Friday, December 5, 2025

The committee met at 1000 in the Mount Community Centre, Peterborough.

Official source

The Chair (Hon. Ernie Hardeman)

Good morning, and welcome to Peterborough. I call this meeting of the Standing Committee on Finance and Economic Affairs to order. We’re meeting here today to conduct public hearings on the 2026 pre-budget consultations. Please wait until you are recognized by the Chair before speaking, and as always, all comments should go through the Chair—and this is meant primarily for the committee but for the presenters too. The Clerk of the Committee has distributed committee documents, including written submissions, to committee members via SharePoint. To ensure that everyone who speaks is heard and understood, it is important that all participants speak slowly and clearly. As a reminder, each presenter will have seven minutes for their presentation. After we have heard from all three presenters, the remaining 39 minutes of this time slot will be used for questions from the members of the committee. The time of questions will be divided into two rounds of five minutes and 30 seconds for the government members, two rounds of five minutes and 30 seconds for the official opposition members, two rounds of five minutes and 30 seconds for the recognized third party members and two rounds of three minutes for the independent member of the committee. I will provide a verbal reminder to notify you when you have one minute left for your presentation or allotted time speaking. Any questions from the committee?

Official source

The Chair (Hon. Ernie Hardeman)

If not, we will ask the first panel to come forward: the Ontario Medical Association, the Peterborough Regional Health Centre and the Community Counselling and Resource Centre. That’s the order we will do the speaking. As we start, we ask each participant to give their name for Hansard to make sure we can attribute your quality presentation to the right person. So, with that, the floor is all yours.

Official source

Dr. Jane Purvis

Good morning, Chair Hardeman, and bonjour and boozhoo to the members of the standing committee. My name is Dr. Jane Purvis, and I’d like to welcome you to Peterborough. I’m the vice-chair of district 6 of the OMA, which includes Peterborough, but I am from Peterborough and I work in Peterborough, so welcome to my town, and welcome to this beautiful facility. On behalf of over 50,000 doctors in Ontario, I’m here to submit the OMA’s recommendations for the upcoming provincial budget. We seek to be a partner with you in helping to shape health care in Ontario, and we believe that a productive and collaborative relationship between the government and the OMA can help to improve the health and well-being of all Ontarians. We’ve recently created a new campaign that you may have seen called the We Won’t Give Up campaign. It has six priorities and 21 practical solutions to improve health care in Ontario; however, I’m only going to highlight a few of them today in interest of my seven minutes. We’re very encouraged by the progress that we’ve made both within the OMA and with you, the government, but we know that there’s a lot more to be done, so I’m going to discuss three separate things. One of them is OHIP, another one is access to community specialists, and then the final topic I’m going to touch on is artificial intelligence. OHIP, much in the news: We contribute, as taxpaying Ontarians, billions of dollars—$26 billion, in fact, in 2023—into OHIP for health care, but the OHIP system is flawed and antiquated. Medical claims are often rejected, innovation is not acceptable and there are agility issues in trying to keep up to date with what’s actually happening in medicine and what can be paid through OHIP. I’m going to give you a few examples. A surgeon, Dr. Gammon, in Ottawa, was presented with a patient who had severed four of his fingers in a farming accident. Dr. Gammon spent 15 hours reattaching those fingers successfully so that ultimately the farmer was able to return to work. That surgery took place in 2022, Dr. Gammon’s OHIP submission was rejected and he didn’t get paid for the work until 2025. The patient had been back to work for years, but the physician himself had not been paid, because the OHIP computers couldn’t believe that someone would attach four fingers in one go. Another even more tragic example is my good friend and colleague Dr. Jane Healey, a pediatrician who cared for a dying infant over 10 days and, in the end, knew she would never get paid, because the only way she was going to be able to get paid was that she was going to have to tell the parents of the deceased child that they had to go to ServiceOntario to apply for a health card number. Needless to say, she chose not to do that. So, that was 10 days of ICU work not paid for, because there are no good-faith payments in OHIP. Finally, another example is a recent occurrence in Hamilton, where three expert breast constructionists, who work with surgeons after breast cancer surgery to recreate and reconstruct women’s breasts, were doing excellent, innovative work that people wanted. Patients were going to them specifically to get this procedure done. But because it was new, OHIP wasn’t paying for it. So these three physicians have actually left OHIP and are doing it privately, because there was no way for them to get OHIP to acknowledge the amount of work that they were doing. We can’t afford to lose doctors from our system. We know that OHIP billing errors are inevitable, because it’s a technical process. As a rheumatologist, if I see somebody, oftentimes that interaction creates five or six billing codes—so, five or six codes per patient in a 25-patient day. That’s a lot of code. My fingers aren’t perfect; I could bill the wrong one. But the challenge is, to try and get them corrected becomes very onerous. For some physicians, they spend an inordinate amount of time on that, where they are not spending it on patient-focused activities. So, what we would suggest as one of our proposals is the creation of an ombuds office that would allow these more difficult rejected claims to be dealt with by individuals who have more awareness of the problem to try to find a collaborative funding resolution, rather than it taking three and a half years to get paid. The other thing that we are hoping is to create a committee with the government working on innovation and OHIP. Things are changing quickly, as you know, but if OHIP can’t be changed, it’s not going to be able to be effective in our sphere. By fixing that, it will lessen the amount of time that, particularly, these innovative surgeons are spending on admin—more time for them to be doing what they do best, which is innovative surgery. The next thing I’d like to touch on is community-based specialists. I’m a specialist, and I’ve enjoyed a long career here in Peterborough as a rheumatologist. But we know that the trends to getting in to see specialists are getting longer. Specialty care is not getting shorter waiting lists but longer, leaving more patients not only waiting, but often having to travel long distances to get the care that they want. The OMA has been very fortunate to work with you, the government, to expand team-based care for family doctors, which is great. However, community-based specialists are still working in that model of one doctor—me—in an office with a secretary, and we are expected to do it all. It’s really not going to work in the future. We would like to see team-based care rolled out for specialists in the community. Community-based specialists help to lessen the load on hospitals by taking care of patients.

Official source

The Chair (Hon. Ernie Hardeman)

One minute.

Official source

Dr. Jane Purvis

Also, patients would prefer to be seen in their own areas. Finally, I just want to speak about AI. We know that AI has given everybody an opportunity with AI scribes, but we would suggest that we need to create a more robust AI strategy for the province. We can talk about it in the questions, but AI administrator, AI office assistant, as well as AI patient navigator and patient assistants are all things that are already available. If we don’t get ahead of this, we are going to be behind. The futurists are telling us that we need to be rapidly engaging with AI to make sure that it serves Ontario in the way that we want it to. So, we would like to see a committee with the OMA and the government working on long-term AI strategies. The last thing I wanted to mention was an online vaccine registry. How many people here still have their yellow cards? No more yellow—

Official source

The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the time. We will now hear from Peterborough Regional Health Centre.

Official source

Dr. Lynn Mikula

Thank you to the committee. Thank you for having me here today. My name is Dr. Lynn Mikula. I’m the president and CEO of Peterborough Regional Health Centre. Today, I’m here to talk to you about PRHC’s regional vascular surgery program. Joining me virtually, I hope, is Dr. Sajjid Hossain, one of PRHC’s excellent vascular surgeons. I’m going to start by providing some context and then invite Dr. Hossain to add some perspective from the front lines of patient care. As a regional vascular centre, PRHC serves a broad geography. We serve patients as far north as Haliburton, south to Northumberland, east to Quinte and west to Durham, covering a population of 600,000 people. We do more than 1,000 vascular procedures each year, and nearly three quarters of these patients come from outside Peterborough city and county. PRHC is, in fact, one of the busiest level 2 vascular centres in the province, but our vascular operating room is not properly equipped. According to standards set by Ontario Health, as a level 2 centre, we need something called a hybrid operating room. In 2017, PRHC identified a hybrid operating room as a key priority. In 2019, we began self-funded construction to create shelled space, making room for several regional program expansions, including a hybrid operating room. This represented an investment of $21 million by the hospital into our priority programs. In 2021, we submitted a master plan which identified the hybrid operating room as one of several critical early works projects. Now, nearly five years after that, the shelled space continues to sit empty, ready and waiting. To make the stakes clear, today, eight years after identifying this as a priority, we’re still unable to provide the standard level of care for a level 2 vascular centre. This means that we need to send more complex patients further from home to get the care that they need. Last year, nearly 200 patients were sent from PRHC to other centres for vascular procedures that we should be able to do locally. This puts our patients and our vascular program at risk. Today’s vascular surgeons train in hybrid operating rooms; they expect to work in one. The longer we go without one, the more challenging it becomes to recruit new doctors and even to retain the wonderful surgeons that we have today. There are also health and safety risks with the technology that we’re currently using, exposing our physicians and staff to higher than necessary levels of radiation. What I am bringing you today is an urgent priority, both for PRHC and for the 600,000 people our vascular program serves. It’s a project that we and the province can capitalize on immediately. There’s no need to wait because we’re ready to go. The space exists; it just needs fitting out. Our community has been waiting to see this project move ahead. Our generous donors, through the PRHC Foundation, have committed to raising $6 million toward the project, a real show of community support. I’m going to now hand things over to Dr. Hossain to talk about what exactly a hybrid operating room is and why it’s so critical to have one as a level 2 vascular centre.

Official source

The Chair (Hon. Ernie Hardeman)

We can’t see, and we can’t hear.

Official source

Dr. Lynn Mikula

Sajjid, I think you’re on mute.

Official source

Failure of sound system.

Official source

Dr. Lynn Mikula

Mr. Chair, would you like me to provide his remarks? I do have a copy of them here. I’ll ask you for your grace with the timing. Sajjid, in your voice, with your permission: Dr. Hossain is a proud member of one of the busiest teams of vascular surgeons in Ontario and would like you to know that this is an issue that hits very close to home for him. Vascular disease is the leading cause of preventable death and disability in Canada. The vascular system is one of the most important systems in the body. It’s what gives us energy, oxygen and allows our muscles and organs to work well. Vascular procedures are often emergency procedures that can be very complex. In addition, vascular surgeons do procedures that are essential to care provided in the cancer program, dialysis program and cardiac program. Care is time-sensitive and can require multiple procedures, and patients often want to know, “Can you do it all today? Can you fix what’s wrong in one procedure? Can I avoid another operation, another hospital stay, another anxious wait?” The technology to address multiple vascular issues in one surgery exists: It is a hybrid operating room. A hybrid OR will bring care close to home and help patients avoid life-threatening waits, difficult transfers, multiple surgeries and the increased risk that comes with all of these things. A hybrid OR allows specialized teams to perform multiple open and minimally invasive procedures on the same patient, on the same day, in the same room. The investment would yield a huge leap forward in vascular care for our patients. In Dr. Hossain’s voice, “It’s what my colleagues and I need to do our job to the best of our abilities. It will help ... save lives.” To conclude, our need hasn’t changed in the eight years since we first identified a hybrid operating room as a priority. If anything, the need has grown. It is hard to overstate either our readiness or the need to move forward. The space is sitting empty. We have the clinical expertise, and our foundation is highly committed. I’d like to extend an offer to the members of the committee. If you wish, come tour the space with me later today. Come to the hospital. I would be happy to show you around. The existing space means that this is an easy yes, and saying yes will help us reduce hallway health care, reduce wait-lists and improve outcomes for patients across the region. The provincial investment needed is $10 million. Please help bring us in line with other level 2 vascular centres in the province by unlocking the funds that we need. Patients in our region are counting on you. Thank you very much.

Official source

The Chair (Hon. Ernie Hardeman)

Thank you very much for your presentation. The next presentation will be Community Counselling and Resource Centre.

Official source

Ms. Kirsten Armbrust

Thank you for the opportunity to speak to you today. My name is Kirsten Armbrust, and I’m the executive director of Community Counselling and Resource Centre, CCRC, your local Peterborough family service agency. I’m also the chair of the board for Family Service Ontario, an association that supports the success of family service agencies across the province. Family service agencies are part of Ontario’s core community infrastructure. In our community, people turn to us when they don’t know where else to go. We serve individuals facing mental health concerns; couples and families navigating conflict; people experiencing homelessness or at risk of becoming homeless; people experiencing or at risk of gender-based violence; newcomers, those with low incomes and other equity-seeking groups; and people with developmental disabilities and complex needs. We are one of the few places where you can address multiple issues under one roof, or where someone does not have to have a diagnosis or fit into a specific eligibility criteria. People don’t always identify themselves as having a mental health issue or being a victim of abuse. They just know that they need some help and we’re a safe place to turn. Our services reduce pressure on hospitals, police, the courts and child welfare—all important services that should be able to do their mandate. And we do this before issues escalate. We do this efficiently, locally and at scale. At CCRC in Peterborough, we do this through providing professional counselling on a sliding fee scale and free housing support such as eviction prevention and housing stabilization. The challenge is simple: Demand is rising, complexity is rising but funding in key ministries has barely shifted in decades. There is a risk of eroding a vital layer of prevention, one that keeps people stable and reduces pressure on other, more costly systems. Consider a young family where there has been job loss and their money is running out. There is strain on the parents’ relationship leading to arguments, and the family is at risk of losing their housing. The children are impacted by the stress in the household and are starting to struggle at school. CCRC can provide free couples counselling to help the parents stabilize their relationship, and a housing counsellor can work with the landlord to prevent an eviction and keep the family securely housed. This stabilizes the entire family, and the children can focus on school. Without support like this, the family could become homeless—and we see this every day—the risk of domestic violence increases and the children’s aid society could become involved. Last year alone, CCRC helped preserve 295 tenancies, and 803 people accessed counselling. Imagine the number of lives impacted by the 40-plus family service agencies across the province. Imagine the impact on the whole social and health system with our upstream interventions. There are many, many more people in our communities who need our support—people who are unable to access other supports. We know that the gap between income and cost of living is widening. That means that families rely on non-profit programs and services more than ever. So here’s the opportunity. A minimal investment allows us to continue delivering what the government needs most: reduced pressure on more costly downstream systems, measurable and meaningful outcomes and the capacity to fill the gaps in care across communities. This investment aligns with current government priorities of economic stability, system efficiency, community safety and value for money. We’re not asking for a major overhaul. A minimal investment will stabilize our workforce, strengthen service continuity and protect community-based care that is already saving the province money. In short, investing in family service agencies isn’t an expense. It’s a cost-avoidance strategy Ontario cannot afford to overlook. A modest investment keeps people well, keeps people strong and secure and keeps systems moving.

Official source

The Chair (Hon. Ernie Hardeman)

Thank you very much for the presentation. That concludes the presentations. We’ll start the first round of questioning with the official opposition. MPP Bell.

Official source

Ms. Jessica Bell

I’m really pleased to be here in Peterborough. Thank you very much, and thank you also, MPP Dave Smith, for helping us host. Also, thank you to the staff for organizing the pre-budget consultations. It takes a lot of work. There’s a lot of logistics, and we’re very grateful for it. I have questions for all three of you. The first questions I have are for Jane Purvis, from the Ontario Medical Association. I’m a member of public accounts. I work with the Auditor General on her report and the recommendations, along with other MPPs. Some of them are here today. It is related to the budget because some of the recommendations and some of the issues, of course, impact money. My first question is around the Auditor General’s work on OHIP oversight and OHIP billing. One of her concerns was that there are only eight staff that oversee auditing for OHIP billing. I would like to know what is the Ontario Medical Association’s opinion on the Auditor General’s report on OHIP billing.

Official source

Dr. Jane Purvis

Thank you very much for the question and the opportunity for the OMA to respond. I think the OMA wholeheartedly feels that the OHIP system needs to be reviewed. The process, the oversight, the reviewing, the response times: I think that the OMA would like to see, as I mentioned in my original statement, the creation of an ombuds office that could go both ways. I think we want to make sure that the money that the Ontario taxpayer has provided OHIP is being spent in the appropriate manner, so being spent on getting fingers reattached and perhaps not on people who are claiming to be working more than 24 hours in a day. We need to know about that before the Auditor General reports on it, but we need a system that can notice that as it’s actually happening.

Official source

Ms. Jessica Bell

Thank you for raising that. I will likely be following up with the OMA once the conversation with the Auditor General begins. The second question I have is around the Auditor General’s report on access to primary care. She did identify some concerns with the primary care system that we have. Some of them included that not many people, doctors or patients, are accessing the Health Connect system to find a doctor. There’s no real plan that understands where physicians are working and where there are shortages. It’s not tracked. The need for doctors was underestimated, which means we’re not training enough family physicians to provide doctors to the two million people that we expect will be looking for one. What is the OMA’s response to some of the Auditor General’s concerns that were raised in the report, and how do you think that we should fix primary care? Just a small question.

Official source

Dr. Jane Purvis

Thank you for this very, very small question. This is a very complicated question. I will tell you that I’ve had the pleasure of working with Jane Philpott on her PCAT plan, which is one part of the solution. The challenge that you have pointed out, though, is that we’re not going to be able to reach everybody even with what she is suggesting, because the distribution of family practitioners is not equitable across the province. And even if we’re training new family physicians, they are not necessarily—and, in fact, almost trying not to choose longitudinal family practice, because currently it is not sought after as an excellent job. Many family physicians are going into things like hospitalist and palliative care because they do not see a viable role for longitudinal family practice, which is where we feel very strongly that the introduction of multi-disciplinary, interdisciplinary teams, as well as AI, can help to maximize the bang that we’ll get for the buck for each physician who exists, because right now there are still physicians working in a fee-for-service model, which is very inefficient. We need to see more teams. We also need to make family practice a great option again, because it used to be something that people really wanted to do. That’s got to be part of our program, the OMA plus the government: to make family practice a desirable activity. There’s lots of work we can do, and we would love to work with the government on all of those things. Because in Peterborough—MPP Smith and I will tell you—family practice is not great. We have a large number of people who are unattached—maybe 30,000 in this city alone. So it’s something that I feel very strongly about, something we have to fix.

Official source

Ms. Jessica Bell

How long have I got, Chair?

Official source

The Chair (Hon. Ernie Hardeman)

Twenty-two seconds.

Official source

Ms. Jessica Bell

Okay. I want to thank both of you for coming. I don’t think I’m going to have time to ask a fulsome question, but I’m sure MPP French will ask some questions next round.

Official source

The Chair (Hon. Ernie Hardeman)

Okay. We’ll go to the Liberal Party. MPP Cerjanec.

Official source

Mr. Rob Cerjanec

Thank you all for your presentations today. Jane, I really appreciated all the different pieces that you touched on. I think I’ll start with AI. I had actually recently moved a private member’s bill that we debated and voted—it didn’t pass—for the province to create an AI strategy, bringing in folks from a multitude of different sectors, from folks doing work in AI, government and everyone to really wrap our heads around this so that we can create jobs, opportunities, drive innovation but also help solve some challenges that we face in health care, that we face in education, that we face in government services. So, your suggestion around AI is that the OMA and the government work together to come up with what needs to happen?

Official source

Dr. Jane Purvis

In short form, yes. I think that there are some issues that are emerging right this minute that if we don’t get ahead of, we are going to be behind on—particularly AI consultant, patient exposure to AI information—but also some tremendous advantages. I don’t know if any of you have heard the AI office administrator answer the phone, but it’s a fabulous tool. I mean, she sounds so nice. She will answer your questions, but she is also able to access the world of information. So it’s something that we have to look into, and then it might actually be a real benefit for offices going forward. And there are so many other possibilities that, as a non-AI person, I wouldn’t even know, but we want to be ahead rather than behind in this situation.

Official source

Mr. Rob Cerjanec

Yes, and it’s a field that’s rapidly evolving and rapidly changing, I would say, where you have—not every day, but very often—people coming up with new solutions, new ideas; people who are working in health care partnering with—we have incredible students in our province, incredible talent, who are doing quantum computing work, who are doing computer science work at places like the University of Waterloo, University of Toronto and other post-secondary institutions in our province. So I really appreciate you coming forward today and saying the province does need to get ahead of it. I think this is an area where it’s not government getting out of the way, because government has to play a really important role in working with the medical profession to help you do your jobs better, more effectively and more efficiently, and to have better patient outcomes as well. So I thank you for coming forward to that, and I really do hope that this is something that the government very seriously considers. Otherwise, we are going to continue to fall behind. Around online vaccine registries: Where are we now, and what should happen?

Official source

Dr. Jane Purvis

Well, we’re with the little yellow cards is where we are, which is sad. Now, the Chief Medical Officer of Health has advocated strongly for the creation of an online vaccine record, which may even exist in another province. So, the comment from the national point of view was that it should be national, but we need to have one in Ontario. If you don’t have your card, you have no idea what vaccines you’ve had, and if you lose your card, you are out of luck. So it behooves us to pull ourselves into this century to create an online vaccine registry. It should be very easy.

Official source

Mr. Rob Cerjanec

What do you think is holding that back right now?

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Dr. Jane Purvis

It’s primarily that the scope of the project is probably fairly large, so it needs to have personnel and funds set aside to do it. I don’t think it would be recreating the wheel. I think the technology exists; it just needs to be done.

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Mr. Rob Cerjanec

Fair enough. I don’t think I know where my yellow card is. It might be in some drawer somewhere at my mother’s. I have no clue.

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Dr. Jane Purvis

That’s not a good system.

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Mr. Rob Cerjanec

I couldn’t even tell you what vaccines I have gotten as a kid. I guess you could maybe figure that out by the age and the grades and stuff that you’re supposed to get some of them.

Official source

The Chair (Hon. Ernie Hardeman)

One minute.

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Mr. Rob Cerjanec

So, I think this is something we’ve got to get into the 21st century.

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Dr. Jane Purvis

We’ve got to do that. As a group, we would agree that that’s embarrassing.

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Mr. Rob Cerjanec

Yes. I think we have the talent, we have the technology and we have the skills and the people. I don’t know if it’s a money issue or folks are afraid of doing it, but I think it’s something that we very much need to do. I appreciate that. I think I’ll move on.

Official source

The Chair (Hon. Ernie Hardeman)

Thirty-two seconds.

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Mr. Rob Cerjanec

That’s fine. We’ll go on to the next round with the other folks. Thank you.

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The Chair (Hon. Ernie Hardeman)

MPP Brady.

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Ms. Bobbi Ann Brady

Good morning, and thank you all for your presentations. Dr. Purvis, I really appreciate your suggestions about an office so that we can see things in real time. When I look at the Auditor General’s report, and we have 365 or 366 days of billing, perhaps that’s not nefarious and perhaps we’re looking at that as kind of a corruption in the system. But seeing it in real time would actually let us know whether or not someone is acting out of line or not. So, I appreciate those comments with respect to the vaccine registry. I think part of the problem would be kind of coordinating doctors’ offices and our public health system. I’ve tried to get updates on my children’s vaccines, and it is like pulling teeth from a dog. So, good luck on that one. I represent a very rural riding. We have a difficult time recruiting physicians to Haldimand–Norfolk, and I’m wondering what OMA’s recommendations are for doctor recruitment, especially in rural areas.

Official source

Dr. Jane Purvis

Thank you very much for the excellent question, and if we had the easy answer, we would have enough doctors everywhere. I’d say we can divide the doctor situation into two groups: family practice and then everybody else. In family practice, the current situation is that there are multiple funding models, some of which are more attractive than others. There are various communities that offer subsidies to physicians coming for return of service, but the thing is that no one has ever studied exactly what makes somebody come and stay. The OMA actually looked into this and said, “Okay. Well, why don’t we just do what works,” and then we’ve realized no one’s ever studied that as to—you know, is it money; is it whatever? So, the fact that we don’t know is a little bit damning because it’s hard to solve the problem when you don’t actually have all the facts. If the supply was better, if there were more family doctors, that would certainly help, but there’s no guarantee that they’re going to go where you want them to.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Dr. Jane Purvis

And even if they went, at this point, there’s no guarantee that they will do what you’re hoping they’ll do, which is longitudinal family practice. Until we change the model of care to make it more attractive, the concern will still be that people are going to be looking at things like hospitalist work and sports medicine rather than longitudinal, lifetime, birth-to-grave care for our patients, which is what I think we all want.

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Ms. Bobbi Ann Brady

What’s the time there? Are we done?

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The Chair (Hon. Ernie Hardeman)

Point-two-nine.

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Ms. Bobbi Ann Brady

Okay. I’ll wait until the next round. Thank you.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. We’ll now go to the government. MPP Smith.

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Mr. Dave Smith

Jane, Lynn and Kirsten, thank you very much for coming today. I’m going to focus primarily though on PRHC, and I’m going to give you some leading questions, Lynn. Obviously, I know the answers to these, so I’m asking them for specific reasons. The shelled space itself was built a few years ago, and it was built because PRHC was getting a new MRI and you couldn’t build above patient space. The additional four storeys or five storeys that were built, how was that funded?

Official source

Dr. Lynn Mikula

Thank you, MPP Smith. The shell space that we constructed—you’re correct: We built what we call the two-car garage to replace an existing MRI and increase access to care. We built four or five additional storeys. They were entirely self-funded by the hospital out of capital reserves.

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Mr. Dave Smith

That took us a couple of years to get the approval from the Ministry of Health to do something that wasn’t going to cost the Ministry of Health a penny.

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Dr. Lynn Mikula

That’s correct.

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Mr. Dave Smith

What barriers did you have in trying to convince the ministry that they needed to approve something that wasn’t going to cost them anything?

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Dr. Lynn Mikula

The capital planning process for hospitals is robust, it is lengthy, it is complex and occasionally not entirely clear in terms of what steps need to be followed. There were a series of conversations back and forth about this project as it evolved. I would say the main barrier—and I was not in my position at the time, so I’m speaking from second-hand knowledge—really was that the approvals process was very, very lengthy and very, very complicated along the way.

Official source

Mr. Dave Smith

Ontario Health and the Ministry of Health have said that a level 2 vascular centre is supposed to have a hybrid operating system, and we’ve been working to try and get this. How is the fundraising going from the foundation to do this?

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Dr. Lynn Mikula

I believe the foundation is closing in on their $6-million goal.

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Mr. Dave Smith

The ministry doesn’t have to pay for the space. The ministry doesn’t have to pay for the equipment that’s going to be put in there. It’s a really cheap proposition, then, that the PRHC is making to do this.

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Dr. Lynn Mikula

We believe, in the context of hospital capital projects, which now tend to run into the billions of dollars, that a $10-million ask would be a huge win for a relatively very small price tag.

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Mr. Dave Smith

The population of Peterborough is about 85,000. How do you get to 600,000 that you serve?

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Dr. Lynn Mikula

Vascular programs do not exist at every hospital. They’re regionalized, as are cancer care, thoracics and other things. The geography that we serve, again, goes all the way north to Haliburton. It’s an interesting geography; it’s very rural, a lot of people who really can’t travel for care. Then it goes all the way down to the 401, to the Cobourg-Port Hope area and the northeast corner of Durham region. Our closest neighbouring vascular centres are in Kingston and Scarborough, so we basically cover the chunk of the population that exists in between.

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Mr. Dave Smith

It’s not my riding; it would be Laurie Scott’s riding. But if somebody in Haliburton, for example, needed this service and Peterborough couldn’t provide it, how long would it take them to get to Kingston?

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Dr. Lynn Mikula

Well, we get them there by helicopter, if necessary, and often with emergency procedures. That’s what we need to do. I think the real question is, how long does it take their family to get there? In the winter sometimes from Haliburton, that is hours and hours. Then they are receiving emergency care, often with an ICU stay, very, very far from home. It is far from ideal.

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Mr. Dave Smith

So it’s not just the patients, then, that are going to see a benefit as a result of this; it’s also the families you would be providing better service to. It really would match the statement that we’ve been making, that we want the appropriate level of care where someone needs it, when someone needs it. Is that safe to say?

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Dr. Lynn Mikula

That is a true statement.

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Mr. Dave Smith

Thank you. I appreciate that. Jane, I’m going to switch over to you. Chair, how much time do I have left?

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The Chair (Hon. Ernie Hardeman)

One point one.

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Mr. Dave Smith

We’ve had a number of conversations about physician recruitment. I think we’ve got a pretty good working relationship on all of these things. You said that no one has done a study on what attracts a doctor to the area. I have been making the argument that simply the geographics of this area are one of those attraction tools. What else can we do, then, to bring more physicians to rural Ontario?

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Dr. Jane Purvis

Thanks for the question. To be really quick, I’d say that attracting them is not the whole problem. They have to stay. That’s been the problem that we’ve seen with a lot of the attraction campaigns, monetary campaigns, is that once the contract is served, they go. We need to find a way to attract them but retain them as well. The other thing that we need to work on is retaining physicians as they’re getting older, because a lot of people—I don’t know if you saw it; it was in the news yesterday, what percentage of physicians. It was like 50% of specialists are thinking of retiring, because there’s a large group of physicians past age 50 that are all thinking about just saying that they’re done. We have to make sure that that doesn’t happen, because that would be a huge loss.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the time. We’ll now go to MPP French.

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Ms. Jennifer K. French

I’m very pleased to be in Peterborough. My grandma lived here for her entire adult life. I learned to skate on the canal, and grandma’s house was the home away from home. Thank you for having me back. I spent four months at the hospital with her at one time, so I’ve done a fair bit of exploring of the hospital, and I support your ask. I’ve heard it before, and I hope we don’t have to hear it again. I hope that you get what you’re asking for. I will say, though, that we have heard it before. As you have very carefully and eloquently put, it is a $10-million investment that you’re seeking. What that would accomplish is significant because you’re already doing important work. I am glad that Dr. Hossein joined us, and we’re sorry we couldn’t hear his voice, but you’re already doing very important work. What are we missing out on by not making this investment? How much more could you do? How much better could you serve that significant, broad community if this investment were made?

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Dr. Lynn Mikula

Thank you very much for the question. I also taught my children to skate on the canal. It’s a great thing. I think the most important way that I can frame this for you is, with a hybrid operating room, you can take two, three, four surgeries and do them in one surgery. Imagine the impact not only to the patient, who can now get this all out of the way with one hospital stay, but it literally frees up operating room time for us to do more. Vascular care is not something where you can afford to wait; it is a life- and limb-threatening thing if you have to wait. We can get more patients in sooner, using our existing resources with the addition of this technology. We will also be able to keep patients here who currently we are sending to Kingston, to Scarborough, who have lengthy wait-lists of their own. We will free up capacity in those areas as well, which they would very much like us to do. In addition, with a minimally invasive approach, we can care for people who currently might not be able to withstand a surgery. They can recover faster. They can recover better. The benefits are multiple.

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Ms. Jennifer K. French

Thank you. Currently, is there a conversation with the ministry, or are we just waiting for a decision? Are they waiting for something from you in terms of numbers or metrics?

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Dr. Lynn Mikula

We’ve been advised that all of our questions are resolved, and we’re waiting for a decision.

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Ms. Jennifer K. French

Okay. I am hopeful that this conversation will get it across the finish line.

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Dr. Lynn Mikula

As am I. Thank you.

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Ms. Jennifer K. French

I want to appreciate all three of you being here. Kirsten, I want to bring you into this very short window of opportunity we have to chat. I’m always appreciative of the heavy lifting that happens in community, with the Community Counselling and Resource Centre in your case. I think all of us can think of our communities and the people who are invested in all the nooks and crannies, build those relationships and support all of the other systems, and we’re grateful for that work. You had said a minimal investment or a modest investment would make a difference. I’d be interested in knowing what numbers we’re talking about. Then, further to that, because I’m a New Democrat and ever the optimist, what would an optimal investment be that doesn’t just get you by and get you through? What could you do with a bit more? What is your base, and what could you accomplish with more?

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Ms. Kirsten Armbrust

Thank you for that question. I think even a modest increase of 10% would be helpful from the ministry. We’ve had funding that has not raised even a couple per cent in decades. That means we’re trying always to do the same with less. We have rising costs, just as other sectors. Even though our costs are generally less, they still increase. We want to keep professionals employed. Our therapists have master’s degrees. They’re part of regulatory colleges. We are a professional operation; we need to attract and retain talent. In terms of what we could do with optimal funding, in Peterborough, we have a wait-list for counselling of almost over a year in some programs. We could double our counselling force and still be seeing people. We know that if you can see people quickly, then their difficulties are managed sooner and they don’t get worse. What happens if you call for counselling, your family situation is in trouble and you’re not getting to see someone for a year? Things have gotten a lot worse by that time. Modest investment will at least keep things static, but an optimal investment would be to increase services in all of our areas.

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Ms. Jennifer K. French

Thank you. We’re all focused on mental health, and it sounds like you are a key piece of that puzzle. I’m running out of time, but Jane Purvis: A challenge for all of the 124 elected MPPs might be, ask us if we can find our yellow little booklets. Because I’ll tell you right now: No, I have no idea where it is. I have scraps of paper, though, that I could maybe—

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The Chair (Hon. Ernie Hardeman)

Thank you very much. That concludes the time. MPP Cerjanec.

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Mr. Rob Cerjanec

Through you, Chair: Kirsten, in terms of the clients and the folks that you’re serving and working with, what’s the biggest challenge that you’re finding right now in Peterborough?

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Ms. Kirsten Armbrust

Housing is a big challenge in Peterborough. We have a very low vacancy rate, and the costs of housing compared to income don’t align, so that is a really big issue in Peterborough. Part of our program is a housing resource centre where we help try to stabilize housing and keep people housed, because it’s a lot easier to keep people housed than to find new housing. That’s an ongoing issue. We’ve had a lot of encampments over the years, with just not enough housing stock. And then on the counselling side, with low wages, pressures on families increase. We heard about not a lot of family doctors; we have a lot of people who don’t have access to primary care because there is such a doctor shortage. They are able to access our mental health services without a referral, without OHIP, which does reduce barriers in those cases. Ideally, everybody would have both family doctors and have access to other services, but in that way we are able to fill some of those gaps.

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Mr. Rob Cerjanec

Thank you. I appreciate the work you’re doing to try to keep tenants housed, because that’s really important and it helps prevent the additional driving up of rents and people ending up eventually falling into homelessness. How many supportive housing units do you think are needed in the Peterborough area?

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Ms. Kirsten Armbrust

I don’t know that I could wager a guess of how many, but I know that, currently, our wait-lists for some supportive housing are close to a decade long. Even for people that are on priority housing—if they’ve experienced gender-based violence, for example—it can be up to two years. That’s for priority, and eight to 10 years for other folks that are waiting for housing, which is far too long.

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Mr. Rob Cerjanec

Yes, it’s a situation that I don’t think is acceptable where we are in this province right now. Folks that are on ODSP—with rents in Peterborough, are people able to access housing if they’re on ODSP, or is it very challenging?

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Ms. Kirsten Armbrust

It’s pretty challenging. It’s pretty difficult. What we find is that a lot of people will stay in housing that is unsafe, that isn’t meeting their needs, because to move is so expensive and they’re not able to find something comparable if they move to another unit.

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Mr. Rob Cerjanec

Thank you. In terms of the staff that you have, how is your retention?

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Ms. Kirsten Armbrust

It’s better than you might think, considering there are definitely opportunities for our staff to earn higher incomes at other places. But we do find that we attract, on our counselling side, people that are really passionate about community-based service. Even though they could go to a hospital or somewhere else and make more money, they will often stay because their heart is in working in community-based services.

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Mr. Rob Cerjanec

Thank you. I appreciate that. I thank you and I thank them for the work that they do, because it’s extremely important and a lifeline in some ways for so many individuals. So I thank you for that. One last question just around technology, AI software: Are you starting to incorporate some of those tools in the work that you’re doing? Probably more on the counselling side, I assume.

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Ms. Kirsten Armbrust

Yes, definitely more on the counselling side. We do have an ambient scribe for notetaking, so that helps our therapists be able to reduce the administrative burden by being able to take notes—with the consent of clients, of course. We also use something called Greenspace, which is a measurement-based care platform. We actually have found that our outcomes at family service agencies are slightly higher than average across the province when we’ve looked. We are seeing a 54% symptom reduction for things like anxiety and depression on scales, which is a little bit higher than across the province using Greenspace.

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The Chair (Hon. Ernie Hardeman)

One minute. Ms. Kirsten Armbrust: So we’re starting to use AI where we can. Of course, all those things cost a lot of money, and that’s another reason that our costs are increasing: to try to keep up with all the technology.

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Mr. Rob Cerjanec

Thank you. Lynn, thanks for the presentation just around the need for the hybrid operating room. It seems like the hospital has put in, through the foundation and fundraising and its own funds, I think $21 million—plus another $6 million to be raised, so almost $30 million. You just need $10 million more from the province and you can make this a reality.

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Dr. Lynn Mikula

That’s correct.

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Mr. Rob Cerjanec

Okay. Well, let’s hope that happens this year. Cheers.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. MPP Brady.

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Ms. Bobbi Ann Brady

Dr. Purvis, back to you again: You spoke about the retiring doctors, and that’s a huge concern in my riding as well. We have doctors on the brink of retirement who have rosters of maybe 3,000, 4,000 patients. The new doctors seem to have much smaller rosters, so it’s taking sometimes two or three doctors to replace that retiring doctor. Is that happening across the province? Do we need to set a requirement on roster size, or what are your suggestions for that?

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Dr. Jane Purvis

Thank you very much for the question. Those are very correct, the things that you’ve just said. I can think of examples here in the Peterborough area of physicians over the age of 80 who have got practices of thousands and thousands, and you would need two or three new grads willing to take on a portion of that. So, it’s a challenge. I think that the challenge should be for us to try and make those who are still practising—and not just in family practice, but in specialty medicine as well—to try and find out what we can do to help them stay. For people who are in fee-for-service medicine like myself, if you try to go part-time, you still have to pay full-time wages for everything—a full-time lease and full-time everything. If you’re older and you want to cut back, it’s economically not viable. That’s an area that we could be working on to try to find alternate ways to move forward. Because certainly the fee-for-service model—an independent practitioner business person—doesn’t allow itself for slowing down; you’re either on or off. So that’s one area. In family practice, I think there has been maybe a sense of the loss of joy of medicine. But if we can make medicine more joyful again—which isn’t necessarily a money thing, but it might be respect and time.

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The Chair (Hon. Ernie Hardeman)

One minute.

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Dr. Jane Purvis

We’ve spoken about moral injury. If you spend 19 hours a week filling in insurance forms, it’s unrewarding. From someone who has been working for 35 years, I’m sure that when an older family physician has to do that, they find it denigrating. If we can find a way to get people back to what they like to do in the first place, which was seeing patients, and make it so that the practice model is more flexible, I think those would be things we could actually do.

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Ms. Bobbi Ann Brady

Great. Thank you. And Lynn, I wish you all the best. I have similar situations with long-term care in my riding. The community morale—when they don’t see the rubber hit the road and they don’t see the project begin, it’s really difficult to continue that fundraising. So I wish you all the best. I’m probably out of time, so I can’t ask you a question. Thank you.

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The Chair (Hon. Ernie Hardeman)

Thank you very much. We’ll now go to the government side. MPP Kanapathi.

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Mr. Logan Kanapathi

Good morning. It’s good to be in Peterborough. I have to thank all the panellists for your presentations. Before I make my comment and question, I have to say thank you to Dave Smith, our MPP and PA, for his leadership and his voice. You have a good voice for Peterborough, I have to tell you. I don’t tell that often or give that credit to too many people, but Dave Smith brings the real voice to Queen’s Park, especially in the caucus. Thank you for your leadership, Dave Smith. Any questions or concerns in the future, please send it through him. I have to thank all the panellists. Thank you for your voice. This is your day to bring your voice, and we heard loud and clear some of those issues. My questions start with Dr. Jane. I know there are a lot of challenges. We took government in 2018, then COVID came. Despite all the challenges, we are increasing the capacity of the health care system. We are firing up with all the cylinders. We are not—there is still so much work to do. Building primary caregivers with the multidisciplinary clinic is working. I am the MPP for Markham–Thornhill, and I have good respect for the doctors. We have the best doctors in Ontario. I have a lot of respect for—not me, my government. Doctors are good people. They’re great people. So thank God, we have the best doctors in Canada that come from Ontario too. You mentioned there are challenges. Our government is investing approximately $56 billion over the next decade in health infrastructure. That’s including $43 billion in capital grants, yet some of the Peterborough doctors are talking about the capital grant for their hospital. This ambitious plan will support over 50 hospital projects and deliver approximately 3,000 new hospital beds to enhance access to quality care and will connect a people-first health care system. So all this investment—how do you see this investment impacting the work your organization does or may do?

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