Dr. Charles Shaver, an internist, says the issue is particularly important in border cities like Ottawa, where many Quebec patients seek treatment. Ottawa doctors usually bill these patients directly at Ontario rates because Quebec's rates are among the lowest in the country. The patients must then seek reimbursement from the province. "Mr. Dingwall is the first federal minister I know of to have made this commitment," said Shaver, referring to a May 24, 1989, news release by Dingwall, then an Opposition member of Parliament. "Why is the federal government letting Quebec get away with this violation, when it was so inflexible on the issue of extra-billing?" Dingwall asked then. "The Canada Health Act forced provinces to ban extra-billing by doctors. If the legislation requires controls, then it's only reasonable to expect them all to be applied equally."