HANSARD

Printed and Published by Nova Scotia Hansard Reporting Services

Ms. Maureen MacDonald (Chair)

Mr.Chuck Porter (Vice-Chairman)

Mr. Patrick Dunn

Mr. Keith Bain

Mr. Graham Steele

Mr. David Wilson (Sackville-Cobequid)

Mr. Keith Colwell

Mr. Leo Glavine

Ms. Diana Whalen

[Mr. Keith Colwell was replaced by Mr. David Wilson (Glace Bay)

WITNESSES

Department of Health Promotion and Protection

Mr. Duff Montgomerie, Deputy Minister

Dr. Robert Strang, Chief Public Health Officer

Dr. Shelly Sarwal, Medical Officer of Health

Ms. Elaine Holmes, Director, Communicable Disease Prevention and Control

Ms. Sue McKeage, Director, Communications

In Attendance:

Ms. Charlene Rice

Legislative Committee Clerk

Mr. Jacques Lapointe

Auditor General

Ms. Evangeline Colman-Sadd

Assistant Auditor General

Mr. Gordon Hebb

Chief Legislative Counsel

HALIFAX, WEDNESDAY, APRIL 23, 2008

STANDING COMMITTEE ON PUBLIC ACCOUNTS

9:00 A.M.

CHAIR

Ms. Maureen MacDonald

VICE-CHAIRMAN

Mr. Chuck Porter

MADAM CHAIR: Order. I would like to call the committee to order, please. Good morning. Today, in front of the Public Accounts Committee, we have the Department of Health Promotion and Protection with respect to the February 2008 Auditor General's Report on Communicable Disease Prevention and Control. We will begin in the usual way with introduction by members and Auditor General's staff and guests and follow that with a round of questions. Mr. Steele.

[The committee members introduced themselves.]

MADAM CHAIR: Thank you and welcome. Mr. Montgomerie, the floor is yours for brief opening comments.

MR. DUFF MONTGOMERIE: Thank you very much. I'd like to, very briefly, introduce a few of our staff in the gallery - Janet Braunstein Moody is our Director of Transition. I'm particularly pleased to introduce Janet because you're going to hear an awful lot about public health renewal and a major report that caused the government to take a new and solid direction. Janet was very much a leader behind that. We have Russell Stuart, who is Director of the Health Emergency Management Centre. Russell also is shared with the Department of Health as we have a joint arrangement around that particular area. Nathalie Blanchet is our Director of Population Health Assessment and Surveillance and members of their teams and I thank you for that opportunity.

Good morning. I'm pleased to be here on behalf of the Department of Health Promotion and Protection to answer any questions that you may have arising from the recent report of the Auditor General.

Let me first start off by saying that our department fully endorses the recommendations put forward by the Auditor General. We feel they will enhance an already safe and effective public health system. In fact, his recommendations are very consistent with changes already underway as part of the process of public health renewal going on in Nova Scotia.

Those changes are already underway because Nova Scotia was the first province in Canada to commission an external review of the strengths and limitations of our public health system, post-SARS. That review, the 2006 Public Health Renewal Report, assessed the coordination, responsiveness, integration and comprehensiveness of the public health system in Nova Scotia. One of its key recommendations was the creation of the Department of Health Promotion and Protection, bringing together Health Promotion, Public Health and the Office of the Chief Medical Officer of Health under one roof.

The thrust of the Public Health Renewal Report was the need to create appropriate capacity within the public health system to ensure the health and safety of Nova Scotians. In implementing the report's recommendations, our department has made a number of critical moves that are germane to today's discussions. These have all happened since February, 2006.

We have established a single leadership position for Nova Scotia's public health system with the appointment of Dr. Robert Strang as our first ever Chief Public Health Officer, named directors for the newly-created responsibility centres of Communicable Disease Prevention and Control, health services management and population health assessment and surveillance. We've added 17 new public health positions at the provincial level, including three new staff specializing in communicable disease and 25 public health positions throughout the nine district health authorities in the IWK.

In short, in a very short time and with the support of the government, we have built up the capacity of Nova Scotia's public health system to address the types of issues raised in the Auditor General's Report. We feel this province has never, ever been better positioned to protect the health and safety of our citizens. No doubt we still have more work to do on building capacity, but we know what needs to be done and we are moving forward on a clearly defined path to achieve our goals. That's why we welcome the Auditor General's Report.

The report made a number of recommendations to our department with regard to storage and handling of vaccine and concerning a vaccine record management. We are in overall agreement with the Auditor General's recommendations in this area and our changes

are already underway as part of the public health renewal, but I also feel it's important to stress that public safety is not compromised with the vaccine storage and distribution system currently in place in Nova Scotia. The Auditor General's recommendations will enhance an already safe and effective system.

In a related area, the Auditor General pointed out the need for our department to implement an electronic immunization registry for Nova Scotia. We wholeheartedly agree, but note that our current reliance on a paper-based registry is not unique to this province and this country. An integrated national public health electronic information system called Panorama, the first Pan-Canadian IT initiative, is under development which includes an immunization registry. Training on this new system in Nova Scotia will begin in September 2009 and it should be operational in the Spring of 2010. I know a lot of our staff will be glad to be rid of a lot of paper files.

Finally, the Auditor General made a number of recommendations with regard to management of the mumps outbreak. Let me say up front that I am confident that the mumps outbreak was well managed by the public health system. The outbreak which occurred in Nova Scotia and nationally is an international phenomenon which is the result of a specific age group receiving one dose of vaccine instead of two. We now know that two doses of mumps/measles/ rubella vaccine are required to help prevent the occurrence of mumps. In response, our department has implemented a vaccination program aimed at ensuring post-secondary students, Grade 12 students and health care workers have the opportunity to get a second mumps/measles/rubella vaccination.

In closing, our new department was created in recognition of the need to build better capacity within Nova Scotia's public health system in order to ensure the health and safety of Nova Scotians. More than two years after our creation, we have greater capacity to manage outbreaks and emergencies than we've ever had before and more resources than our department had in February 2007, when the mumps outbreak actually began. More importantly, with Dr. Strang as Chief Public Health Officer, and his team with a mandate, the authority and independence necessary to assess the risks and marshal the appropriate necessary resources to keep Nova Scotians safe - an authority backed up by legislation. We look forward to answering any questions that you might have. Thank you, Madam Chair.

MADAM CHAIR: Thank you very much. The opening round will be 20 minutes. I recognize Dave Wilson with the NDP caucus.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Madam Chair, and thank you for coming before the committee today. I think it's so important that we recognize the importance of public health and I think far too often the general public takes it for granted that the government has plans in place to ensure their safety and that's why this committee is important to the process to oversee and look at departments throughout the government

like Health Promotion and Protection. It's so important that we have an Office of the Auditor General do audits like they have.

As much as the deputy minister has said that we are ready and nothing is compromised here in Nova Scotia, the Auditor General's Report indicated and shows several deficiencies and the need to have better controls and change how things are worked or how things are planned now. I think it's so important.

One of the areas I want to concentrate on, and I've been a bit concerned with this area for a long time as a health care provider myself before entering public life, is around the concern and the safety of health care workers. I was disturbed when I read in the Auditor General's Report, in Paragraph 4.33, around the idea that there was no plan in place to address immunization of health care workers. It even went as far as, I think I believe I read in The Daily News on June 2^nd, you know, they were urging nurses to get immunized.

So that's an example, I think a prime example, of how the government has this disconnect with front-line health care workers and I have personal experiences over that and how I think it's so important that we recognize that those individuals, those front-line health care workers, are the key component to any plan the minister has, the deputy minister has, or anybody in the office has. I think we will learn from mistakes and far too often we hear from the deputy minister or actually the minister that things are great and we know different.

So really my first question, and I don't know if the deputy minister will answer this or not, or pass it off to the most appropriate person, but why was there not a plan in place to immunize health care workers? I would think that that's a key component to any plan that we should have had here in Nova Scotia.

MR. MONTGOMERIE: Two perspectives and I'll give one and ask Dr. Strang to give another if that's okay, Madam Chair. First of all, I totally agree with you about front-line health care workers. They're absolutely fundamental and we have a responsibility to protect them and support them. I think for context purposes that if the Auditor General had done his report two and a half years ago we would not have had the need of a public health renewal report. So in the context of where we were two and a half years ago and where we are now is a dramatic difference and I would refer the guts of your question to Dr. Strang.

MADAM CHAIR: Dr. Strang.

DR. ROBERT STRANG: A couple of comments. You have to deal with each outbreak as it occurs because each organism, each virus, each bacteria is different. So we don't have, off the shelf, a plan which would say vaccinate health care workers. That has to be done in the context of the specific outbreak, whether it is mumps or pandemic flu. Understanding that for the first couple of months of the mumps outbreak, health care workers weren't being affected - it was post-secondary students - but as we got larger numbers of

people and we started to get health care workers involved and the need to immunize them, within a matter of a few weeks we were able to then start immunization programs in collaboration with the district health authorities.

The responsibility for occupational health in the health care system sits with the district health authorities. It's not a Public Health function directly. We have to work in close partnership and we did that, as I said, within a matter of a few weeks to mount a program. Despite having a program, we still have only had roughly 40 per cent of health care workers take advantage. We have annual programs to immunize health care workers against flu vaccine. Despite that opportunity, less than 50 per cent of health care workers take advantage of that. So I would argue we do have plans to immunize health care workers.

We have the systems in place through Occupational Health and Infection Control. However, their resources are limited and so it was somewhat problematic but we were able to develop and roll out an immunization program for health care workers in the space of a few weeks.

MR. DAVID WILSON (Sackville-Cobequid): I think the Auditor General mentioned it was close to 58 days after the initial outbreak that an outbreak was declared. I think it is so important that we have to learn from past experiences. The deputy minister mentioned SARS and I think that has resonated throughout the country on deficiencies in public health and the concerns around public health, especially with health care workers. Some of these health care workers paid an ultimate price, we are all aware of that, that they lost their lives supporting trying to contain this virus. The deputy minister mentioned the 2006 report and that is why I am criticizing the fact that I think we are two years past that and several years past SARS, that we need to make sure that these plans and these priorities are implemented.

[9:15 a.m.]

You had mentioned the fact that the public health nurses, and the nurses themselves, are under a different structure, under a different identity. The accountability structure is not always clear to those who are involved in public health. This was mentioned in the Auditor General's Report. Accountability structure is so important to the key to ensuring public health employees follow directions that come from your department and that are set from public health. Front-line health care workers and employees are all under the district health authorities. They don't actually report directly to your department. What are you doing to improve that communication, that structure, to ensure that those health care workers, even though they are under another component to this whole plan and strategy, what are you doing to ensure that communication, that structure has been improved over the last little while?

MADAM CHAIR: Mr. Montgomerie.

MR. MONTGOMERIE: Again I agree with you absolutely around, probably for quite a while, the neglect to the public health side. Part of that has come out of governments have wrestled dramatically with the acute care system for the last decade or so to try to get it where it should be operating. In the meantime, SARS occurs. You are right. What SARS highlighted was the neglect that we have paid to the public health side - paper-driven systems, lack of adequate staffing, lack of support, lack of communications. So when our report was commissioned, it was the result of SARS but it was also an acknowledgment that we have created nine district health authorities and the IWK and we have a great accountability framework - meet regularly with them, CEOs and so on, on a regular basis - and the public health side tends to be at the bottom part of that, to your point. So when the government received this report, 21 recommendations, those recommendations dramatically showed we were not well off in many areas of which the Auditor General basically had confirmed.

So the report was accepted by government, the department was created, and finally protection was on the front door and a Cabinet Minister is now at the table that has the ability to speak for public health and speak for the public health dollars. From the accountability framework, keep in mind we added - I think we mentioned earlier - 17 staff plus 25 in the districts, plus developing our structure, that took time from February 2006.

One of the first things I did, as the acting deputy, was meet with the CEOs of the DHAs and talk accountability because you are absolutely correct, we have to be clear on what our roles are and what our accountabilities are and how we show results to the people of Nova Scotia and also how we show that we are keeping them safe and keeping their workers safe so they were fully supportive of that. So when Dr. Strang came on as Chief Public Health Officer, he immediately embarked with the vice-presidents, who the CEOs said these will be our leads to develop that accountability process and Dr. Strang and his team are now actively engaged in doing that.

MR. DAVID WILSON (Sackville-Cobequid): So when Dr. Strang said there was no formal plan, probably because of some of that structure that we work in now around immunization of health care workers, was there a plan to immunize or is there a plan or has there been a plan implemented to immunize high level officials? Dr. Strang, yourself, your team, the minister? In any outbreak, any pandemic, we need to have those individuals there. So was there a plan implemented to immunize those high-level officials, those senior bureaucrats?

MADAM CHAIR: Dr. Strang.

DR. STRANG: Through part of our work nationally, because all the provinces and the federal government with the population of Canada are working collaboratively around pandemic planning, there we are working on one of the many components of pandemic planning - mass immunization. There have been no final decisions made as to who would

be the priority groups to be immunized. We were certainly developing the protocols and the frameworks to do mass immunization, regardless of who, in the end, because we really have to wait, as I said earlier, until the actual outbreak to say who becomes a priority for vaccination. There is work going on with vaccine manufacturers to ensure adequate amounts of vaccine all the way down.

You have to remember that rolling out mass immunization is part of the core skills of public health and, if necessary, we can roll something out in a very short period of time. Before I was here, in 1992, there was an outbreak of meningococcal disease that required mass immunization of school children and that was able to be rolled out very quickly because that is part of the core set of skills. So we do have that capacity, if necessary. In a case like the mumps, first of all the health care workers weren't a primary group but when it became evident that they needed immunization, we were able to develop those processes.

I just want to comment - when you talk about health care workers, it's a relationship that has to be developed between public health, infection control and occupational health. We are working, and that's one of the learnings from the mumps outbreak - there needs to be a stronger relationship and that is something we are working together with the Department of Health and the district health authorities on. We have developed an infection control framework which is all around the interface between public health and occupational health and infection control within health care facilities. That is now moving forward and both departments are working to resource that but I am confident that framework is going to give us a more robust capacity in the event of whatever the next outbreak is to have this better dialogue, better discussion between the acute care, long-term care sectors and public health.

MR. DAVID WILSON (Sackville-Cobequid): So you didn't really answer my question. Really my question was, were the senior bureaucrats - were you or your team vaccinated maybe in the last outbreak during the mumps? Did you have a plan? Did you implement a vaccination program for the senior bureaucrats in the last outbreak of the mumps.

MADAM CHAIR: Mr. Montgomerie.

MR. MONTGOMERIE: I think the best way to answer that is from the senior bureaucrat perspective. When Dr. Scott, the Chief Medical Officer, came to me as deputy and said we are now moving to a stage where we have to action our command control centre, which basically Dr. Sarwal and her team headed up, that is when the team began to look at those kinds of things as the mumps progressed. So Dr. Strang's point - the first bump was the health care workers. Myself, as deputy, I had no contact with any folks who were dealing directly with the mumps, nor did the minister and nor did other senior members of the team. So in that context, I never thought of being vaccinated, nor did Dr. Sarwal or Dr. Strang when they were briefing myself make that a recommendation. I think that might be the best . . .

MR. DAVID WILSON (Sackville-Cobequid): I appreciate that. That's good. One of the things I'm trying to get clear is that, you know, if you had a plan for yourselves and didn't have a plan for front-line health care workers. So that's where I was going with it. So we'll go on to another area.

One of the things in the Auditor General's Report that he noted was that the mandate for Health Promotion and Protection and the structure of Public Health are not clearly defined in either legislation or regulation. So Recommendation 4.1 - his first recommendation for the Department of Health Promotion and Protection - should be to draft new legislation to clearly identify the mandate, authorities and accountabilities for the public health care system. When will we see new legislation to deal with that recommendation?

MR. MONTGOMERIE: Here again, just about every recommendation the Auditor General made to us, we were either well underway or had identified a time frame. The best way to characterize the legislative scenario was, we had probably agreed to disagree a little bit with the Auditor General. We felt that once we received the public health renewal, 21 specific recommendations - that was the bedrock of us moving forward to resource and to go forward around really creating public health renewal. For us to jump right into legislation, for us to jump right into strategic planning without first appropriately staffing up and consulting with our stakeholders, we would have been putting things ahead of ourselves.

My concern as deputy was, was there legislation in place that protects Nova Scotians and the Health Protection Act is in place which clearly gives Dr. Strang and his medical officers of Health the ability to protect Nova Scotians during that time. So we consulted with several experts around the development of the legislation. With Janet, when leading the report, checked with some folks, they reaffirmed that you're best to go down the road, develop your accountability, begin that with the DHAs in the public health side, begin your strategic planning, and probably around 2010-11, then begin the formal legislative piece.

I've been involved in developing legislation, as some of you may know, and there are two things you shouldn't watch - sausages being made and legislation being made; that's the old joke. I say that in context of when you're ready to go with a legislative approach, you've got to be ready. That's why I, as deputy, supported the recommendations from our team.

MR. DAVID WILSON (Sackville-Cobequid): And that's great for us to hear but one of the other criticisms that was very evident in the Auditor General's Report was the fact that the current government doesn't have a great record implementing recommendations from audits done in the past. You have 39 per cent of the recommendations that were implemented fully since 2005, I believe, maybe even 2004. So you have to understand where I'm sitting here, you know, listening to you say that you fully understand the recommendations and support them, but we need this stuff to happen I think quicker and I think government needs to recognize the importance of the Office of the Auditor General and the role they play in

ensuring really the safety of Nova Scotians in this case and the best appropriate use of taxpayers' money.

So, you know, the Auditor General - you mentioned that you may disagree with the Auditor General on his recommendations around the need for legislation or the timeline for the need for legislation but he does indicate in there that there should be more of an urgency placed on this and I would agree with the Auditor General.

Another area that I would like to concentrate a little bit of time on in the next few minutes is around some of the point recommendations that he made. One was around that there seemed to be a lack of plans. I mentioned the immunization of health care workers but he also made mention, and I think you made mention in your opening statement, around no formal plan existed to address the storage of additional vaccines required to deal with an outbreak. So you have mentioned I think in your opening statement that that's a scenario you're going to look at. Where are we at with ensuring that proper storage of vaccines is there, or is going to be there and can you give me a timeline on that?

DR. STRANG: A couple of points on that. We didn't have a written plan, but we had arrangements made and we had used them previously through the provincial Drug Distribution Centre, where we had already purchased a walk-in refrigerator. So, we did have increased capacity for storing vaccine if necessary - we just didn't have a formal written arrangement on that.

There has been an opportunity - Public Health Services and Capital Health has moved to a new facility in Burnside that they are now in. We have worked with them and we have developed a new provincial vaccine distribution centre with increased capacity in that location. I will ask Elaine to speak to the timelines - I don't think we have actually moved our distribution there yet, but we will be doing that very soon. There is significantly enhanced capacity already and the space has been built with the opportunity, if necessary, to add even more refrigeration space. I'm very comfortable that we have adequate back-up systems for immunization.

My last point is, at a meeting last week, where there are plans over the next few years in some of the other communities across the province to move Public Health into as we build new hospitals. Certainly, I have raised the issue that we need to be paying attention to what additional vaccine storage capacity we could potentially build into those new facilities to make sure we have more than enough back up capacity for vaccine storage.

I'm just going to ask Elaine to talk about the timelines around the Burnside facility.

MS. ELAINE HOLMES: We hope to have the vaccines available for moving into the new facility mid-May. Our fridges are currently in the process of being established on the new site and we require the fridges be up and running with an alarm system back-up in check

for at least 48 to 72 hours. The folks over in Public Health in Dartmouth have just moved and are settling into that facility, so within the next couple of weeks we'll be making those arrangements.

MADAM CHAIR: Thank you. Order. The time has expired for the NDP caucus. I recognize Mr. Wilson from the Liberal caucus.

[9:30 a.m.]

MR. DAVID WILSON (Glace Bay): Thank you. Good morning everyone. It's good to see you here. It's always a pleasure to be here, Duff, you know that as well. Deputy, I should say - sorry, I was on a first-name basis, a little too informal. But, the deputy knows, he has probably been around politics more than any of us over here and he's quite good at what he does. Everyone over on that side will probably know that by now and he has quite a way of making things smooth in terms of wording. You did say, deputy, you agreed to disagree with the Auditor General in his report, which, anyone who has read it, would find is a pretty damning report of what happened.

Let me quote from the summation of that report, quoting the Auditor General:

We found overall planning inadequate. The Department does not have a strategic plan. Although the Department has outbreak plans in place, many significant areas are not addressed and had to be dealt with during the recent mumps outbreak. Additionally, the provincial mumps outbreak team had not considered recommendations from previous outbreaks."

"HPP's information systems are inadequate. Key systems such as an immunization registry do not exist or are paper-based. Information which is recorded is often incomplete. HPP does not provide adequate guidance to the districts regarding information to include in immunization records.

Now, deputy, I would have said after reading that, ouch. That's just not a slap on the wrist. That's pretty well as close to an outright condemnation of what you're doing as you can possibly get from the Auditor General.

Let me ask you, after that report, what has changed, what are you planning on doing to deal with that issue and just how serious do you think the whole problem is?

MR. MONTGOMERIE: I think the protection of safety of Nova Scotians is incredibly serious. The fact that the Government of Nova Scotia took a report with 21 recommendations, received it in January 2006; in February 2007, created the Department of Health Promotion and Protection; and in April 2006, accepted fully the 21 recommendations.

To your point, many of the things the Auditor General said - that is why we support his recommendations - we absolutely agree with. For example, the paper-based system is terrible but with the acceptance of the Public Health Renewal Report and budget support from Cabinet, we have entered into negotiations with Canada Health Infoway to implement a national information system that will get to the root of that. That was well underway before the Auditor General graced our door.

So the point is, from my perspective, there are many things the Auditor General said - and by the way, we are tracking them very well and, to the former member's point, we want legislation. We want these things implemented and we are working hard to make sure they do get implemented because at the end of the day, you are absolutely right, it is about the safety of Nova Scotians.

So are we doing better record keeping? Are we heading toward strategic planning? Are we doing the accountability piece? Have we created a public health lab? We are doing all those things. Are some things going to take a little bit longer? Yes. The proof in the pudding will be, will we continue to be resourced to do it? Right now, we are moving reasonably well and we certainly are using the Auditor General plus the Public Health Renewal Report as our guide.

MR. DAVID WILSON (Glace Bay): Deputy, I am sure you are aware that back in 2005, there was an Act tabled in the Legislature and it was proclaimed on November 1, 2005 - it was the Health Protection Act. It was a resource probably from which the department should have taken some action, should have used as a resource in order to respond to the mumps outbreak. Do you agree or not agree? It was there - mumps is considered a communicable disease, is it not? This was set up to deal with communicable diseases in Nova Scotia.

MR. MONTGOMERIE: I am going to take a chance and go 50,000 feet around the Health Protection Act. By the way, I was part of that and so were both Parties of the Opposition of the government and I thank you for your great support. The Health Protection Act is the centrepiece of the safety of Nova Scotians because what the Act does, to your point, it gives Dr. Strang and public health officials the ability to overrule deputy ministers and politicians if they feel, at the time of a major public event, they are not getting properly resourced. That's a heavy responsibility. It is a similar type of responsibility to the Auditor General except this is a public health responsibility legislated to Dr. Strang and his team. So I am very cognizant of the fact, as is Minister Barnet, that when we are briefed on anything, whether it is a food poisoning outbreak, any event that our public health team is managing, we always know the Health Protection Act is there. It's protection for a reason. It is for the safety of Nova Scotians, it is to make sure that the team that is here in the House with me -first of all, based on science, based on best evidence, that is their responsibility - they assess the outbreak.

For example, Dr. Sarwal and her team, day after day after day, were in a command and control centre, in constant communication with the district health authorities, in constant communications with the Public Health Agency of Canada, the Centre for Disease Control, the United Kingdom, all those kinds of things that Dr. Sarwal and her staff were managing on a day-to-day basis were assessed. So at the end of the day, what Dr. Strang and his team have to do is a risk assessment. They assess what is going on and they come to the deputy and say, we made the following assessment and we feel we need the following - or to our management team, sorry - and then I go to the minister.

So the Act, to your point, is very much there and it is there, I am going to say as a last resort, if we are not appropriately responding to the needs of public health leadership in the event of an event.

MR. DAVID WILSON (Glace Bay): My colleague from the NDP has talked about and Dr. Strang brought up the pandemic, SARS, that occurred in Ontario. We talk about SARS and we talk about an outbreak of mumps - we are talking about apples and oranges, are we not? One is a pandemic, one is an outbreak of a viral illness. If I am an ordinary Nova Scotian and I listen to what has been said in the media and I read what we have before us here today, I'm a little worried. How can Nova Scotia handle - never mind a pandemic - if we can't handle an outbreak of mumps in our province?

The Auditor General's staff concluded that the Health Promotion and Protection response to that outbreak was in compliance with the outbreak management guidelines, agreed. But, they found the guidelines were insufficient so the response, as a result of that, was less than timely. The outbreak team was addressing areas that should have been covered in the actual plan.

That's pretty strong language, again, that the Auditor General has used. So I will ask the deputy minister, do you believe that given the information available, that Health Promotion and Protection could have reacted in a more timely fashion?

MR. MONTGOMERIE: I will respond in a couple of ways. Having been involved around many difficult files involving some pretty serious situations, I always look to see what type of leadership is being provided. What I saw was a very professional, organized, well directed, focused team recognizing an event that was starting to move, that needed to bring more resources to it. As a matter of fact, there was a report out of the 2005 mumps piece that the Auditor General mentioned, that report was actually written by one of our staff and Dr. Strang was the Capital Health Medical Officer at the time. Everybody's very familiar with that.

So my answer to your question is, it's up to the professionals - and there are a myriad of them in that room - there are directors of communicable disease, there are different support systems, Capital Health and so on - that make those assessments on a daily basis and

where I would definitely agree with the Auditor General. One of the things, if you ask me, that I see is different, was when Dr. Scott said we need to go to the stage, I said, just tell me what resources you need.

What I saw for the first couple of days was our public health staff really wrestling with the nuts and bolts of getting the room ready, getting stuff ready. Now that we have an emergency planning system in place, now that we have Russell Stuart as director of Emergency Management, we now have a very solid support system that will automatically kick in. That's something that was in the Public Health Renewal Report that we've now actioned. As a matter of fact, there's a major test of an event coming up called Staunch Maple that Russell Stuart and his team have been very much informing that will test the system.

I hope I've answered your question.

MR. DAVID WILSON (Glace Bay): No, you haven't.

MR. MONTGOMERIE: Okay.

MR. DAVID WILSON (Glace Bay): For the last minute and a half or so, you've said everything else but. I only asked one question, if indeed you thought it was handled in a timely fashion. So, let me ask Dr. Strang.

Dr. Strang, you're the expert. You have an outbreak of mumps, you have front-line health care workers who haven't been immunized until about 58 days after the outbreak was declared. You know, you immunize front-line health care workers that long after the outbreak, you've lost control or you may have lost control. Let me ask you point-blank then, do you think that this outbreak could have been handled in a more timely fashion?

DR. STRANG: I think that outbreak was handled extremely well and was handled in a timely fashion. As I stated earlier, the gap, as identified by the Auditor General, in immunizing health care workers, does not appreciate the changing epidemiology of the outbreak. An outbreak is a fluid situation.

At the outset of the outbreak, there is no evidence that health care workers needed to be immunized. When it became apparent that we needed to move in immunizing health care workers, we were able to start that program within a fairly short period of time. So I am very comfortable standing up and saying we handled the outbreak extremely well. Are there things we could do better, looking back retrospectively? Always. Part of our process is we are now going to be evaluating. You have to remember, the outbreak has not been declared over yet.

We are engaging with the Public Health Agency of Canada around this. We are in discussion with them about having them assist us in some external evaluation of our response

because we are always prepared to look at what we're doing, evaluate it, and make things better for the next time because we can always do things better but I'm very comfortable standing up and defending for the public of Nova Scotia that we have done an extremely good job of handling a mumps outbreak. We have learned things from Iowa and from the United Kingdom at the very beginning of the outbreak, because they had previously gone through outbreaks. Much of the processes and the materials that we have developed have been shared and have been adopted by other provinces that are having similar outbreaks of mumps, although they're not as large. So I'm very comfortable in saying we have done a very good job with the mumps outbreak.

MR. DAVID WILSON (Glace Bay): Thank you, Dr. Strang. Let me ask you this question as well. We had some testimony here today regarding the temperature monitors or temperature vaccines and whether or not they become ineffective during transport. It was one of the areas that was brought up during the Auditor General's Report, but what has changed today from then to now? How is that handled and how are they transported and are those guidelines being followed?

DR. STRANG: We're in the process of adopting and having those thermometers in vaccines. Again, we have to remember that there was no context given around those thermometers, that there is a much broader process and structure in place that we have followed for years in terms of ensuring the viability of vaccines are maintained by keeping them at the correct temperature.

MR. DAVID WILSON (Glace Bay): You don't have those monitors today, do you?

DR. STRANG: We're in the process of implementing that recommendation, I'm not sure exactly where we're at.

MADAM CHAIR: Ms. Holmes.

MS. HOLMES: Currently we're waiting until the biological warehouse and distribution centre is transferred to the Capital District Health Authority at which time we will trial temp tails within our vaccines over the next month or so and those processes are being developed as we speak.

MR. DAVID WILSON (Glace Bay): So if vaccine is being transported around this province today, it still is possible that it can be compromised. According to what I've been told anyway, the manufacturer has stated that those monitors - or as you called them, thermometers, is that what you said, whatever they are - they should be in place for a range of two to eight degrees Celsius and if those manufacturers' recommendations are being ignored and we're still, as you say, ongoing with the outbreak, then vaccine is being transported around this province and could possibly be compromised and people could be given compromised vaccines leading to a further outbreak, Dr. Strang.

[9:45 a.m.]

DR. STRANG: The presence of a thermometer is not the only way to assess whether there has been what we call a break in the code chain. I will use an analogy of if you buy ice cream at the store, it's pretty easy to tell if that ice cream has risen in temperature by the time you get home - it's melted. It's a bit more sophisticated but our staff is very trained.

MR. DAVID WILSON (Glace Bay): I hope so.

DR. STRANG: We pack vaccines in ice. They monitor that when they transport, when they assess, open up the coolers. There's a whole process in place. Can it be made better by the addition of thermometers? Yes, and we're in the process of doing that but, again, I'm very comfortable that we have a good process in place today to ensure the safety of Nova Scotians through having appropriate storage and handling systems for vaccines.

MR. DAVID WILSON (Glace Bay): I'm not sure how much time I have left, Madam Chair?

MADAM CHAIR: You have three minutes.

MR. DAVID WILSON (Glace Bay): Thank you very much. Dr. Strang, again to continue to ask you some questions, as Chief Public Health Officer, when did you report to the deputy minister that there was a serious problem in this province regarding a mumps outbreak?

DR. STRANG: I didn't begin my job until September. I was in the role of Deputy Chief Medical Officer of Health at the time of the beginning of the outbreak. Dr. Jeff Scott was the Chief Medical Officer of Health. Very clearly from the very beginning, one of the ways we operate, I know Dr. Scott would have had very immediate communication with Deputy Montgomerie at the very beginning giving him a heads-up that this is what's going on, this is the process we're going to put in place. So clearly the deputy would have been involved from the very beginning through Dr. Scott.

MR. DAVID WILSON (Glace Bay): Deputy, Dr. Scott reported to you when that there was a problem with a mumps outbreak?

MR. MONTGOMERIE: I'm not sure of the exact date but the conversation went something like, Duff, you should be aware that we're starting to see one or two cases of mumps and I'm saying, is that bad? Well, it can be because usually we only get one or two a year, I think - I'm going from context - so, he just said, Duff, it's something we're keeping an eye on and we'll keep you apprised.

Then as it moved along, I think, I'm trying to remember the timeline, I may have to go back and check my BlackBerry, but I think it was January 2007. (Interruption) Was it February? February, thank you, Shelly.

MR. DAVID WILSON (Glace Bay): On April 13, 2007, in a press release, the government announced there were 75 cases of mumps in Nova Scotia and by December 31^st of that same year, there were 777 cases of mumps in Nova Scotia. Where do we stand today, deputy?

MR. MONTGOMERIE: If I can, I will refer that to Dr.Sarwal.

DR. SHELLY SARWAL: As of today, we have 793 cases.

MR. DAVID WILSON (Glace Bay): Would you consider that, doctor, good news or bad news?

DR. SARWAL: It's a bit of both. I mean, I think prior to this outbreak of mumps in Nova Scotia, there were outbreaks both in the U.K. and in the U.S. Since this, there have been outbreaks across the country. Compared to the U.K. and the U.S., they had tens of thousands of cases, so we don't really compare to that.

The outbreak in Nova Scotia is not over yet, we still have one or two cases a month, but it is under control compared to where we were this time last year where we were having 40 or 50 new cases a week.

MR. DAVID WILSON (Glace Bay): I've probably used all of my time, Madam Chair.

MADAM CHAIR: Thirty seconds.

MR. DAVID WILSON (Glace Bay): Well, that's fine, I'll leave it at that. Thank you, Madam Chair.

MADAM CHAIR: Thank you very much, Mr. Wilson. I now recognize Mr. Porter from the PC Caucus. You have 20 minutes.

MR. CHUCK PORTER: Thank you, Madam Chair and thanks to the guests as well for being here today. I, like others in this room, have had a fair number of years in the health care industry and have seen a lot of different things by way of viruses and so on. This has been somewhat interesting. I've read a lot about it and I keep thinking about it.

I remember as a kid, it seemed to be a normal thing that we would have the mumps, measles, chicken pox. In a big family like I came from with seven kids, it seemed like by the

time you got into school, everybody was coming home with something and then it just got passed through the household. How different are things now? The mumps didn't seem like that big a deal in those days and it has been made to be a very big deal by way, obviously, of the numbers, I guess. I'm now curious. Maybe Duff or Dr. Strang could answer, but in comparison to years ago, things were very different - there weren't all these great scientists and vaccines and so on. How do our numbers compare overall from even 15 or 20 years ago to today?

MADAM CHAIR: Dr. Strang.

DR. STRANG: We didn't begin routine immunization against - and I'll focus on measles, mumps and rubella, they come together in a vaccine - until the 1970s. Before the 1970s, as you said, these were endemic diseases and most people got immunity through acquiring disease during childhood. The problem was, they can have very serious complications.

Since we have begun immunizing, it is now rare to see these diseases, thank goodness. Part of what we have now learned, with the mumps, is that we were giving people a single dose of mumps vaccine, starting routinely in the mid to late 1970s. You can only assess this over time. We are now seeing that to have high enough numbers of people in the population with immunity so you don't have outbreaks, you actually need to give people two doses of vaccine.

The mumps component of the vaccine is not as effective as the rubella and the measles component. Some people, when they're given the MMR vaccine, won't develop immunity right away, especially to mumps, and an additional proportion of people will, over time, lose their immunity - again, especially to mumps. That's why we now have this group of people who are too young to have gotten immunity naturally, it's not until 1996 that we routinely started giving kids two doses of MMR.

So, you have this group of people basically between 18 and 35 years of age; there are enough of them that don't have immunity that you can sustain an outbreak. That's why the key part of our outbreak management has been to offer second doses of MMR to post-secondary students, because that has really been the focus of where most of the disease activity has been, but also to protect health care workers and minimize the impact on the health care system to offer the second dose of MMR vaccine to health care workers as well.

MR. PORTER: So even though I have had the mumps as a kid and I'm a health care worker in my 40s, would I get a second dose then in my lifetime?

DR. STRANG: We weren't testing people to see - if you had the disease naturally, you likely have long-lasting immunity but we were offering a dose of MMR vaccine to every health care worker regardless of age. Logistically, it is much easier and also cost-wise it is

much easier to do that than to test people first and then decide if you are going to immunize them or not.

MR. PORTER: So is the two-dose system, successful? Do we know? I think there was an article in the New England Medical Journal, or something like that, that spoke to the two-dose system.

DR. STRANG: Well, there is some evidence that for the mumps component, you may even need a third dose of vaccine, but that is still very preliminary. I think the general consensus is that we need to focus on getting good uptake of the second dose of vaccine. So, for instance, we still have a lot of work to do. Only 25 per cent of post-secondary students have taken advantage and gotten a second dose of MMR. Roughly only, as I said earlier, 40 per cent of health care workers have gotten their dose of MMR. So before we would ever contemplate expanding the program, we need to get better coverage in our existing program.

MR. PORTER: Is there testing that you are doing? You know, I get the dose, the second dose, whatever, am I going for a blood test to say my immunity is this or is there any way of sort of determining how effective it is?

DR. STRANG: We don't offer that on an individual basis, as a matter of fact, but there are certainly ongoing studies like the one you saw in the New England Journal of Medicine from a research perspective where you study populations and say what is the percentage of people who develop immunity for the vaccine, depending on however many doses. We use that research evidence to understand, in a real life, when you have a broad scale population program, what the likely coverage is going to be.

MR. PORTER: So you talked about mumps is not special to Nova Scotia, it is obviously in other areas of the world. How do we compare, even just in the country of Canada, other provinces? Are there issues by way of the mumps in general?

DR. STRANG: There have been a number of other provinces, Alberta most specifically, Ontario, that had outbreaks, and B.C. as well, that had outbreaks of mumps. This phenomenon of the roughly 17 to 35 year olds with a certain number lacking immunity to mumps is an international phenomenon. So the fact that it happened in Nova Scotia is not that there is something unique or different or we did something wrong in Nova Scotia, it is just that our understanding now of the mumps component of the vaccine and how that works and, again, this issue we are dealing with is an international issue.

MR. PORTER: Do we have any indication in this province, I will use the words, I guess, how it began, where it came from by way of this outbreak, given that it is post-secondary? Did that come via a student or two or a dozen and then . . .

DR. STRANG: It seems like, because we had some initial cases, the sequence of this - and some of this is based on some educated guesses, some of it we got definitive information - but in the mid to late 1990s, there was a resurgence of mumps in the United Kingdom. From there it spread to the New England States and it seems that it is likely that our outbreak, because we did have a small outbreak in 2006 and then another, the large outbreak in 2007, it seems likely that it was transmitted from there. New Brunswick, at the same time, had a few cases of mumps and what the nidus of our outbreak was, we had some infected university students in some of the downtown bars. The close social behaviour there of non-immune people mixing with a few infected individuals sparked our outbreak but it is very clearly linked to this international resurgence of mumps.

MR. PORTER: How is this spread?

DR. STRANG: It is spread through direct contact or close, within a metre or so of somebody coughing, sneezing, sharing food, drinks. So one of our theories is that when you are in these, The Dome or The Palace, wherever, to even talk to somebody, you have to get this close and let alone all the other behaviours that go on. So there is lots of close, personal contact between post-secondary students and also other people of that age group so there are lots of opportunties for spread.

MR. PORTER: Yes, I can understand that maybe in those places, cheering the Queen or one thing or the other perhaps and toastings. Certainly we have read a lot about it in Nova Scotia. I haven't read a lot about it in other places though. I mean, how are we so different than, you know, you mentioned New Brunswick, you mentioned Ontario and Alberta. Maybe they're just not promoting that here in the local papers but I don't remember reading as much significantly as I did on our cases here in this province.

DR. STRANG: New Brunswick had a cluster of cases, not nearly the number we had at the same time of ours and, unfortunately, it went from, you know, students travelling, it went to Ontario and then B.C., I think we were unlucky and maybe it's because of our concentration, our large number of students. We're not sure of all the dynamics but it certainly sparked here and caused a considerable amount of attention and work.

MR. PORTER: How do the numbers compare to, I don't know if we would call them pandemics or not, but the flu, for example, I mean a lot of people get the flu and a lot of elderly and young die of the flu every year in this province as it is elsewhere. How do our numbers compare in such things as simple as what we call the flu here?

DR. STRANG: Numbers in terms of cases?

MR. PORTER: Yes, cases.

DR. STRANG: We don't track the number of cases because most people who get the flu don't get tested. A normal flu season, we anticipate 10 per cent to 20 per cent of the population being sick - which you're absolutely right to point out that we pay a lot of attention to mumps but every year we have outbreaks and an annual epidemic of flu which has a significant impact on our health care system. We have a very robust annual immunization program and Nova Scotia has some of the best immunization coverage rates across the country. They're not where they should be but we're as good, if not better, than other provinces in terms of seniors, health care workers, household contacts, people with chronic disease.

MR. PORTER: Any idea what the numbers are that are getting immunized, the percentage of our 900,000 plus in Nova Scotia?

DR. STRANG: Our annual order, we order 350,000 doses of vaccine. I'm going a little bit off the top of my head, a year, but roughly around 95 per cent of people in long-term care facilities get immunized. Around 70 per cent to 75 per cent of seniors living in the community get immunized. Those are two of the highest risk groups. As I said earlier, less than 50 per cent of health care workers, despite them all being eligible, less than 50 per cent of the health care workers take the opportunity to get immunized but those numbers are as good, if not better, than other provinces.

[10:00 a.m.]

MR. PORTER: Maybe just to the deputy then on those numbers, what are we doing, deputy, to promote, educate, I mean health care workers, less than 50 per cent is a concern to me when I hear those numbers. It would just seem like an automatic thing and I know in a former workplace we would set up a shop for the nurse who came in, or whoever was giving the immunizations, and have a day or two where they would be in the common centre, or wherever, and they would be provided. I sort of recall fairly high numbers in those days if I remember correctly. How are we promoting this, especially to that group?

MR. MONTGOMERIE: I will take a crack at it and maybe Dr. Strang can add but basically, as Dr. Strang indicated, we have the vaccines and part of it is working with our partners, the district health authorities and other key stakeholders, particularly around health care workers, to encourage them to have the workers utilize the vaccines. We're a bit frustrated too. Sometimes, as Dr. Strang says, we've got a pretty good rate nationwide but we want to be better than that.

DR. STRANG: Our number, the problem of low acceptance of flu immunization by health care workers is international. For some reason doctors and nurses don't in large numbers get the annual flu immunization. There's a lot of reasons for that. It's a personal interest of mine. I've been involved and continue to be involved with some research projects when I was in Capital Health with some psychology professors at Saint Mary's, looking at

some of the psychological parameters, looking at ways to promote that. Some of the things we have studied in a small way actually show that to be effective we're now engaged with IWK and perhaps we could get some opportunities to test those in a more robust way. So we're taking a research perspective of this. It's a complex decision-making process that health care workers make and we need to understand but as part of our annual flu campaign every year, we deliberately target our message in partnership with the district health authorities to health care workers.

MR. PORTER: Is the message inconsistent with the district health authorities? I mean does it matter what region we're in? I know that there are some other variables within DHAs. I guess I just want to be confident that our messaging is the same across the board.

DR. STRANG: We developed posters, pamphlets, materials. We have fact sheets to understand the myths around flu vaccine. All those things that we developed are shared across the province through the health system, not just DHAs, but long-term care facilities, health care workers. It's very much a consistent approach.

MR. PORTER: You talked about myths, I know there are a lot of folks, with regard to just the flu vaccine, who say there are allergies. Is there a great difference in the vaccine from year to year? Is there that much change by way of strains, or whatever the proper terminology is?

DR. STRANG: What we do every year, based on what was circulating the previous year, and some understanding of how flu virus changes from year to year, there are predictions made and then those new strains - there are three strains that go into the vaccine, two of influenza A and one's a B. Most years, the match of what is in the vaccine, actually, is a good match of what's circulating. But, because of the nature of the rapidly changing nature of flu virus, we're always playing a little bit of catch-up. Some years there is a change in what we anticipate is going to be, and in some years the coverage is not as good. That's just the nature of the flu virus.

There is work underway to make - I'll call it a more generic flu vaccine that you wouldn't have to then change from year to year. That's in the early research experimental phases.

MR. PORTER: So, having said that, going back to the mumps disease, is there more than one strain of mumps? Does that vary by way of strength, abilities, disease, whatever?

DR. STRANG: There are different strains of mumps. There is one strain that - the mumps virus doesn't change like the flu virus. That's not an issue with mumps disease.

MR. PORTER: So the same vaccines would be used regardless. On that, with regard to vaccinations - and we've heard a little bit of talk about it, I'm sure we'll hear more - the

transferring and storing and so on of the vaccine, I'm more interested in the amount of storage you have available to Nova Scotians today. How long does it last? Is there an expiry date on a vaccine?

DR. STRANG: The vaccines have a multi-year expiry date. We're continually bringing in new vaccines, it goes out to a doctor's office, so we don't allow them to stockpile months and months of vaccines. They'll have a month or two in their fridge and when they run low, they order more from their local public health office in a systematic way. When that public health office knows what their monthly needs are likely going to be, they'll order from the province, we will order from the vaccine manufacturer.

We are continually bringing in vaccine from the manufacturers to our central depot which then goes out to public health offices across the province and ultimately out to doctors' offices.

MR. PORTER: Any idea how many doses you have on hand in the run of a year, how many to give? I mean, I guess you'd look at population . . .

DR. STRANG: All vaccines in total?

MR. PORTER: No, just with regard to the mumps. You've talked about it being the more specific one today, 793 cases.

DR. STRANG: I'm going to turn to Elaine for an answer.

MS. HOLMES: I don't have specific numbers to date. We base our MMR vaccine on our birth cohort, which is about 10,000 a year. As you know, we brought in vaccine to immunize health care workers and post-secondary students this year which was an extra amount of about 80,000 doses. We bring that in, as Dr. Strang said, on a staggered approach, depending on the need in the community as identified by family physicians in contact with the local Public Health Services offices.

MR. PORTER: Thank you. We talked a little bit about how an outbreak happens, we think it comes in via maybe students, but how much natural occurring would we see outside of what we will refer to as this current outbreak? How many cases, on average, would we see in a year, looking back over time, without it being an extreme or an outbreak or whatever the terminology would be?

DR. STRANG: Prior to our resurgence of mumps, we saw one or two cases a year.

MR. PORTER: Only one or two a year.

DR. STRANG: Yes. Mumps is no longer endemic, or naturally circulating in Nova Scotia. It comes from somewhere else, it's like all infectious diseases, they're worldwide and easily transportable.

MR. PORTER: We've talked about SARS a little bit, that being somewhat significant, very significant, in Ontario and other parts of the world. They seem to have some kind of handle on that and how it evolved. How often would we expect, in the country or specifically in a small province like Nova Scotia, to see something very significant like an unusual number of cases of mumps? I mean, what's next? Do we have any idea and what are we doing to prepare?

DR. STRANG: It is not predictable. SARS, nobody predicted SARS. We didn't predict mumps. I don't know what the next thing will be. Part of what we are building, learning on as we develop our response to potential - or it's not potential, we will get a pandemic flu sooner or later, we know that. We just don't know when or how severe. So we are building a response to that but we are really building not just a response to pandemic flu. Through the health system emergency management team, their partnership with EMO, we are really building a robust, what we call an all hazards response. That is so the health system, which is our responsibility, is prepared, whether it is a weather disaster, whether it is a plane crash, whether it is a huge number of planes being diverted and landing in Halifax, all of which we had and have had very good responses to. But also part of the all hazards is being prepared for an infectious disease event, regardless of what it is. So we don't want to try to predict which disease, we want to have a framework of response that will then allow us to be flexible and whatever the unpredictable event is, we will have capacity.

So we are moving in that direction very strongly and events like the mumps outbreak help us learn and we are already applying those learnings to increase our capacity for pandemic or whatever the next infectious disease outbreak is. The capacity we have built over the last year, many of the folks you see up in the gallery were not in their places last year so we have much stronger capacity to deal with infectious disease events at a provincial and local level, based on the process of public health renewal that is unfolding in the province.

MADAM CHAIR: The time has now expired for the PC caucus. The next round of questions will be 13 minutes and I recognize Mr. Wilson from the NDP caucus. You have until 10:21 a.m.

MR. DAVID WILSON (Sackville-Cobequid): Madam Chair, I want to go to one of the concerns that was discussed in the Auditor General's Report around outbreak evaluation and reporting. Under the Disease Control Outbreak Management Guidelines, it is required to do an evaluation of a response to all declared outbreaks. In 2005, we had two outbreaks, I believe, and it was indicated in the Auditor General's Report that a report evaluating the response was not prepared for one of the outbreaks and an overall clinical report was prepared. However, this did not address the districts' response to that outbreak. The Auditor

General's Recommendation 4.9 indicated that the Department of Health Promotion and Protection should take a leadership role to ensure all required documents are prepared following an outbreak. Why did that not happen after those outbreaks?

These reports will indicate what went right and what went wrong during an outbreak. So if we don't have those reports for any outbreaks or all the outbreaks, how can we learn from our mistakes? That is truly how we learn and hopefully we will proceed to deliver and improve on our reaction to an outbreak.

MADAM CHAIR: Mr. Montgomerie.

MR. MONTGOMERIE: I wasn't there at the time. Dr. Strang, are you prepared to answer?

MADAM CHAIR: Dr. Strang.

DR. STRANG: We had an outbreak in 2005, a report was done. We had an outbreak in 2006. I don't have the document in front of me but a report in the form of, it was actually published in the Canadian Medical Association Journal, a summary of that outbreak and the lessons learned. Do we need to do more robust evaluations of our outbreaks? Yes, we do. That is part of the process we are engaged in now with the mumps outbreak, with our added capacity. Part of the problem has always been, when we have an outbreak response, a lot of other stuff goes on hold. As soon as the outbreak is over, we have to try to catch up on the other stuff. So capacity to do this, to have the luxury to be able to do that robust evaluation, has been limited. Now, with our increased capacity, both in communicable disease and through the support of the health system emergency management, we are committed and, as I said, we are in discussion with the Public Health Agency of Canada because I think it is important that some of the evaluation be external, not just ourselves evaluating ourselves.

Doing a formal evaluation of the mumps outbreak, not just how Public Health responded, there needs to be an evaluation of how did the health system respond and we are committed to doing that.

MR. DAVID WILSON (Sackville-Cobequid): I can appreciate the deputy minister said he wasn't there at the time, you weren't there, and many of the people here and in the gallery weren't there, but that doesn't make an excuse for government not to react. I'll go back to the government knowing since 2006 from the report that the deputy minister mentioned, the Renewal of Public Health in Nova Scotia, that the overall planning had no real strategic plan for the department. So why did it take two years until April 1, 2008, before the government decided to put out a tender for a multi-year strategy for public health in Nova Scotia?

MR. MONTGOMERIE: I wasn't ducking the question, I was being truthful. Dr. Strang answered the question and he indicated both reports were done. In fact, one was in the medical journal. The point that you're making around strategic planning, that particular event, I go back to the implementation of the Public Health Renewal Report, the 21 recommendations, the department being created in February 2006, staffing up over that next year. During that time we were actually engaged in the beginning of the strategic plan for the department and as a matter of fact we've done our vision. We've done our values. We've done our several strategic goals. We're now, with our staff now complete overall, our management staff, we're in the middle of the department's strategic plan, but at the same time through Dr. Strang's leadership and Janet Braunstein Moody's and their team in dealing with the DHAs, we are now engaging the DHAs within the system-wide strategic plan which also will help us with the accountabilities.

MR. DAVID WILSON (Sackville-Cobequid): And I noted, I appreciate that you weren't there, but that is not an excuse for government. The information that I go on and this committee relies on is the Auditor General. In his report he indicated that the process wasn't fully implemented on evaluating the mumps outbreak in 2005. That's what I'm going on and I would appreciate, and I would think that the Auditor General would look at that, and one of his criticisms was the failure to review responses to outbreaks means the province will not know what works well versus what did. I appreciate that maybe there was a report generated but I don't think and the Auditor General had indicated that a full response evaluation was not prepared at that time. So we'll maybe disagree on that.

So I would like to go now to an area where we just heard today actually, heard on the radio on the way in, around a possible problem at the correctional facility with MRSA, or a superbug. Far too often this is a disease or a bug that can be detrimental to someone's life. So what role are you playing in ensuring that the inmates are taken care of but, most importantly, that the workers over there are protected and they have the knowledge and the experience and the support that they need to deal with this current situation?

MR. MONTGOMERIE: If I can, to Dr. Strang.

[10:15 a.m.]

DR. STRANG: My understanding is that first and foremost the health and safety of workers there is not the responsibility of Public Health. Capital Health runs the health services there. We will be working in collaboration with them to ensure that they have information, fact sheets, whatever they need, information on infection control practices, so that they can apply those in that institutional setting.

MR. DAVID WILSON (Sackville-Cobequid): And far too often, in my experience, you know, the front-line workers are the last individuals to be contacted, to be given the support they need. Far too often, I know in my experience as a paramedic, I would get a call

after doing a call and delivering and transporting someone to a hospital that, oh, by the way, you have to take your truck out of service because that patient was MRSA positive. I understand and respect that maybe under Public Health those individuals aren't your responsibility but as a whole and as a government, I hope the deputy minister recognizes that those individuals need to have all the resources possible because far too often those at the bottom of the chain are forgotten and that has been a criticism of mine for a long time.

With that, I will quickly jump into something that might not be on this topic but I know that the government has stated that they have had documents and have stated that they have worked with Injury Free Nova Scotia to renew the Injury Prevention Strategy this year which will establish a five-year strategic plan, I believe. Do you intend to provide operating funding for this organization in the upcoming budget?

MADAM CHAIR: Mr. Montgomerie.

MR. MONTGOMERIE: If I can, to the honourable member, could I get you the specifics afterwards because we deal with a lot of areas and injury prevention absolutely is critical. As a matter of fact, we are showing tremendous leadership in the country around that area and we give them support now. If you don't mind, I don't have it here with me and I don't know if we have any of our staff who are related in that area but we will endeavour to get it.

MR. DAVID WILSON (Sackville-Cobequid): We always like to take an opportunity, if we have you in front of us, to ask a question.

One of the other things, I think it was noted in the Auditor General's Report, was around the fact that we need to ensure that we work with our colleagues in Atlantic Canada around ensuring that we could contain and work together during any kind of outbreak, such as the mumps. So how successful has the government been developing maybe a good neighbour policy around a strategy or plan to address an outbreak here in Atlantic Canada?

MR. MONTGOMERIE: I think one of the more positive outcomes from SARS - and I was engaged in the periphery of SARS and saw the communication system that worked day after day after day across the country, as CMOHs from every province talked with each other. The outcome of SARS was, in fact, to formalize a process among the provinces and territories and the Government of Canada, particularly around a pandemic framework that ADMs have been working on and I believe there are now two MOUs that are close to being ready to be signed with the federal government and a third that we are beginning to discuss with them, that all the provinces and territories are agreed upon protocols and so on for dealing with pandemics. I think it is useful to reassure Nova Scotians in the public health world that there is an amazing amount of communication that is going on and has been going on. I anticipate at the Health Ministers' meetings in the Fall, there will be a formal

acknowledgment of the arrangements between the provinces and territories around a pandemic.

I should emphasize, the provinces and territories are totally in agreement with those protocols. We are just now negotiating the last part with the Government of Canada.

MR. DAVID WILSON (Sackville-Cobequid): Also, in the Auditor General's Report, he made mention around minutes of provincial meetings during the mumps outbreak. I believe he mentioned in the Auditor General's Report that there were no minutes for the first provincial mumps team meeting and that minutes were discontinued after the August 17, 2007 meeting. He made a recommendation that the department should ensure adequate information as maintained to a lot of departments to formally evaluate its response to an outbreak. I would think that that is a given, that any meetings, especially with health promotions concerning a mumps outbreak, would have minutes pertaining to that. Why was that the case in this situation?

MADAM CHAIR: Dr. Strang.

DR. STRANG: Part of that is capacity issue. We had to actually bring on casual clerical support at the start of the mumps outbreak because that capacity did not exist. The decision to discontinue taking minutes was simply as we got through the Summer where the mumps outbreak had, while it was still there, our response had become fairly routine, if I can use that word, for us and that really even though there are no formal minutes, it was really a group of people meeting once a week to say what are we doing, who is doing what and people took their own notes about what they would do. We decided not to use scarce secretarial resource for that once we got to a certain point in the outbreak because we were able to manage that and, as I say, it was much more of a routine kind of work process going on.

MR. DAVID WILSON (Sackville-Cobequid): What I take from that is the fact that you didn't have the resources you needed to have these meetings and have the information in front of you. I think that's a clear indication that we have some issues with government and the support to your work and the work of the people in your department. I hope the government recognizes that.

MADAM CHAIR: The time has expired now for the NDP caucus. I recognize Mr. Glavine for the Liberal caucus. You have until 10:34 a.m.

MR. LEO GLAVINE: Thank you, Madam Chair and thank you for coming in today and addressing the Auditor General's Report. I wanted to start with the issue of the development of the mumps around February 2005. We know the cases were mounting through that period. It wasn't until April that we officially declared an outbreak. I'm

wondering why this wasn't done earlier when we seemed to have all the indicators that this was going to be a serious period for mumps.

DR. STRANG: That's really the distinction between an outbreak unfolding over time. We knew we had an outbreak very quickly, but it was, at that point, limited to Capital Health and they had mounted an outbreak response team that we were part of and supporting them.

It was only later on, as we got into April, the mumps started to spread and we declared a provincial outbreak. It's not that we were slow in declaring a provincial outbreak, it's just as the outbreak spread and moved from a local outbreak to province-wide that we said now we officially call it a provincial outbreak.

MR. GLAVINE: During that first phase, then, it was a more localized response then is what was occurring?

DR. STRANG: Absolutely. I mean, don't take that to mean that we weren't doing anything until we declared the provincial outbreak. We were doing things from the very beginning. I was the medical officer when we got the first couple of mumps cases and from there very quickly we moved in Capital Health to start to mount a response.

MR. GLAVINE: One of the things, I'm sure, that would probably be done differently, if we have a similar occurrence - especially among the demographic of the university student, when you consider today that 90 per cent or more have access to electronic messaging, in fact, university students are encouraged to have that availability - would that be a way of getting information out quicker to students around the precautionary areas that they can be taking?

DR. STRANG: We actually did that. In a part of our communication plan, as we worked very closely with the universities, the post-secondary institutions, we developed the message, the content. We said to them, you know best how to communicate with your students. For instance, Dalhousie had a Facebook site set up, were using their e-mail systems to communicate to students. All those ways were being used to make students aware of mumps, make them aware of what they should do if they got symptoms that could be compatible with mumps and then when we started immunization programs, make them aware of the opportunity to be immunized.

MR. GLAVINE: Just going in a different direction here. One of the things I think the average citizen often wonders about is whether or not the vaccine they take will be at full strength. We know that there were issues after transport, storage, there were issues. Is there some way of not just relying upon the expiry date, but are batches of vaccines actually able to be tested and determined for their strength and their effectiveness when they are administered?

DR. STRANG: Certainly each batch of vaccine goes through rigorous testing before it leaves the manufacturer. Before a vaccine is even licensed, there's very rigorous testing, starting with animals and then moving on to humans, around what is the effectiveness of that vaccine, i.e., what is the strength of the immune response. It has to be shown to be an effective vaccine.

There's a process in the country, there's a national advisory committee on immunization that makes recommendations on vaccines, on the science. Part of what they will look at is, what is the strength of the evidence, is that an effective vaccine? Then, before we adopt our provincial program, we will say what's the evidence of an effective vaccine?

There's no way, unless we tested every person, and when would you test them? We have to rely, as I said earlier, around these large clinical trials to inform us about the vaccine. I do want to stress though that the mumps outbreak is not related to our handling and storage of vaccines. As I said earlier, it's related to this international phenomenon of people in a certain age cohort who we now know should have a second dose of MMR. I do want to stress the point, as I said earlier, this is not unique to Nova Scotia; it's not something we have done or something in our system that has caused this. It's an international phenomenon. So, again, our vaccine storage and handling is not related to this outbreak.

MR. GLAVINE: Thank you very much.

MADAM CHAIR: I now recognize Mr. Wilson. You have until 10:34 a.m.

MR. DAVID WILSON (Glace Bay): Madam Chair, I wanted to change the topic a bit away from the topic of mumps. It does have to deal a little bit about what we're talking about here today under the Health Protection Act. I wanted to ask the deputy minister, or whomever can answer these questions for me. According to the Health Protection Act, tuberculosis is classified as a dangerous disease. It has come to my attention that, for instance, nursing students would have to be vaccinated against tuberculosis as a precaution. The issue that I've come up and found out about, and these people have come up against, is that for nursing students in Cape Breton, in order for them to be vaccinated now against tuberculosis - which by the way requires two sessions I believe, one is the initial vaccination and then 48 hours later you have to go for some sort of follow-up, maybe you can explain that to me too. But for the nursing students in Cape Breton, what's happening now, because Public Health no longer does those vaccinations, they now have to travel to Antigonish which is two to two and a half hours away to be vaccinated for tuberculosis and then 48 hours later travel back to Antigonish for the follow-up. So my question to the deputy, and as I said he can pass it on or answer it, why isn't it possible for a nursing student to be vaccinated for such a dangerous disease in the Sydney area?

MR. MONTGOMERIE: No, I thank you for the question and I will refer it to Dr. Strang.

DR. STRANG: First of all, it's not a vaccination, it is a skin test to show whether they have been exposed to tuberculosis or not. I can't answer specifically. We'll look into the decision made in Public Health but it is not the responsibility of Public Health to address all the occupational health issues of the health care system. So, you know, we'll look into it but it may be that there needs to be more capacity within the acute care system to provide this along with a number of other occupational health issues, just like health care workers should be immunized against hepatitis B and a number of things. That is the prime responsibility of occupational health within the acute care or the long-term care sector.

[10:30 a.m.]

MR. DAVID WILSON (Glace Bay): It would seem to me, and I don't know if this is happening in other areas of the province, but that would seem to me to be an excessive driving distance in order for someone to protect themselves from a dangerous disease. In this case it has to be done because you're a nursing student and when you talk about it not being the responsibility of Public Health or the Department of Health, or Health Promotion and Protection, then you're talking about communication. I think communication is probably a key message that we should get from today's session. Apparently there was a lack of it during the mumps outbreak and it was something that perhaps you should be working on, I know you are, but it's a solution that you're looking for down the road. Thank you, Madam Chair.

MADAM CHAIR: Ms. Whalen.

MS. DIANA WHALEN: Yes, I have about three minutes perhaps. Thank you very much, Madam Chair, and just a quick question. I wanted to go back to something that we were told at one of the earlier Public Accounts Committee meetings where we were speaking to the Auditor General. In fact, the answer had come from Ms. Colman-Sadd. We asked about the staffing at the department and in answer to one of her questions she said that there were a lot of vacancies in your department at the time that the audit was done or people acting in positions that weren't filled.

So my question is around the recruitment and I had a good look at your organizational chart that we've just gotten this morning, there are still a lot of acting positions in your department. So I wanted to ask you whether this is current, the current organizational chart that we got today, it just says 2007-08 at the top.

MR. MONTGOMERIE: It is.

MS. WHALEN: Just in the very top level, the first page, we have three senior positions that I guess would appear to be vacant. They are three acting positions at the senior level. Dr. Strang is covering one of them, acting, and there are a couple of others, the Director of Health Development and the Senior Director of Public Health Renewal, all acting

positions. Have some of the positions been filled since the audit took place? Is this an improvement from where we were? First question.

MADAM CHAIR: Mr. Montgomerie.

MR. MONTGOMERIE: Quite frankly, I am very excited about where we are. I will speak to the positions you refer to in a second. All the other positions are relatively new positions, I pointed out, and have been filled, which has been exceptional and we have been working on that for the last year and a half.

The positions, for example, Janet Braunstein Moody is Director of Public Health Renewal. That is basically a secondment for Janet to continue to lead the renewal of public health. She is our conscience and our guide, particularly to Dr. Strang, and her team is to make sure we continue to move down the 21 recommendations and make sure they get implemented. In her place, where she was, Healthy Development, Heather Christian is acting in that position. So those are more process pieces.

The Chief Medial Officer of Health position, Dr. Strang, as the Chief Public Health Officer is in fact the Chief Public Health Officer.

MS. WHALEN: So that will stay that way?

MR. MONTGOMERIE: That will probably stay that way. Actually, it is probably a good time to say that we are very pleased to say that Dr. Maureen Baikie, who many of you may know, is coming back to join us in June and she will be the Assistant Chief Public Health Officer of Nova Scotia and we are pretty excited about that.

MS. WHALEN: Well, that's a good announcement for today. I don't have enough time to talk about that just now but what's the impact of this kind of new creation? You have a whole new section. One, every single position is new under the Health Services Emergency Management. It looks like a big job but also one that could create a lot of chaos and perhaps a lot of uncertainty when you are in the midst of this kind of reorganization or creating an organization.

MR. MONTGOMERIE: Recognizing that some of the directors have come on at different times, I cannot tell you how pleased I am because the safety of Nova Scotians is a pretty heavy responsibility. Let me give you the Director of Health Services Emergency Management. I said, in the early remarks, the support for the mumps situation, the normal day-to-day stuff was the stuff that was lacking. Dr. Strang talked about that about clerical. Now with this Director of Emergency Management who works both for DOH and ourselves in a collaborative way, those things are in place.

MS. WHALEN: One quick question, if I could interrupt, just for my last one. That is a whole new area but two of the managers, your only two managers in that area are acting. Why haven't they been formally put in that position?

MR. MONTGOMERIE: Because it is new and those are existing staff who are there and acting and our director is taking them through the normal Civil Service process. Russell has been there since, oh gosh, . . .

MS. WHALEN: Just because it is a new area, I would have thought that you would unveil it, bring it out with permanent positions. So my concern is just in the recruitment and perhaps the difficulty in filling these positions.

MR. MONTGOMERIE: The key is the director was recruited and he is in the process of recruiting his managers.

MS. WHALEN: Okay, thank you.

MADAM CHAIR: Order. The time has expired now. I recognize Mr. Bain for the PC caucus. You have 13 minutes, until 10:47 a.m.

MR. KEITH BAIN: Madam Chair, I just have a couple of questions before I turn it over to my colleague. Just for my own satisfaction, I guess, we talked about the influenza vaccine and many times we hear a person goes to their family doctor with the flu, can we say, and they will get the response that the vaccine doesn't protect against this particular strain of the virus. So does that strain become part of the vaccine the following year? Was I correct in hearing you say that?

MADAM CHAIR: Dr. Strang.

DR. STRANG: I'm a bit concerned if family doctors are giving that information. It shouldn't be a frequent message because even this year when there is not a complete match, there is some 50 per cent protection so the vaccine is still beneficial. How the process works is the World Health Organization has a number of laboratories, I think there are four or five of them across the world, which closely monitor the strains of influenza virus and their expertise, they are able to make some predictions of what the strains are likely to be for the next flu season on both the northern and southern hemispheres. They will make recommendations. For Canada, the recommendations have already been made for next flu season so it's in late Winter-Spring. They will recommend to the vaccine manufacturers, these are the three components you put into the flu vaccine for next year and then the vaccine will be produced. Unfortunately, the way the technology is, we do have that time lag and there is a potential for further evolution of the flu virus in a way that we didn't quite anticipate and I said in most years, we do have a good manage between what's out there and

what's in the vaccine. Some years the predictions are not as good and then we have some of a mismatch.

MR. BAIN: I guess that's where a doctor would say not full protection, I guess that's in fairness to . . .

DR. STRANG: That was the situation this year where one of the strains was only partially protected by this and it was in the media around that the vaccine isn't as fully protective as it usually is.

MR. BAIN: My other question is you mentioned the process for vaccines, the family physician doesn't keep a large inventory, he does keep an inventory but not a large one, and he or she in turn then orders it from the DHA, through the province to the manufacturer. Now, I guess my question would be, we've gone that process now, just coming back and there are controls in place, what happens when it gets to the family physician's fridge? Are there controls in place by Health Promotion and Protection to make sure that that's being kept at the proper temperature at all times and, you know, what happens when it gets to either the DHA or the family physician?

DR. STRANG: Certainly within Public Health we have very strict protocols around the storage and handling. All our fridges are temperature monitored and alarmed. When it goes to the family doctor's office, they are then taking control of it. We provide them with a whole set of guidelines around what type of fridges and the type of monitoring they should have. Does that work perfectly? No, and we continually are doing education with physicians and frankly we spend more attention on their office staff because they're the ones who actually do that. We are now, with some of our increased capacity, one of the people that is a part of Elaine's team is an immunization coordinator. One of the key priorities we have identified for her is to update our storage and handling guidelines and to do further education with front-line public health as well as front-line physician offices so we have a better understanding and better processes being adopted around the storage and handling.

MR. BAIN: So that's reassuring to know that the process is going up the line and there are requirements as it gets right from the manufacturer back to when the patient receives the vaccine. That's great. I'm going to turn it over to my colleague, Madam Chair.

MADAM CHAIR: Mr. Porter, you have until 10:47 a.m.

MR. CHUCK PORTER: Madam Chair, I just want to bounce back, deputy, I'm not sure if it was you or Dr. Strang mentioned the building of a response, an all hazards response. It's where we kind of left off there. Who are the people or the partners who are involved in this response and partnership and getting the team you've talked of ready? Who are these people?

MR. MONTGOMERIE: We have actually - I'll explain it in the broader sense- in a major event we're part of a corporate response managed by EMO. In an event within the health sector we work closely through a formal arrangement with our colleagues at the Department of Health, Dr. Strang and Dr. Miller, who is a program director at the Department of Health, are colleagues around that process and Russell Stuart, our director of Health Services and Emergency Management manages that process. That ensures that we're connected as departments, also connected to the district health authorities. So at any time or in any way we have the ability to communicate easily and readily and again as Dr. Strang talked about earlier, as something begins to ramp up, then you ramp that process up. It becomes more formalized and it becomes more regular in that kind of way. Dr. Strang might be able to add a little more detail if you need it. That's at the high level.

MR. PORTER: That's fine, no, I was just wondering on that as well, given that things are obviously busy and you're just building this and so on, is there a plan or has there been, you know, because we don't know what the next one will be. I think I asked the question earlier, are we doing anything with regard to a mock exercise in these preparations and so on with those folks you just talked about?

MR. MONTGOMERIE: One of the things that again we're excited about is there is a major exercise coming up over a three-day period called Staunch Maple. Mr. Stuart, as our director of Health Services and Emergency Management and his team have been absolutely critical in getting this up and running but it involves other provincial government departments, it will involve other federal agencies. It is a major event that will test our system in various ways.

I think Dr. Strang would refer to it as sort of an all hazards kind of an event so it will test our public health system, it will test the acute care system, Community Services and so on.

MR. PORTER: Okay, very good. Just a little bit on the handling of the vaccines. Given that Nova Scotia has had quite an experience, I guess we'll call it, a significant one, not yet finished, has anyone come our way asking, Dr. Strang, asking your opinion around the world, who or anyone else with regard to how we're handling it and ways we may be able to assist him in improving ongoing issues?

DR. STRANG: Not from around the world, but we have throughout the outbreak and continue to be in dialogue and sharing with our provincial counterparts and our colleagues of the Public Health Agency of Canada. As I said earlier, a lot of what we put in place - our information resources, I don't know if you've seen our mumps posters, targeted for post-secondary students, they have become a hot item in Alberta.

A lot of what we're doing, we're sharing. At meetings I go to, we continually talk about what we're learning from the mumps, there are lessons learned here for the broader

infectious disease and pandemic. Certainly, that sharing and the understanding and communicating and the lessons learned are happening across the country.

MR. PORTER: Deputy, you talked about a number of staff that have been hired since maybe before and since the recommendations have come forward in building the department. Where do these people come from and are they specialists in a field?

MR. MONTGOMERIE: I'm excited they have decided to join us, quite frankly. Elaine is our Director of Communicable Disease Prevention and Control within our system and she's doing an amazing job building her team, particularly building capacity in the system. Mr. Stuart already referred to earlier, came from the Armed Forces and he has given us a great, very practical, well-focused approach around emergency management. I'd like to say to the minister, Russell keeps us honest because he keeps in the weeds, the practical part that Dr. Strang and Dr. Sarwal and those folks need the kind of support during an event.

We also have a director of environment who came to us from Alberta, Stephen Parker. Stephen is responsible for working and leading with agriculture, fisheries and environment, key collaborative efforts around those areas.

Those are just some of the new staff. Dr. Baikie is returning, who was an amazing resource for us in the past and she has agreed to take on the Assistant Chief Medical Officer of Health's responsibilities and she'll be a tremendous assent and will return in June.

[ 10:45 a.m.]

MR. PORTER: Thank you. I want to ask just one or two more very quick questions. I know my time is growing short. There are 793 current cases, what was the maximum number we reached? Do you recall?

DR. STRANG: I refer that to Dr. Sarwal.

DR. SARWAL: That's actually the number of mumps cases we've had since the outbreak began last February. That's the peak, we were having 40 or 50 cases a week and now we're having maybe one or two a month.

MR. PORTER: One or two a month. That's wonderful, that's great. My last question, and I'll leave it open to any of you who wants to take a chance of answering it, how much longer would you foresee the end of this outbreak as we are referring to it, given the number of cases we currently have, now that we're down to one or two a month.

DR. SARWAL: Like any outbreak, it's a bit difficult to predict. One of the problems now with this ending is that there are now mumps outbreaks across the rest of the country,

particularly in B.C. and Alberta. Given the travel of students at this time of year, we still could have new cases.

The point of this though is that we're always on the lookout and we have the good measures in place that we're not going to go back to where we were last year.

MR. PORTER: Okay. I guess I have time for one or two more. What, start to finish, if I get the mumps, how long am I actively able to pass it on to one of you?

DR. SARWAL: Mumps is something we haven't seen for a long time. A lot of the history of mumps is based on what kids used to get it in the 1950s and 1960s. What we think is that once you get symptoms - the big, swollen glands - you're infectious. Based on studies, it looks like for up to a week or so afterwards you can be contagious. That's why during the outbreak we were telling people to stay home for nine days after they developed symptoms. So it is a fairly long period of time that you can actually spread the disease.

MR. PORTER: What are you treating them with?

DR. SARWAL: There is no treatment for mumps.

MR. PORTER: Thank you very much for the answers today and that would be all the questions I have, Madam Chair.

MADAM CHAIR: The time has now expired for the questioning portion of our meeting today and I would invite the deputy minister to make some closing comments.

MR. MONTGOMERIE: Thank you, Madam Chair, and thank you to the honourable members for your questions. We welcome the opportunity to be accountable and we welcome the opportunity for you to challenge us and to continue to remind us that we have a responsibility to keep our citizens safe.

Mr. Wilson talked about the front-line health workers and I have to tell you a very brief story because I firmly believe the way you believe. During the SARS crisis when we were trying to anticipate, across the country, resource needs for Ontario, we turned inward in Nova Scotia and we asked for support from the President of the NSGEU and the President of the NSNU to help us try to understand. We soon found out that they had better intelligence of what the resource challenges were in Ontario than high level government folks did and we, as a department, respect and understand that our front-line health care workers are pretty important folks to us. So again, we thank you for the opportunity.

MADAM CHAIR: At this time we have just one or two short items of business. We have the letter from Mr. Rafuse, the controller with the Department of Finance which we had

put off from last meeting to discuss at this meeting. What is the wish of the committee? Do you want to do that at this time?

Mr. Steele.

MR. GRAHAM STEELE: With respect to the letter, as you know, Madam Chair, the NDP caucus discussed this and we believe that the current format of the Public Accounts is fine the way it is. We don't want to cut down the amount of information unless Mr. Rafuse can persuade us that, in fact, it costs a great deal of money and takes a lot of staff time to have the cutoff at one place rather than another. But in this age of computerized financial systems, it is hard for us to see how it would make much difference in time and effort and if people are being paid with public money, they should expect the information to be public, so the privacy concerns cited by Mr. Rafuse really don't hold much water with us.

MADAM CHAIR: Ms. Whalen.

MS. WHALEN: I would certainly like to concur with what my colleague has just said. We believe that there should be as much transparency and openness as possible in the Public Accounts and therefore any move that would be limiting or removing some of the information, we think, is moving in the wrong direction.

MADAM CHAIR: I would be happy to write Mr. Rafuse and ask for some clarification with respect to staff time, et cetera, but at this time we wouldn't be supporting a change. It sounds to me like that is the will of the committee.

I tabled a letter from Mr. Lapointe at our last meeting. It was following up on a request for additional information that had occurred in May and that was really for tabling purposes only.

Mr. Steele.

MR. STEELE: If I may, Madam Chair, I did have a comment on it. One of the things the members will have noticed is that it was from a May meeting and it wasn't brought to the Auditor General's attention until the following March. When you read the transcript, it is easy to see and I think perhaps what I would like to suggest is that the committee be a little bit more disciplined so that when one member asks for information, that is not in and of itself a request of the committee. So that at the end of each meeting, perhaps the clerk could read off the items that were requested and the committee as a whole could then confirm whether or not it is a request of the whole committee. Otherwise, it is difficult sometimes for our witnesses to know what exactly it is they are or are not supposed to follow up on.

MADAM CHAIR: I think that makes good sense. Thank you very much.

The final thing is, we continue to have difficulty getting from the Department of Immigration the Conflict of Interest Commissioner's report that we had passed a motion on. I have had the clerk circulate to you the latest letter from the Department of Immigration, from the deputy minister with respect to this. Today is the first opportunity you have had to see this letter so I would recommend that we put off the discussion of this and how we are going to follow up on this until our next meeting. That would be my recommendation.

Mr. Steele.

MR. STEELE: Madam Chair, I think that is a good suggestion. I had asked Legislative Counsel if he would drop in for this portion of the meeting because I think this is extremely serious. We have asked for a document from the government and they are simply flat out refusing to give it to us. I think this committee may as well pack its bags and go home if we don't follow up on this and say to the government if we want a document, we get to see it. Therefore, what I would like to do is propose a resolution which would say:

Be it resolved that this committee affirm its desire to receive the Report of the Conflict of Interest Commissioner and that it authorize its Chair to issue a subpoena to the Minister of Immigration and the Deputy Minister of Immigration to produce the document to the committee without delay.

But I do agree with you, Madam Chair, that actually debating or voting on that motion can be deferred to another day.

MADAM CHAIR: The resolution is in order. However, again, I would recommend that we table the resolution for full discussion at our next meeting, if that is agreeable with the members.

It is agreed.

At this point, I would like to draw the members' attention to the fact that this is the last meeting that our clerk, Charlene Rice, will be here with us. I want, on behalf of the members, to thank Charlene for the great work we have had with her over a very all too brief a time and we wish her the very best in her new position which will be working in the new Department of Labour with the deputy minister. We wish you well. We are sorry to see you go and we very much appreciate the work that we have had with you over the short time that we have had you here with us. Thank you.

At this point we stand adjourned until next week.

[The committee adjourned at 10:54 a.m.]