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Ontario Health Minister Deb Matthews photographed in her office on Feb. 8, 2012.

On Valentine's Day, Deb Matthews was shaking hands with people who owe their lives to heart transplants. She moved about the room in her Hillary Clinton pantsuit and campaigner's flats, listening to each survivor's story with the intensity of Oprah pulling a confession out of a celebrity: one, a young mother of two with a hint of a scar poking out of her V-neck top; another, a man wearing a green sweatshirt emblazoned with the slogan "Don't take your organs to Heaven, Heaven knows we need them here."

During those 30 minutes at Toronto General Hospital, few in the room could sense the kind of week this was going to be for the smiling Ms. Matthews, Ontario's Health Minister.

She knew that the following afternoon, economist Don Drummond would drop a highly anticipated report on the dire state of the province's finances. There were 362 recommendations – and more than 100 of them were aimed at dramatically reshaping her portfolio, which accounts for 40 per cent of Ontario's deficit-addled budget.

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She likely knew that the day after that, Thursday, she would have to call in the police to investigate a mushrooming scandal at Ornge – the air-ambulance service that, under her watch, has sparked the first major criminal probe of a provincial agency in Premier Dalton McGuinty's government.

And she may have even known then – as she spent time with a few of the individuals who depend on the system to keep themselves and their loved ones healthy – that she would stand before the microphones on Friday to announce the dismantling of the air-ambulance service as we know it.

Ms. Matthews shows poise under fire. And that's a requirement when your job is to oversee surgery on the health-care system.

It's the "toughest assignment in the country," health-care analyst Michael Decter said.

And she asked for it.

From protest to Parliament

When Mr. McGuinty was re-elected for his third consecutive term last fall , this time with a minority, Ms. Matthews asked if she could keep the health portfolio because she didn't want to lose the "momentum" she had created.

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She did this despite the monumental task of reforming Ontario's health-care system, one of the most recalcitrant systems for any minister – federal or provincial – to tackle. She also knew that the scandal at Ornge could engulf her ministry. Controversy, in fact, is what propelled her into the health portfolio in the first place. The tendering scandal at eHealth derailed her predecessor, David Caplan, who was forced to resign in 2008, even though he had inherited the mess from his predecessor, George Smitherman.

"This is a time of real transformation," she explained in an interview earlier this month at her office. If we don't change how we deliver universal health care, she said while gesturing to photographs of her grandchildren, "it won't be there for those little kids as they grow up."

"We cannot protect the status quo," she said: If we do, the money just won't be there.

Tall with blond hair and a disarmingly direct manner, Ms. Matthews is a rounder version of her older sister, actress Shelley Peterson, wife of former Ontario premier David Peterson. At 58, the twice married Ms. Matthews has three grown children, four grandchildren, a PhD in demography and a happy life with a "wonderful man" named Richard Nancarrow, an environmental engineer who lives in London.

She carries her passion for politics and health care in her genes, beginning with her CCF-supporting working-class grandfather, John Jack Matthews, a one-term mayor of Brantford, Ont.

Her father, Don Matthews, like his father before him, supported the CCF. But as he became more successful in life – he owned Matthews Construction – he moved to the right politically and joined the Progressive Conservative Party.

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Although she grew up in an affluent family, Ms. Matthews, the third of her father's six children by his first wife, Joyce, went to public schools and worked weekends and summers in a fruit and vegetable stand at the market in London. She got the "political bug" campaigning for her father as a teenager in his first run for office, in 1968.

After high school, she went to McMaster University in Hamilton for a year, dropped out to campaign in her father's second unsuccessful run for the House of Commons and then went to Ottawa to work as his assistant when he served as national president of the party. Along the way, Ms. Matthews became disillusioned with the party and was "soured" by the way she felt the establishment turned against her father when he wanted a second term as national president..

Politics was still personal for her, as it was when her brother-in-law David Peterson decided to run as a Liberal in London Centre in the 1975 provincial election. She declared herself a "free agent" and switched to the Grits. Ms. Matthews was 21 and just back from her honeymoon, having married Robert "Robbie" Nash, a stockbroker and the son of the proprietor of an upscale London jewellery store. "She was key to winning the nomination," Mr. Peterson said. "She got out about 2,000 people," he said. And then she worked for him.

Family got her into politics, but what kept her there was the realization that she was a Liberal. For her, that means concentrating on "social-justice issues, caring for those who have the least; but it also means being pragmatic, balancing budgets, making tough decisions" – and having a clear understanding of the power, the responsibility and the limitations of government.

What isn't so clear is why she went from running other people's election campaigns to putting herself out there as a candidate.

After Ms. Matthews and Mr. Nash divorced in 1990, she married her second husband, Bruce McCaffrey, a William Davis-era cabinet minister, in 1995. They had separated but not divorced by the time he died in 2002. In the late 1990s, she was a single mother and a mature student at UWO, who had been picking up courses for years to complete first her BA, then her MA and finally her PhD. Studying with students from different backgrounds, she saw "the gap between rich and poor was getting wider not narrower," at least in part because of Conservative policies.

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When tuition fees were increased at Western, she joined a protest march to the constituency office of Dianne Cunningham, the Minister of Training, Colleges and Universities in the second Harris majority. That night she had "a little soul search" and said to herself: "If you really care about these issues you can protest, you can march or you can actually get to work and run for office."

She knew the riding because it incorporated Mr. Peterson's old stronghold of London North, and she figured she had as good a chance as any Liberal to hold the minister to account. "I put my money where my mouth was," she said. "It was that important to me."

First of all, though, she had to get her kids on side. All three of them were university students and they knew how hard she had worked to complete her own education. They made her promise that if she ran, she wouldn't abandon her doctorate. "If I had not made that solemn promise, there is no way I would have finished it," she admitted. Even so, it took her four years of 1-hour days during legislative breaks to write her dissertation.

She loved campaigning. "I had the best education imaginable listening to people in my community and those stories still guide me today." A retired janitor exacted a promise on his doorstep: She said he told her, "Every time you make a decision about spending money, just remember it is me who is paying for it in my taxes. If you think it would be okay with me, then go ahead. But if you think I might not think it is such a good idea, then I want you to think twice."

Another encounter involved an elderly man with a sick wife. "He was heartbroken," she said, because it was costing so much more to keep his wife in hospital than to give him the help he needed, but the system wouldn't let him bring her home. That experience "absolutely guides the work I am doing right now," she said, adding "you would never hear those stories anywhere else than going door to door."

By the time the votes were counted on Oct. 2, 2003, in London North Centre, Ms. Matthews had not only called the minister to account, she had trounced her by nearly 7,000 votes. A month shy of her 50th birthday, she had finally embarked on the career she was meant to have.

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Tough road ahead

Eight years later, no one questions that Ms. Matthews is tough enough for that career. She's demonstrated her mettle by holding the line in a showdown with generic-drug manufacturers, getting them to agree to a cost reduction that will save the province about $500-million annually. ("That is five medium-sized hospitals," she said, proudly.) And she can be expected to be equally hard-nosed when it comes to her next fight: the upcoming negotiations with the Ontario Medical Association over doctors' compensation.

There is nothing simple about health care in Ontario, or anywhere else in the country. Our federal forebears promised us universal health care, but it is the job of provincial and territorial governments to implement it. How Ms. Matthews does that in formerly fat cat Ontario is of keen interest to other jurisdictions, for the cat is now scrawny, howling for food and battling a projected $30.2-billion deficit by 2017-18. Once the engine of growth, prosperity and transfer payments, Ontario may well be asking for handouts from richer provinces if Ms. Matthews fails to deliver her agenda of cutting costs and implementing real change while improving care.

One of those changes includes making private-public partnerships and selling home-grown expertise and medical knowledge internationally with the revenues benefitting the people of Ontario. That was the idea behind moving Ornge out of direct ownership and into a stewardship arrangement with the government back in 2005. Over the years, Ornge began creating spin-offs that appear to have been much more about profit than medical service.

Ms. Matthews has acted swiftly in the last two months, severing ties with Ornge principals without severance, appointing new leadership, calling in forensic auditors, and launching a criminal probe late Thursday afternoon – but questions remain about what she knew and when.

The minister's usually chipper voice grows distressed when she discusses the file. "When I sent in the forensic team, I specifically said, 'Follow the public money,' because we had been assured by Ornge and by their lawyers that there was no intermingling of private and public funds."

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As the Health Minister, she said, she doesn't have the luxury of saying whether Ornge officials deliberately set out to obscure transparency and thwart oversight in the score of spin-offs they created. That's why she called in the OPP: to find out.

"I see patients who are desperate for more care, shorter wait times, more drugs to be covered, and people who are working very hard every day," she said. So when she discovers "a handful of people" who were given huge responsibilities and opportunities to improve the system and who have "lost sight of who it is they are there to serve. … I struggle to find the words, but I think it is a betrayal of that trust."

Will she resign when the legislature resumes on Tuesday as the opposition is already demanding? Emphatically not. "The Premier has confidence in me, he has expressed that many different times," she said. "I have demonstrated my ability to make tough decisions, I have demonstrated my ability to stand firm when the going gets tough. And I think that is the kind of leadership we need right now."

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