creating an
environment where QA activities are undertaken consistently throughout the
province but in an environment that's conducive to frank and fruitful
discussions, because without frank and fruitful discussions some of this could
easily devolve into lip service. So there is an element whereby we have to
generate some trust with the RHAs and our health care providers so that they
will feel engaged in this process and want to engage. Once that happens and we
have those discussions, that's when you'll see the true benefit of QA activities
as they feed back to make a good system even better.
Providers do need reassurances that the reporting of
occurrences and adverse events will actually trigger something, and that once
that process is triggered it's not going to be one that exposes them
unnecessarily. It's not going to be a witch hunt and it's not going to be blame
and shame, because that has been a real concern that we've heard. I think this
framework goes some way to addressing what are basically cultural problems.
Mr. Speaker, we know that an adverse event can be
devastating for everybody involved. The patients and families have to live with
the consequence of the adverse events and the health care providers go home and
beat themselves up over it. They wake up at night and they dwell on it, and they
don't get back to sleep and it makes their life very difficult. It benefits no
one.
A framework like this, quality assurance activities do
improve patient care and do reduce adverse events in those jurisdictions where
they have a structure. This is a comprehensive bill, the like of which has not
been seen in Canada. It will reduce adverse events. It will allow for sharing of
information. And the important thing is that at the end of the processes people
involved and the system as a whole is wiser than it was the last time.
I will take my seat now, Mr. Speaker, and I would ask
all Members of this House to join me in supporting this bill.
Thank you very much.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER (Warr):
The
hon. the Member for Mount Pearl North.
MR.
KENT:
Thank you, Mr. Speaker.
Good afternoon once again. I'm actually very happy this
afternoon to rise to speak to Bill 70, An Act Respecting Patient Safety and
Quality Assurance in the Province.
I certainly won't be as eloquent as the Minister of
Health and Community Services, but I do have a few things I want to say about
the legislation. I should say upfront, that I support the legislation. I intend
to vote for the legislation and I suspect many of my colleagues will do the
same.
SOME HON. MEMBERS:
Oh,
oh!
MR.
KENT:
Thank you. Thank you for your enthusiastic support. I can hear you; it's not
that big a Chamber.
It's good legislation. It's legislation that I'm quite
familiar with. It's been drafted for quite some time, for a number of years.
There were some outstanding issues that needed to be resolved. I believe many of
those issues are resolved. There's a couple that I don't feel are fully resolved
that I do wish to speak to during my time today in second reading debate. I'm
hoping the minister will be able to address those particular points in his
closing comments in second reading. I suspect he will, and I suspect he can
anticipate some of the questions that I do have.
This is good legislation and it is necessary
legislation. Really, what we're doing here is providing a legal framework for a
whole bunch of policy that's been created over a number of years that already
exist. We're taking a whole bunch of policy and a whole bunch of things that are
in practice in health care today in our system here in Newfoundland and Labrador
and elevating it to the force of law. That's a logical step. It's a step that's
been planned for several years and I'm pleased to see it finally come to
fruition here this afternoon and, ultimately, very soon, I suspect this bill
will be brought into law.
So as the minister says, I think there will be those
who say that this legislation goes too far and there will be others who will say
this legislation doesn't go far enough. I know I've answered questions on this
draft legislation in this House of Assembly when I sat in the minister's chair
for a brief period, and trying to strike that right balance was a challenge then
and it's a challenge today.
I think for the most part this legislation, as it's
proposed, strikes a good balance. So I know full well that not everybody is
going to be happy with every element of this legislation, but based on my
limited experience I'd say that's predictable. That's to be expected.
I know that the Newfoundland and Labrador Medical
Association, for instance, has a view on medical peer review and does have some
concerns that they've shared with the minister on this particular piece of
legislation. So that speaks to the point I just made. Some folks are going to
say this goes too far, some are going to say it doesn't go far enough, and it is
about striking the right balance. But what's most important is that this is all
about enhancing patient safety and taking many things that are already now in
place in our health care system and making them law, actually putting them into
legislation. So I think that makes a lot of sense.
I'll just give you one example of the kind of work I
was familiar with that was going on and is going on in the health care system
already that I think is very much in line with this legislation. One project I
took an interest in during my brief time in the department that related to
quality and patient safety was a clinical safety reporting system. The clinical
safety reporting system was put in place, I believe, in the fall of 2012, and it
was in response to the Report of the Task
Force on Adverse Health Events. It recommended that a provincial electronic
occurrence reporting system be developed and that it be implemented across all
services and programs in the regional health authorities.
So there has been a lot of work done, and I want to
acknowledge the work of people in the Department of Health and Community
Services who've brought a lot of those initiatives into place, and the folks in
our four regional health authorities who've worked hard to bring a lot of those
initiatives into place.
We also talk about the recommendations coming out of
the Cameron inquiry, which in very large part have been successfully acted upon
and implemented, and this legislation addresses the bringing into legislation
that was called for in some of the recommendations that the minister spoke to
today.
But, in practice, a lot of the work that was being
called for is actually being done; it's been happening for years. I want to join
the minister, I think, in giving the people of the province some confidence that
this is not new; it's not like all of a sudden people have decided let's put
greater emphasis on patient safety. A lot of the initiatives that this
legislation is now bringing into law, so to speak, are in place today. There is
lots of good quality assurance and patient safety practices in our health care
system today, I would argue, better than ever before in our history, and that's
a good thing.
And, unfortunately, it took some failures in the past;
it took some near misses in the past to get to that point in some ways. But the
good news is significant progress has been made, and those reports that have
been referenced here today, the recommendations in large part were implemented.
I suspect this is much the same for the current minister. I would receive
regular reports from the department and from the regional health authorities
that measured and monitored compliance with recommendations coming out of
Cameron, and with recommendations coming out of the
Report of the Task Force on Adverse Health Events.
So that's been ongoing work for a number of years, and
this is not a I was going to say this is a final step, but it isn't, because
quality assurance and patient safety, that's an ongoing priority and it's an
ongoing journey, and we have to constantly be striving to make the system safer
and make the system better. This is a final step in dealing with some those
recommendations, because now we're actually taking what's in policy and practice
and bringing it into legislation.
Anyway, I started to talk about the clinical safety
reporting system as one example. Some of the benefits that that system brought
to patient safety involve a really timely process for reporting and feedback and
appropriate follow-up on occurrences across all four regional health
authorities. This system that was put in place in 2012 by the previous
administration ensures that those relevant occurrences are communicated among
the regional health authorities and with the Department of Health and Community
Services as well.
The system also helps ensure appropriate and timely
follow-up to prevent negative outcomes for clients receiving health services.
Another benefit is the provision of trends and analysis and reports on
occurrences at multiple levels of the health care organization. So managers are
involved in the health care system, the executive of the regional health
authorities are involved, the board of directors has a role to play.
While the regional health authorities have an
operational responsibility for programs and services that they provide,
including managing occurrences like the ones this legislation addresses, there
is a leadership role that the department has to play and is playing by dealing
with legislation like this, and by implementing systems like the clinical safety
reporting system.
Each RHA today, unless it's changed in the last 18
months, has an occurrence reporting policy that provides direction for reporting
and managing occurrences. It also includes a timely process for the follow-up of
occurrences. So I point all of that out because there has been a lot of progress
made. This legislation is about tying all that together. And it would have been
possible in the past to deal with this piecemeal and amend various pieces of
legislation to try and achieve the same effect, but what we're doing here is
taking an approach that is unique.
It's a made-in-Newfoundland-and-Labrador piece of
legislation; we've learned from others' experiences across the country, but
there isn't a piece of legislation quite like this that ties it all together.
I'm starting to sound a little too positive, but I have to say I do feel
positive, for the most part, about this legislation because I have a vested
interest in it. I spent time debating it, spent time talking about it, and
trying to move the work along. It's an evolution, and I applaud government, and
I applaud the minister for following through and getting the legislation to this
point today.
At the same time, let's make sure we acknowledge and
celebrate the great work that's been done by health care professionals and
health care administrators and managers and leaders over the last number of
years in implementing all of those recommendations from the Task Force on
Adverse Health Events and from the Cameron inquiry. Because I do sincerely
believe that the system is better and stronger today as a result.
So I'll talk a little bit about the legislation. I
think the minister did a reasonable job of providing an overview of what the
legislation's all about, so I won't go through it in incredible detail; but, I
do want to, for the benefit of those following the debate, provide some context
to what it is we're doing here in Bill 70.
Ultimately, it's all about improving patient safety and
ensuring that quality assurance processes don't just happen because somebody
recommended that they happen and don't just happen because someone has set a
policy saying they have to happen. It's about bringing it into legislation,
bringing it into law to make sure that there is a solid framework for reporting
and investigating close calls, near misses, occurrences and, unfortunately,
adverse health events that do happen in a system that deals with thousands of
people in our province each and every day.
So the first part of the legislation talks about
reporting. It talks about the requirement for our regional health authorities to
compile and report information that relates to the quality of health services
and if there is a close call or an actual occurrence, that the RHA becomes aware
of, the regional health authority, the RHA will review that and report on it.
There will be a process established for reviewing it in a way to do whatever we
can to ensure that there's less chance of a similar incident happening again.
In practice, from my limited experience, that is what
happens today but now we're making sure that it's actually in legislation so
that it will be, in the eyes of the law, required to happen. This legislation
also gives the ministry the ability to request quality assurance information,
which I know to be important. There's information through a quality assurance
process that may be provided to the public, without identifying people's
individual personal information, of course, but the public does have a right to
know about issues that are affecting patient safety within our health care
system.
This section of the legislation also makes sure,
obviously, that the regional health authorities can share information with one
another and with the department which, obviously, makes sense.
The minister talked at length about quality assurance
committees and patient safety plans. Each regional health authority will have a
quality assurance committee. The committee will report to the board of trustees.
The committee will improve the quality of health services, monitor and report,
make recommendations, maintain confidentiality and carry out some other duties
as well.
The regional health authorities will also be required
to implement a patient safety plan according to regulations that will be
established. Again, I would suggest that, in practice, these are things that are
happening within our health care system today.
There's a section related to disclosure to patients,
and people that are affected by an occurrence in our health care system
obviously have a right to be informed and have a right to certain information.
They deserve to know the facts of the adverse health event or any other new or
unknown facts that become known through any kind of investigation.
They deserve to know about the consequences to the
patient. They deserve the details of the health services provided to the patient
as a result of an adverse health event. If there are recommendations coming from
quality assurance activities in the system, they deserve to know what those
recommendations are as well. So it makes good sense.
Part four of the legislation speaks to the provincial
patient safety and quality advisory committee, and there will be a whole host of
individuals involved in that from the deputy minister, or somebody designated by
the deputy minister, to patient reps, reps of the regional health authorities,
physicians, and there may be others that the department decides are appropriate
as well.
That provincial committee plays an important role as
well. They'll make recommendations. They'll measure and monitor and assess
patient safety indicators and the quality health services. They'll identify good
practices, assist in implementing and evaluating. So it's not just going to be
another advisory group. It's a committee that will play an active role in
ensuring that this legislation is truly brought to life in the way that it's
envisioned.
As there typically are, there are some general
amendments and provisions in section 5 of the legislation as well. There will be
a number of things to find in regulation which is quite normal practice:
reporting of close calls and occurrences, and adverse health events; how the
appointments to the committees, I just mentioned, will take place; how a quality
assurance committee can access information from a regional health authority.
So there's some work to be done in regulation. I
suspect those regulations are ready to go as well. I share the minister's
enthusiasm for bringing this into force as quickly as possible.
As I said earlier, there's a desire here to amend a
number of pieces of legislation all at once and bring a number of elements of
other pieces of legislation together in this bill and in this act, rather than
having done it piecemeal in the past. I think this kind of comprehensive
approach in this instance makes sense.
On the point of the regulations, while I suspect a lot
of them are ready to roll, I also understand from the briefing that we received
from the minister's staff that it will probably take several months more to
develop some of those regulations. And that's reasonable as well, given the
complexity of some of the processes that are being dealt with here.
So, overall, a positive piece of legislation. A couple
of questions and concerns that I'm hoping the minister will be able to address
in his response today. One major gap we are concerned about relates to the Child
and Youth Advocate. The Child and Youth Advocate has been saying for some time,
not just the current advocate but specifically the previous advocate, had been
saying there should be mandatory reporting of deaths and critical incidents to
the Child and Youth Advocate. It would seem to me that this legislation could go
all the way and actually address that request, reasonable request by the Child
and Youth Advocate in this legislation, to actually bring that into law as part
of what we're doing here in Bill 70 as well.
I was surprised to hear the Child and Youth Advocate
was not consulted. I know we're going back into history now, but it was my
understanding during my brief time working on this that it was the intention to
consult the Child and Youth Advocate. And given the attention that the Child and
Youth Advocate has drawn to the whole issue of mandatory reporting, it seems
this legislation would be a place to address that because incidents are now
going to be reported through these quality assurance systems. Systems are in
place today within the system for the most part, but now we're bringing it into
law. So it would seem there was an opportunity here to address the concerns of
the Child and Youth Advocate at the same time.
I guess my question to the minister is why wasn't the
advocate consulted? Also, why not in this legislation address that need and
address that request from the Child and Youth Advocate to ensure mandatory
reporting of critical incidents and deaths that would affect children and youth
in the health care system?
The other concern, which I recognize is a complicated
one, I'll say that upfront. It's part of what I was struggling with myself in
dealing with this proposed legislation. The definitions as they are outlined
here really only apply to those working directly in the regional health
authorities, but health care in our province is certainly bigger than that.
When we talk about all the provisions related to
quality assurance and patient safety, none of them will apply to GPs, family
physicians who have their own private practices, their own offices. It won't
apply to unless they're interacting with the regional health authority. So if
a physician is working in the regional health authority, that's a different
story, but for the work they do outside of that with individual patients in
their own offices, then it doesn't apply. It doesn't apply to our paramedics. It
doesn't apply to our private ambulance services or non-profit ambulance
services. It doesn't apply to home care. For the home support personnel that
work for agencies in private sector, it doesn't to them as well.
Community supports and home care is actually listed in
the services covered by the legislation but there's really no practical
application from what I can see because they're not actually going to be
governed by this legislation. So I know it's not given the complexity of the
system and the fact that not everybody falls within the auspices of the regional
health authorities, it's not simple to put everybody under the umbrella of this
legislation, but at the same time I'd like to hear the minister's thoughts on
why those issues were not addressed, or perhaps he can tell us how they are
being addressed. Maybe there are other provisions planned to ensure that some of
the issues we're trying to get at here will also cover those disciplines and
those professions.
So those are really the two big concerns related to the
Child and Youth Advocate, the lack of consultation and the fact that this
legislation doesn't ensure mandatory reporting of critical incidents and deaths.
Then, the fact that there are a number of significant health care providers in
our province that won't fall under this legislation, family doctors that work in
private practice, paramedics, home care workers, just to give a few examples.
And I know, given the challenges, you have to draw the line somewhere, but it
just feels to me that those are gaps that could possibly be addressed. I'd
appreciate hearing the minister's thoughts on those.
Overall, though, this is a positive step forward. I
want to thank those that have been working on it for literally years. This goes
back; I'm going to say four or five years. My time in the Department of Health
and Community Services was very brief. The current minister has been in the
office already longer than my entire time in the office, but I know that even
for ministers before me, this was on the agenda and there was significant
progress made. I'm glad to see it get to this point and to be debating this bill
in the House of Assembly today.
To recap, this is an appropriate response and it's part
of the evolution when it comes to Justice Cameron's report on hormone receptor
testing that came out in 2009, I believe, and then there was the
Report of the Task Force on Adverse Health
Events that was actually even before that in 2008, I think. As a result of
those reports, there has been a lot of work done. A lot of the concerns and
recommendations have been addressed and, in practice, much of what we're
debating today is already happening. And that's good news for patients; it's
good news for everybody in Newfoundland and Labrador.
We've been working to get patient safety legislation in
place that addresses even more aspects of patient safety, and it's not just
about the things that were recommended in those two reports. This legislation
provides a framework through which the policies and procedures that are already
in place in the area of quality assurance will be given the force of law, and
that's an appropriate step for us to be taking here.
It will provide legal support for initiatives already
being undertaken by the department and our regional health authorities and it
provides direction as to the expectations of quality assurance initiatives
within the regions and across the entire province.
I think having one piece of legislation on patient
safety will complement the culture of patient safety that I think has developed
in our health care system. There's a much greater focus on quality and patient
safety over the last eight or nine years or so than there has been ever before
and it's evolved, and it needs to continue to evolve. We need to continue to
show leadership. We need to continue to have conversations like this one,
because the work will never be done.
Putting this in legislation is a positive step forward.
I think it demonstrates that, regardless of party stripe, regardless of which
government is in power, we all know how important patient safety is in our
province and in any province, because of some of the things that have happened
in the past that were preventable and, to a degree, were predictable. It's going
to continue to evolve. We're going to constantly be trying to find ways to make
the system function better and be safer.
In summary, what we're doing here is addressing those
recommendations that required a legislative response. We're addressing concerns
that I heard and I'm sure the current minister has heard and ministers before us
heard from patients and families about adverse health events. We're addressing
concerns from health care providers who do have to participate in peer reviews
and quality assurance activities. And again, not everybody will be happy with
every element of this legislation, but I think it strikes a reasonable balance
overall.
What we're doing here is developing and mandating
public reporting of specific indicators of patient safety. And that provision
for public reporting, that kind of transparency, is incredibly important when
you want to ensure that people have confidence in the system. Actually mandating
the quality assurance committees makes sense and making their terms of reference
public makes sense. Mandating reporting and investigation of adverse health
events, even though it's happening today, mandating it through legislation makes
sense.
So overall, I'd say this is good legislation. I believe
there are a couple of gaps that can be addressed. I suspect the minister will
have reasonable answers for the couple of points that I've raised. I certainly
hope so anyway. Because perhaps there's an opportunity here to make this
legislation even better or perhaps there are other plans to address some of the
concerns that I've identified related to the Child and Youth Advocate and
related to the health care providers that are not included under this
legislation.
I'll wrap up my comments there. I'm pleased again to
have the chance to speak to this. I know a lot of great work has been done. I
feel this is one where we can all say this is good work and there's more to do
and it needs to transcend politics. Anything that's going to improve patient
safety in our health care system is something we should all stand and support.
It's also important that we ask the right questions and make sure that we do
everything we can to make it even better.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Virginia Waters Pleasantville.
MR.
B. DAVIS:
Thank you, Mr. Speaker.
I'm pleased to rise here today. I must, first of all,
thank the Minister of Health and Community Services for passing on we can't
say he's not a generous individual because last week he passed on this flu that
I'm nursing here today. So I'd just like to thank him for that. Hopefully, I can
get through this without coughing in his general direction, that's my hope that
the hand-washing stations we have set up will help get us through this here
today.
Mr. Speaker, this bill is a very good sign, as you can
see from our colleague across the hall here, he's supporting this. This is yet
another example of us delivering and not talking about it. We're going further
and we're finishing off things that may have been started by the previous
administration but we're delivering on those initiatives. So we're pleased to be
doing that in this department. We're quite happy to be here today to debate
this.
Mr. Speaker, I believe that it's safe to say that just
about everybody in this province and in this House have received health services
offered through one of our four regional health authorities, or has a family
member who has received health services from one of those four regional health
authorities. I, myself, have received services on numerous occasions over the
years and I'm pleased that the government is moving in this direction.
With such an important legislative initiative, whose
primary goal is the enhancement of patient safety in our province, when people
enter a facility operated by an RHA or receive health services provided by that
regional health authority, they want to know that all the efforts have been put
in place to ensure that they receive the best possible care available. They want
to know the health system is safe and that it has all the checks and balances
put in place to ensure the services provided to the patient are safe.
The intent of this bill is to provide a legal framework
for the quality assurance activities undertaken by the regional health
authorities and the Department of Health and Community Services. It will also
provide the direction to the RHAs so that they can achieve consistency among the
regions by setting standardized requirements for reporting, conducting quality
assurance activities, for disclosure to patients and their families as
mentioned by the Minister of Health and Community Services, that's an important
piece. You should not have to rebuild the wheel each and every time. If one RHA
has a very good process in place, why not copy that and put it into the other
RHAs, and that's where we're going with this.
The patient safety bill is divided into five parts. The
first part is entitled reporting, investigation, and release of information. In
our province our health care system is administered by four regional health
authorities, as we all know. Part one of the bill imposes a number of
obligations on the RHAs related to patient safety in its delivery of health
services to our people in our province.
The RHAs will be required to report to the department
on certain patient safety indicators, such as hand washing, as mentioned
previously. This public reporting will enhance transparency and accountability
within the RHAs, and it is expected to protect the public and the health care
workers by ensuring that the indicators are monitored and lessons learned from
the reporting are shared.
Each RHA will be required to establish the process for
reviewing close calls, occurrences and adverse health events for the purposes of
reducing and mitigating the risk of similar events.
Mr. Speaker, the bill sets out the definitions for the
terms of close call, occurrence and adverse health event. A close call is a
potential occurrence that did not actually occur due to chance, corrective
action or timely intervention. An occurrence is an undesired or unplanned event
that does not appear to be consistent with the safe provision of health
services.
An adverse health event is an occurrence that results
in the unintended outcome which negatively affects a patient's health or quality
of life. RHAs will be required to notify the Minister of Health and Community
Services for certain adverse health events which occur during the provision of
health services to a patient.
The RHAs will also be required to notify the minister
of certain occurrences that involve multiple patients or occur in multiple
regions. While it is not anticipated that the minister will be notified of every
event that occurs in the RHAs, given his responsibility for the health system in
the province, it is important, Mr. Speaker, that the minister be notified of
specific, adverse health events and occurrences.
The particulars regarding the specific events will be
reported to the minister, will be set out in regulations. The bill also protects
the health care providers who report a close call or an occurrence to the RHA,
and anyone who provides information to a qualified assurance committee from
appraisal of providing that information.
Part II of the bill is entitled Quality Assurance
Committees and Patient Safety Plans. In occurrence with this part, RHAs will be
required to establish a quality assurance committee whose mandate will be to
monitor, report, and make recommendations on the quality of health services.
This committee will report to the board of trustees of the RHA.
The quality assurance committee will be responsible for
establishing or designating various subcommittees referred to in the bill as
quality assurance activity committees to carry out a range of quality assurance
activities within the RHAs which may include quality reviews into specific
events or broader reviews of the health services.
In order to ensure consistency of the establishment of
a broader quality assurance committee, as well as various quality assurance
activity committees, regulations will be drafted to set out, and set out in
requirements regarding the membership, composition, structure and terms of
reference of those committees.
In accordance with the bill, RHAs shall also develop
and implement patient safety plans. These plans will focus on improving safety
within the RHAs, preventing outcomes which negatively affect patients' health or
quality of life, and promoting safer care for patients.
SOME HON. MEMBERS:
Oh,
oh!
MR.
B. DAVIS:
There seems to be a little noise in the House here. Mr. Speaker, can I have some
protection please.
Part III of the bill focuses on disclosure to the
patient, which is very, very important. Section 17 requires the RHA to establish
a policy for ensuring that an adverse health event is disclosed to the patient
and his or her family. You recall, Mr. Speaker, that an adverse health event
occurs when a patient is harmed while receiving health services.
While all four RHAs currently have disclosure policies,
regulations will be developed to provide direction and to ensure consistency in
the information that is provided to patients, regardless of the region in which
they receive the health services.
The bill imposes a positive duty on the RHA to disclose
certain information to patients. An RHA must disclose the following information
to patients affected by an adverse health event: the facts of the adverse health
event and any new or otherwise unknown facts they have learned during the review
or investigation into the event; the consequences to the patient; the details of
the health services provided to the patient because of the event; any
recommendations from quality assurance activities conducted to review or
investigate the adverse health event. It is also a requirement that the
information disclosed to the patient must be recorded in the patient's health
record.
Part IV of the bill deals with the establishment of the
Provincial Patient Safety and Quality Advisory Committee. This committee will be
comprised of representatives from the Department of Health and Community
Services, the RHAs, as well as public members who will represent the views of
the patients. Its mandate will be to measure, monitor and assess patient safety
indicators, as well as the quality of health services in the province in order
to make recommendations on how to improve patient safety and the quality of
health services.
Part V of the bill is simply entitled General, but
contains some very significant amendments to the
Evidence Act and to
the Public Inquiries Act,
2006
which I would like to take some time to highlight.
The bill sets out legal protection as mentioned by
the minister that does not currently exist for quality assurance information
which is the information created for or generated by quality assurance
activities and committees. Advocates and associations representing health
professionals, as well as the RHAs, have advised that without clear protection
of quality assurance information, health care providers will be less inclined to
fully participate in the quality assurance activities. This will drastically
impact the quality assurance activities undertaken by the RHAs. People have to
feel that what they're saying in there is protected in these committees, which
is very, very important that we do that protection.
In some cases, health care providers may refuse to
participate, or if they do participate they may be very guarded in what they say
or unwilling to participate in an open and frank manner which is important. This
level of participation is of limited value to the process. The legal protection
of the quality assurance information is regarded in the health system as
essential to ensuring an open environment where health care providers are more
likely to share opinions and make recommendations.
Following the Cameron inquiry, the Canadian Medical
Protection Association advised the department on a number of occasions, without
adequate legal protection physicians would be reluctant to participate in
quality assurance activities which will have a highly negative impact on the
efforts to improve patient safety in the province.
This concern is not unique to physicians. We have heard
the same from organizations representing other health care professionals. To
address this concern, the bill amends the
Evidence Act to clarify that quality assurance information cannot be
disclosed in the context of legal proceedings.
A legal proceeding is defined to include persons and
committees, including disciplinary committees of the RHAs who are mandated to
review the clinical competency of a health care provider. Legal proceedings also
include committees of health profession regulators.
It is important to note that, in order for the
information to be protected, the quality assurance information which, as I said
earlier, will only be the information created for or produced in the context of
quality assurance activities. Health records such as patient charts will not be
protected from being released in a legal proceeding. Furthermore, information
related to the skill, knowledge or clinical competences of a particular health
care provider will not be protected. This information can be released.
While it is recognized that quality assurance
information needs to be protected from being released during a legal proceeding,
it is acknowledged that its protection should not exist in a commission of
inquiry, thus the bill sets out changes to the
Public Inquiries Act, 2006 and
clarifies the commission of inquiry will be able to access quality assurance
information. A commission of inquiry is created in response to a significant
event and it is important that these inquiries have access to the full and
fulsome amount of information.
Mr. Speaker, we know that when an adverse event occurs,
it can be devastating to everyone involved. Quality assurance activities are
undertaken to improve patient care and reduce adverse health events within the
health care system through sharing of learnings from each and every event.
In summary, Mr. Speaker, let me recap the objectives of
Bill 70. First, it aims to standardize the quality assurance activities
undertaken by the regional health authorities and how the results of those
activities are reported within the organization, which is very, very important.
Secondly, it imposes a positive duty on the regional
health authorities to provide patients and their families with the
recommendations from relevant quality assurance activities and the public with
information relevant to the quality of the health care services.
Third, it creates a mechanism whereby learnings related
to close calls, occurrences and adverse health events are shared within the
RHAs. Fourth, it protects quality assurance information from being released in
the context of a legal proceeding. This will support an open and frank
environment in which health care providers are comfortable providing opinions
and speculations during a quality assurance activity. It is this level of
participation which will help to achieve a safer health system, which is what we
all want.
Mr. Speaker, this bill is one of a kind in this
country. No other province has a comprehensive statute which contains all of the
elements found in this bill. For this reason, it is an important piece of
legislation and I encourage all Members in this House to support Bill 70.
Hopefully, they'll be supporting us in this initiative. It's a very
ground-breaking one for our province. We're interested to try to hear what the
questions are and I'm interested to hear the minister's responses to the
questions from the Opposition, because I know we've delved into those in the
department over the past number of months and years, as the Member mentioned
before.
SOME HON. MEMBERS:
Oh,
oh!
MR.
SPEAKER (Bragg):
Order, please!
It is getting a little loud.
MR.
B. DAVIS:
Oh,
thank you very much.
With that said, I'd just like to say thank you very
much, and hopefully we can encourage everyone in this House to stand together
and vote for the future of the health care system in our province.
Thank you.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
Order, please!
The Speaker recognizes the hon. the Member for St.
John's East Quidi Vidi.
MS.
MICHAEL:
Thank you very much, Mr. Speaker.
SOME HON. MEMBERS:
Oh,
oh!
MR.
SPEAKER:
Order, please!
MS.
MICHAEL:
I'm
very pleased to stand here today and to respond to Bill 70, which was presented
so well by the Minister of Health and Community Services. I want to thank his
staff for the great briefing we had last Friday. It was very comprehensive and
they didn't rush it. They took the time that we needed to make sure we had a
clear briefing.
This bill is extremely important. There's no way that
we're not going to agree about that in this House. And it's been a long time
coming. I think we were about 10 years waiting for this bill to appear in the
House of Assembly.
It's not that safety of patients hasn't been part of
our health care system and all of the regional health authorities do have
aspects of this bill in their regulations and in how they operate, but what is
so important about this bill is that we now will have a unified system that's
concerned about patient safety. Now we will unanimity. We will have something
that we can expect.
I think the minister pointed that out well, that
whether you're in a hospital on the top of the Northern Peninsula or in
Labrador, or on the Avalon Peninsula or on the West Coast, it won't matter where
you are that the same legislation, the same regulations, the same practices will
be in place and that's extremely important. I was glad that he pointed that out.
It would nice to think that we don't need this kind of
legislation, but I can't imagine
SOME HON. MEMBERS:
Oh,
oh!
MR.
SPEAKER:
Order, please!
I'm having a problem hearing the speaker.
MS.
MICHAEL:
Thank you very much, Mr. Speaker.
This is important and I think it's important that we
listen to each other.
What I was about to say was that I can't imagine that
there isn't a Member in this House who hasn't heard some of the stories that
I've heard as an MHA, which tells me that we do need this kind of legislation.
It's not that anybody out there in our health care systems are deliberately
trying to cause accidents, are deliberately wanting to cause adverse events.
Nobody is trying to do that. It's not that our people aren't professional or
aren't trained, of course they are, but we're all human and things happen and we
have to acknowledge that things happen.
One of the issues that's been brought to me recently
and I brought this up on Friday and asked would it be covered by this
legislation. I was told it certainly would be. A number of people have come to
me with something that may seem simple but could, in actual fact, be quite
serious. Something that I think probably would defined as close calls, if they
haven't actually gone further.
That is people coming to me and saying I was in
hospital and before you go in either to stay overnight or have some kind of
procedure done, you sit down, you go through meetings with people and one of the
things you're asked are what are the medications that you are on, do you have
any allergies, do you have any situations that we need to know about. Certainly
people give that information.
What's been told to me by a number of people recently,
and I've been a bit startled by how often it has happened, just in the last
couple of months, is people saying to me: I didn't know what was wrong, what was
going on. And it turned out that a mediation had been given that they had
identified they can't take. When they asked well, isn't that down on my file
like I told when I did the pre-op stuff and came in and gave my information I
said that three people have told me this recently. And when the person they
said this to checked the documentation, no, in actual fact, this hadn't been
noted.
Now anything can make that happen; however, sometimes
that could end up with being a real adverse event. In the cases where I have
been told about, people picked up on it in time and something didn't happen that
really could have caused them being very sick or even dying in one case, but it
was picked up in time, et cetera. But that kind of thing is happening regularly.
Every now and again you hear about, with a surgery, for
example, something like a sponge or something being left inside a body, inside
the person. And down the road this becomes discovered and whatever was left
inside has to be removed. It does happen. I'm not blaming anybody; I mean this
is human frailty. Lots of things can cause those kinds of things to happen. So
we do need this kind of legislation, and I'm more than happy that we now have
it.
I'm not going to go through all the things the minister
went through because he did an excellent job. He did point out that in actual
fact, as we know, this legislation in particular, the need for it was
highlighted by the recommendations from the Cameron report and the task force
that policy and their recommendations pointed out that policies should be
legislated around reporting, investigating, releasing information, quality
assurance committees, disclosure and the patient safety advisory committee. And
since those recommendations, some things have been put in place, but I think
this piece of legislation is really a culmination of a lot of those
recommendations which are extremely important.
Another response to some of the recommendations that
have been made was the Apology Act. I
think we brought that in, in 2009, I think the
Apology Act, which was an extremely important piece of legislation
as well where it is a recognition that if something happens to a person while
being taken care of in our public health care system, that it be acknowledged
and steps be taken to make up for it, obviously.
So safety provisions need to be firmly placed inside of
our health care system, and I think it's really important that our regional
health authorities will now have a common document to work from; will have
common regulations to work from that we can be assured that everybody in the
province is receiving the protection they need. It is a concern to me, and I
heard my colleague from the Official Opposition mention this as well.
That because the bill only covers providers who are
affiliated with regional health authorities for example, salaried and
fee-for-service physicians, and ambulances that are part of the health care
system, because it only covers those who are directly under the regional health
authorities, it means that for example, if I live in an area where the
ambulance system is either a private ambulance, that's a for-profit ambulance,
or it's one of the community based ambulances, these ambulances are not directly
under the regional health authorities.
So if something happens to a patient in one of those
ambulances, there's no protection for them in this bill. Whereas, here in St.
John's, if I get an ambulance that comes to me from the Health Sciences Centre
and something happens to me in that ambulance, that will be covered by the bill.
So one of the things I am asking, and if the minister doesn't get a chance at
the end of second reading I'll be asking for when we go into committee, one of
the things I want to know is what is the protection we are going to offer? That
difference is very problematic.
The difference you know, I think I understand what
it's all about, that the health system and the regional health authorities don't
have authority over the private operators, no matter what those private
operations are, because it even includes GPs with their own clinics for example.
That if the bill is not covering patients in those situations, what is the
protection for them? Because whether or not there is a legal bind between the
health system and people who are using facilities or services that aren't under
the health authorities, certainly government has the responsibility to all the
population.
How do we protect people who may have a close call or
an adverse event or whatever happen, when it's health related, in a health
facility, but not part of our public system, not under the authority of the
health authorities. To me they're still under the authority of the province. So
how do we deal with that?
Now, of course it begs the question, and I've said this
before in this House of Assembly, and it is: Why do we have the mix that we have
with regard to ambulances? I firmly believe we should have a completely public
ambulance system and find a way in which to make that work and bring into that
system all the different facets we have.
If we had a completely public ambulance system, then
the question when it comes to ambulances wouldn't exist because all of them
would be under the regional health authorities. I think there are a number of
reasons why we need them under the regional health authorities besides patient
safety. A lot has to do with the working conditions of the people who work in
the ambulances, salaries, et cetera, but right now I'm focusing on the issue of
patient safety. And this certainly because it didn't dawn on me until we were
at the briefing, this was a real bit of a shock, the fact that somebody on an
ambulance coming from the Bonavista Peninsula, for example, or up from the Burin
Peninsula, is not going to be covered by the legislation.
It's the same way with the personal care homes. Again,
it's the same reasons of course. These are private, they're not under the
authority of the health authorities but at the same time people are being taken
care of in those homes. So again it's my question: How are we going to make sure
they have protection? How are we going to make sure that they too, if something
happens, can report it and can have something be done about it? So this is a big
concern I have, and I'll be interested in hearing responses from the minister
about this.
Some other things I'm concerned about; I'm really glad
we are going to have, for example, a good database created, that we are going to
have events reported on a regular basis by the regional health authorities, that
they will be publicly reporting on patient safety indicators. They're also going
to have to make sure that information on serious events get reported every three
months; whether, for example, surgical events. I made reference to something
being left inside a person, for example; product or device malfunction; care
management events and I think what I described with regard to people not
having all their information recorded ahead of time, that would be a care
management event. All these things will have to be reported. But what I'm really
concerned about and not happy about, actually, is that the data is not going to
be automatically public. That there's not going to be a place where that
database is going to be published, and where people can go online and read.
I've been told, when I asked the question in briefing
that no, you can ATIPP and when you ATIPP, you'll get the information. My
concern is that, first of all, that's a process that takes time. Secondly, it's
a process maybe not the general public is going to be comfortable with. And
thirdly, it shouldn't be happening.
I think we really should be looking at what they do in
Nova Scotia, because in Nova Scotia everything is publicly posted. All of the
events that are reported: close calls, adverse events, whatever, there is a
public database. And I really like the reasoning that the Nova Scotia
authorities give.
This is publicly on the Q&A that they have on their
website; they say: Making the information available to the public raises the
level of accountability and demonstrates a commitment to transparency and
openness. The goal is to share lessons learned and prevent the event from
happening again.
This new province-wide data this is when they put
theirs in place will help us understand what is happening across the system.
This information and I think this is the important point I want to make will
enhance patient safety by improving and standardizing the way serious events are
reported.
It will also free people up. If people all of a sudden
hear that there's a database, and somebody heard that somebody else had the
experience for example with information not being recorded, that makes that
person say, oh, this is not just me, this has happened to other people and may
be reported as well. Because one of the aspects of the legislation is that the
close call or adverse event doesn't have to be reported immediately when it
happens. It can happen post the event as well, and I think that's very
important.
So having a public database, having a database where
people can go in and read what's going on, will make the public more safety
aware and observing more. For example when the minister talks about the
hand-washing, which is extremely important, even on a personal basis when some
people know that my mother was bedridden for 2½ years, and I coordinated her
care. I wasn't the caregiver in that sense because I had a full-time job but we
had caregivers but with everybody, and the caregivers too, it was the minute
somebody came in the front door was wash your hands.
Because we didn't want my mother getting the flu, for
example, or any other bug that was running around. Wash your hands. And I'm
proud to say that for the 2½ years that she was bedridden she did not pick up
anything. Because we were so careful, her caregivers were so careful, we made
sure that she did not get anything. The awareness factor is extremely important.
Having a public database does increase the awareness factor. It does increase
people becoming educated.
They did it in Nova Scotia; if it's available
information, why should it have to be ATIPPed? It doesn't make any sense
whatsoever and I really do think it's a real weakness in our legislation. So I'd
like to hear from the minister at some point, while we continue this debate if
this is going to be given consideration down the road. Does he himself have a
desire for this to happen at some point? And why wasn't it put in the
legislation at this moment? I really don't see why it wasn't.
A couple of other points that I want to make there
are a number; I'm not going to get to everything today. It has to do with regard
to the committee that will be set up and which is set out in the act and I
think it is important that it is set out in the act rather than in regulations,
or actually a lot of things are being left to regulations that we're not going
to get to see here in this House, that aren't in the legislation. But the
committee that is being put in place is important. It will have two patient
representatives on the committee, the Deputy Minister for Health and Community
Services, and two safety officials from the health not the Health Sciences
Centre. I forget what HCS stands for; I should know
AN
HON. MEMBER:
Health and Community Services.
MS.
MICHAEL:
Yes, right; Health and Community Services: two safety officials from Health and
Community Services and the vice-presidents of patient safety from each of the
regional health authorities, and one or more patient safety physicians.
When I asked about the patient representatives, I liked
what I was told. They will actually go through the Appointments Commission, so
people out there can really think about who to get, put their name in to get
nominated and go through the Appointments Commission to be on this committee,
it's going to be extremely important. I'll have to end there, Mr. Speaker. I
could go on, but I'm going to have to wait I guess for Committee.
Thank you.
MR.
SPEAKER:
The
Speaker recognizes the Member for St. George's Humber.
SOME HON. MEMBERS:
Hear, hear!
MR.
REID:
Thank you, Mr. Speaker.
It's great to have an opportunity to get up and speak
on this very important bill today, the
Patient Safety Act. As the name states, it's about patient safety. But it's
also in a large respect related to the confidence that people have in the
medical system in this province, Mr. Speaker. It's about confidence; it is about
restoring confidence in the system.
Today I'm going to keep my comments relatively brief,
Mr. Speaker. There are some things I want to do; I want to give a little bit of
background of where this bill came from. I want to go through some of the main
provisions of the bill and to make some comments and observations on each of
those. Also, I want to make some overall comments about the legislation and the
bill, Mr. Speaker.
So Bill 70, as other speakers have noted, is a response
to two reports that were released in the late 2000s: the
Task Force on Adverse Health Events
and the Commission of Inquiry on Hormone
Receptor Testing, commonly known as the Cameron inquiry. Those two reports
really provided an overview of some problems that existed in the system.
And based on that review, and the problems that had
occurred, there were some, really, doubts in the system as it existed then, Mr.
Speaker. With the release of those two reports, there were measures taken by the
government of the day to improve patient safety, taken immediately upon the
release of these reports. Bill 70 is really a continuation of those actions in
relation to those bills and those problems that existed in the system at that
time.
So it involves the creation of a better, more
consistent and province-wide framework in relation to patient safety. That's
what this legislation is all about, that's what it's trying to achieve.
The specific items in this bill relate to reporting,
investigations and release of information; quality assurance committees, the
establishment of these committees; disclosure of incidences to patients and
families; and patient safety advisory committees, the establishment of those in
hospitals, Mr. Speaker.
In terms of reporting, Mr. Speaker, I'm going to go
through each of those items now and give a little bit of information about
those, and give some reflections on the necessity of these sorts of things.
Certain indicators will be specifically regulated,
which will be reported publicly. This could include things like the Minister of
Health mentioned. Hand hygiene could be one report. Another report could be
infection rates and things like that. So the idea there is, I think, that if
this information is publicly available, then people have a right to see what the
problems in the system are, and if they don't think the rates of hand hygiene or
the infection rates are acceptable, then they have an opportunity to lobby
government, to put pressure on government to push and to bring to light some
possible alternatives.
So the full idea, the principle that patients have a
right to know what is the state of the system they're going to for service is a
very important part of maintaining the confidence in that system. Things aren't
hidden, they're there, they're available and people can get the information if
they want, Mr. Speaker.
Another aspect of this provision is reviews and
investigations. Procedures and
regulations will be developed on how to handle reviews and investigations. The
procedures will become more formalized than it had been in the past.
Although we've had
investigations, and different regional health care boards may have had
provisions for how things are going to be investigated, this legislation makes
it more consistent across the province. The type of investigation that would be
done in one hospital is the same as would be done in another hospital. So it's
good to have that
consistency, and that as well adds to the confidence in
the system.
There are also stronger requirements for reporting to
the minister, Mr. Speaker. That's one of the things that came out in the Cameron
inquiry. When do you report an incident to the minister? When is it significant
enough to report, to involve the minister? Those were some things that came out
of the Cameron inquiry and I'm pleased to see that these requirements are being
strengthened in this piece of legislation here that we're debating today.
Quality assurance committees; right now, we have
quality assurance committees in regional health care authorities but this
legislation requires the establishment of quality assurance committees in each
regional health authority. While they currently exist, the legislation requires
province-wide consistency in their operation and in their terms of reference. So
it provides that consistency. It ensures they are working in a proper way that
is consistently applied across the province through various regional health
authorities.
Also, further activities will be undertaken in terms of
quality assurance activity committees, and these may be related to specific
events that occur or instances that occur. It may also relate to situations
related to one specific hospital or one specific regional health authority.
These quality assurance committees are going to be more rigorous, they're going
to be more involved and they're going to be more formalized and consistent
across the province. So that's a good measure as well. I think that is something
people can expect to be applied and there should be an expectation of that.
Disclosure is another item that's dealt with in this
piece of legislation, Mr. Speaker. The regional health authorities will now be
legally mandated to disclose to patients and their families, adverse health
events. They're legally required to tell the patient if something has gone
wrong. They're legally required to tell the family or the patient that something
has gone wrong.
Now, while they currently maybe operating under an
ethical requirement that they do that, it's not a legal requirement. This piece
of legislation makes that requirement a legal requirement. So it's very
important to see this piece of legislation include that provision, Mr. Speaker.
For example, if a patient gets the wrong drug or gets
the wrong dosage, or, as the Member for Signal Hill Quidi Vidi mentioned, if
the person gets a medication they're not supposed to have gotten, then there is
a requirement for this to be disclosed to the patient or to the patient's
family. It's outlined in the legislation what the requirements are for
disclosure. The facts surrounding the event, you have to tell the patient, tell
the family what happened. You have to tell the consequences to what are the
consequences to the patient? What are the possible harmful effects? What could
happen to the patient because of this mistake that has happened?
You have to detail the health services that are being
provided as a result of this event, to mitigate the problems that could result
from this event. So there's that sort of requirement for disclosure, and any
form of recommendation that is being made in relation to this event also has to
be made available to the patient and the patient's family.
So it's really: What happened? Why did it happen? What
are the consequences of it happening, and what provisions are going to be taken
to ensure that this doesn't happen again? What recommendations are going to be
made as result of this event? It's part of the recommendations that are being
brought forward as well.
Mr. Speaker, another provision in this bill, Bill 70,
Patient Safety Act is patient safety
advisory committees. The legislation also provides for the establishment of a
Provincial Patient Safety and Quality Advisory Committee and outlines the
representatives who will serve on this committee. So it provides for the
committee and it outlines who should serve on this committee and it's a very
important part of improving patient safety, improving confidence in the system,
the health care system in the province.
I guess in summary, this bill is about improving
patient safety. It's about improving confidence in the system. It's about
rebuilding confidence after we had some things happen in the system that need to
be changed, and it's a very detailed sort of provision of, okay, what is
actually going to be done?
In closing, I just want to congratulate the minister
and the people in the department on the things they've done to bring about this
piece of legislation, to bring it to this House. I'm very pleased to be able to
participate in the debate.
As I went to the briefing the other day, I noticed the
Minister of Health was there. He had detailed examples of how this would change
practice in hospitals. So I think we're very lucky to really have him in the
position he is and to be able to look at bringing this type of legislation
forward here in the province.
Also, I have to say the minister's parliamentary
assistant; I know he's very efficient in what he does as well. He's very astute
in terms of recognizing problems and how they can be solved. So I think they're
a very dynamic team and the fact that they've been able to bring forward this
type of legislation is very important.
So, next, after this piece of legislation is passed,
then we'll go on to look at the more detailed aspects of the legislation in
Committee and then for the final approval. But it's very good to see all sides
of the House to work co-operatively in discussing and negating this piece of
legislation.
Thank you, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Member for Stephenville Port au Port.
MR.
FINN:
Thank you very much, Mr. Speaker.
It's certainly great to stand today and add my voice to
the debate for just a few moments. I believe a lot has already been covered. The
Member for Gander and the hon. Minister of Health has done a great job in his
opening remarks and we'll certainly hear from him shortly, I think, in terms of
wrapping up debate. But for those who are listening and for the record, today
we're discussing Bill 70, An Act Respecting Patient Safety and Quality Assurance
in the Province.
Earlier this morning, the minister held a press
conference and outlined a number of the initiatives and I guess some of the key
features of this legislation. I will say, having attended the briefing just the
other day, it seems a bit complex, but that's primarily due to some of the legal
ramifications around the Evidence Act
and what is permissible and not permissible and as well it's around the
Public Inquiries Act.
With those two pieces aside, essentially this
legislation is just looking to standardize quality assurance processes and
reporting with our regional health authorities. As the minister had alluded to,
as well as his parliamentary secretary earlier, it's not that any of the
regional health authorities aren't doing this work now, but this is merely a
measure to ensure that there's a consistent approach across the province and a
consistent approach through all of the regional health authorities.
So we're going to impose a positive duty on them to
provide patients, their families and the public with information relevant to
care provided within the health care system. Certainly creating a mechanism
whereby learnings related to close calls, occurrences and adverse health effects
are shared amongst the regional health authorities. We're also providing some
legal protection of quality assurance information that does currently not exist.
As the Member for St. George's Humber alluded to in
his remarks, there certainly will be a number of quality assurance committees
developed within the regional health authorities. Within that as well there will
some subcommittees and the subcommittees would be looking at quality assurance
activities on a bit more of a smaller scale.
One of the interesting things in this as well is that
these committees will then report to a provincial patient safety and quality
advisory committee that will be established as a result of this legislation. On
this committee we will also have some public representation; I guess,
noteworthy, is that that public representation will be brought in through the
Independent Appointments Commission. So there will be an opportunity for anyone
who has any great interest in patient safety and what that means and what that
means as it relates to the regional health authorities, there will be an
opportunity for the public to apply for this position and that would then be
dealt with by the Independent Appointments Commission.
So I guess we're putting in place some real legal
framework for quality assurance and ensuring that each regional health authority
can then talk to another. As in the past, this wasn't a common practice.
Regional health authorities would have held this type of information on any
adverse health effects or any instances; they would have held this information
in high confidentiality. We're allowing the regional health authorities now the
mechanism which they can speak with each other.
With that said, this legislation being brought on I'm
terribly sorry, I'm just looking over at the Minister of Health here; he's just
giving me a little nod of encouragement as I try and articulate what's certainly
a complex piece of legislation to some degree. This was brought on, as
mentioned, by two reports that were released in the late 2000s, and two reports
which most of the Members here and certainly a lot of the public would be
familiar with. So it's great to see that running on the heels of Justice
Cameron's report, we're able to bring this legislation in today.
With that said, I'm not going to take us much further,
Mr. Speaker. I have no trouble supporting the bill, as I understand most Members
here and across all sides seem to have great support for this legislation. But
with that, I'm going to take my place today and I'm going to let the Minister of
Health take us with his concluding remarks in wrapping up second reading in
debate today.
Thank you very much, Mr. Speaker.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER:
The
hon. the Minister of Health and Community Services.
If he speaks now, he shall close debate.
MR.
HAGGIE:
Thank you very much, Mr. Speaker.
I've caught something off my parliamentary secretary.
SOME HON. MEMBERS:
Oh,
oh!
MR.
HAGGIE:
It's heartening to listen to the comments from all sides, which are broadly
supported. And I'm grateful for the comments from all parties and all sides.
The Member for
AN
HON. MEMBER:
Signal Hill Quidi Vidi.
MR.
HAGGIE:
Signal Hill Quidi Vidi, thank you very much.
AN
HON. MEMBER:
St.
John's East Quidi Vidi.
MR.
HAGGIE:
St. John's East Quidi Vidi my apologies was right; the
Apology Act was 2009. The
Apology Act actually simply made it straightforward for health care
providers to actually apologize for an adverse event without that apology having
any legal implications or undertones. So it wasn't by doing such, which had been
the fear at the time, that it was some kind of admission of liability or error.
So it was a step and as others have alluded to, this legislation is part of a
road towards a better quality framework and a safer system.
It is a systems- based look at legislation. Currently,
for example, paramedics, they are actually regulated through provincial medical
oversight, which is actually an offshoot of Eastern Health. So incidents that
might occur in that arena with any licensed paramedic would actually feed back
into the RHA system because of that. And as has been alluded to already, there
are lots of reports there are two Fitch's reports and Pomax report, for
example, that discuss how we can do better with the dollars that we spend on
ambulance services.
We have community ambulances who are, in some areas,
part of the glue, the fabric of smaller communities. There are generations of
people who've worked on the ambulance or their training and served their
communities, and that spans the altruistic spectrum all the way to the more
business-like arrangement. And certainly in the future, I think, we need to look
at how we get the best value for the dollars that we put into the ambulance
system.
This legislation is based on other jurisdictions to
some extent, where really they have focused on the provincially funded health
care system. If you look at solo practitioners in the medical field, for
example, the systems issues they're going to encourage are going to be fairly
limited and fairly straightforward. Often what happens in those environments is
an issue becomes one about competency or skills or standards, or practice
variation.
One, in actual fact, is outside the remit of this even
if it is an RHA-run facility. The other, we are starting to develop tools to
address in different directions. I think whilst it's all part of a quality
assurance process, it probably needs to be nuanced for the fact that there are
differences in practice styles between people who work in groups and those who
don't.
So I take the comments about the private practitioner
element but really I think those will be addressed over time in other ways. This
is a unifying piece of legislation with a theme which lends itself to this
approach and it's tidier, in some respects, as a next step.
With regard to the Child and Youth Advocate, we have
actually had fairly significant discussions between Health, as well as Children,
Seniors and Social Development, about the whole issue of adverse effects or
adverse events in children. I think the feeling is that's better dealt with
separately as a specific area of concern given the prominence that children's
issues have currently in the province. So it wasn't from neglect, it was simply
from a different focus.
So with that, I would draw to a close the debate around
second reading. I look forward to any exchanges around questions that might
arise during Committee.
I thank the Members on both sides of the House for
their support.
SOME HON. MEMBERS:
Hear, hear!
MR.
SPEAKER (Osborne):
Is the House ready for the motion?
SOME HON. MEMBERS:
Yes.
MR.
SPEAKER:
The
motion is that the bill be now read a second time.
Is it the pleasure of the House to adopt the motion?
All those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
MR.
SPEAKER:
All
those against, 'nay.'
Carried.
CLERK (Murphy):
A
bill, An Act Respecting Patient Safety And Quality Assurance In The Province.
(Bill 70)
MR.
SPEAKER:
Bill 70 has now been read a second time.
When shall the bill be referred to a Committee of the
Whole House?
MR.
A. PARSONS:
Tomorrow.
MR.
SPEAKER:
Tomorrow.
On motion, a bill, An Act Respecting Patient Safety
And Quality Assurance In The Province, read a second time, ordered referred to
a Committee of the Whole House on tomorrow. (Bill 70)
MR.
SPEAKER:
The
hon. the Government House Leader.
MR.
A. PARSONS:
Yes, thank you, Mr. Speaker.
Given the hour of the day, I move, seconded by the
Minister of Education and Early Childhood Development, that the House do now
adjourn.
MR.
SPEAKER:
The
motion is that the House do now adjourn.
All those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
MR.
SPEAKER:
All
those against, 'nay.'
Carried.
This House now stands adjourned until 10 a.m. tomorrow,
being Wednesday.
On motion, the House at its rising adjourned until
tomorrow, Wednesday, at 10 a.m.