And it is now time for all questions. I recognize the leader of His Majesty's loyal opposition. Thank you, Speaker. Good morning. This question is for the Premier. Nearly 10 years ago, three women were tragically murdered in Renfrew County on the same day by the same man. Since then, hundreds of women have lost their lives to acts of intimate partner violence. The first recommendation from the coroner's inquest into the murders in Renfrew County was to formally declare intimate partner violence an epidemic. It's a simple yet very important and impactful step that this government has so far resisted. So my question is, will the Premier right this wrong and support the NDP's bill to declare intimate partner violence an epidemic in Ontario? Thank you, Mr. Speaker. I appreciate the question from the Leader of the Opposition. Indeed, the government and this caucus will be supporting the private members bill that comes before the House later today. In fact, we'll be going a step further, Mr. Speaker. The Premier has asked that we seek the advice of the Standing Committee on Justice to do an in-depth study on all of the aspects with respect to intimate partner violence, both the current programs that are available, some of the root causes of it and how we can do better in the province of Ontario. So we will be seeking that advice from the Standing Committee on Justice in the coming days as well. Thank you. Supplementary question. Premier, well, there's not many days when we do something like that. So I want to thank the government for agreeing today. I didn't feel, I think all of us here often feel like we have a great privilege in being able to speak for so many who have been more directly impacted often by things like intimate partner violence. And I always say it's a privilege that we are able to be the ones to be here to advocate. And I do want to thank the government. I am going to move on. I appreciate the government's commitment to creating a committee. I'd like the government to consider taking everything a little bit of a step further today. We are joined, as I mentioned earlier, by dozens of survivors, their supporters, their loved ones. And they're here because, frankly, this government has ignored survivors for too long. This is the same government that cut millions in funding for the Victims Compensation Fund. And they changed the eligibility rules so that it's even harder for survivors to get justice. So I'd ask the minister and the premier if they might consider today explaining to the folks here today why they've taken that lifeline away and perhaps restore it. Thank you. Thank you. Thank you. Again, I think the opposition for the question, oh, look, there are a number of supports that have been put in place. But I think it is fair to say that as we continue to hear more, that we have to do even more in terms of responding to this. We have a very good program with respect to human trafficking that the member for Halberd and Fourth Lakes, Brockton, and in fact, all members of this House said. I think it is an example of what we can accomplish when we work together on this. So we will have the opportunity, should the justice community seek to approve such a study, to do a very, very in-depth study, come back with recommendations on what supports are available, how can we do better. We have heard across different ministries that this impacts different communities differently. I think the committee will have to go into all parts of the province and be given the tools and the resources that it needs to come back with recommendations that will ensure that we have all of the supports that are in place and that we continue to lead the nation in terms of how we respond, Mr. Speaker. So we will do that. And we will work aggressively and quickly with the support of all colleagues to get action on this. Thank you. And the final supplementary. Thank you. Thank you, Speaker. And while I appreciate that the government has agreed to pass the NDP's bill today to declare intimate partner violence epidemic, and I am very grateful that we will have that done today. But I have to stress with the government the urgency of the situation. Everywhere I travel in this province, everywhere I go practically, I have the privilege of visiting organizations that are working with survivors of intimate partner violence. They are struggling. They are struggling deeply. I heard one shelter refer emergency shelter tell me that they feel often like they're losing staff so fast because they haven't seen an increase in base funding in so long that they feel like they've just become a training ground for social workers and other organizations. This is urgent. We need to increase that base funding right now. I would ask the government, let's not push this over to another committee for another ten years or twelve years. Let's get this done today together. Thank you. Government House Leader. Look, Mr. Speaker, I want to avoid today the temptation to talk about and try and defend all of the programs and services that we have brought forward. I think what we're hearing across the board is that more needs to be done. There needs to be more targeted measures and approaches to this. I think we have, as I said, a very, very good example in the province of Ontario. We literally lead the world when it comes to how we combat human trafficking. And we have heard not only from members opposite, from members of this caucus, from different ministers that there has to be a better coordination of how we approach this. I think a standing committee with the full backing of this entire House to go to all parts of this province, have the ability to call ministers in front of that committee, have the ability to call survivors and victims of this, have the ability to, in fact, call on federal ministers to also appear before that committee, do a very in-depth, thorough investigation to come up with reports that we can enact as quickly as we possibly can, Mr. Speaker. Look, I agree. This is a challenge that we're facing, another one of these challenges that we're facing. But as I said, I want to avoid the temptation to talk about, you know, there are many good things that have been done, but we can do better. We will do better and we will ask all parliamentarians to help us in coming forward with something that works not only for the province of Ontario, but it's been so effective when it comes to human trafficking so that we can show the rest of Canada and that we can show the rest of the world how Ontario can lead and do a better job for all. Thank you, Speaker. Next question, the Leader of the Opposition. Mr. Speaker, I have to urge the government to consider, please, reinstating the funding for the Victims Compensation Fund. The government changed the eligibility rules so that it's even harder for survivors to get justice. That fund gave survivors a way to pay for mental health supports or safe and supportive housing, but this government took that lifeline away. This is extremely important. I also want to mention courts again. We were joined this morning by a survivor who had the case against the accused stayed because too much time had passed. We hear this over and over again. We would ask the government to please consider properly funding the court so that victim survivors can truly see justice. I know the government doesn't want us to be talking about all these issues today, but this is what it means to declare this an epidemic. It means that you have to now treat it like the epidemic that it is. And so I would ask again, the government, to restore the funding to the Victims Compensation Fund and ensure that our courts are properly funded. Mr. Speaker, I know that the Attorney General has been seized with ensuring that we have the proper resources in our court system to address this and the other issues that we're facing in the criminal justice system. But as I said, Mr. Speaker, I want to be very clear about this. To the Leader of the Opposition and to colleagues on all sides of the house, everything is on the table. We want to look at every aspect of this so that we can come with a Team Ontario approach to how we deal with the challenges that are being faced, Mr. Speaker. We could include issues with respect to how the federal government, criminal justice legislation from the federal government, it could definitely include the supports that we already have in place. How do the courts deal with this? What are victims? What are the challenges that victims have faced in addressing some of the concerns? Are there obstacles? Are there roadblocks? I would suggest that everything should be on the table, Mr. Speaker. We will authorize, should the committee accept this challenge? We will authorize them and provide them all of the necessary resources that they need to travel the entire province to go to other jurisdictions, if that need be. We will do better and we can accomplish that together, Mr. Speaker. Thank you. Supplementary. Mr. Speaker, the Renford report gave us 86 recommendations. This government, 68 of those are provincial jurisdiction. We don't need another study. The action from this government, 68 recommendations, 68 recommendations, 30 women last year were killed in 30 weeks in this province, 58 women killed in incidents of intimate partner violence. There is no waiting around. There is no need for more studies. They have written you the recipe for getting close to fixing this. Will the government implement the 68 recommendations of the Renford report? Thank you very much, Mr. Speaker. I want to resist the temptation to outline and highlight all of the things that we are doing because there are a number of things that we have done to implement many of the recommendations of the report. I know the ministers, along with the Justice Minister and the Solicitor General have been working very, very hard across government departments to ensure that we have a whole of government approach, but it is clear to us, Mr. Speaker, that more needs to be done and that we need greater advice not only from parliamentarians on both sides of the chamber, but we need to hear from victims of this. We need to hear from subject matter experts. We need to hear from those who respond. What are the challenges that they are facing in helping to deal with this, Mr. Speaker? Everything is on the table. I don't know how much more clear I can be to the leader of the opposition. Everything is on the table. We want to build the programs and services that we already have, but we also want to look at other jurisdictions to see what they are doing and how Ontario can not only copy good programs but be a leader the way we have been in so many other ways, Mr. Speaker, so we will get that job done. The final supplementary. Thank you, Speaker. With the greatest of respect to the minister, we have seen this government use committees and opportunities like this to just stretch things out, and people do not have time for that right now. I want to tell you one of the issues I wanted to raise today as well is the major hurdle that so many who are escaping intimate partner violence experience. Without access to funds, survivors are facing an often impossible choice of whether or not they flee violence with their children and risk that and take the risk of ending up homeless or in living in poverty or living with endless uncertainty. The government is, I think, going to maybe call another committee together. I would again urge the government to consider simply looking at the recommendations of the Renfrew inquest. We have had so many reports over so many years. The trauma that people experience is generational. I would ask the government again, consider what you are being told by the experts, the people living on the front line, the people working on the front line, and please don't spread this out anymore. Let's just get this done, except the Renfrew recommendations. Government House Leader. Again, Speaker. Look, I think the leader of the opposition with the questions, this is about ensuring that we move forward. I know that the minister is responsible and the minister in cooperation has been a whole of government approach to how we deal with this so that we can be as effective as possible in dealing with concerns of not only victims, but those who provide our services, Mr. Speaker. Let me be very, very clear. I have every faith that a parliamentary committee, given the resources that is required, will come forward with very valuable recommendations. We have seen this time and time again. We need not look any further than the extraordinary work that was done on human trafficking, led by the member for Halliburton Court, the Lakes Brocks, but supported by all members. We have done such an amazing job on that, Mr. Speaker, that what Ontario has done has become a beacon of hope for jurisdictions around the world. And now we are going to do the same. I trust parliamentarians to give this vigorous, vigorous study, but I want to go, if the committee agrees, we want to go into every part of this province, we want to go to other jurisdictions, we want to go across Canada, we want to ask our federal partners to participate in this. We will come back with a plan that works better, that improves on what we have already put in place in response to the needs of victims and those who are helping victims. Next question, the member for Windsor West. Thank you, Speaker. My question is to the Premier. I am incredibly disappointed to hear the government House Leader talk about sending this to a committee. To nearly half of the survivors and the parents who have lost children to intimate partner violence and listened to what I had to say years ago, there was an inquest and a jury said that the government needs two immediate enditions that came from that, that for two years says that they are going to support Bill 173 and declare intimate partner violence and epidemic. Not for me, but for the people in the gallery and the people watching at home is don't send it to committee for another study because the inquest was clear what needs to be done. Pass the legislation today, pass it. To make their comments through the chair. To reply for the government, the government House Leader. Thanks again, Mr. Speaker. Look, again, there have been a tremendous amount of resources put forward, a whole of government approach to how we deal with this challenge. I know the ministers have been working on that and have continuously been improving systems, but we know that more needs to be done and that is why we have agreed that we will pass this today. But at the same time, we want to seek the advice of a parliamentary committee to give us a better understanding of what additional supports are needed. We've heard this consistently, we've heard this from victims, we've heard it from members of the opposition that they have suggestions and that we can learn. That is what this parliamentary committee will do, Mr. Speaker. I am disappointed that the opposition is frustrated by that, but I am actually very encouraged by what a parliamentary committee working together can accomplish. We will leave no stone unturned to improve on what we have already built in the province of Ontario. We will look at the justice system. We will look at the services that we provide victims. We will look at ways of making it easier for victims to get those services. We will look at laws or legislation that might be on the tables with the federal government that might need to be changed. We will look at other jurisdictions that will work quickly and effectively and we will criss-cross not only the entire province but we will go anywhere that we need to to ensure that the people who have been victims of this and the people who provide those services get the care and the resources they need to address that. Mr. West. Mr. Speaker, again I will remind the government house leader you've had almost two years, two years to act on that one recommendation among others and you soundly rejected it, soundly rejected it. So there is no trust on this side of the house or for survivors or for victims' families or for the advocates that you are going to move this bill through committee in a timely fashion. So again I ask that you immediately pass it today, pass it through reading and give it royal assent. Regardless of whether the Minister of Energy wants to heckle me previously saying that it's not going to do anything if it receives royal assent. Speaker, the government rejected recommendation 4 which called on the creation of the role of a survivor advocate and they rejected recommendation 5 to institute a provincial implementation committee dedicated to ensuring that the recommendation from the inquest are implemented and reported on. So I'm going to ask the government side, why should survivors and their families and the service providers believe that you are not just going to send this bill to committee in the hopes that nothing actually comes out of it. I will remind the members to make their comments to the chair. Government house leader. So Speaker to be clear that we are passing the bill through the community but simultaneously we will be reaching out to committee and asking them to conclude or to begin the process of a very extensive study on all aspects of intimate partner violence concurrent with the bill being in front of committee. We will have the ability to call ministers in this government, we will have the ability to call victims in front of the committee, we will have the ability to call providers of services and we will crisscross the entire province to find out what we can do better and how quickly we can enact some of those changes. Look I can sit here and highlight all of the great work that the ministers have done to address this but I don't think today is the day for that. What we are going to do is we are going to engage all parliamentarians in an effort to replicate the great work that we did on human trafficking. I think members on both sides of the house will agree that what we accomplished on human trafficking is an example of parliament working at its best and I believe that we can do the exact same thing here and we will provide the resources necessary to do just that. The next question the member for Perth Wellington. Thank you Speaker. My question is to the Minister of Energy Speaker. We all know that the people of Ontario are struggling with the rising costs of food, fuel and everyday essential items because of the federal liberal carbon tax. However, when the premiers of all political strikes speak, NDP, Liberal, PC, the members opposite are saying no but it's the truth speaker. Even the NDP Premier in Manitoba is against the federal liberal carbon tax and the Prime Minister said that they were making political hay speaker when they did that. I don't think our Prime Minister has ever lifted a bail hay in his life speaker. When I speak to farmers in my riding of Perth Wellington, I constantly hear about how the production I have lifted plenty of bills of hay sir, I grew up on a farm and I am proud of that. The rising expenses for our hardworking farmers are only making food more expensive for all Ontarians. The federal government needs to enact now and get rid of this regressive tax speaker. Can the minister please explain how the carbon tax is driving up the costs of everything for Ontarians, especially our hardworking farmers? Thank you. Thank you. I can tell the time. Thanks very much. Minister of Energy. Thanks very much and thank you to the very robust member from Perth Wellington who comes from one of the largest agricultural communities in the entire province, Mr. Speaker. And the carbon tax isn't just affecting energy bills, the cost is affecting everything that we purchase in the province and making life more unaffordable for the people of Ontario and that's why under the leadership of Premier Ford we fought the federal carbon tax since 2018, Mr. Speaker. It is, you know, causing obviously a tax on greenhouses where tomatoes are grown. It's putting a tax on the transportation to get those tomatoes to the grocery store. It's creating a tax at the grocery store where they're paying the carbon tax, Mr. Speaker. So clearly it is having a multiplying effect and driving up the cost of everything and everybody seems to understand that across Canada, except for federal Liberals and Ontario Liberals in this house. We know the Queen of the Carbon Tax, Bonnie Cromby, supports her federal cousins Justin Trudeau and Stephen Gibo. We don't, Mr. Speaker. Supplementary question. Thank you, Speaker. And thank you to the minister for that response. Last week the grain farmers of Ontario said they were going to see an additional $2.7 billion worth of expenses because of the federal liberal carbon tax. For vegetable growers they're looking at an additional $90,000 per acre in carbon tax by 2030, Speaker. Speaker, that is more than three times what the current cost of farmland per acre is in Ontario, Speaker. Our farmers need our support and that's why our government continues to fight this disastrous liberal carbon tax every step of the way. But Speaker, the Queen of the Carbon Tax, Bonnie Cromby, has never seen a tax she does not like. To this date, the Liberals in this place still refuse to stand up against this carbon tax. Speaker, can the minister please tell this house why Ontario families cannot afford this tax increase that Bonnie Cromby is planning for? Thank you, Speaker. Minister of Energy. Speaker, I want to thank our Minister of Agriculture who hosted an event along with the Premier last week with a number of different farming organizations including the grain farmers of Ontario to talk about the impact that the carbon tax is having. It's ironic actually that it's driving up the cost but it's actually discouraging reducing emissions across the agriculture sector because many of these grain farmers and many other farmers, you know, want access to natural gas so they can move away from more emitting fuels to this less emitting natural gas. Now the federal Liberal government wants to slap the carbon tax on everybody and they don't just want to slap it on now, which they did last week, they want to increase it by triple by the end of the decade, Mr. Speaker, which is unheard of. It's going to make everything in our province unattainable and more expensive, Mr. Speaker. At the same time, the NDP in this House are opposed to Bill 165, which is going to make it impossible for natural gas to be extended to these same grain farmers who want to use it to drive down their emissions from higher emitting fuels, Mr. Speaker. So there's only one party you can really trust when it comes to the energy system in Ontario and that is Premier Doug Ford, our Ministry of Energy that's making life more affordable for the people of Ontario in spite of the Thank you very much. Thank you. The next question, the number four, Mr. I have a question for the Prime Minister. Violence committed by people who are in intimate relationships, the government closed the provincial police station at Abogama and the long times when people are calling for help, it's created a lot of dangers. I'm happy that the government is going to agree with the bill that's been presented by the NDP, but is the government going to assure us that we're going to have solutions as soon as possible to help Francophone and northern Ontario communities? Again, I appreciate the question from the member opposite. Of course, we're going to work as quickly as we can. We understand the severity of the situation. As I said, there is no point in us highlighting all of the extraordinary work that has been done already. I think there are a lot of things that we can be very proud of, but we have to do more. Right? We've heard that loud and clear that more has to be done. There needs to be more work done with respect to how it is impacting the northern communities. We've heard from various other communities, too, that it is impacting them in different ways. We've heard, frankly, across the country from our partners in other provinces that more work needs to be done in cooperation with each other. Of course, the people who provide services to the victims have asked for better coordination. So, yes, absolutely. We will work quickly. We have extensive study, but the committee can work as quickly as it possibly can. And we will provide it with the resources that it needs to get the job done properly, Mr. Speaker, and provide parliament recommendations that we can act upon as quickly as possible. Thank you very much. A supplementary question from the member for Kuwait now. Miigwech. Speaker of the First Nations Police is funded as a program, not as an essential service. Extra resources are needed to ensure women experiencing intimate partner violence on reserve. Get referrals to victim services they need. If First Nations policing were essential services, they wouldn't need to apply to get this kind of funding. Speaker, will this government stop underfunding First Nations police support services? Mr. Speaker. Well, thank you, Mr. Speaker. I want to thank the member for the question. We take public safety all across Ontario very, very seriously. And as the federal government is considering making it the essential service, as the member opposite said, this is something that we will absolutely support. But in the meantime, as the member knows, as the Community Safety and Policing Act came into force just last week, First Nations police communities have the right to opt in and we hope that they do so that we will continue to fund adequate policing services and to provide those monies for the communities that they need. I take this responsibility very, very seriously. I take public safety across Ontario very seriously. Thank you very much. Next question, the member for Newmarket Aurora. Thank you, Speaker. And my question is for the Minister of Transportation. The carbon tax is hurting our economy and businesses. When I spoke with many families and business owners just last week in my great writing of Newmarket Aurora, they were telling me that they feel that the federal liberals are out of touch. They are especially concerned about how the federal government is adding to the cost of living by increasing the carbon tax yet again. People in our province are already struggling with high interest rates and living expenses. Speaker, the last thing they need is another tax hike. Unlike the opposition, NDP and the independent liberals, our government will not stop until the federal liberals scrap the tax once and for all. Can the Minister please explain the impact the federal carbon tax is having on Ontario families and businesses? To reply, the Minister of Transportation. Thank you very much, Mr Speaker. My colleague is absolutely right. In fact, Mr Speaker, last week we joined farmers, truckers, small business owners, workers in urging the federal government to scrap the 23% increase to our carbon tax. We know it makes life harder for businesses and families across this province. While those businesses and families are struggling, the federal liberals continue to pursue an increase to the federal carbon tax. We know there are going to be more of these. But what's most surprising, Mr Speaker, is that Bonnie Cromby and the provincial liberals refuse to add their voice and asking the federal government to scrap the carbon tax, Mr Speaker. We will always be supporting small business owners, truckers and farmers in our fight to stand united against this carbon tax. Supplementary. Thank you, Speaker, and thank you to the Minister for his response. Every day, the hard-working men and women in our trucking industry deliver the goods that we all rely upon. They play an essential role in keeping our hospitals equipped with the supplies they need and keeping the shelves stocked at our grocery stores. However, Speaker, the carbon tax only makes it more expensive for our truckers to do their job. While the carbon tax queen Bonnie Cromby and her liberal party continue to ignore the concerns of our constituents, our government will always stand up for the Ontarians. It's time to eliminate the tax now. Speaker, can the Minister please explain the impact the federal carbon tax is having on our trucking industry? Minister of Transportation. Thank you, Mr Speaker. The carbon tax makes it harder for truckers to deliver the goods that we all need. The unsung heroes of our economy, whether it was during the pandemic or every single day, they are the reason our store shelves are stocked, our pharmacies are stocked, our materials are getting to places across this province. But let's listen to the Ontario Trucking Association, Mr Speaker, that says the carbon tax raises the cost of deliveries by 6%, Mr Speaker. And that doesn't even take into consideration the cost to truckers as they deliver these goods. $15,000 to $20,000 is what the carbon tax costs a long haul truck driver in this province, Mr Speaker. That is $15,000 to $20,000 that could be going towards their families. That's $15,000 to $20,000 that could be going to them to make life more affordable and secure for themselves. So we continue to call on the federal government and our provincial liberals to condemn this 23% hike, Mr Speaker, because we need to support the drivers and the people of this province. Thank you, Mr Speaker, my questions to the Premier. 18 months ago I stood here, right here, demanding action on the Renfrew County recommendations. What did we get? Half measures and empty promises. Since then, Niagara declared the intimate partner violence is an epidemic. Since then, Niagara women's shelters like Gillian's Place and Gateway had to turn away nearly 1,000 women for lack of space.   Minister, boost the shelters. Commit to base increased base funding and give our survivors the resources in the affordable housing they desperately need right now. Minister, if you're serious about inter-partner violence and you care about the survivors and respect them, when will you act on this, Minister, and implement it? Again, I'll remind the members to make their comments through the chair. Minister, children, community and social services. For the question, and I thank all the members here in this House, Mr Speaker. Through our government, I thank the leadership of Premier Ford. We have made this very clear from day one, Mr Speaker. This is an issue that affects all communities across the province. It requires action, which is why in December Minister Williams joined me in announcing Ontario stands. Mr Speaker, it was a statement to the province that we take this issue seriously and we back that up by investments working with the federal government. I said this throughout the entire time that I've been a minister at this ministry, Mr Speaker. No woman or girl in this province should ever have to live with the fear of violence or threat or exploitation. We will stand with them. We will make sure every single provider that's helping to partnership with us across the province will have a partner in our government. We will not let them down, Mr Speaker. A supplementary question, the member for Oshawa. Thank you, Speaker. I'm wearing purple today in support of the very brave women who endure violent and often unseen crimes. There is no excuse for violence against women ever. The Violence Prevention Coordination Council of Durham represents 35 local agencies and they have reported a significant increase in demand for assistance. These aren't numbers, these are women. I'm pleased that Durham Region a year ago adopted the number one recommendation of the Renford County Inquest to declare intimate partner violence and epidemic in this province. We're glad to hear that the province is going to, but I can't just say thank you. I'm going to say that many women that Luke's Place Support and Resource Center that they're working with don't have access to a lawyer. Legal aid could waive the eligibility requirements for victims of domestic violence. The province could put money in to legal aid. So we're going to ask for specifics. Will the government put money into legal aid to ensure women leaving abuse have the legal support that they need? Thank you. The Minister of Children, Community and Social Services. Thank you very much Mr. Speaker and I thank the honourable member again for the question Mr. Speaker. Through Ontario stands, as I mentioned when we worked with the federal government, there were initiatives here in support in this statement and this action plan that the province has forwarded. Mr. Speaker, the investments that we announced in December to all the partners on the ground, an additional $18 million for the duration of this fiscal year. That investment will increase Mr. Speaker. In budget 2024 an additional $13.5 million was added to the support. Mr. Speaker there's a lot of great work that's being done on the ground by service providers and partners. We want to make sure they have the resources to be able to provide those supports. That needs to become backed by investments. We've passed legislation to make sure that happens so that people are protected but that needs to be backed by investments and I thank the Premier for the commitment and I thank the Minister of Finance as I said Mr. Speaker, we will not let them down we will make sure that they have the support they need on the ground to help every single person in every community. Thank you Mr. Speaker. Mr. Speaker, retired judges have warned this Premier to give up his agenda of taking away Lady Justice's blindfold and replacing it with blue tinted glasses. Justice doesn't come from judges thinking like the Premier but from judges believing that they have a duty to follow the law and their conscience and to serve the people. For everyday disputes people rely on Ontario's tribunals and expect to get a fair shake. The powers that be can't just do whatever they want but under this government experienced adjudicators appointed under the previous government were not reappointed leaving many vacancies. The landlord and tenant board social benefits and human rights tribunals lost 35% of their members by 2020. Will the Premier admit he is taking his time to find and appoint like minded adjudicators for Ontario's tribunals? To reply, the Attorney General. Thank you Mr. Speaker. Not only are the tribunals independent but so is the recruitment process Mr. Speaker and I'm very proud of the fact that we have doubled the number of landlord tenant board adjudicators Mr. Speaker in the last hour or while. It's unfortunate that the tremendous members that we have across the 15 tribunals under MAG are being slighted by the member opposite Mr. Speaker they are professionals who are doing the work of the people of Ontario in an independent and fair manner Mr. Speaker and it really is unfortunate that the member wouldn't celebrate that with us. Supplementary back to the member for Kingston in the islands. Mr. Speaker the Attorney General touts the large number of adjudicators now working at the LTB but here's the story. They let the big tribunals lose a third of their experienced adjudicators in 2020 and backlogs grew. By last year LTB backlogs had grown from 14,000 when they took power to 53,000 so they had to react to a problem they created. The LTB has doubled the adjudicators it had when the Conservatives took power in 2018 but things have not improved. Big problems double the payroll that'll fix things kind of like the Premier's own office. Will the Premier acknowledge the grief and financial losses because landlords and tenants and victims and accidents harassment and discrimination have had to wait too long? Will he admit that this can't happen again whenever the government changes? Will he support Bill 179 the few ad-logs and less partisan tribunals act and send it to committee? Attorney General Thank you Mr. Speaker and just by way of an update I guess for the member who may not have been paying full attention of the 15 tribunals 13 have come back to balance after COVID we are now hitting our targets in 13 of those 15 tribunals and we are well on our way with the landlord tenant board Mr. Speaker by putting in resources for administrators for adjudicators for back office systems Mr. Speaker that the Liberals let go follow they were broken when we got here we are fixing it we are getting it done Thank you Mr. Speaker Next question the member for Hastings Lennox and Addington Thank you very much Mr. Speaker My question is for the minister of natural resources and forestry Last week when I was in my riding of Hastings and Addington I heard from so many constituents about how the federal liberal tax is simply making their life unaffordable Ontarians are already coping with high interest rates and a rising cost of living and the last thing they need with last week's hike the liberal carbon tax is now forcing Ontarians to pay 17.6 cents on every leader of gas that's hundreds of dollars a year for the average household speaker and unlike the Liberals and the NDP members across the aisle who are still refusing to admit that the carbon tax cost all of us our government will always speak up on behalf of Ontarians the federal government needs to scrap this tax now will the minister please tell us how our government is keeping costs down for Ontarians while the members office continue to remain silent Minister of natural resources and forestry Thank you very much Mr. Speaker First I want to thank the member for Hastings and Addington for being a great PA for me for almost two years did an absolutely fantastic job and I know the member from Newmark and Aurora Speaker you know we all know that when you go to work every day you're paying the carbon tax in your vehicle driving on the road but you know you're also paying it off the road too we've got members of the Ontario Federation of Trail Riders here today that are supporting responsible trail use all throughout Ontario with off-road motorcycles and every time you gas up that motorcycle now you're paying a carbon tax every time you want to enjoy the great outdoors by riding your ATV filling up your boat you're paying a carbon tax it's almost Mr. Speaker almost like the federal liberals and their Ontario cousins here do not want people to enjoy the great outdoors in Ontario taking away a little bit of fun a little bit at a time with the carbon tax it's time for them to end this carbon tax time for them to support people getting out and enjoying the great outdoors in Ontario supplementary thank you speaker and thank you to the minister for his response and for being a great leader for me for the last couple of years it's just not fair to punish the hardworking people in our province with this carbon tax life has only become more challenging for individuals and families in both rural and northern Ontario who end up relying exclusively on their vehicles for transportation they are being hit hardest at the gas bumps and at the grocery stores and what's worse is that Bonnie Crombie the queen of the carbon tax and her Liberal cohort want to keep on rising increasing your gas prices and bring back the cap and trade system they're just like the federal liberals who take every opportunity to add more costs to Ontarians bills they've never met attacks they wouldn't raise can the minister please explain what our government is doing to make more affordable for the people of rural and northern Ontario and all across this province thank you Mr. Speaker you know what we're doing is exactly what the liberals aren't doing which is supporting the people of Ontario every day supporting them with the actions of the minister of finance and the premier of Ontario reducing the cost of gas in this province so people can get up in the morning take their kids to school let's think about the life of a northern Ontario person they're going to get up in the morning they're going to take their kids to school they're going to fill up their truck pay a bunch of carbon tax go to the grocery store pay a bunch of carbon tax on the food that got shipped there go to work for a while go home pick those kids up again all this carbon tax baked into it they're going to want to go out for a little bit of fun afterwards maybe take the kids to the arena or get on that off-road vehicle and enjoy it carbon tax, carbon tax, carbon tax Mr. Speaker I know April 1st is coming gone but it's never too late to do the right thing is somebody once said on the other side of the aisle one time let's get rid of that carbon tax our friends across the aisle know that it's the wrong thing for Ontarians tell your federal thank you thank you very much next question the member for Ottawa Central thank you speaker my questions to the premier Ann Marie and Jasmine Reddy were killed in their family home almost two years ago by a young man with a history of assault and sexual harassment their father Raphael Reddy has now devoted his life to ending violence against women and he wants this house to act on recommendations 32 and 33 of the Renfrew County Ingress Report so we can reach perpetrators of violence against women and people who are likely perpetrators of violence against women is the government committed to implementing those recommendations today the associate minister with responsibility for women's social and economic opportunities thank you Mr. Speaker thank the member for the question and I want to just commend that man for the work he's doing to make sure the tragedies that have happened have not happened in vain and I want to make it very clear that we no women should ever be subjected to violence no women should ever have to live in fear and that's why I know we are working really hard in our government to put strategies in place to ensure that we're looking to community and organizations I want to encourage everybody to take a look at Ontario stands for the minister of responsible community children's social services we went and brought this to Ontario and we said we want to hear from you and the minister of responsible calls for community organizations to bring us the proposal so that we can fund and close the gaps to keep women safe in Ontario and so please if community members don't know about it share Ontario stands because we believe every woman has the right to be safe in Ontario my question is to the premier just last year a Niagara woman a first responder to what police called an active intimate partner violence the family is devastated navigating a broken and difficult system to find justice for their loved one that was so cruelly taken from this world as one of the most heartbreaking realities for a family is the knowledge that this type of violence is far too common nearly 100 municipalities have declared IPV including Niagara will the government do the right thing today support my colleagues bill to declare IPV and epidemic immediately a study is not needed the recommendations are clear declared an epidemic today thank you Mr. Speaker and again I thank the honourable member for the question as the government house leader indicated already we are looking at passing this and as he mentioned taking it a step further to make sure all members of this committee have the opportunity to contribute to the solution all partners who are doing great work on the ground are contributing to this Mr. Speaker that is what our government has said from day one I have said this on many occasions this is an issue that affects every single person in every community of our province we need to work together which is why we signed the national action plan an agreement with the federal government for us to be able to work together this is not a partisan issue we will work with municipalities we are working with all partners on the ground to make sure that we end violence against women in all its forms in every community and we need your help you need to come together we need to work on this committee to make sure that we hear from survivors we hear from community partners Mr. Speaker we invest over $250 million annually on violence against women initiatives over $10 million on preventative measures thank you very much thank you the House will come to order the next question the member for canada carlton thank you speaker this government insists on tightening the belt for everyone but themselves they've cut the salaries of nurses and healthcare workers teachers and education workers even air ambulance drivers but a quick look at the premier's office and you will see his budget has exploded his staff is being paid $6.9 million the most expensive premier's office in history 48 staffers not just in total but 48 staffers are earning more than $100,000 every single year when this premier was running for office he said he'd be the one to stop the fat cats to stop the gravy train but he's worse than any of his predecessors spending $6.9 million every year the premier is the most expensive premier we've ever had more than double any other premier when ontarians face austereo how will the premier explain his runaway and self-serving expenses the people of ontario and she was fine thank you very much thank you very much speaker really an ironic question come from the member opposite who is a member of a federal government to expand the civil service by what 35% whose federal cousins are literally devastating the community that she represents Mr. Speaker but you know what we're going to do we're going to go back to the people of ontario two years from now we've put in place the climate that has seen 700,000 jobs created in the province of ontario we've cut red tape we're building subways Mr. Speaker we're building hospitals Mr. Speaker we have got over $40 billion worth of economic development jobs created in the province of ontario you know why Mr. Speaker because we're doing the work that is necessary to make ontario the engine of the economy of the country and we're going to be more tolerant and scream and Mr. Speaker because for them what they like is when Canada and Ontario doesn't work we're going to ask the member for Ottawa south to come to order and the member for Mississauga center to come to order supplementary question thank you speaker this government is wasting time and money by continually needing a do-over implementing disastrous legislation to repeal it months later the green belt urban boundaries bill 124 and now development charges now it's not a bad thing to reverse a bad decision but you need to learn from your mistakes rather than continuing to follow an unintelligible ideology measure twice cut once was my dad's advice but the premier okay with wastefully burning through ontarians hard-earned tax dollars while expecting ontarians to scrimp and save well let's be clear Mr. Speaker what we're doing is putting more money back in the pockets of the people the province of Ontario it is actually the Liberals who have said that they will reverse the tax cuts that we have made right the Liberal leader actually said so that when we put more money back in the pockets of hardworking Ontarians it's a gimmick because what they want to do again is increase taxes Mr. Speaker for the people the province of Ontario they want to drive away jobs because we know what the Liberal plan always is right it is to make people responsible to government it is not to help people Mr. Speaker they want people to rely exclusively on government Mr. Speaker what we want to do is build an economy where all Ontarians can thrive we don't want a carbon tax they do the taxes that we've reduced they want to increase their very first job of the leader of the Liberal party was to beg for a million dollars to come Order Member for Ottawa South will come to order the minister of energy will come to order the next question the member for Thornhill Thank you Mr. Speaker my question is for the minister of economic development job creation and trade so there are plenty of countries around this world who have proven you can take climate change seriously without an inflationary carbon tax so unfortunately Trudeau's Liberal government has chosen to implement a carbon tax that punishes the hardworking people of this province by driving up prices across the board you don't fight climate change by taxing citizens until they can afford to heat their homes, drive their cars and put food on their tables just look south of the border where politicians of all political stripes are vehemently against the idea of a carbon tax can the minister please highlight how since we took office we've strengthened our trade relationships with the US who doesn't have a carbon tax Order Minister of economic development job creation and trade Thank you Speaker when we are in the US companies tell us they cannot comprehend this carbon tax they know any additional taxes are harmful now Ontario is the US's third largest trading partner after Mexico and China $494 billion in two-way trade between Ontario and US that's up more than $100 billion since we took office but all the products that these companies buy from us are now more expensive because of this carbon tax we are putting our trade at risk with our largest partner because of these rising prices Mexico does not have a carbon tax the US has alternatives than buying from Ontario scrap the tax Supplementary question Thank you Mr. Speaker and thank you to the minister for his globe trotting and tireless efforts for the people of Ontario the federal liberal government always touts how well the US is doing on climate change but what they don't mention the US does not have a carbon tax that raises the cost of everything the Trudeau liberals continue to hike their carbon tax all the while their friend Bonnie Cromby says nothing if the liberals listen to the businesses and workers of this province they would understand that no one supports their carbon tax in 2019 they told everyone the carbon tax wouldn't increase but it's now costing people an extra 18 cents a liter at the pump while it drives up the prices of everything Speaker we know where the US stands on carbon tax but can the minister talk about what Ontario's other trading partners think about the liberals carbon tax Minister of economic development job creation and trade Speaker companies always ask us to explain the federal government's carbon tax and it is a difficult answer because one in five jobs in Ontario depend on trade Ontario has tariff free markets in over 50 countries around the world adding a carbon tax is adding a cost to everything we sell globally the federal liberal carbon tax is putting companies sales at risk it's putting our economy at risk it's putting Ontario jobs at risk now Ontario we've lowered taxes we're showing the liberals that there is a path scrap the tax today the next question the member for Waterloo thank you very much speaker my question is to the Premier and I want to acknowledge that today is a very emotional day for many of us including the survivors who are here with us today I'm thinking LaTonya Anderson from Whitby and Angie Sweeney from Sault Ste. Marie Argentina Fuentes from Mississauga they lost their lives to intimate partner violence their families do not need to go through another re-traumatizing committee work we have the answers to address intimate partner violence we need to apply them money speaker is actually or rather lack of it has always been a major hurdle for those trying to escape and abuse poverty often keeps women and children in unsafe situations and without access to supportive funds survivors face the impossible choice of living under ever present threats of death or flee into poverty homelessness and endless uncertainty that's why it's more urgent than ever that we fund and build supportive housing options to the Premier why was dedicated funding for supportive housing for survivors of intimate partner violence left out of this year's budget again Minister of Children, Community and Social Services Thank you very much Speaker and again I thank the honourable member for the question Mr Speaker as I mentioned through Ontario stands we all have a proposal in place where in every single community they can put forward proposals for support in the during the duration of the national action plan which is we're in the second year now that is backed by investments that we do there are localised solutions that community partners are aware of we want to hear from them we want partners on the ground to come forward with ideas and submissions for us to be able to support them that is what the call for proposal is about we invest it in our partners in the first year the second year we are looking at working with them on localised support supports Mr Speaker that in rural and downtown Toronto we want to hear from the partners on the ground who we're ready to work with them to make sure that we combat violence against women in all its forms in every corner of this province Mr Speaker That concludes question period for today to do a point of


B. Dollywall is currently the director of many things at the University of Pittsburgh Medical Center, including cornea and refractive surgery, cornea and external disease, medical director of their laser center, and the Center for Integrated Eye Care. She also has some training in acupuncture. I understand she gave a great talk last night, and she was a medical student at Northwestern, was a resident at the University of Pittsburgh, came here and did a fellowship at Moran in cornea, external disease, anterior segment surgery, and was selected as our alumnus of the year. That's why she has been invited here to speak to us, and we are thrilled to have her here to talk to us today. We did have a little bit of a speed bump with the computer, but it's here to be cooperative now, so I'm going to turn things over to Dr. Dollywall. Thank you. There you go. Thank you so very much for that introduction. You'll recognize a few of these cast of characters as I go along the way here. I was here 21 years ago. Mark, Mark Mifflin, and I were co-fellows. I know he looks a lot younger than I do, but we are the same. So anyway, I'm coming from Pittsburgh, and I have to say, I really feel like I'm coming home to Utah. You guys are just a family, and it's been just a wonderful road. Instead of doing a talk on the latest in corneal transplantation, I decided to do something a little bit more fun, I think. I hope you'll tell me that is more about kind of the lessons I learned. And when I think about my life, I realize that a lot of the stuff that I still do now, it's because I learned that in fellowship. It's kind of scary, but really true. So my title is All I Really Needed to Know I Learned in Fellowship, and I'm going to go through several lessons to kind of highlight that. So these are my disclosures. And really, it all started with a visionary. Too bad Randy's not here. I saw him last night, and he had to be in Chicago because he's such a visionary. And so he had the foresight. Now think back 21 years ago. Refractive surgery was just kind of really the cowboy operation, right? I mean, very few fellowships offered refractive surgery training. You were kind of lucky if you got to run after a refractive surgeon on a certain half days, but there weren't really a lot of fellowships that said, you know what, you will learn a systematic kind of approach to it. And then Randy Olson developed this amazing fellowship where he kind of married cornea and refractive surgery. So what it was is you did refractive surgery for six months with Charles Casebeer. And this was the Casebeer Center for Character Refractive Education and Research that's in Scottsdale, Arizona. And then you would come back and spend six months with the home team. And in those days, it was Randy, Claren Aldridge, and Tom Clinch. So really incredible lessons learned. My fellowship was a life changing experience. And really it formed this broad and stable foundation upon which I built my career.  First lesson number one, it's okay to take a risk. And when Randy started this fellowship, it was outside the match. It was brand new, and I didn't know, was it good, was it bad? So I asked everybody I knew what I should do. So all the faculty, University of Pittsburgh, when I said, should I do this fellowship in Utah?   I said, okay, I guess I shouldn't do it. And I asked Peter Leipzig when I went to interview there. He said, no, you need to come to Wills. I said, okay. And then I asked my friends, actually these friends that were a little bit more forward thinking in Pittsburgh. And he said, absolutely, what's wrong with that fellowship? That sounds amazing. So I said, all right, I followed my heart because I really wanted to come here. I just needed one person to say it was okay. And so I found that one person and I called Randy and I said, okay, I'm ready. So I took a risk and it really ended up being one of the best decisions of my life. So it's okay to take a risk, follow your heart. The other thing is life is really full of opportunities. And if you always stay guarded and kind of in the middle of the road, yet your life may not reach its full potential. And so you sometimes have to reach outside that comfort zone to experience life to the fullest. And really, no risk, no reward. And of course, they should be calculated risks. All right, lesson number two, if you are at the cutting edge, you can get cut. So Mark and I had the opportunity to spend a lot of time with Charles Casebeer. And he was a true pioneer. I mean, they would have model one of a micro keratome and Charles would be trying it. So you would do these new procedures like automated lamellar keratoplasty. ALK and we would, you know, some things worked well, some things did not. So hacks, which was hexagonal keratotomy, not so good. In hyperopic ALK, what we did is we cut 70% into the cornea to create a controlled ectasia to create a myopic shift. So it's kind of scary. Dr. Patel's shaking his head, you know, the retrospectoscope is always very clear. But at the time, when you're doing these things, you're not sure. But some of those principles of corneal and lamellar surgery are still useful today. So the basic things about incisions, really important, like astigmatic keratotomy, what we do, or LRIs, you're basically segmentally flattening a given meridian to neutralize astigmatism. You all know that the longer incisions have more effect, closer to the optical zone, you're going to have more effect. And because of coupling, the spherical equivalent does not change. So I learned that back then and it's still true now. Another super important concept that we learned by doing ALK is that there is something called the stromal structural threshold. And to prevent ectasia, you have to leave enough untouched cornea behind. And how much is that cornea? Well, the rules that we used were either 50% of the corneal thickness or at least 250 to 300 microns, whichever is greater, should be untouched. And the Lasik flap does not provide any tectonic support. So this type of equation is really important where you take the corneal thickness and you subtract the flap thickness with the ablation depth, and that should always be greater than 50% of your cornea or 250 microns. And again, in a hyper-opic ALK, so for those of you who don't know, when Mark and I did our fellowship, there was no FDA-approved eczema laser. So we basically did this procedure where we made a flap just like in Lasik, but we had no laser that was FDA-approved. We had an investigational one that was in Scottsdale, but we couldn't use it. So then to decrease the, or to change the curvature here, we would just take the same microkeratome and just slice off a little extra cornea there in the center. All right. So, but the thing that we have to remember is that we have to thank the pioneers. If it wasn't for them, we would not be doing Lasik now. So if we didn't do ALK, we really would not be doing Lasik. So really, we should just take a minute and thank those pioneers. I'm definitely not a pioneer. I follow those before me. So this is a picture for those of you who haven't seen. This was the automated corneal shaper. And I'll show you a picture of the inventor of this later on, Louis Ruiz, but this is the actual type of microkeratome we used. We didn't have femtosecond lasers. And then things could get caught on here, like lashes and drapes and things like that. Lesson number three, we learned how to be a pilot. It was really exciting. So Charles Casebure was a pilot. And as a fellow, we would be the co-pilot oftentimes. We'd have the headset on. We'd be sitting there. And it was wild. OK, so this is the type of plane that we flew in. It's a turbo commander. And his was 2-4, Charlie Charlie. I still remember. I remember flying into O'Hare Airport with Charles in the turbo commander. And there was a huge 747 next to us. And he was really amazing. So the key that he brought into ophthalmology, because he was a pilot, he brought this whole aviation framework into ophthalmology. So that whole concept of a pre-flight checklist, that came from Charles. And it's something that we even think about right now. So you want to make sure you have everything's in order. Everything's a system. And he would give courses. And he would say, you know, you have to say, well, if engine two doesn't sound right, you're not going to proceed. So that's a good way to talk to your patient. So if you have a laser that's malfunctioning, you just make this analogy to aviation, to flight. We often are in the airports and our flights get canceled, because engine two does not sound right. So they kind of get it. And they're less upset, because this is just high-tech stuff. The other thing that he taught is to have a system. The same ingredients come in. You do the same thing every time. And you'll get very predictable post-op results. And that is another critical thing, be methodical. Another lesson, lesson number four, is never let them see you sweat. And this was a lesson that we learned during our fellowship, especially in Scottsdale. So we had visitors from all over the world fly in to this case beer center. And they would watch all these cases through glass. So basically, there was glass. And then there you were using the micro-caratome, doing radio-caratotomy, doing all this stuff.  And Charles was kind of showcasing you and him and all this, so you had to develop this kind of sense of confidence. And even if you didn't really know, you just had to kind of fake it till you make it. So this confidence is really a critical, critical thing in terms of successful doctor-patient interaction. So when you walk into a room, you got to own it. And when you're examining the patient and you don't know what they have, that's OK. Just answer your pager, exit the room, look it up, and go right back in there, OK? You don't have to say, oh my god, I have no idea. Don't be perplexed, right? The key is these patients know less than you.  So call your, call a friend, phone a friend, whatever you need to do to get the answer that you need. So I think that's really important. And I get, we all see patients as third opinions, fourth opinions, and we don't give a different opinion necessarily, but when you say it with confidence, ma'am, you have XYZ syndrome, and then they believe you, and then they feel a little bit more comfortable that you know what you're talking about. All right, another lesson number five now was we learned how to teach in our fellowship. And part of our fellowship was helping to teach refractive courses all over the nation. And what we would do is we would finish clinic. Our clinic was in the Scottsdale Air Park. So we would finish clinic, we would go out the back door, we'd jump in the plane and get ready for this, and jet off to the next course. Okay, I was kind of excited. I learned how to do that on the airplane. Well, this, I'm like, how do you do these animations? So that was exciting. All right, and that's what it was like. We would just, it was crazy.  Now, teaching, you know, as we learned, and Charles was just incredibly entertaining. He would tell a story. He would keep it relatable. He would bring it home. He would have the confidence, and he really knew his stuff, but he would have fun while he was teaching. And his courses were really well attended. He taught over 7,000 ophthalmologists, incisional keratotomy. So it was really impressive.  And years later, Jim Katz and I, who was also a fellow, he was a fellow after Mark and I, we would go to Scottsdale and do LASA courses, and Charles would be in the back of the room, and he would give us feedback on our lecturing style, and it was incredibly valuable critique. And that's another thing, is that when you're, you know, teaching, ask your mentors how you did, how you can improve, get feedback, because there's always room to improve. Now, in terms of how to teach surgery, I learned this here, especially in Utah. And I remember Alan Crandall saying, why is the eye moving, right? I mean, I don't know if he still says that, but he said that so much to me, and I distinctly remember that. But the key is you want to teach finesse, right? The finesse of surgery. It's not necessarily just all the little, you know, how to make an incision, how to, you get to the next step, and that's what Alan really taught so beautifully. Videotaping your cases is great because you can teach and learn from them. The cannula from the BSS bottle is a great tool to teach residents and fellows, and the careful vocabulary. We think our patients are sedated in their lullaland while we're operating. Some of them remember every single word you say and how you said it. So, you know, you can just, I remember the vocabulary, you know, that Alan used, notice how I carefully bring this, Rex's back from the zonules, you know, and he would just be very calm and just kind of notice, you know, notice how I do this and notice how this happens, and it was brilliant. So, that's another thing that was critically important. Another thing is that cowboy boots and bolo ties are really cool, and both Charles Casebeer and Alan sported them and still do, so this is just at our recent meeting. We were at ASCRS, and there's Alan with his bolo tie, and these are Alan's boots. We got a picture courtesy of Amy Lynn and one of the Guacomo fellows, I think, helped get these. And then, you know, you gotta pick your own style.  The other thing is we also learned as part of our fellowship how to learn. We learned, like our mentors in Utah and Scottsdale were incredible. To learn, you really need to watch carefully, initially emulate everything your mentors are doing, and be prepared. I remember learning with Randy Olson, we would review charts at the end of the day, and he would teach us pearls left and right. Claren, I remember, I felt like I was in the remedial PKP course because he made me, he came in on a weekend and he actually, we practiced tree finding on a rubber ball because he had that manual tree find that he used to use, and so I needed extra help and he came in and taught me how to do that and replay the video, obviously, with Alan. So here is a picture of one of the fellow reunions that we had with Charles, and our first fellow's reunion was on a cruise ship, and you can see Charles there in the middle, and there's a special guest there, Mark Mifflin. It's more. Sure, sure, sure. Nice, sure, Mark, nice, sure, it's okay. Definitely want to highlight that. All right, so, and, you know, we would just sit around in a small group and just, he would just teach, we would go over cases, it was fantastic. So the other thing is when you're learning, look for opportunities. Don't just wait for this, you know, this learning opportunity to fall in your lap. So when the glaucoma fellow would be out of town, I would operate with Alan Crandall. That was my chance to jump in there, and this was because of Peter Derienzo. He was, he just knew what was happening when, and he had been here six months already before I got here, and he really showed me the ropes, and I really owe him a lot, and so we, you know, basically take advantage of the opportunity. Alan didn't need me to be in the OR, for sure. He would have been much, he would have been done much faster if I didn't show up, but it was great for me to have that opportunity. And more recently, you know, when you're out in practice, you gotta keep on learning, keep on evolving. You can't keep on doing the same stuff. So we, you know, we transitioned to DMACC, and I personally didn't feel comfortable until I flew to my, you know, to watch my friends operate, and also, you know, watch videos and speak with people. You can't just read a book and learn surgery, obviously. So now we have a lot of resources. And the other thing is you really shouldn't be doing the exact same thing this year as you did last year. There's always gonna be something different, so always, always pay attention. Another thing is, you know, be nice. Be nice to everybody. Be nice to your patients, obviously, to your colleagues, to the surgical staff, to your techs. It goes a long way. You're part of a team. Don't ever think that there's you and them. That is not gonna last very long. So, you know, definitely in Utah and Scottsdale, you know, this kind of collegiality was wonderful. And I don't know if there's any nurses here that were here 21 years ago, but they were so wonderful. They would actually take my socks because they would get wet during Faco. I don't know, I never learned the draping thing very well. And my socks would be wet, and I hated that. And they would actually put them in the autoclave and dry them for me. It was so nice. I mean, they offered it. I hope there weren't instruments in there, but it wasn't like fabulous, right? And it was just about being nice. They were nice to me. I tried to be nice to them, and it was fun. And my feet were dry, so it was great. So, you know what, I really noticed is that when my mentors went into a room, they made every patient feel like they were the most important patient that day. They might only have spent two minutes in the room, but man, that patient felt like they had the best exam and best patient experience ever. And that's because the eye contact. They were awesome. They just looked people in the eye and said, whatever they needed to say, and it didn't have to be 15 minutes. It could have been two minutes, but it was really that quality time. So I highly encourage that. Now with EMR, it's so hard, because we're typing all the time, but make sure you take at least a minute and just look the patient in the eye and tell them exactly what you think. Lesson number nine. The more you do, the more you do. So surgery is definitely a system and you wanna develop muscle memory, okay? Practice a ton. The stuff that you couldn't practice in the wet lab. Practice and practice, when it was our day, we were practicing suture in the wet lab. Now nobody sutures anything anymore, but whatever you can do, Capsule Rex says, whatever you can practice, do it. It's the same movements every time. And really, the better you are surgically, you guys know this, the more cases you're going to end up doing. So make an awesome first impression wherever you are. Lesson number 10. Don't just follow the crowd, okay? This is something that, as ophthalmologists, we often just kinda, well, everybody else is doing it, so I guess I'll do that same thing. It's just kind of the wave, you just kind of ride the wave, don't do that. Think about what you're doing every step. Which faker machine you're using? Why are you using it? What tip you're using? Which implant you're gonna implant? Think about these things. Is this the best way you can do that procedure? And is this the best lens that's gonna, is this the best lens for that particular patient? So when I was a fellow, a new IOL was introduced to the market, the Acrosoft lens, can you imagine, in this wagon wheel type of configuration. And Randy, being the astute observer that he is, noticed that this lens had glistenings. And then because of that, he was concerned and we followed our patients and we actually did a study looking at the visual significance of glistenings. And Nick, mammalist, figured out what those glistenings were and we published this. And this was back in 1996. And this is one of the first clinical papers on the glistenings seen in the Acrosoft lens. So again, you have to do what you think is best. And the litmus test that I do is would I have that lens in my eye? Would I have that procedure done to my cornea? Would I have that chemical put on my conjunctiva? If the answer's yes, then you've probably, it's probably good. But if you say, oh no, I would never have that.  So think about what you're doing. Another thing is think outside the box. So when I was here, 21 years ago, people were doing surgery kind of the old fashioned way with a block and this and that. And this concept of topical anesthesia came around. And I remember Dr. Patel was even involved with this topical anesthesia study. And so think about how to make things better. And it might not be your classic technique, but you can think outside the box. And so I thought outside the box and I became a licensed acupuncturist in 2006 to study alternative integrative complementary treatments for eye disease. I was actually having an acupuncture treatment in 2005 and I was thinking, this is crazy. I was from my back or something, I don't remember. But I was thinking, this is 2000 years old, right? And we're still doing it today. Maybe there's something to this. What about the effects on the eye? So again, I became an acupuncturist and we started the Center for Integrative Eye Care at the University of Pittsburgh. We completed a dry study and now we're performing a pilot study on dry macular degeneration. So here's a video. So let's get started with the treatment. The first needles are in the scalp. These needles are short. And the pattern has been all worked out by an MD. His name is Dr. Alston Lundgren. He's in Santa Fe, New Mexico. And his goal with acupuncture is to treat difficult to treat conditions. And luckily for us, he picked macular degeneration as one of those treatments. He's not an ophthalmologist. These points are near the back of the scalp to stimulate the occipital cortex. So there's six needles in the back and then we put two here in the front. These are longer needles. They're sometimes a little trickier to thread through. These are long and thin. And then we're gonna go ahead and check her ears. This is an optic nerve point. This is an eye point. And these needles are stimulated with a magnet for one minute, three times a day. These all look fine. So there's five in the front and then there's one stainless steel one in the back. And let's check your other ear. One, two, three, four, five. Those are in place. And this whitish stuff is actually liquid band-aid. So the indwelling needles stay there. The studs stay there longer. The next thing we do is get you connected and there's a specific way to connect these leads. So this is the pattern. Okay? So these points go in the four corners of the orbit and the idea is to connect with the orbital periosteum. And really there's no specific landmark just to have crisscrossing current. And you'll see when we put the electrodes, you'll see how we crisscross the current. So we are hoping to get more blood flow and just relax. And any pain when I do that? So I can, does it hurt when I get the needle through the skin there? No, okay. That's what everyone will want to know, how much this hurts. Yeah, there's 10 treatments. I punched her in the eye before we start. Okay? Mm-hmm. Okay, done. So we put this on so that we can stabilize the leads that are gonna be connected. Statue of Liberty, pose. Okay, very nice. Anything hurting right now? No. Okay. So we're gonna go ahead and start with E. All right, so we- Allegeable stimulation. Here's her results. Okay, I know you think I'm crazy, but just listen. I was excited about it because I was having a lot of visual problems. And I'm a professional person. So I've got a lot of reading to do. I teach, I'm dealing with new books. And the vision, it was a problem because I have a blind spots that I would miss syllables or words or numbers. Also, I couldn't keep the line straight. And so I ended up that I've been reading for the last couple of years just using one eye. And then I get tired reading because I have to go back and fill in the blank spots and so forth. So maybe I have to read the line two or three times. Then I'm frustrated because I've always been an avid reader and I don't wanna waste that much time. So the fact that my vision keeps improving is exciting to me. And I can also read longer lines or longer amounts of printed material. I can read the whole road sign instead of just seeing the right hand side of it. And I'm not using glasses at all to drive, to watch TV, to watch movies. And the image is just real sharp. So I'm very pleased. Life changing medicine. Okay, here we go. So it's an interesting concept, right? I mean, we don't have a good treatment right now for dry AMD. Who knows? I know researchers in Germany, I believe, are just doing this kind of trans-cortical stimulation for glaucoma, things like that. So you gotta think outside the box and we'll see what happens. All right, something more conventional and ophthalmitis prophylaxis. So does anyone still use a collagen shield in Utah? All right. Okay, I cannot stop because Randy Olson taught me how to do this and touch wood, I've been thrilled with our results. And honestly, I'm scared to stop. It's working, so I don't wanna mess it up. But obviously, end ophthalmitis prophylaxis is a critical thing that we all need to think about. And I'll just show you how we prep the eye.  Close and look down. Good, and close, very nice. And now we're gonna get the beta-dyne. This is the key part. To turn your head toward me and look down first and we squirt and look up. Close and just gently. Okay, rock and roll, done. You're awesome, thanks. I love how he winks to the audience. Okay, and then I wait three minutes until the next part, which is instilling the lidocaine gel. Look down and look up and close. Perfect. Okay, and now he's ready for surgery. So I do this myself. I don't delegate this to anybody or our fellow does it or a resident. Somebody, when they're in the holding area, we do this.  Just put a couple of drops of povidone iodine. But I'm not overreacting, because in the literature, there's a paper that shows that irrigation of the fornicies with 5% povidone iodine was associated with significantly fewer positive conjunctival cultures at the time of surgery compared with the application of two drops on the conjunctiva. So you know, it's all about prophylaxis. There's no organisms on the eye around the surface. They're not gonna get in, right? So just, I think that if we just pay attention back to the basics, back to just preparing the patient. I mean, right now, I don't use any intracameral antibiotics. I still use topical antibiotics with a collagen shield. And, you know, we've been pretty happy. In addition to the pre-op, it's really important to look at your wound. And I know, you know, we definitely paid attention to this during the fellowship. So I thought my wound was awesome. You know, and then when you look with OCT, you can see that there's actually a little gap there. And then on the internal area, in the internal part of the wound, there was also a little gap. So these wounds, we think they're okay. They may not be all the time. You know, we hydrate the wound and it looks great. But we know the hydration's not gonna last forever, right?  So I spend a lot of time looking at the wound. And if I'm just not happy, I'll seal it. And, you know, we'll either put a suture in or put reshure sealant. And you can just see how when you put the sealant over the wound, it really is a nice barrier. So I think just prevention, you know, is critically important. So, you know, those are the old things that we did. How about beyond, right? 2016 and beyond. So it would be great to take compliance out of the equation. So we're actually studying the intervitrial antibiotics and story delivery, the imprimise formulation. We're looking at in a rabbit study to see if this is effective, the trimoxy and the trimoxybank. We're also about to do a study with Avenova. We've done some work already with it. This is the hypochlorous acid 0.01%. It's an antiseptic. And it turns out it's perhaps kinder and gentler to the surface of the eye. We did a time kill study in vitro to show that the time to kill 99.9% of the organisms with MRSA, MSSA and coag negative staff is one minute for Avenova and two minutes for povidone iodine. So it actually kills faster. So antiseptics are great because bacteria don't get resistant to them. So I really like antiseptics. Another thing, an exciting project we're doing in Pittsburgh is this micro particle hydrogel. It goes in as a drop and it turns to a gel. So there's a rabbit eye and so you put this in the lower phoenix and it turns into this kind of whitish gel which basically you should stay in there until you remove it. So we did a rabbit study with our endothelmitus model that we have in the Campbell lab and group one up here is Vigamox pre and post inoculation. Group two was the moxifloxacin hydrogel. Okay, just before the inoculation and these eyes all look very beautiful and there was no endothelmitus. Group three was a control which is the blank hydrogel and you can see that these eyes got infected. So who knows? We'll be able to maybe get rid of even drops. So enough about endothelmitus. Let's talk about some more important lessons like giving back. That's a huge philosophy here in Utah and it's awesome, right? So we need to use our talents to help our community, our country, the world. And you guys in Utah see that all the time and live it, so it's fantastic. Another thing is it's okay to make a mistake and admit it and show it to other people. Just try to learn from it. It's not, you shouldn't hide all your mistakes. And so I've been really fortunate to be part of this course at Ascarus and AO, that David Crandall, Allen Crandall, Jeff Petty, and Susan McDonald are part of. And it's basically the title is learning from our mistakes. A video kind of a complication management session. And so we show all our cases and it's cathartic and we learn. Another big lesson is how cool the Utah family is. So these are just some members of the Utah family.  There's kind of this Utah bond that I think we all share and it's a wonderful, wonderful family to be part of. And there's also the Utah Scottsdale family. And we had fellows reunions. One was on the cruise ship where you saw Mark Mifflin and his shorts. And now this was another reunion we had. This was at Charles Ranch, the Sea Bar Sea Ranch in Montana. This was, and that's a picture from when we were out there. This is a cruise ship and there's Mark again. And his lovely wife. And this, we had our first fellows kind of summit there at the biosphere, it was interesting. Another important lesson is how to mentor. I think that as we move on in life, mentoring is really important and all of my fellowship mentors have opened doors for me. I've been very grateful. But then as you go on along in life, don't forget to mentor that medical student or college student or wherever you are, there's always somebody, there's always somebody below you if you make it to residency, right? So reach out and it was amazing. Charles introduced me to some of the world's pioneers in refractive surgery. And here we are, this is in the 90s still, I believe. This is Joseph Collin, he invited us to his home in France, it was very special. And this is Louis Ruiz as part of my fellowship in 1995, we flew down to Bogota, Columbia to watch Louis Ruiz using that new micro-caratome that automated micro-caratome and he was doing Lasik because he had a laser and watched him doing Lasik. It was Steve Slade, Charles Casebeer, Steve Upt, Graf, myself and Jeff Machot had never touched a micro-caratome by then. Another thing I learned is to be more adventurous and to enjoy nature as a part of my fellowship. So I learned how to roll a blade and I had lots of fun exploring nature with Judah Warner. We went on a road trip and it was great. So we had a blast, I had so much fun at my fellowship, just enjoying life and nature and everything. A critical thing is though, family first. I really believe in this and I think that this is truly exemplified in Utah and you can see here's Jeff, he brought his baby, his new baby and his wife to the academy meeting and there's my sister feeding Jeff's baby and here are my beautiful children, Dia and Covey and then here's my mom and nephews and here's my husband, Sanjeev. Family first and the thing is that when I had kids, I kind of took a break from the travel. For four years, I said no to pretty much every obligation that would take me away from my family because I wanted to be with them. I didn't want someone else to be there to, I wanted to be with my babies anyway. So I did and now that they're this age, nine and seven, I feel happy to travel again. So it's okay to take a break. I couldn't believe it. At ASCRS, I was moderating a symposium and there was a physician from Johns Hopkins who had a newborn at home. She flew in that day, gave her talk, which was 10 minutes and then caught a flight back that same day to go back to her baby. I would have just said, no. I would have just said, I will not be able to be there. She was kind of, it was very impressive, I have to say, but unnecessary, it's okay to say no. You can have a family and a career and do what you need to do, but just all in good time, don't kill yourself doing it. And these are just some of my final slides. This is really rings true. A teacher affects eternity. He can never tell where his influence stops. And we, this is an incredible quote that I love. And here's this incredible picture and what you see here is you see Randy Olson in the middle. You see that, okay, you recognize him. Then of course you all know Susan McDonald because I know she was giving this lecture last year. This is Lorenzo Cervantes and he was one of my fellows, one of my favorite fellows. Don't tell him I said that. And he though was inspired to go into ophthalmology by Susan McDonald. Isn't that incredible? So he was a medical student and Susan came and gave him a lecture. And so he went into ophthalmology and then we were both trained by Randy and then Lorenzo was trained by me. That was fascinating. So it's just a all big happy family. So thanks Utah for changing my life and my, of course, my family.