Mr. W. G. Blair (Lanark):
Mr. Speaker, before the adjournment for the dinner recess the minister spoke and he gave me the impression-indeed the suggestion was made- that 90 per cent of the costs of mental hospitals in the province is paid by the provinces themselves. I want to point out to the minister that a person who is mentally ill-and let us have this point clear in the beginning -is suffering from an illness comparable with any other illness to which the human body is heir. It is just as important to consider mental illness as it would be to mention carcinoma or cancer, pneumonia or any other disease. The patients going into those hospitals are paying their bills; they are not all indigents. In fact, the proportion of indigents in mental hospitals in my own province is not any higher than the proportion of indigents in the ordinary general hospital. The only people who might be classed as indigents in those hospitals are those that have been there for a long time and have exhausted their finances as a result of long treatment.
I want to point out that when a patient goes into a mental hospital a form is filled out by the bursar of the hospital and inquiry is made into the patient's assets. His whole financial condition is analysed. I am going to point out various extracts I read from the mental hospitals act, Revised Statutes of Ontario, various extracts to prove my point that patients going into mental hospitals are paying their fees in a way comparable with that of patients admitted to general hospitals. I will read these extracts. I want to prove to the minister that patients going into hospitals are obliged to pay fees. I therefore read from section 16, paragraph 2, of the mental hospitals act:
(2) The charges of such hospital treatment shall be paid by the patient unless he is an indigent person, in which case the charges shall be payable in the same manner as charges for indigent patients are payable under the public hospitals act . . .
That is clear; there is no difference there. Then I read section 16a of the mental hospitals act:
16a. The minister,-
That would be the minister of health of the province of Ontario.
-out of such moneys as may be appropriated by the legislature for the purpose may contribute toward the cost of treatment in public hospitals of indigent patients transferred thereto under subsection 1 of section 16 in such amounts, in such manner and under such conditions as may be prescribed by the regulations.
But I go on with this proof. There is the question of the liability of the municipalities, and I read from section 57 of the same act;
57. (1) The necessary costs and expenses incurred under sections 23 to 29 and section 35-
That is a further reference.
-in determining the mental condition of any person including a fee not exceeding $10 and a travelling allowance of ten cents per mile of each medical practitioner who issues a certificate-
Those are charges. Then we come to the question of admission of a patient, and this is extremely important. This is section 60:
60. (1) Upon due application for the admission of any person the superintendent and steward of the institution shall make a full and thorough inquiry respecting the estate, either in existence or in prospect, of the person and of its sufficiency, free from all claims of his family, to supply the means necessary for his maintenance and clothing in the institution as provided by the regulations.
That is maintenance. Do not forget that this is the beginning of the section where they deal with maintenance. If that were not enough we find this:
(2) The superintendent and steward shall where possible require from the person liable for maintenance of the patient an agreement or bond to secure the payment of the patient's maintenance, either in whole or in part, and the agreement or bond shall continue in force so long as the patient is maintained in any institution.
Then it goes on, of course, to point out:
(3) Where the obligation is for a limited period nothing herein shall extend the liability beyond the period limited.
And then we find this:
(4) The giving of an agreement or bond shall in no way release the estate of the patient from its obligation to maintain and clothe him in the institution as hereinafter provided.
If funds are not forthcoming otherwise, they will be taken from his estate. Further we find this:
61. Every patient admitted to an institution who has at the time of his admission or subsequently comes into the possession of property shall be liable for his maintenance.
Then there is a section with respect to his wife:
62. Every person whose wife is a patient shall be liable for the maintenance of such patient.
64. (1) The steward of an institution shall send a written notice on the first day of each of the months of January, April, July and October to the person liable for payment of the maintenance of a patient, giving the date of the patient's admission to the institution and the amount which is due and owing for his maintenance . . .
And so on. It is clear that patients are paying in the mental hospitals in Ontario. Now we come to the powers of the public trustee. Directly a patient is admitted into a hospital within a province the public trustee, from the time of his admission, takes over control of his estate. I therefore read into this record chapter 77 of the same statute:
77. The costs, charges and expenses of the public trustee and any money advanced by him for the patient or for the maintenance of the patient's family shall be a charge upon the property of the patient, . . .
That is clear; there is no doubt about that. I further read into the record section 83 which is as follows:
83. The public trustee shall, out of the money in his hands belonging to a patient for whom he is statutory committee, pay the proper charges for his maintenance in the institution in which he is a patient, and he may also pay such sums as he may deem advisable to the patient's family-
The public trustee has control of the patient's money and he pays the hospital bills out of the patient's estate, the administration of which is under his control. I mentioned the fact that upon admission of the patient to the hospital inquiry is made and a financial statement given-actually it is called the blue form. I shall read extracts from that form.
The minimum rate for which a patient or his estate or the person liable for his maintenance shall be liable in the general wards of any institution-
I understand that varies from $7 to $10.50 per week.
-in cases where the patient's condition requires special care and treatment, such further charges may be made as the superintendent may determine.
This illustrates that extra charges may be made when the patient is in the hospital. One has to consider that under present conditions and new forms of treatment that are being used now, tranquilizing drugs may be included. The cost of these tranquilizing drugs is very heavy and may run from $20 to $40 per week. Nevertheless it says in this form that in cases where the patient's condition requires special care and treatment, an additional charge may be made.
I am going to cite some of the questions asked on the blue form by the bursar of the hospital when the patient is admitted. I have seen this happen quite often in my own province of Ontario, and I may say that every possible opportunity is given to lower
the fee as far as possible. However if there is a charge, certainly there will have to be payment by some person responsible. A member of the family may go and help fill out this blue form or it may be filled out by the solicitor who has charge of the estate. Questions like these are asked under the mental hospitals act:
Give the number of the lots, concession, township, and county; the number of acres, whether leased or freehold; the name and address of mortgagee, if any, and the market value of the property.
There are a lot of questions about property. Then if the property is rented there are many questions concerning who is receiving the rent. Inquiry is made into life insurance. They ask the name of the company; the number of the policy; the amount of insurance; who has the policy at the moment and who is the beneficiary under the policy. There are questions also about the personal estate and personal property. In the case of a farmer, they ask the approximate value of his farm implements; his stock in trade: livestock; farm produce; and other property, if any. They ask about moneys secured by mortgage. Then, there is this sentence:
What suggestions do the relatives or friends make for the guidance of the public trustee?
The rate of maintenance is then set, and as I said in any case in which I have participated these people have been most helpful in trying to put that fee down as low as possible. There is no doubt on that score, that the public trustee does keep very close track if a person is declared incapable. If he has an estate, they certainly have to pay for the patient's maintenance out of that estate.
Then I come to form 30. I am only trying to prove to the minister that if a person is declared incompetent to handle his estate, payment is made. Form 30 of the regulations under the mental hospital's act is a bond for the maintenance of the patient in the hospital. I feel that that proves beyond all doubt that patients going into hospital pay their hospital bills. I have stated that the number of indigents in these hospitals is at a rate comparable with the number of indigents in general hospitals.
Before the dinner recess I heard the minister mention what the federal government had done by way of providing beds. He pointed out what was happening in the city of Ottawa. Let me say to you that there are insufficient beds in the city of Ottawa to cope with this program. The civic hospital is going to put in 40 beds. There will be 80 beds in the city of Ottawa for mental patients. In so far as the hospital at Brockville is concerned, I am not aware of the number of patients in that large
hospital but I would say that 300 or 400 of the patients in that hospital come from the Ottawa area and not entirely from the Ottawa valley.
Let us look at the regulations as they stand. In answer to some of the questions that were put to him today the minister pointed out with a degree of pride that we are going to take care of mental patients in general hospitals. There is no doubt that is the case under this bill. However there is no restriction on the length of time which a patient may be in that hospital. Remember that when a case of mental illness occurs, no doubt the relatives will want to have the patient put in a general hospital rather than in one of the Ontario hospitals. It is only normal and natural that they would want to do that. I want the minister to pay particular attention to this, that they would have a further incentive to do so because the care of such patients is free in general hospitals and if they go to the Ontario hospitals they will be charged. It is going to come out of their estate or some place. Payment has to be made.
As I said the other day, I feel this is a retrograde step. You are not really recognizing the problem of the number of mental patients in Canada. The amount of money you are giving under the health grants does not begin to cope with this problem of hospitalization. As my leader has said, even if the province of Ontario or any other province is paying a large percentage of these costs there is this drag on the province's finances. After all, taxes have to be paid and the financial agreements that are made between the province and the dominion under this bill are of some help, but the provinces are having their own troubles in trying to finance other things. There is no doubt of that.
To recapitulate, I think I have clearly proven that patients going into mental hospitals in my own province are paying their bills. I do not believe this figure of 90 per cent the minister has mentioned. If they are not paying their bills, they might be classed as indigents, but there is a very strong inquiry made under the regulations. In cases where the estate is taken over, the hospital bills are paid. There is a percentage of indigents in these hospitals. If long-term treatment is required and it is certainly expensive, a small estate might easily disappear.
It is not sufficient to say that the cost of caring for the mentally ill will put up the cost of caring for the others. There was some suggestion that there might have to be an additional tax levied under the present 82715-214
10, 1957 3389
scheme in order to take care of mental hospital facilities. As my leader has said, I feel that this should receive further consideration. There are 10,000 more people in Canada suffering from mental disease than there are in all the general hospitals put together. Some people do not understand that. They have taken the minister's statement that the provinces are paying 90 per cent of the bills.
Let me say this to you, sir. These are sick people the same as anybody else. If they are to be ignored under this scheme, then we shall arrive at this situation. We will pay for pneumonia, yes; that is fine, but we will not pay for mental disease. We are not giving recognition to one of the greatest problems that the minister has to face in the whole of Canada. If you are to face up to it, then some place, somehow additional funds must be provided for the care of these people. You should not set them aside and say that it is the duty of the province to look after them.
The minister made the statement this afternoon that the province is looking after 90 per cent of the mental patients. Their bills are being paid but there is no greater percentage of indigents in those hospitals than in other hospitals. We must look at that. Let us take a second look at this; let us inquire into it and do something to help this population which is growing in Canada.
Topic: HEALTH INSURANCE
Subtopic: AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND