1973 Legislative Session: 2nd Session, 30th Parliament
HANSARD
The following electronic version is for informational purposes
only.
The printed version remains the official version.
(Hansard)
MONDAY, MARCH 12, 1973
Afternoon Sitting
[ Page 1205 ]
CONTENTS
Routine Proceedings
An Act to Amend the Government Liquor Act (Bill No. 121) Hon. Mr. Macdonald.
Introduction and first reading — 1205
An Act to Amend the Public Schools Act (Bill No. 131) Mr. Wallace.
Introduction and first reading — 1205
Oral Questions
Possible sale of Okanagan farmland. Mrs. Jordan — 1205
Increased fees for UBC students in residence. Mr. Wallace — 1206
Egg price increase. Mr. Williams — 1206
Increase in Mincome to watch food price rise. Mr. McClelland — 1207
Purchase of Glenshiel Hotel. Mr. Chabot — 1207
Political science course at Oak Bay High School. Mr. Wallace — 1208
Court decision on Kamloops amalgamation. Mr. Fraser — 1208
Proper notice for ferry service suspension. Hon. Mr. Bennett — 1208
Steveston to Yellow Point ferry study. Mr. D.A. Anderson — 1208
Absence of Ministers. Mr. D.A. Anderson — 1208
Bilge oil wastes on ferry route No. 1. Mr. Curtis — 1209
Committee of Supply: Department of Health Services and Hospital Insurance estimates.
Mr. McClelland — 1229
Hon. Mr. Cocke — 1230
Mr. D.A. Anderson — 1232
Hon. Mr. Cocke — 1232
Mr. Radford — 1232
Mr. McGeer — 1233
Mr. Brousson — 1233
Hon. Mr. Cocke — 1235
Ms. Sanford — 1236
Hon. Mr. Cocke — 1236
Mr. Smith — 1237
Hon. Mr. Cocke — 1238
An Act to Amend the Workmen's Compensation Act (Bill No. 130) Hon. Mr. King.
Introduction and first reading — 1238
Reports Select Standing Committee on Standing Orders and Private Bills.
Nos. 10 and 11 — 1239
The House met at 2 p.m.
Prayers
MR. SPEAKER: The Hon. Minister without Portfolio.
HON. F.A. CALDER (Minister without Portfolio): Mr. Speaker, I would like the Hon. Members to join me in welcoming two representatives of the Chamber of Commerce from my headquarters of Stewart, British Columbia, in the persons of Sharon Hosick and James McKelvie.
MR. SPEAKER: The Hon. Minister of Mines.
HON. L.T. NIMSICK (Minister of Mines and Petroleum Resources): Mr. Speaker, I would like the Hon. Members to welcome a member from my constituency, Mr. James Patterson, who is the business agent for Local 651. He is down here as part of the delegation from the B.C. Federation of Labour executives.
MR. SPEAKER: The Hon. Member for Mackenzie.
MR. D.F. LOCKSTEAD (Mackenzie): Mr. Speaker, we will have with us today at 3 o'clock, 50 school children from the Elphinstone Secondary High School at Gibsons. Please join me in welcoming them.
MR. SPEAKER: The Hon. Member of Esquimalt.
MR. J.H. GORST (Esquimalt): Mr. Speaker, it is my honour today to ask the House to join with me in welcoming 10 honour students of the political science class at the University of British Columbia who are in the House today with their professor, Dr. Walter Young, professor of political science at the University of British Columbia.
I hope anything done here today does not in any way discourage them from their goals but instead spurs them on to the day when they will take a seat in this Legislature.
Introduction of bills.
MR. SPEAKER: The Hon. Attorney General.
HON. A.B. MACDONALD (Attorney General): Mr. Speaker, I have the honour to present a message from His Honour the Lieutenant-Governor.
AN ACT TO AMEND
THE GOVERNMENT LIQUOR ACT
MR. SPEAKER: His Honour the Lieutenant Governor herewith transmits a bill intituled An Act to Amend the Government Liquor Act and recommends the same to the Legislative Assembly, Government House, March 8, 1973.
Bill No. 121 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
AN ACT TO AMEND
THE PUBLIC SCHOOLS ACT
Mr. Wallace moves introduction and first reading of Bill No. 131 intituled An Act to Amend the Public Schools Act.
Motion approved.
Bill No. 131 read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
MR. SPEAKER: Before we start on the question period — I draw to the attention of the Hon. Members that our faithful and loyal and aged Clerk, who is unfortunately not here today through illness, has saved for a long time a particularly historic bell. He presented it to the House today, unfortunately in his absence, with the view that it be used to save the Ministers from disaster 15 minutes after the stopwatch starts. So the bell, you will note, is on the clerks' table.
It has an interesting history. It was in the Bird Cages, which were the first parliament of British Columbia. I think it is of great historic significance and we should thank the Clerk for it.
AN HON. MEMBER: Does it work?
MR. SPEAKER: You'll find out if it works.
Oral questions.
MR. SPEAKER: The Hon. Member for North Okanagan.
POSSIBLE SALE OF
320 ACRES OF OKANAGAN FARMLAND
MRS. P.J. JORDAN (North Okanagan): Thank you, Mr. Speaker, I would like to address my question to the Hon. Minister of Health (Hon. Mr. Cocke). Has he had an opportunity to investigate the possible and rumoured sale of 320 acres of north Okanagan farmland to one Colin Andrew Youngstrom, as reported, a member of the Brotherhood of Eternal Love cult and closely linked to the
[ Page 1206 ]
Timothy Leary cult?
HON. D.G. COCKE (Minister of Health Services and Hospital Insurance): Mr. Speaker, my department hasn't too much to do with the sale of property. I have told the Attorney General about the sale. It was a sale I understand, that was totally consummated and there was lots of warning, Mr. Speaker, about this sale. It has been going on for something over a year. It is a sale of land. I would like to defer the question to the Attorney General, Mr. Speaker.
MR. SPEAKER: I may point out the question is not in order directed to that Minister who has no jurisdiction over the field of sale of land that I know of. So there really is no question before the House that needed to have been answered. I should have stopped it, but I was wondering what it was all about.
MRS. JORDAN: A point of order, Mr. Speaker. The reason it was directed to the Minister of Health was that the Attorney General was absent on Friday when this was a matter of urgent concern. And the Minister of Health should in fact be deeply concerned about the sale of this land if the rumours surrounding the sale are true.
MR. SPEAKER: You are not to bring rumours into the House. You are supposed to state the facts and be responsible for the facts and the Minister concerned…
HON. MR. COCKE: You should redirect the question, Mr. Speaker. You see, unfortunately, it is just not my department. As I indicated, on Friday, that I would defer it to, or at least I would recommend it to the…
MR. SPEAKER: Order please.
MRS. JORDAN: …the Attorney General had an opportunity to investigate the possible sale of 320 acres of agricultural land in the north Okanagan to one Colin Andrew Youngstrom, reported member of the Brotherhood of Eternal Love cult, closely linked with the Timothy Leary drug cult in the United States.
HON. MR. MACDONALD: Mr. Speaker, in answer to the question. This is a private sale of land and the Government has no power under statutes now, or to come in the future, or lying before this House. We are not land dictators in spite of people who have been running around the province saying we are. We cannot step in and prevent, and we do not want to step in and prevent, the private sale of land. However, if there comes to be a law enforcement problem on that property or any other, I expect Members of this Legislature and other people to draw that to my attention and law enforcement will take its usual course.
MRS. JORDAN: A supplementary question, Mr. Speaker. Am I to understand from the Minister's statement that there is no intention on the part of the Government, in light of the undesirability of this sale, to utilize the Green Belt Protection Fund Act to purchase this land from the current vendor and then return this land without loss to the involved parties to the people of British Columbia?
Interjection by an Hon. Member.
MR. SPEAKER: Order please. There is absolutely no jurisdiction and the Minister has explained it already. Therefore the question is out of order. The Hon. Member for Oak Bay was next.
INCREASED FEES
FOR UBC STUDENTS IN RESIDENCE
MR. G.S. WALLACE (Oak Bay): Mr. Speaker, I would like to address a question to the Hon. Minister of Education, (Hon. Mrs. Dailly). Are there plans to increase the fees paid by students in the residences at UBC next year, and if so by what percentage are the fees to be increased?
MR. SPEAKER: Here again, is this a matter within the jurisdiction of the Minister or the University of British Columbia, because they're separate? The Minister wishes to answer.
HON. E.E. DAILLY (Minister of Education): It's of concern to me as Minister. It's certainly under the autonomy of the university basically how they handle their budget. The matters that affect the students concern me also — as they do the Hon. Member who asked the question, I'm sure on that reason.
I've had discussions and correspondence on this matter. To my knowledge at this time, to the Hon. Member, I do not believe they are being increased.
MR. SPEAKER: The Hon. Member for West Vancouver-Howe Sound.
EGG PRICE INCREASE
MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Mr. Speaker, thank you. To the Hon. Attorney General, with reference to the announced price increase for eggs in the province: would the Hon. Minister indicate whether or not he or his department had any advanced knowledge of this proposed increase?
Interjections by some Hon. Members.
[ Page 1207 ]
MR. WILLIAMS: Correction, I'm sorry — Agriculture.
HON. D.D. STUPICH (Minister of Agriculture): Mr. Speaker, my only concern was that I almost turned off when he said Attorney General, and went on reading my correspondence.
Mr. Speaker, we did have advanced knowledge of this. My concern was that the egg board, I felt, was being rather slow in acting in view of the increases in costs that were being absorbed by the poultry producers up to that time. They did discuss it with members of my Department, and myself, on various occasions.
I felt that perhaps there could have been a more gradual increase in view of the fact that the costs had increased by more than the 7 cents a dozen that they are currently increasing the egg prices to the producers. I felt that there was no way that we could persuade them to do anything otherwise than what they're doing.
The price of feed is the factor that has gone up more than anything else. The price of feed alone accounts in the last six months for the increase to the producer of 8 cents per dozen.
MR. SPEAKER: On a supplementary, the First Member for Vancouver–Point Grey.
MR. P.L. McGEER (Vancouver–Point Grey): I would like to ask the Minister of Agriculture: in cases like this, is the Consumer Protection Bureau warned so that there is not profiteering on the part of the food stores in raising the price to the consumer immediately rather than selling the old stocks off at the former price?
HON. MR. STUPICH: Well, Mr. Speaker, they're not warned by the Department of Agriculture. Whether the Egg Marketing Board does any warning, I'm not sure. I think the public statements that have been issued should serve as warning to some people, though.
MR. SPEAKER: The Hon. Member for Langley.
MR. R.H. McCLELLAND (Langley): Mr. Speaker, I've noticed that for the third question period in a row the Minister of Lands, Forests and Water Resources (Hon. Mr. Williams) is not here in order for us to ask questions.
MR. SPEAKER: I think he's in Washington with…
MR. McCLELLAND: I'd like to address this question, Mr. Speaker…
MR. SPEAKER: Order please.
INCREASE IN MINCOME TO
MATCH FOOD PRICE RISE
MR. McCLELLAND: …to the Minister of Rehabilitation and Social Improvement (Hon. Mr. Levi), with regard to the increase in milk and egg prices. Has the Government given any consideration now, Mr. Speaker, to raising the old age pensioners' $200 income, under Mincome, to reflect this increase for people over 65, who naturally find both of these items most necessary for their diet?
MR. SPEAKER: On a point of order. I can't see how, under the rule, you can ask the advice a Minister is going to give the Crown. You can ask if he's given that advice. I presume your question…?
MR. McCLELLAND: Mr. Speaker, I'll ask then. Has the Minister given that advice to the Government?
HON. N. LEVI (Minister of Rehabilitation and Social Improvement): Mr. Speaker, I made a statement a couple of weeks ago, in reference to the increase in the old age security pension, that the Government will be staying with the $200 a month, and will review that pension in the fall.
MR. McCLELLAND: Mr. Speaker, a supplementary. Could I ask the Minister of Human Resources (Hon. Mr. Levi, Minister of Rehabilitation and Social Improvement) whether that statement holds true regardless of what happens to the cost of living? — even though there's a 10.2 per cent increase in one year alone, without this increase in these…
MR. SPEAKER: There again you can't ask theoretical questions of that kind. It is out of order. I would ask the Hon. Member for Columbia River.
PURCHASE OF GLENSHIEL HOTEL
MR. J.R. CHABOT (Columbia River): Thank you, Mr. Speaker, I'd like to direct a question to the Minister of Public Works (Hon. Mr. Hartley).
I was wondering if the Minister could advise the House whether he's completed negotiations for the purchase of the Glenshiel Hotel, which he announced as being purchased about 85 days ago at a Press conference then, December 15th; and if so, at what price,
HON. W.L. HARTLEY (Minister of Public Works): The answer as recorded on the order paper still stands.
MR. SPEAKER: The Hon. Member for Oak Bay. Order please. No debate.
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MR. WALLACE: I would like to address another question to the Hon. Minister of Education.
Interjection by an Hon. Member.
MR. SPEAKER: Order!
POLITICAL SCIENCE COURSE
AT OAK BAY HIGH SCHOOL
MR. WALLACE: Could she tell us whether further consideration regarding the political science course at Oak Bay High School…whether decisions have been taken as to whether this course shall be permitted, or whether the department has decided against such a course?
HON. MRS. DAILLY: I am aware of this particular decision and I have arranged for a meeting with departmental officials and the Victoria School Board this afternoon.
MR. SPEAKER: May I point out to the Hon. Members that a question that has already been answered on the order paper will not be entitled to further question on the same point. The Hon. Member for Cariboo…
MR. CHABOT: Mr. Speaker, on that question. The answer was brought forward on the order paper about three weeks ago. The matter probably has been settled by the Minister, and probably a price has been arrived at. I think…
MR. SPEAKER: On your point of order; it's not well taken. If you look at Beauchesne on page 147, it says:
"A question oral or written must not repeat in substance a question already answered, or to which an answer has been refused…."
And I gave this to the Hon. Member. He knows that. Now, the Hon. Member for Cariboo.
COURT DECISION ON
KAMLOOPS AMALGAMATION
MR. A.V. FRASER (Cariboo): Mr. Speaker, I have a question for the Attorney General. Has the Minister had time to review the court decision regarding the Kamloops amalgamation? — and to advise the Minister of Municipal Affairs (Hon. Mr. Lorimer) how to proceed with this situation on a legal basis?
HON. MR. MACDONALD: Mr. Speaker, fortunately the Minister of Municipal Affairs is a lawyer, and the matter remains in his hands. No doubt, he will be making an announcement shortly after consulting with me.
Interjections by some Hon. Members.
MR. SPEAKER: The Hon. Leader of the Opposition.
PROPER NOTICE FOR FERRY
SERVICE SUSPENSION
HON. W.A.C. BENNETT (Leader of the Opposition): I want to know if the acting Minister of Highways has instructed his department that when the ferries are suspended for a period of time, proper notice will be set up. For instance, yesterday I arrived at the Mill Bay Ferry, and there was a sign that they had tied up the ferry. It was closed for two weeks. It was going to start again today. Dozens of cars were all lined up there. People were not informed at all.
Interjections by some Hon. Members.
HON. MR. STUPICH: Mr. Speaker, I'm pleased that the Member has brought this to my attention, and I will certainly bring it to the attention of those responsible — or if you like, irresponsible.
MR. SPEAKER: The Hon. Second Member for Victoria.
STEVESTON TO YELLOW POINT
FERRY STUDY
MR. D.A. ANDERSON (Victoria): I would like to ask the acting Minister of Highways. I wonder whether he would indicate whether his department is carrying out studies for a Steveston to Yellow Point Ferry going through Poilier Pass.
HON. MR. STUPICH: Mr. Speaker, everything is under consideration. But there are no active studies being taken at this time of that route.
ABSENCE OF MINISTERS
MR. D.A. ANDERSON: Mr. Speaker, I would like to ask the acting Premier whether or not in future we can arrange some way of knowing what Ministers will not be present — Municipal Affairs, for example, and Highways were two departments we wished to query today. I wonder whether she would indicate to the House whether it would be possible to indicate beforehand what Ministers would be here and…
MR. SPEAKER: There is no obligation under our present question period. If you want a question period with notice, or if you want to give notice to a Minister, then you can be sure he'll be in the House.
[ Page 1209 ]
MR. D.A. ANDERSON: No, Mr. Speaker, I'm sorry, my question must have been misunderstood. The question I was asking the acting Premier was: if Ministers are to be away, would it be possible in some way to…
MR. SPEAKER: I suggest that you take that up privately by writing to the Premier, or the acting Premier. It's not a matter for the question period. This is why they have the notice in the British House. Any further questions for the question period? The Hon. Member for Saanich and the Islands.
BILGE OIL WASTES ON
FERRY ROUTE NO. 1
MR. H.A. CURTIS (Saanich and the Islands): We are waiting for the bell, Mr. Speaker. But, if there are a few moments — to the acting Minister of Highways: would he undertake to investigate further the question of disposal of bilge wastes, oil wastes, from ferries plying route No. I — Tsawwassen to Swartz Bay? I am aware of the fact that these wastes are being disposed of over the side at night. In an era of strong concern about oil pollution, Mr. Speaker, I feel this is a matter which the Department of Highways should investigate.
HON. MR. STUPICH: Mr. Speaker, if he remembers the question, the answer is simply yes.
Orders of the day.
House in committee of supply; Mr. Dent in the chair.
ESTIMATES, DEPARTMENT OF HEALTH
SERVICES AND HOSPITAL INSURANCE
(continued)
On vote 86: Minister's office, $66,400.
MR. CHAIRMAN: I recognize the Hon. Member for Oak Bay.
MR. G.S. WALLACE (Oak Bay): Thank you, Mr. Chairman.
As I said in the education debate, there are two portfolios which surely should have the attention of all of us, inasmuch as they spend about 70 per cent of the budget. But, more importantly, without health and education we're all in trouble.
At the outset, Mr. Speaker, I'd like to compliment the Minister of Health Services and Hospital Insurance (Hon. Mr. Cocke) for several reasons, since he took office. We have a Minister who obviously is willing to listen. That's certainly one tremendous advantage over his predecessor.
AN HON. MEMBER: Hear, hear!
MR. WALLACE: Not only is the Minister of Health Services and Hospital Insurance willing to listen, and obviously he is listening, but he rescinded — I notice the Socred benches have emptied since I started to speak and that doesn't surprise me. They never listened when they were Government and I don't suppose they're about to listen now.
The Minister of Health Services and Hospital Insurance has rescinded a decision regarding wage increases to employees in hospitals. I can just recite for the House what happened under the former administration — they agreed to pay 70 per cent of wage increases for hospital employees. The result was that the hospitals had to cut back on staff in various ways or, when staff resigned or retired, they were not replaced. This put a very considerable hardship on hospitals and, in my opinion, and in the opinion of many administrative staff who don't like to talk in public about these things, they did feel that there was a lowering of the standard of care in the hospital as a result. I would agree with that opinion.
The fact is that the Minister has rescinded that order and has in fact agreed that the employees in hospitals should be paid the wage which they negotiated for.
Speaking with hospital administrators, I know they're grateful to the Minister. It has meant the difference between struggling along with a very sizable deficit and breaking even.
The Minister said that he has received co-operation from all arms of the health field. I think, Mr. Minister, through you, Mr. Chairman, the reason you're getting cooperation is that you're listening and you yourself are cooperating. That again is one tremendous advance compared to the previous Minister.
I would like to say a little bit, first of all, about philosophy of health care. Incidentally, for anyone who's really interested in this philosophy in depth there's a very excellent article written in this publication UBC Reports, dated February 22, by Peter Thompson, who is a staff writer. He has entitled this "UBC's Role in the Health Care Crisis." I can send it over to the Minister if he would like it.
This sums up somewhat the dilemma, you might call it, of health care. I think the whole field of health care and the provision of health services involves a high degree of administration and co-ordination of what is available, even beyond that it's very timely for society to look at the tremendous resources which technology and research are putting in our hands every day, and then leaving us with the moral dilemma of trying to decide what priorities should be set and which patients should perhaps be given consideration ahead of others.
If that sounds a very cold, calculating statement, I
[ Page 1210 ]
am afraid this is the kind of choice that society, regardless of which government is in power, is faced with today. This is why that article is so good, because I think it hits it right on the nose. Do you concentrate on setting up artificial kidney machines or very expensive, sophisticated heart operations, or do you emphasize preventive medicine or do you treat the ordinary pneumonia at home instead of treating it in the hospital? There is a whole variety of questions which in many ways are moral in nature because surely our philosophy should be that we should help all people who are in need of care and whose health, in one way or another, requires treatment.
It's too trite to say that we're all interested in promoting good health. We have an established amount of serious disease and disability. Ten years ago we didn't even have to be worried about the cost of treating it because we didn't have the know-how, we didn't have the skilled personnel, we didn't have the electronic pacemakers for the heart, we didn't have the various gadgets and machinery to replace heart valves, we couldn't operate on the arteries in the heart because we probably didn't have the anaesthesia, and so on and so on. But there's a tremendous array of new techniques in the 20 years certainly since I qualified — perhaps 50 per cent of the things we're now doing in the health field weren't even available. It is considered that the rate at which knowledge and technical know-how is increasing is in itself creating a tremendous problem for our medical educators. Even the students leaving medical school now find that within a few years — 5 years or 10 years — 50 or 60 or 70 per cent of the material that they were taught in medical school has to be revised.
One could spend hours — and I won't — discussing first of all why it is so important for society to try and understand the way in which governments do attempt to deal with this very enormous problem whereby the amount of care and the type and intensity of health services which it is within our human power to provide, is a bottomless pit. As the Minister pointed out in his budget speech, you cannot spend endlessly, even although it might all provide positive results for all the people receiving the treatment.
I was a little disappointed in the Minister's leaving the subject of health education to the end of his speech. Through you, Mr. Chairman, that probably was unintentional and it did not reflect the tail-end of his speech in the sense that it was the least important part of his speech. If we hope at all to begin to cope with the health needs of our citizens, by and large, we have to embark now on a positive programme of promoting health rather than trying to deal with disease once it's established.
In the long run I think this is the hope we have — to come close to providing the high quality and the amount of care which our society not only expects but demands. I am talking about sound nutrition and exercise, which other Members have talked about, healthy recreational habits, proper sleep habits and so on. More importantly, of course, trying to educate the citizens against or away from some of the habits which promote disease.
I won't recite, as I've done year after year, the absolutely convincing statistics in relation to smoking. Anybody who still tries to argue that it has not been proven that smoking creates disease and disability and leads to premature death, really has to be blind. There's none so deaf as those who will not hear.
While the Minister did mention health education, I think that this should be the absolute, number one point that we're hammering away at, particularly in our schools.
Mr. Lalonde, the federal Minister of Health just announced the other day — I thought it was still peanuts that he was talking about — that over the next three years they will triple the funds made available for sports and fitness programmes from $8 million to $25 million. While I still think that in the total federal picture of the federal budget this is peanuts, at least again it appears as though we're getting across the idea to public leaders that the emphasis must be a positive one on health measures rather than simply trying to cope with disease once it's present.
On this subject, and it's mentioned also in that article that I sent over to the Minister, there's the question of annual medical examinations when the patient has no symptoms. This always fascinates me, Mr. Chairman, that it is such a sound, sensible, positive approach. Yet for the record the people of British Columbia should know that that is not covered by Medicare. You can come and see your doctor about dandruff or ingrown toenails or a pain in the neck and the Medicare pays for the visit. But if you as an intelligent, well-informed citizen, wanting to preserve your health, go to the doctor and ask for a checkup, if you don't have any complaints, that visit and the cost of the examination is not covered by Medicare.
Now I forget the quotation from Shakespeare, that something makes liars out of all of us. The fact is that most doctors, by taking a complete history from the patient, can find something wrong. This, in a very devious way, and a dishonourable way in my opinion, justifies the fact that we can then bill Medicare for the cost of the examination.
I have mentioned this before and I would like to leave it with the Minister, that hopefully we won't have to be devious. If someone comes for a checkup this should be covered under Medicare.
We are very critical of people who drink too much alcohol and we're critical of people who smoke too
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much, but what is our attitude to people who eat too much?
AN HON. MEMBER: Name names.
MR. WALLACE: I won't name names. The guilty parties have just spoken up for themselves.
Seriously, Mr. Chairman, obsesity, like smoking, is certainly a strong predisposing factor to certain types of illness and the need for hospitalization and medication. We know, for example, that you certainly increase your chances of sugar diabetes if you are constantly and persistently overweight. High blood pressure, with all its disastrous consequences of strokes, hemorrhages, blindness, kidney disease and a dozen other things I could mention, very often has a very strong predisposing origin in obesity. Yet as I say, we tend to feel sorry for people who are obese, but we tend to criticize people who drink too much or smoke too much. As far as I can see, the person who eats too much isn't in too much of a different category in terms of respect for their own health.
I have mentioned some of the challenges that arise from our increases in technology and I still think by and large, and I don't say this with disrespect, that it would help if the Minister would take a more definite, educational programme and try to tell the people of this province and Canada more specifically about the degree to which some of these changes have occurred.
This whole question of artificial kidneys and kidney transplants, for example, and the field of cardiac surgery is absolutely exploding in terms of potential to treat and operate on middle-aged men with heart disease, which would otherwise likely shorten their life considerably.
The whole field, I believe, of deafness is on the verge of another breakthrough. There are two types of deafness. One type is called nerve deafness, which we have never really been able to treat. I understand that a famous clinic in Los Angeles, the House Clinic, is close to devising electronic mechanisms that will, perhaps, partially restore the ability to hear in the people who have nerve deafness. We can think of the many, many numbers of such elderly people who would benefit from that.
I have already mentioned anaesthesia. People today really don't realize that a lot of the surgery they have isn't just due to the fact that we have the surgical techniques but to the fact that we have sound, safe anaesthesia which can last five, or six, or seven hours to carry out some of these very extensive surgical procedures.
We have talked a lot about drugs in this House and we tend to emphasize their abuse rather than their sensible use. Certainly today, again even in the last 10 years, the number of people who are restored to normal functions, particularly in the realm of mental disease, is really staggering and certainly most encouraging.
I am sure that progress will continue in these areas.
As I said at the start, while this makes all these treatments and progress available, it is a tremendously expensive feature. The Minister might care to give some cost figures, for example, on the open heart programme at VGH. I don't know what it costs to set up the programme and I don't know what it costs to operate but I think the Minister would be promoting education of the public on this subject if he gave us these specific figures. It often means that a person who would otherwise be a cardiac cripple and who would be unable to support his wife and children, perhaps, in middle age, is restored to functioning capacity in society.
I don't want to sound too negative just based on dollar cost. It is the last thing I am trying to say. But I do hope that people across the province will get to know that there isn't a bottomless pit, and that somehow the money has to be raised to pay for these expensive procedures, and that as knowledge of technology increases there are going to be more and more extensive and expensive procedures that can be developed.
The Minister touched — and I don't want to go into this in detail, because you can talk around it forever more and not reach a conclusion — on diagnostic and laboratory services. The Minister raised this subject in a different way asking about the validity of private and public labs. I think that's the whole debate in itself.
What is very clear, Mr. Chairman, is the tremendous importance of diagnostic and laboratory procedures in modern medicine. Many of these complicated operations that I've discussed could only be made possible if the patient is properly investigated in the first place. Now we have so many very complicated tests and manoeuvres and injections and X-rays and what-have-you which provide us with information about the patient which, in effect, enables us to go ahead with treatment.
I recognize and so, I hope, does every doctor that this can be overused and that we can go overboard in the prescribing of diagnostic tests. Again I come back to the point that were it not for many of these tests we would have disease, disability and early mortality in many citizens who, because of the tests and the new treatments, certainly can be restored to a normal function in this society.
So what about this business of costs? We have talked about how high they can become and I have talked about the potential for improving health. Nevertheless, to be really practical, we are landed with certain basic costs, particularly in hospitals. I was delighted to hear the Minister talk in the way he did about reviewing levels of care. If there is one relatively simple key to this problem of health care
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costs, it is to get us away from almost the obsession that a patient can only be properly treated in hospital.
This in many ways is an impression left over from the days when you went to a hospital to die, because our knowledge was limited, our techniques were limited, and all these advances that I have just described were not available. A much greater percentage of patients going into hospital went in to die. The treatment and the facilities were not available. So the acute hospital bed became the catch basin for anybody, really, who could not function at home or where the help that they needed was not made available at home.
It was interesting to me — I looked back at the old election material that I wrote in the newspapers in 1969, prior to the election. Just briefly it is interesting to say that:
"What we need is a coordinated programme of home care to be developed and provide a wider range of nursing and medical services in the home." Such a service would be provided by combining the resources of the VON, the Metropolitan Board of Health, the Victoria Welfare Council and the Health Branch of the provincial government. The financing would be provided by the provincial government and would be more than offset by the reduction and costs resulting from the more efficient use of hospital beds."
I'm not claiming that I was any prophet. This has been preached all the years I have been in B.C. We had the royal commission talking about this in 1962, I think it was, and then we had the federal task forces a few years. They all emphasized the fact that the expensive, acute hospital beds were being badly used or inefficiently used. Yet many other Members have spoken in this House over the last four years, since the 1969 election, asking that the government not give just lip service to this, but do something about it and provide the other levels of care and the big level of care.
I know the Minister is aware of this and this is another area of disappointment to me. I think the Minister is doing a terrific job, but this is one area where he has disappointed me. We need some action to provide not only facilities for intermediate care but to provide some form of government financial assistance. Again, I apologize to the House for the confusion that arises over these different words. I'm sure Members wonder what we are talking about. Acute care, extended care, intermediate care, chronic care — the words are all used and I'm sure they are confusing to the layman.
Very briefly, Mr. Chairman, what actually happens is that if you are seriously, acutely ill, you pay $1 a day. If you are classified as extended care and you are elderly and senile and need a great deal of nursing care around the clock, you are classified as extended care and you pay $1 a day.
Right in the middle of this, the two ends of the spectrum, the people who need some continuing degree of medical care and nursing care in society, I think, are getting a shocking deal from society. It doesn't need to be repeated; it has been said many times and we have questions on the order paper which the Minister has answered. My colleague from Saanich and the Islands (Mr. Curtis) has asked about it.
But, Mr. Chairman, one of the subjects about which the NDP spoke very forcefully when they were in Opposition was this disgraceful social problem of having elderly people in nursing homes and private hospitals where they were spending their life savings, selling their homes, putting their spouse usually into great difficulty.
If one or other spouse was well and the other one needed a nursing home, it very often meant that the healthy member of the marriage had to sell the home to pay the cost of a nursing home for his wife, or vice versa.
I feel that I just have to be critical of this Government. Despite much of the positive things that I like that it has done, it has certainly fallen short in my view. This was such a central, positive, repetitive measure which the socialists, when they were in Opposition, said they would move immediately to correct. The fact is that the patients in nursing homes are exactly in the position today that they were when this Government was elected.
I know that providing this coverage will be costly, but it won't be that costly. The argument is always brought out — and I hope, Mr. Chairman, that this Minister won't drag out the same old weather-beaten argument that we had from the Socred government, that the federal government won't pay 50 per cent of the bill.
My answer to that feeble argument is simply this: if the federal government were willing to pay 50 per cent of the bill tomorrow, the provincial government would be paying 50 per cent also. So why at least can we not now go ahead and have the provincial government pay its 50 per cent right now? It's going to be paying that much anyway, sooner or later.
Certainly in terms of the patients, as we calculated it out the last time I spoke on this in the House, we're talking of something in the order of $10 million a year, which, in the kind of budget that we've just debated, I really don't think is an enormous sum of money. Certainly in terms of the tremendous service which the patients who are in acute and extended care beds need, it's just such a complete contrast and it's so totally unjust.
It's a promise that you made when you were in Opposition. I just say that if there is one particular area in which this Government has disappointed those who supported it, it is in failing to come through with
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financial assistance to patients receiving intermediate care.
MR. CHAIRMAN: Order. I would just remind the Hon. Member that he has a bill on the order paper which deals with this matter. Therefore, I would ask him not to pursue the subject.
MR. WALLACE: Yes, Mr. Chairman. I am just finished on that subject.
My note just reads, "Plead for the patients in the nursing homes," and I'm on the next heading.
I think the subject of care for the elderly in itself is tremendously important in British Columbia and certainly in the greater Victoria area, where our percentage of citizens over 65 is I think twice the national average. This is why I would like again to say that the Minister is making very good, positive suggestions when he is discussing the availability of help to the elderly citizen who wishes to remain in his or her home.
It isn't just a question of saving dollars. There's no question in anybody's mind in the health field that if the patients can be assisted and comforted in their own homes, the chances of them continuing to live productive and comfortable lives are improved. It is very difficult to repeat in a hospital the kind of atmosphere and peace and quiet which can exist in the home but which is very difficult to create in a hospital.
This is not with any disrespect to the hospital. I was looking at Gorge Road Hospital today, which has just created 300 extended-care beds. This, Mr. Minister, through you, Mr. Chairman, is really a tribute, not only to the Government but to the people who operate and the people who work in that hospital. You can sense the real dedication in the staff when you talk to them, from the administrator down. I think that this kind of facility is really a credit to the province and to the people who plan our health services.
I know there aren't enough beds and that we need to create more. But to look at the Gorge Road facility is certainly very encouraging. I hope that the regional hospital board in this district will quickly go about deciding where the other 150 beds are to go. The Minister smiles.
The fact is that I'd have to say that I feel somewhat disappointed in the delays, for whatever reason, that have resulted in the greater Victoria area in carrying out all the plans that were included in the last referendum for I forget how many millions of dollars. This was several years ago and there's still no definite decision where these last 150 beds should go.
This question of intermediate care is important in all aspects of illness, but nowhere is it more important than in mental disease. The archaic approach of the federal government towards mental disease certainly answers for me the reason we've got such a weak-minded government in Ottawa.
Their attitude to the role that mental disease plays in society is the same attitude that people had 100 years ago, that is, "if you're mentally sick, well, that's something else; but if you've got a broken leg we'll spend a thousand bucks putting you back on your feet."
It's very annoying to find that half or two-thirds of your medical practice is people with emotional, mental problems and if we have to, as we should, meet the costs of helping these people, that we have this very unreasonable, uneducated attitude at the federal level.
There's tremendous potential for facilities to help people with mental disease and emotional problems when they leave the acute facility. I've spoken before in the House on the case of one psychiatrically trained nurse who tried to set up a domiciliary facility in Victoria as a — I think the best term that's understood by lay people would be a "halfway house" situation; the patient doesn't leave the acute hospital one day and go right back into a state of independence and self-sufficiency right away. This lady, Miss Pask, set up such a facility and unfortunately was banging her head against a brick wall as far as the government was concerned. She went through an enormous amount of red tape and bureaucracy just to get the place set up.
Mr. Chairman, if you could see the correspondence and the obstacles that were put in her way, from the municipal level upwards, you would have thought she was trying to build the Taj Mahal instead of just converting a domiciliary building on Quadra Street into a facility which, when she finally got going, proved its worth, inasmuch that of patients that she helped, the number who subsequently required readmission to the Eric Martin Institute was very small — smaller than the average degree of repeat admission.
I understand that her health finally gave out and this was simply because she wasn't given enough financial assistance to employ enough help. She tried to work around the clock herself and I understand her health gave out and finally the facility was closed.
I would plead with the Minister. I don't know all the details, but the principle is so sound and so exciting that it's the direction in which we should be going. If we're going to help elderly people in their own homes with the methods the Minister mentioned, there's a whole world of prospects for the emotionally ill patient leaving the acute mental hospital to have some intermediate type of domiciary setting, staffed with nurses who have had psychiatric training, who I think would hold a great deal of potential for the patient, inasmuch as you would be reducing the chances of that patient's having a relapse if he tries to go back into his full
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responsibilities in society right away.
It comes down to this whole question of the proper use of our health personnel. There again, Mr. Chairman, the idea has a lot of merit that we're not using our skilled personnel properly. Certainly in the last few years we've upgraded the responsibility of many nurses in the acute hospital and I think we should pay credit to the nurses now employed in what are called the "coronary care" units of our hospitals in this province.
These are the nurses who, far more importantly than the doctors, have the survival of patients in their hands, patients who had had coronary thrombosis. These girls are highly trained in the reading of cardiograms and in the immediate treatment of a person who either has a heart attack or who had cardiac arrest or who has some impending signs of cardiac arrest.
If there's any doubt in this area of heart disease about the role of the nurse, the nurses that have been trained in this particular specialty certainly come through, in the view of the medical profession, with flying colours and with contributing enormously to the success rate and the survival rate of many of these patients.
There just isn't time to wait for the doctor to arrive when the patient develops an irregular heart rhythm, or indeed if the heart stops beating. It is the nurse who takes the action immediately which very often saves the person's life and gets the heart going again. I am maybe overstressing this, but I think not too much credit and respect is paid to the number of arms of the medical profession and the health services who have made this kind of contribution in a relatively few years.
There has been a lot of talk, on the other hand, of using the doctor more efficiently. I agree with that principle, but I'm also a little worried about the danger of over-simplification.
The Minister, in his budget speech, said that doctors really should be freed from the chore of dispensing birth control pills and family counselling. With respect, Mr. Chairman, I would have to sound a note of caution. There are few pills that are more dangerous to prescribe than birth control pills. I'm not trying to be funny.
I don't mean that they might not work. I'm saying that there are one or two very basic complications which can arise, sometimes fatal, from the use of birth control pills. I'm referring particularly to vascular problems that we call thrombo-embolism, where you either get clotting in the vessels or a piece of clot dislodges from the blood vessel and travels to some vital part of the body, such as the lung, and may cause sudden death.
I'm sure that the Minister meant this in good faith that we should limit the doctor's role if it can be done by somebody else. This is something that I think has to be put on record: while the doctor himself wants to be freed of many of his paperwork duties, and many of the routine chores that could be done by somebody else, let us not go overboard and finish up with strictly medical responsibilities being given to people who have not had the adequate training to make some of these important decisions.
In politics and in this House it's all too frequent that a Member attacks a Minister, but I'm just about to attack the Minister's wife, which I guess is even worse. But in jest, Mr. Chairman, I would have to comment on the fact that a certain statement appeared in the Press suggesting that the four Deputy Ministers have it in their power to decide what kind of surgery a woman would have if she had breast cancer.
She felt that this upset her very much, and it would upset me if this was the case. But I think the House and the public should be clearly reassured that the responsibility for deciding medical or surgical treatment rests in the hands of the attending physician or surgeon.
I'd like to make some specific suggestions if I could, Mr. Chairman. One of the practical complaints that I hear all the time from the hospitals and from the administrators is the bureaucracy of BCHIS; that when you start trying to get things done, there are holdups and red tape and delay and apparent lack of cohesion between the three different arms. We have hospital, and we have mental health, and we have public health. If I ask anybody in the hospital field, "What is the one thing you would first of all like to see improved about our health services?" this, from any administrator at least, is the first answer you always get: that BCHIS seems to be really tied up in its own bureaucracy, with delay and numerous letters passing back and forth.
When I say this, I'm passing on the comment in the light of others in the administrative field. I have very little direct experience of this myself. But it comes up so frequently when you talk with people in the hospital field that I have to assume that there's some grounds for this kind of complaint. I wonder perhaps if the Minister would comment when he answers.
There was great misconception in the House the other day in discussing the subject of hospital boards. Again I think that the Minister, in attempting to expand the hospital board in terms of having people on the board who have community identification and interest, is very important. And the suggestion put forward by the Hospital Employees Union shows just how much or how little they know about the important input of local, voluntary, dedicated help to hospitals. Anybody who talks about abolishing local hospital boards just doesn't know what they're talking about.
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The one improvement which I'm sure the Minister is trying to make is to have a higher percentage of hospital boards elected by the local hospital society rather than have a large number of appointed members of the board.
To correct some of the statements that were made Friday, there is no hospital board I know of in the province…a few years ago I did a private study of close to 80 hospitals in the province. On that occasion I was trying to find out why a doctor couldn't run for election as a member of the society — election I'm talking about, not appointment.
We all, as doctors, can become members of a hospital society and pay our annual dues, but we are prevented from putting our names forward for election at the annual meeting. But anyway, this study showed that while the percentage varies there's no hospital board where all the members are elected.
I'd like to touch on a few specific needs which I'm sure that the Minister would like to comment upon — needs which would not be of great financial significance, but tremendously helpful to the minority of patients concerned.
First of all, I'm talking about children with cleft palates. The Minister nods, and I know we've been around this racetrack before. We've been around the racetrack on private nursing homes, Mr. Chairman, before too, and they still haven't been dealt with.
The child with the cleft palate has a terrible row to hoe in this life. But at least we can do more for him or her than ever before. I really must belabour this point, because the surgery which the plastic surgeon eventually carries out gets very good results. But he in turn depends on proper orthodontic treatment of the deformity in the mouth prior to the surgery.
The surgeon's ability to produce in the end a good cosmetic and functional result, is very dependent on the availability of preceding orthodontic treatment with various moulds and appliances.
I'm sure that the Members can understand, Mr. Chairman, that these happen in young babies and children and that the children of course grow very rapidly and the degree of the deformity and the mechanics of the problem change very rapidly — almost from month to month in the first few months of life and within the next year or two almost as rapidly.
The orthodontic care required for these unfortunate children, in the first year or two or three of life in particular, is very expensive. It continues right up, or can continue till the child is in its teens. The expense gets less as the time goes by.
The point that's so important to I understand is that where Medicare is paying for abortions and sterilization, and it's paying for a whole variety of physical complaints in society, here we have children with a serious congenital deformity which influences their whole physical and mental development as they go through childhood, and Medicare doesn't pay for what is a vital part of treatment in a very small minority of children.
I can't give you figures. I meant to get them before I spoke today. The figures are available. The Society of Plastic Surgeons has tried very hard in years gone by to persuade the Minister that this would not be an enormous output of funds — but the benefits to the children would be enormous, and in the long run would benefit society. We'd be less likely to have emotional and mental troubles and behaviour on the part of these children who either can't eat or speak properly.
This brings in the subject of speech therapy, Mr. Chairman. I'd like the Minister to comment on whether we could have a serious look at providing coverage for people who require speech therapy. We have many citizens who have a stroke and initially they're paralyzed in an arm and a leg. But this very often recovers, at least maybe 70 or 80 per cent, and they become mobile again.
I think we can all contemplate what a loss it is to have confused or garbled speech. You can become mobile and go out and take your walk in the park, or you can go to the corner store; but if you can't ask the man in the store what you want to buy, or he thinks you're drunk because you're not speaking properly, the emotional impact of this kind of complication is really serious.
We're dealing, not with a large segment of society, but an important segment, whose functioning and normal mental health would be greatly enhanced if they had access to speech therapy.
Another small segment of society who I think the Minister should be in a position to help are those unfortunate persons who require surgery and finish up with an artificial opening on their abdominal wall. I'm talking about people that we say have a stoma, such as a colostomy. I think that anybody in society who is unlucky enough to have their survival depend on such an operation — surely, Mr. Chairman, if we're providing so much coverage to so many people with really pretty simple minimal complaints, it's not asking too much that at least we should financially help the person who has to buy the appliances and the cream and the ointment and several other aspects.
I don't want to go into details. It gets rather clinical. But I'm saying that the person with an artificial stoma has already suffered a tremendous handicap in his life. If we're willing to pay for the cost of many other procedures which are much less important to the individuals, things like speech therapy, cleft palates, stomal openings — I would like to hear the Minister comment as to whether we're close to giving these people help.
He mentioned oxygen in the home the other day. It's just joy to my ears. We asked for that for the last three or four years too, and the Minister was always
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going to do something about it but he never did. Again, apart from the tremendous convenience and help to the elderly citizen to have an oxygen tank available in the house, it helps to keep them in the home, where they're comfortable and happy, and it keeps them out of hospital. So it just makes both medical and human sense, plus sense in terms of dollars.
In talking about oxygen, Mr. Chairman, I know the Minister has a request from a new group of paramedical personnel who have appeared in the last few years. Respiratory technologists, they're called. I don't know if the Minister recalls right at the moment who they are. I have a copy of a document dated February 26. It's actually a petition. I won't go into all the details, but these are technologists who can train certain patients whose problem is respiratory, in particular people with a condition we've come to call obstructive lung disease, which, simply put, is a form of asthma.
These people train the patient while he's in hospital to use a type of positive pressure inhalator. If this kind of treatment were more readily available in the home, once again, we would have the potential to treat the patient at home and save him from frequent hospital readmission. The thing is, Mr. Chairman, that this has become recognized as a paramedical specialty, you might say, in every province except B.C. and Saskatchewan. Any technologist who wishes to take up this profession or to be transferred from, say, nursing to this, cannot have the training in British Columbia. The two gentlemen that I've spoken to were trained in Alberta. They are asking the Government to consider setting up programmes whereby training would have established standards and the persons concerned would no longer have to leave this province to take the training.
It would also help to maintain the standard of work by these technologists in a hospital by giving them a recognized diploma or some degree of training. They, in turn, are very keen to upgrade their training and to have in-service teaching and so on. I would hope that the Minister is aware of this petition. It's addressed to him. I know that he must receive many, but I would be interested to know what his advisers have felt about the sound nature of this proposal.
I would prefer not to talk about acupuncture, but I feel that certain things have to be said. There are very few times that a doctor seems to be beyond suspicion when he attempts to discuss some other arm of the health team providing medical care. The most frequent criticism that I have received, both privately and in the news media, is that doctors are opposed to acupuncture because they feel that this would encroach on their particular domain — earnings, prestige, call it what you like. I don't really care. All I do care about is getting the facts straight.
The fact is that the Chinese themselves do not know how acupuncture works. They have no clear understanding of how it works. We do know that there are benefits, particularly in the realm of the pain-killing effect. Let me make it plain, Mr. Chairman, that I accept that there's something very important and useful in acupuncture. I'm convinced of that. We've seen operations on television where people have operations on their lungs. There was one where the skull was opened and the brain operation was carried out under acupuncture. Everybody has to accept that it has a great deal of merit and value.
The reason that doctors may appear to be unduly sceptical is simply that we are concerned in this area — as we are in relation to chiropractors also — that diagnosis, knowing what the problem is, must precede treatment. It just makes no sense, because you can kill a pain somewhere in the body, to go and stick needles in, albeit kill the pain, without having made a diagnosis to be sure that the patient may not have some underlying organic disease which requires, let us say, surgery.
That's all the doctors are saying. And I'm happy to say that this is, I think, the attitude of the Minister, from his public statements — that we have to protect the patient.
If anybody thinks that I'm exaggerating, I had one of my colleagues bring two cases to my attention in the last few months. There were two patients, each of whom went to the person practising acupuncture in Vancouver at some travelling expense and the fee of having the acupuncture treatment. The patient was only asked, "Where's the pain?". The needles were inserted and the treatment was over. In both cases the patient received several treatments without any benefit. They finally went to a medical doctor because of the failure of response. It happened that both of them had organic disease which did require surgery. In both cases, I'm told, the delay did not affect the final outcome.
The fact is that we, as medical men, are concerned about patients who might choose all too easily and without any restrictions to consult an acupuncturist. The application of needles simply to relieve pain in the absence of a diagnosis is a very dangerous thing for the public. If that's what the public want, they can speak out and say so. I feel that, as one doctor — and I'm not speaking for doctors generally, just speaking for myself. I've seen other cases happen in the hands of chiropractors. I make no apology for saying that either.
Somebody down the way here the other day asked if chiropractors were to be brought under the Medical Act. The Minister, I think, gave a definite "no", for which I think he is to be complimented. The chiropractors are not, any more than the acupuncturist, medically trained in a scientific way to make accurate diagnoses. In fact, I'll go further and say that
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chiropractic practice is really a cult which is not based on scientifically demonstrated principles. Originally, the concept behind the chiropractic practice claimed to cure cholera and diabetes by spinal manipulation. Certainly the dogma to which chiropractors adhere does not accept the proven scientific practices such as vaccination and inoculation. The established, fully trained medical man certainly feels that vaccination and inoculation are one of the pillars in our preventive medicine practice which avoids and prevents a tremendous range of diseases in children and young adults.
Once again, I'm just saying that doctors are not opposed to anybody who can help the well-being of a citizen. But there has to be protection for the citizen also, to the degree that various forms of treatment, which superficially may appear to hold tremendous potential, should only be applied after diagnosis.
I have examples here, too, of two particular patients who had their spines manipulated in the absence of a diagnosis, after X-rays had been taken and misread by chiropractors, one of them a patient with cancer of the spine whose condition, under manipulation, deteriorated rapidly so that she lost control of her bladder and became paralyzed, then was rushed to the hospital and had emergency neurosurgery. The X-ray which had been misinterpreted by the chiropractor showed the cancerous lesion of the spine.
We have another case of a person with rheumatoid arthritis who finished up quadriplegic — that's paralyzed in all four limbs. Now, I'm not saying this is happening every day, or every week. But the fact is that when doctors take a stand and sound a note of caution about acupuncture or chiropractic, it isn't from any selfishly motivated point of view — it's simply that we have a high sense of obligation as doctors to protect the public from the dangers of ill-informed, potentially damaging forms of treatment. And I can't put it any plainer than that. But I think it's time some doctor did stand out in public and say this.
I know I am going to have every chiropractor down my neck after what I've said. But I've got the documentation. I know the cases. This happens. I think that under these circumstances it might even be worthwhile for the Minister, through you, Mr. Chairman, to perhaps do some statistical analysis of the patients admitted to hospital who have previously had some of these treatments with a view to evaluating how successful they've been. And perhaps equally important, to evaluate how many of the patients ran into serious complications.
I am not going out of my way to attack branches of the health services field; I am trying to put things in context. I am trying to say that when doctors make certain statements and call for the Minister to set up committees and so on, this is certainly not, in my view, motivated by a self-protective mechanism. The person we're trying to protect is the patient.
One of the other subjects that I just want to finish on and which has already been mentioned, is the whole question of prescription drugs. I know it sounds rather tedious, but sometimes you have to ask many times before you get what you want in life. Sometimes you never get it.
But this whole question of prescription drugs, particularly as to elderly citizens, as the Member for Vancouver–Point Grey (Mr. McGeer) mentioned the other day, their very life depends on it. When they're on a restricted budget, the monthly sum of money they can put out for drugs is really considerable. I think the progressive legislation which has provided Mincome could easily be extended to provide very substantial assistance to the senior citizens for drugs. I've talked too long.
MS. CHAIRWOMAN: The Hon. Minister.
HON. D.G. COCKE (Minister of Health Services and Hospital Insurance): Ms. Chairman, it's nice to see you back in your favourite chair. Thank you very much for many kind words, Mr. Member. This day is starting better than Friday did, I'll tell you.
Let me first deal with the question of recreation — and thanks very much for the UBC reports. But the old question of recreation — I met this morning with the B.C. Council of YM-YWCA's, their whole council is meeting over here. They're interested, very interested in the question of recreation and fitness programmes as a preventive measure in health care.
We realize that we have to get a more definite programme, a type of programme that's going to be sufficiently attractive. One of the great problems of course is when the federal government committee met just recently in January, at least one of the areas in which they agreed was the fact that there isn't necessarily that much that you add to a person's life. I think that is one of the studies they have to do.
I agree with you on the cigarettes, and the overuse of alcohol, overuse of food, and that type of thing. That's quite clear. But there's a very definite need to get people involved in a sort of a programme that's going to make them aware of how to care for their own bodies.
I have here some pictures of a little robot. He's the cutest little thing you've ever seen. That robot will be seen on television starting about the end of March. He belongs to us — everybody in B.C., I hope. I hope they get very friendly with him.
His purpose is to sort of draw in an analogy. If you had a machine like this, the only one in existence, would you look after it? This little machine works along and then it shows the contrasting situation, your own body which is your only machine — would you look after it?
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We think that that might be an excellent way to kick off a programme of fitness consciousness in the province. So that will be a part of our health department advertising programme sometime around the end of March. If any one wants to see this little robot, we can send it around. You can name him if you like. I've heard quite a few, but haven't decided what to call him yet.
That's one way of getting public information out there. We're very interested in it, and want to get going.
I notice here we were talking about the high costs of certain areas of health care. For instance you were asking if I could tell you what open heart surgery would cost. The figures all put together, it averages somewhere between $4,000 and $5,000 per person. That's not just the operation. That's the medical attention, and the pre-operative care. But that basically is what our estimate is. It's very difficult to say because one might cost $10,000 and another might cost a great deal less. We're getting patients out of hospital now in a couple of weeks and less. And I'm very pleased of course, with the addition of the Willow onto stream. It's going to give us a fair capacity for B.C. But I have to warn the people that you can only go so far with this kind of sophisticated medicine — there may be other areas that we're going to move into. As you know, we're in renal dialysis to a great extent. The board assures me that there are none of these life and death decisions being made — anybody who can be helped is being helped.
But, we're getting to a point in time where we have to be very careful in assessing just how far we can go in sophisticated medicine if we have to think in terms of depriving a large number of others by virtue of the fact that we've gone this way for a very small minority.
The private versus public lab question — I'm glad you don't want to discuss that to any extent; neither do I. We haven't made any great decision. The only thing is, I'm not going to stand around while there's a public lab serving people and having served people for a number of years, and then somebody builds a private lab across the street to go into direct competition with the public lab. That's just it, period.
If some people are accusing the hospitals and other public labs of being too slow, if necessary, we'll sharpen up then. We'll get the work done properly.
But, I just don't see us running our own labs out of business by virtue of saying, "O.K., go ahead and build across the street." And that's what is happening because that's a handy place to have it.
The private hospital situation — I think that I have been fairly definitive about that. I don't think you should be too surprised about our position. We're working at top speed in providing care for those people who qualify for care.
We haven't moved to intermediate care yet. One of the reasons is that it's very difficult to decide where you draw the line for intermediate care. That's a whole new level of care. We have one facility that's just opening, and two more to go, where we're going to be able to test this level of care as to how far down you go for the day when we introduce it into Medicare — or rather under Hospital Insurance. It'll happen.
I don't agree with your price, Mr. Member, however. You said $10 million. I suggest it might be $20 million plus. And that's only if those that are actually known now to be in need of intermediate care.
My suggestion is, once we get in on intermediate care — and don't forget that's ambulatory chronic illness — once we get into that, then if we're not careful it could very well be a dumping ground for people. We feel that the only way to go is to go home care first so that we can reinforce all of the chronic illness.
MR. WALLACE: What about people in nursing homes right now? You're not doing anything to help them.
HON. MR. COCKE: Well, the people who are in the nursing homes right now, those people who qualified for extended care, we are getting them out as quickly as possible.
In your Capital Regional District, we've moved everybody who wanted to go into Gorge Road.
MR. WALLACE: What about the ones who don't qualify?
HON. MR. COCKE: The ones who don't qualify are intermediate care — and they are stuck at the moment. But as I say, what is intermediate care? Where do you go, where do you stop? Where do you draw the line on that type of thing? Now, I'll tell you it takes a lot of care. Because something that we think in terms of $20 million could be $100 million before you know it, and then we're into a very, very rough situation.
We have right now a great number of private hospitals dealing with us, asking if we'll buy them. We're assessing all these situations. O.K. We want it just as badly as that Member. We're going to provide that service as quickly as we possibly can, With respect to the greater Victoria utilization of the last referendum, there will be 75 of the 150 beds built in the Colwood region. I think that they'd better resolve that very quickly myself. It's been a bit of a problem. There have been arguments as to where it should be.
Now this morning, as you know, we formally announced the new referendum, which is to go to the
[ Page 1219 ]
people on March 31. That referendum will be for $22.5 million for the next four years or so. What I want people to understand is that the $22.5 million that they're voting for isn't going to come out of their pockets entirely, by any stretch of the imagination — 40 per cent of it comes from the taxpayer and the other 60 per cent of it comes from this Legislature, from the provincial government. So their load is only something in the order of $10 million. It's not going to be a charge to the home tax. That's the way the referenda work.
Unfortunately, when you announce a referendum, it always looks like a fantastic sum. For instance, in Vancouver recently there was a $95 million referendum. Many of the taxpayers feel that that is all going to come out of their land tax dollars which it won't. Only 40 per cent will.
You, along with the Press, I believe, were misinformed about the statement. I happened to be at that meeting. I was most impressed with the speaker who spoke at that meeting about my four deputies deciding on radical mastectomies. That was two entirely different conversations but they had managed to box it in together. However, what she did say was that she didn't like the idea of a male doctor, or a number of male doctors, making decisions around radical mastectomies that were often wrongly made by virtue of the fact that the male does not give as much attention to that particular part — that is to say he does not have as much concern about that particular part of the anatomy as women have.
There's been a great deal of research done on this question. The research says that many of those operations are totally unnecessary. The operation for the cancer is quite necessary but the total removal of the breast is not.
MR. WALLACE: That's debatable.
HON. MR. COCKE: It's debatable, all right. But I'll tell you, they've got some pretty hard facts. But that was the statement. It has nothing to do with my deputies making decisions as to whether or not women suffer that kind of operation.
BCHIS bureaucracy. BCHIS comes to me and says, "What about the bureaucracy that we're confronted with?" It's a very tough question — deciding how much to spend on hospitals and where to spend it and all the rest.
Another thing too. When a government department in as sensitive a position as they are makes decisions, they've got to be right. That's one of the reasons why they're more careful than a number of government departments. I'm very pleased with BCHIS. They've got some people in there working long, long hours for not too much appreciation. Frankly, from what I've seen in the last six months that I've been in this department, I'm really pleased.
Cleft palate. We're studying that very carefully right now. You recognize, of course, that there's no problem about the surgery. The problem is around the orthodontic work that has to be done both prior and subsequently. That work has to go on for a number of years. We recognize that it's a very few cases and therefore, while it's very expensive for the individual, it wouldn't be that expensive as a global thing.
Then we have to start thinking how far we carry. Do we carry it into malocclusions and all the rest of it? You know, the dentists can give us a really wide range of things that they should be in right now. We're looking at it and I wouldn't be surprised that something happens there very quickly.
Speech therapy. There aren't enough speech therapists in the province to do the job that we need doing. We are adding eight, we've got 10 now, but there just aren't enough audiologists and speech therapists around.
If somehow or another the Department of Audiology at UBC, which is a relatively recent innovation, can really get off the ground — and they're having some problems, I can tell you, a shortage of funds among other things — I am sure that there will be a supply and then we can get involved in this whole question of speech and hearing deficiencies.
Acupuncture. It's becoming quite a subject. It's hard to know about acupuncture. But the one question on which I agree completely with you is that I don't want to see people go to another health group for diagnosis and then find out to their sorrow, too late, that they're going to die as a result or suffer ill health for the rest of their lives as a result. That's why we're going slowly. The one thing that I want to bring to your attention is that I have had hundreds upon hundreds upon hundreds of letters on acupuncture. So far I've yet to receive one that has indicated any harm as a result of that particular therapy.
We met the acupuncture committee last weekend. We've decided we're going to move towards — providing we can get co-operation from some local acupuncturists — controlled, clinical situations where the patient is referred to rather than just going directly off the street. Also I think it will give us an opportunity to assess some of the work that the acupuncturist is doing.
We haven't got agreement from any local acupuncturists yet, but we will be going to a number — you know their names, they're the prominent ones basically — and asking them if they'd care to participate in that kind of activity. We hope that they will give us an opportunity to work with them.
The "chiropractic cult." It's a little harsh, Doctor.
Mr. Member, I think that there was a time when you could very easily say that about the chiropractors. They are relatively well trained now, according
[ Page 1220 ]
to the information that I get, and they have a large following of people who feel that they provide good service. They are not going to be licensed under the Medical Act because they are not medical people. Agreed.
I think what we want to do is develop a closer understanding or liaison between doctors and the chiropractors. As long as there's this impasse, this no-communication situation, then there'll always be mistrust and lack of understanding.
Interjection by an Hon. Member.
HON. MR. COCKE: Yes, I understand those disasters. But, you know, disasters have grown. We can go back a number of years and we can find, for instance, prior to the Carnegie report in 1911, that the medical profession was a disaster too in many instances.
Interjection by an Hon. Member.
HON. MR. COCKE: No. I'm not arguing that, and I'm not arguing that the medical profession is in any way a disaster at the moment…
Interjection by an Hon. Member.
HON. MR. COCKE: That's right.
At the same time I think there should be more understanding of the chiropractors' problems. I think there should be more dialogue and we should get this thing together. Because I'm quite sure they could work together if given an opportunity.
There are some things that chiropractors do well. There's a tremendous number of people in our society who say, "Boy, if it wasn't for that chiropractor I'd be in really tough shape today." So that's about where it stands at the moment.
I hope that I've answered most of your questions. If I've overlooked any, you can come back at me. Thank you.
[Ms. Young in the chair]
MS. CHAIRWOMAN: The Hon. Member for West Vancouver–Howe Sound.
MR. L.A. WILLIAMS (West Vancouver–Howe Sound): Thank you, Ms. Chairwoman.
Dealing with the matter of chiropractors, I wonder if the Minister could just make a note — I won't be very long — and perhaps he could tell the committee whether or not he has any chiropractors or other medical disciplines in his departmental staff. I know that there are medical doctors. It would be interesting to know the extent to which these other disciplines are welcomed into the department.
Ms. Chairwoman, I want to go back to this question of the government's attention to the chronic care patient and the facilities that are provided. I don't think the Hon. Minister intended to sound like some of the answers that we got in previous years but it did sound much the same. "It's a question of the classification of patients. There's acute, intermediate, extended and chronic — it's how you draw the lines." This is what we used to get from the previous Minister.
The simple question that the Hon. Member for Oak Bay (Mr. Wallace) asked and that I ask — I don't care whether there's a person in a private hospital that might qualify for your extended care unit if they could get a bed. The fact of the matter is: What is the government prepared to do today for the patient who today is in a private hospital? It's those patients that we have to concern ourselves with. It's those patients, based upon their experience, that led to the $10 million figure that the Hon. Member quoted.
We are aware that in order to provide for all of this kind of care would cost $20 million or more a year. But all that the Member for Oak Bay said was that if you were going to contribute 50-50 to that scheme with the federal government, why don't you put up your half now?
MS. CHAIRWOMAN: Order, Hon. Member. I believe you're out of order. There is a bill on the order paper, An Act to Amend the Hospital Insurance Act, that covers the acquisition of buildings and land for the purpose of providing intermediate care of all types. I think that your questions are covering it. It's Bill No. 92.
MR. WILLIAMS: Golly, Ms. Chairwoman, I'm sure glad you brought that to my attention. I wouldn't want to offend against the orders of the committee in any way.
Let me raise another similar subject, but not dealing with the provision of facilities.
AN HON. MEMBER: It's a private bill.
MR. WILLIAMS: It's a private bill but it's on the orders. But there's another matter which arises out of the same problem. I'm not going to deal with the construction of facilities even though we could do it the way they've done it in Alberta. It really works there.
After the October session, Ms. Chairwoman, I'm sure you are aware because all Members received correspondence concerning the increase in rates that were charged by private hospitals, ostensibly because of the change in the minimum wage that was brought in at the last session. I would like to ask the Hon. Minister a particular question in that regard: Did his department make any examination into the operation
[ Page 1221 ]
of private hospitals and did that examination show that the increase in rates which took place late last fall was justified because of the change in the minimum wage?
It's a very serious financial burden that is borne by people who are patients in those hospitals and often by the relatives of those patients. We find elderly couples, one having to go to a private hospital and the other unable to continue to live in the family home and look after himself or herself, forced to find other accommodation and sell the family home. The eventual consequence of this is that both of them end up on welfare.
It doesn't take very many months at $400 a month to use up the savings of some of our older citizens even if they own their own home and sell it and get $4,000, $5,000, $6,000 or $8,000 in equity back. By the time the one who is not in hospital cares for himself or herself and pays the large expenses for the other, that money is very quickly gone. They have nothing but welfare — after all the years of contribution to the community. I'd like to know whether those rates were, in fact, examined and whether they were justified.
I'll now turn to the matter of health delivery in this province. As I listened to the Hon. Member for Oak Bay — and he certainly knows the problem — it clarified for me one of the basic problems that we have in this province. It's always said that the squeaking wheel gets the grease. I get the impression that the bigger the wheel, the bigger the squeak.
It's all very well for us to stand here, many of us from urban areas, and talk about $22.5 million capital referenda, $95 million in the Greater Vancouver Regional District, sophisticated care, homemaker service, ambulances that you can call by picking up the phone, heart surgery — all the sophisticated medical talent and facilities that technology has been able to design. We get terribly excited about this because there are a lot of people involved. There's a lot of money — a tremendous expense to the public purse. Naturally it must, I'm sure, consume a very large portion of the time of the Minister and of his department.
But what about those people who don't live in those major urban centres? What about the delivery of health care in the outlying areas where maybe if you're lucky you've got a doctor, where maybe if you're lucky you're within 50 or 60 or 70 miles of some kind of hospital facility?
What is the policy of the department now, Ms. Chairwoman, through you to the Minister, concerning health care delivery under those circumstances? I know that the Minister has had representations from doctors, from community leaders who come from outlying areas. Some of them don't have a doctor at all; some of them may be fortunate enough to have one. That doctor is virtually able to deliver health care for those communities out of the little black bag that he carries with him.
We should realize, Ms. Chairwoman, the serious consequences that this has for some of these communities. It's all very well if you're in the City of Vancouver and suddenly in the course of your daily occupation you are injured or become ill. Maybe you've got a first-aid attendant at your plant if you're at work. If not, they put you in an ambulance and away you go off to a hospital. They have all the facilities of that hospital made available on an emergency basis. What's the cost? Insignificant.
But if you're in some of these small communities and that occurs, first of all they have to find the doctor and he may be at the other end of the community, 25 or 30 miles away. Then, when they finally get the doctor and the patient together, the doctor makes his examination and provides what emergency treatment the circumstances indicate.
But let's say it's a fractured arm; it needs to be X-rayed. If the doctor has the equipment, maybe you're lucky and you get an X-ray. If it's X-rayed and the doctor can set the arm, then he applies a plaster cast. But the doctor pays for the plaster that's used in the cast. That's all the expense of the doctor. Whereas, if you're in a position to go to the hospital, it's all the expense of the hospital.
So we have this strange anomaly where doctors who practise in the city have the facilities of the hospital available to them. They send their patients to the hospital where they go and perform their medical skill. When they're all finished, they say to the nurse, "There, fine, you just clean up this patient. Thanks very much." The doctor washes his hands and away he goes.
But when you're in the outlying areas, that's not the way it happens. You diagnose, you treat, you bind up the wound and then you send the patient home. Then it's the doctor or the doctor's wife or somebody who cleans up the mess, hopefully in time for the next patient. If there isn't time to do that, then you go ahead and treat the patient under those conditions.
I happen to think that this downgrades very seriously the position of the doctor in those outlying communities and in the kind of health care that gets delivered. I think we owe a very great debt to those doctors who are willing to go out into those outlying areas and bring health care to those communities. I think they need some special kind of consideration. I think they should get assistance from the government to ensure they have at least those basic facilities which will enable them to do a better job.
After all, the doctor who is in that position is on call 24 hours a day. Some of them work just that long. I think that we have to consider that, after all, they're human beings too. They're not robots like the Hon. Minister has in his photograph. They've got
[ Page 1222 ]
wives and they've got families and they like to spend a little bit of time doing some of the things that husbands and wives and families do. Therefore, they need to have some special consideration from the government to ensure that they can do the job in their community and they can also function as human beings.
Too long, under the previous administration and the previous Minister, we had offers of solutions to this difficulty. I would like to know what the Minister is going to do about it under his administration.
MS. CHAIRWOMAN: The Hon. Minister.
HON. MR. COCKE: Yes, Ms. Chairperson — if that's what you prefer.
The question of private hospitals and qualifications: I know, I've made speeches in this House myself where I've indicated that it was a very simple procedure. But it isn't quite as simple as has been indicated by the previous two speakers.
It's very simple to decide who an extended-care person is. An extended-care person is a chronically ill person who can't walk, just that. It's very simple. People who cannot get around by themselves.
Intermediate care, which is where we want to go, is an announced policy, and a policy which I just don't understand how anybody could have expected us to have implemented in six short months. We're working in that direction. As far as I'm concerned I just hope that we're going to be able to pull it off as quickly as possible.
Let's say that we decided that that was the way to go. There are patients in private hospitals right now that couldn't conform to any standards. They are there by virtue of the fact that that was a place to go, a place to retire. Then on the other hand there are people in there who are very ill.
I'm not unmindful of what happens to people in a private hospital setting. It took only 3 1/2 years to break my father-in-law. I'm not unmindful of that at all. But I don't think that anybody here wants us to hasten to the point where we're going to undo it as opposed to do it properly. The only assurance I can give you is that this is one of our top priorities.
We are going to Ottawa again at the end of March, and again they're not going to admit that there is any such thing as mentally ill people. They're not going to admit that as far as they are concerned there are people chronically ill but not extensive. So we'll do our very best to come up with the kind of programme that's necessary.
It's not just the financing, it's the programme. That's the important aspect.
Now as to the question of whether we justified the rates for private hospitals. About half of the patients in private hospitals are my Hon. colleague's clients; half of them right now are being paid by the Minister of Rehabilitation and Social Improvement (Hon. Mr. Levi).
The only thing we did was to take a look at our particular participation in that programme. We said, "Yes, there is a need to increase the rate by a matter of $40-odd." So we increased the rates for those people in private hospitals who are on welfare up to $3.58. That's what we are now paying for those people who are in private hospitals. That was as a result of the increase in rates.
As far as what they did themselves, they came out with an earlier rate to their own patients. I must say that some of those rates jumped a lot further than I personally felt they should have. But there's no control over it and that's all there is to it.
Interjection by an Hon. Member.
HON. MR. COCKE: Our department studied it from our standpoint. We recognize that the increase of $48 was valid. But we can't speak for their own private patients.
Delivery of health care in isolated areas: as you know, we've got a salaried position now right in the middle of the Chilcotin.
The suggestion that you have about diagnostic and treatment centres would work out very well, providing we can get personnel. I think probably it would be a lot better if people think more in terms of the community health centre concept. In other words, a doctor and a group of people are told, "Okay, will you look after this number of people in this geographical area for 'X'?" You know, if you can keep them well, so much the better. But we're sure looking at that.
I recognize where some of your concern comes from in the Pemberton region. As a matter of fact we're discussing this question of Pemberton right now.
MS. CHAIRWOMAN: The Hon. Second Member for Vancouver–Little Mountain.
MR. R.T. CUMMINGS (Vancouver–Little Mountain): Thank you, Madam Chairwoman. I wish you didn't enjoy saying "second" so much.
As you know, Madam Chairman, our Government is concerned above all with the quality of life. It is
[ Page 1223 ]
this, perhaps, that most sets us apart from previous governments, which were only concerned with small businessmen and how fast they could become big businessmen. This basic difference in the way problems are approached is already noticeable. That is why I would like to speak now to extended care in British Columbia.
In 1965 the previous government discovered that there were patients being discharged from acute care hospitals who were functionally disabled. This means that they needed 24 hour nursing care because for various reasons, mostly non-medical, they could not perform the simplest tasks, like going to the bathroom or feeding themselves.
Most of these people, though not all, were just old and had been dismissed by their doctors as senile. Previous to 1965 these patients had been cared for in private hospitals, if they had the money, or by their families, if they did not. In many cases I am sure, Madam Chairman, they died of neglect.
In 1965 extended care was created under BCHIS — a dollar a day care.
Looking after the aged, however, is not as straightforward as looking after a patient in an acute care hospital. How do you deal hour after hour with a 90 year old man who is confused and forgetful, who is helpless, who can't feed himself, and who dirties the bed? Who wants to deal with him? No one, Madam Chairman, who can get a better job. At least, that's the way it has been.
I think, Madam Chairman, that you remember the recent report made by BCHIS on the situation in the extended care annex of the Vancouver General Hospital in which the orderlies were accused of brutality to the elderly patients. Madam Chairman, I spoke recently to a highly-placed staff member in another of this province's extended care hospitals, a hospital with comfortable rooms, wonderful facilities, and a competent administrative staff.
This person, who was aware of what had happened, had this to say:
"Frankly I'm surprised that there haven't been more headlines like those about the Vancouver General Hospital annex. The same situation could easily have happened anywhere. Here we deal with the same frustrations."
This person gave me an example of a common occurrence in many extended care hospitals.
It is reported that a patient had fallen while going to the bathroom. There is blood on the patient's face. The attendant says that the patient fell; the patient insists that the orderly pushed him.
What do you say to the orderly? Because of this incident the orderly is already three bed-changes behind in his work. And in room 10 he knows that an old man is crying because no one will take him to the bathroom.
How many such incidents are not reported because families, who know there is a shortage of extended care beds, are reluctant to cause trouble? How many patients keep quiet because they fear more physical harm?
What frustrations were behind this incident? How many elderly patients in our extended care hospitals are suffering the indignity of having to wear a catheter, not for medical reasons but because the staff does not have time to change bed linen?
Are we going to lay all the blame at the door of the staff?
I think you must know, Madam Chairman, that in most cases the staff in extended care hospitals are not prepared for their jobs. It is true that they know how to give custodial care but extended care patients need much more than that.
They have emotional needs, above all, and the horror of what they are experiencing in terms of emotional stress becomes clear when you realize that, for many of them, the staff is the only family they have.
Madam Chairman, it is not only the aides and the orderlies who are unequipped for their jobs in our extended care hospitals. In many cases the professional staff of our hospitals has been drawn from acute care hospitals. Many have no special training in caring for extended care patients.
Madam Chairman, is it really necessary that doctors be required to take special courses in the care of the aged? I think so.
For example, I have been told that this is a frequent conversation in extended care hospitals:
"Have you seen a doctor?"
"No, he won't come."
Why won't he come, Madam Chairman? Perhaps he won't come because he won't be able to give a diagnosis to hang his hat on. The diagnosis is "old age," and old age is not a medical problem. Old age, in fact, has become so much of a non-medical problem that other unfortunate occurrences arise.
One staff member of an extended care hospital tells the story of an old woman who broke her leg badly while being treated for an illness in an acute care hospital.
[ Page 1224 ]
She was at the time also diagnosed as senile, so the doctor did not set her leg, but instead left it to heal itself. The woman was afterward transferred to an extended care hospital where she underwent a dramatic emotional change. What had been diagnosed as senility disappeared. She began taking an active part in the activities of the hospital. She is now, however, crippled for what remains of her life. This is not to say that the doctors are the only professionals who are insensitive to the needs of the old. Nurses too, with their acute care hospital outlook, are often too busy to give anything but physical care to their patients.
Extended care is first of all nursing care, and yet the BCHIS guide for extended care programmes gives the medical supervisors in each extended care hospital the sole responsibility — "The development and continued application of a suitable patient care programme." Yet this programme is not a medical programme. It has nothing to do with medicine. It has everything to do with nursing. But the nurse is relieved of all responsibility in this key area.
Jealousy. Perhaps the nurses and the medical staff are only the victims of this system. Whatever the reason, the patient must not be sacrificed to it. BCHIS has recently appointed a nursing consultant for extended care, yet it is still the medical staff that has the final word about the individual programme in the extended care hospitals of this province. I know of no prerogative given to the doctors which says that they alone are responsible for the qualities of life their patients live.
I will, Madam Chairman, give another example of why the staff in extended care hospitals must be made aware that the measure of compassion and understanding they bring to their job is vital to the well-being of their patients.
Mrs. X is now a patient in an extended care hospital where she has spent many months. She had withdrawn completely. When she was admitted to the extended care hospital, Madam Chairman, her knees were drawn up tightly under her chin in a fetal position. She could not control her bowels. She was babbling uncontrollably.
Within several months, because of the unique philosophy of this particular extended care hospital, of which I will speak later — she walked again, she spoke again, and she gained complete control of her bowels. She has undoubtedly received the best medical care in this hospital, but it was obvious that the staff of the extended care hospital was able to give her a totally different kind of care than she received in the acute care hospital.
I believe, Madam Chairman, that there is a need in this province for strong leadership, which the previous government did not give, to see that the staff in the extended care hospitals are aware of their responsibilities to the patients. This can be done in several ways. We must decide whether more staff is needed in extended care units, whether better training programmes are needed or whether we can use the staff we now have in better ways. We must ask why patients are being physically restrained — strapped down — because their personal frustration results in violence. We must ask why it is necessary to drug an 80-year-old patient for non-medical reasons. These patients, Madam Chairman, are you and me in how many years?
There are, Madam Chairman, BCHIS guidelines for the requirements of extended care hospitals already in existence. But we must realize that these guidelines were made without proper studies being made. For example, how many patients in how many hours can an orderly or an aide really deal with? How much nursing time per hour does a patient need? And how we have never determined what rights the patients in extended care have. These are questions that have until now been ignored. The previous government did not even think to ask them.
Is it the right or the privilege for a patient to go to the bathroom? And how many times a day? If it is a privilege, then let's draw straws and see who goes. How many minutes should a patient be entitled to be fed dinner in? In 5 minutes — 10 minutes — 15 minutes? How many minutes or hours must a patient be expected to lie in a wet bed?
We know, Madam Chairman, from the experience of an 80-year-old woman in the acute care hospital that custodial care only leads to the breakdown of the patient. Let's make sure we're using our staff properly and showing them that whether they have a grade 10 education or a post-graduate degree, they are most important.
Our attitude toward the patients must change too. In the BCHIS 1971 Guide for Operation of Extended Care Programmes, there is a chart showing the administrative structure of an extended care hospital. In this structure, even the community is included. There is, however, no patient representation. At Cornwall Hospital in New Zealand, a council of 35 patients, elected by the patients, handle all patient complaints and make suggestions to the staff in the extended care unit there. This is not being done in B.C.
These changes that I have been talking about are philosophical changes, changes
of attitude, changes
[ Page 1225 ]
that require direction from a government that is concerned with quality of life.
Nothing is more revealing, Madam Chairman, of the leadership, or lack of it, given BCHIS by the previous government than a booklet which you may purchase from BCHIS for $10.50. It is entitled Hospitals for Extended Care: A Programme and Design Guide. There are 88 pages in this book and 12 chapters.
The chapters have titles such as Plumbing, Heating, Ventilation, and Administration. Only three pages in this whole book discuss any needs of the patients other than physical needs. Madam Chairman, it must be clear that a new emphasis, an emphasis on the emotional and personal needs of the patients is now required. At present, under the current BCHIS guidelines of administration for extended care hospitals, no one is made responsible for the quality of life experienced by the patients in these hospitals.
Do we have no extended care hospitals in B.C. which emphasize first the quality of life of the patients? Yes, we have at least one. It is St. Mary's Priory Hospital here in Victoria. It is the belief of the director of hospital services there, Mrs. Vera McIvor, that when neglect causes a deterioration of the mind and the body, it can be reversed.
The method used at St. Mary's Priory has become known throughout Canada, and beyond, as the Priory Method. I would recommend, Madam Chairman, that every MLA with an extended care hospital in his or her constituency visit St. Mary's Priory.
At the Priory, patients are not hidden away from the community. Last year patients there, whose average age is 80, and who, Madam Chairman, require 24 hour nursing care, planned and help decorate a float which they entered in a local parade. Each year patients are responsible for planning and organizing a mutt show and a rodeo on the grounds of the Priory. Patients also have their own kitchen in which they make special sandwiches and other goodies for parties. So obvious is the spirit at the Priory that volunteers from the community come in droves. Children run through the halls after school. A 91-year-old volunteer visits patients every morning. This participation by the patients and by the community doesn't cost a cent, Madam Chairman. It requires only imagination, cooperation and dedication.
But there is no doubt that money does enter into it. On February 20, this government announced a programme of home care service to take the pressure off chronic and acute care facilities. The need for this programme is desperate. Perhaps it has come in time for the woman I would like to tell you about.
What happens when a person has been rehabilitated physically and emotionally to the point where she can leave the extended care hospital? Whose responsibility is it to see that adequate care will be given that person? The answer in B.C. at present is no one. Not the staff of the extended care units in B.C., except where they feel morally responsible. Not BCHIS.
There is the case of a 45-year-old woman with multiple sclerosis, now in St. Mary's Priory Hospital, who is in just such a position. She was admitted to the hospital four months ago in an advanced state of deterioration mentally. Her 89-year-old father had been looking after her to the point of changing her diapers. After four months at St. Mary's, she can again control her bowels and her mind is alert. The Priory staff has been told that she is now no longer eligible under the terms of extended care. Where will she go? Whose responsibility is it to see that she will not be allowed to deteriorate again?
Her case is not unique. Many extended care patients are discharged either to nursing homes or home care from where they originally came, and within a year are back again in extended care with the same problems.
Finally, Madam Chairman, let me point out the desperate need in this province for more extended care beds. There are only 2,870 now. A problem which the previous government ignored.
I would like to close now, thank you.
MS. CHAIRWOMAN: The Hon. Second Member for Vancouver South.
MRS. D. WEBSTER (Vancouver South): Thank you, Madam Chairman. I would like to ask just one question, a very short one. To what extent is extra billing permitted under Medicare?
Are any limitations put on this practice? I know that not many doctors use it; however, it does exist.
I had a case referred to me some time ago of a woman who had been referred by her doctor to a specialist. She required necessary surgery. One week before she was to go into hospital, she received a form from the specialist asking her to sign that she would be willing to pay $150 extra for her operation. She phoned me in desperation, I got in touch with the medical care unit in Vancouver and they had the extra billing deferred because she could not afford it.
I'm just wondering to what extent this is permitted. I understood when we paid our Medicare fees that that would cover not only our own general practitioner's fees but also fees for surgery or anything else when it was referred to a specialist by our own practitioner. Thank you.
MS. CHAIRWOMAN: The Hon. Member for Prince Rupert.
MR. G.R. LEA (Prince Rupert): Ms. Chairwoman, I would like to bring up the subject of mental health
[ Page 1226 ]
services, especially those services that affect the northern part of the province, and more especially those that would affect my riding of Prince Rupert.
Once again, I hate to use this term, but it seems that anytime I am talking about services to the north, I have to preface it by saying, "lack of services" to the north. I do that because all throughout the north there is a lack of adequate mental health services. Basically it stems from not having trained people in the north and I guess we would have to go back to the reason that we do not have enough trained people in Canada to meet the need and the demand.
I would ask the Minister, through you, Ms. Chairwoman, to look into the training of more people in regard to psychologists, psychiatrists and to Masters in Social Work because we surely do need those people in British Columbia, especially in the north.
It always amuses me just a bit when I am talking with people from the south and they say, "We only have three people in this particular field and we need six." When I point out to them that we would like to have just one, or possibly two, they realize that, even though they may be understaffed in these institutions in the south, we have literally none.
Prince Rupert is a perfect example. We have had the openings, or at least the jobs have been posted, and we had applications for those jobs. But the thing that seems to be holding it up is lack of money. We are asking people who are trained to come into the north for very little money, when they know full well that it costs a great deal more money to live in the north. For those reasons we are not able to attract people to come up to give us this very vital service in mental health.
It is almost getting to be a cliché in this House, when we talk about "services to people." We always end up saying, "The previous administration didn't do this and didn't do that." I think that now we have to forget what the previous administration did or didn't do and look to what we are going to do. I would like to have the Minister of Health tell me what general direction we are going, in regard to mental health.
I believe that society has always treated the mental health patient, the person with a mental illness, in one way — we put them to the side and hope we don't have to see them and we can forget about them. I believe we have done that in government for a great many years in this province. We have pushed the Mental Health Branch to one side and hoped they don't show their face also, because it seems to embarrass us in this society to have to deal with mental health. I think the way we can get over it is to take the lead.
It seems to me that the correct method would be to take mental health services in this province and put them where I believe they should be — under the same roof as public health. I would like to hear the Minister's views on that.
Specifically, I would like to mention the situation we have in Prince Rupert, where we have the openings posted but we cannot attract the people to fill them. I mentioned the fact that more money, I think, is in order. It seems to me that a person who is trained as a psychologist or is trained as a social worker and has his master's degree deserves at least the same kind of money to work in Prince Rupert as the person who is trained as a plumber or an electrician or a truck driver working for the pulp mill, in Prince Rupert, or someone working in the fishing industry. It would seem to me that they deserve that kind of money. I would ask the Minister of Health to use his influence with the Civil Service Commission to have the wages of these positions raised.
Also, it has been pointed out to me by the director of the mental health unit in our district that it is probably ridiculous to ask the people to come up there with a PhD in psychology, when a master's degree would do just as well. He has pointed out to me that most PhD's in that field are academics, and that what we need is a person who is trained, with experience, and who has a master's degree. That would be adequate in his opinion. He has convinced me it would be adequate and I would like to hear the Minister's views on that.
One subject I'll probably always talk about when the subject is remotely related to health services in this Legislature is air ambulance service. There is a need…
MS. CHAIRWOMAN: Excuse me, I believe you are out of order. Hon. Member, there is a bill on the order paper referring to air ambulance aid; it's No. 93.
MR. LEA: Right. I think there are a couple. One further subject that I would like to mention, because it bothers me, is that when you go in to see a doctor there is no way of knowing — I realize it is impossible to tell where he came out in his class when he was going to medical school. That is a part that I don't think can be corrected, because it would be too hard to put all their marks up on the wall.
Throughout small communities in this province, oftentimes you go into a community where there is only one doctor who is not a young doctor, and who took his training some years prior. I know of one instance where a doctor hasn't been to medical school for 40 years. He graduated 40 years ago, and it would very much surprise me whether he has read a medical paper since that time or even driven by a university. It bothers me that this kind of service is there for the public and there isn't any choice.
It seems to me that if we are concerned enough in
[ Page 1227 ]
our society to make aircraft mechanics go back and take an upgrading course and plumbers and many other of the trades, that the trade of being a doctor could also have upgrading courses. I believe it should be a requirement that doctors every so often have to go back and become familiar with what is new in the profession. I don't think it is good enough that we leave the policing and the discipline up to the British Columbia Medical Association.
I believe we have to accept that responsibility as a government. I would like to hear also the Minister's views on that.
MS. CHAIRWOMAN: The Hon. Minister of Health Services and Hospital Insurance.
HON. MR. COCKE: Madam Chairman, first I shall deal with the extended care question that the Hon. Member for Vancouver–Little Mountain (Mr. Cummings) brought up. You are quite right. There is a real problem around this whole question of the care for the aged and the geriatrics situation. I would like to inform the Member, however, that practical nurses, who are directly licensed, are being trained to a greater extent than they once were in this particular area.
We feel that one of the things we should do is to broaden out to the point that everybody realizes that one of the best places for that kind of training is on the job, but take the time to provide that kind of training on the job. It is not going to be easy but it is going to be a lot easier when our facilities broaden out. In the dark ages in the past we have had some pretty monstrous operations, that is, grotesque sort of operations. It was very difficult to train or motivate anybody under those circumstances.
There are now, just to give you a number, in the last short while, the Gorge Road Hospital here and the Vancouver General Hospital has 201 extended care beds now. That is the kind of facility in which these people can be best trained, in my view. That is to say that they shouldn't have more of it in their classes, but I do think it is the kind of on-the-job training that will be most helpful.
Extra billing: well, you have a right to extra bill, right now, in this province. There is that right provided. I'm not here to advocate that right. I'll just tell you what the rules are, however.
In the Medical Services Act and regulations, it indicates quite clearly that providing the practitioner meets certain criteria, he can extra bill. It says here that:
"Where a practitioner renders an insured service to an insured person, he may charge the insured person a fee in excess of the tariff in relation to that service if:
(a) prior to rendering the service he gave a reasonable notice to the insured person of his intention to charge a greater amount in respect of that service; and
(b) the insured person or some other person acting on his behalf consents in writing to the extra charge; and
(c) the amount of the extra charge is made known to the commission."
This extra $150 is a large amount. We recognize that it's certainly counter-productive to the direction of Medicare. We don't in any way advocate it. I hope that sooner or later we can come to some sort of an agreement or make necessary rulings in our own regulations that will stop that sort of situation. We realize that it's a real problem.
Getting back to the far north. Yes, I agree, Mr. Member through you, Madam Chairman, that we are having trouble up there. We're going to have to do something about it.
The Civil Service Commission. Unfortunately this isn't his estimate, but I would suggest that this be brought up again under the estimates of the Provincial Secretary (Hon. Mr. Hall). It's partly their responsibility to set salary scales, et cetera. I would think that we're probably heading toward a direction — and we are. It's a Government announced policy that after the Higgins report came down, this whole question would be studied thoroughly. I recognize that it must be studied particularly in health.
I understand that we've lost the person that you were talking about the other day when you confronted me with this problem personally — that is, he's gone to another job as a result of the fact that we were unable to pay the amount that was necessary. That's just unfortunate but we are bound up by rules, many of them old rules.
As far as doctors going back to school, I think that that's probably a suggestion that they will be getting from time to time over the next few years not only from here but from their own ranks. I've noticed on a number of occasions the association and the college and people just in that particular profession indicating a grave concern about making sure that they keep up with their education. It's a good message and I'm sure that many of the doctors heard it and will move in that direction.
MS. CHAIRWOMAN: The Hon. Member for Cariboo.
MR. A.V. FRASER (Cariboo): Thank you, Ms. Chairperson. I just have one question to bring to the attention of the Minister. It's been brought to my attention just recently about the lack of renal dialysis machines in the central and north part of the province. I understand that these machines now exist in places like Victoria, Vancouver, Kamloops and Trail. The one farthest north is at Kamloops. In the case of a point like Prince George or Quesnel, a
[ Page 1228 ]
patient has to be driven 275 to 350 miles to get onto one of these machines.
I further understand that you have a committee working on this, Mr. Minister, but I believe it's a bit urgent in the central and north part of the province that one of these machines be located. Probably Prince George would be the logical geographical centre for it. I'd like to know what the problems are and why we haven't got one.
I also understand that staffing is a problem. How do we go about getting it? Do we go after the medical profession and get them to apply? Just what is the score?
HON. MR. COCKE: Madam Chairman, the Member brings up a valid case — the problem for those people who happen to be in the areas. For instance, there was a time when a great number of people felt that they should have cobalt bomb treatment dispersed throughout the province, not in major areas but in some of the areas that are fairly dense in population. For your area, we only have renal dialysis now for Kamloops. The people in Vernon, Penticton, Osoyoos and so on raise exactly the same argument as you do — not that they're quite as far away.
You can only have so many areas where you can apply this particular procedure for two reasons: (1) there's a real limitation on the number of people who are technically trained to care for it; and (2) there has to be enough people ill in the area to provide them with sufficient work. We feel that the population isn't that great up there to meet those two standards.
As you know, we're moving into more and more home-training in renal dialysis. There aren't that many affected up there, but of the group that are, many of them will be taking training so that they can operate their own home machine. They'll be cared for.
So then we're just getting down to the real nub; just a handful of people. I realize it's very upsetting, but for a handful of people you're better off to move them down here or down to the lower mainland or to Kamloops or some area where they can get the direct attention that they require, as opposed to moving a number of specialists and technically trained people up into that area.
There will be a time possibly, when the home-training and the home units will take up most of the slack. I certainly hope so. We're not unmindful of this. If it's economically feasible and at the same time can be done, we'll sure look at it real hard at that point.
[Mr. Dent in the chair]
MR. FRASER: Mr. Chairman, the cases that have been brought to my attention are on the home unit now. Apparently, every three or four weeks they have to go to the renal unit in Kamloops. This was what I can't understand.
HON. MR. COCKE: Just to finish this off, we do assist, as you know, with transportation and drugs and so on in this programme. We realize that it's a very difficult thing. But let's carry this case just a step further so that I can make my example valid, and I realize this is being ridiculous.
You would sooner move a patient to a doctor than move a doctor to be the doctor of one person. I realize that's ridiculous but at the same time that rather tells the story of where we are in renal dialysis.
I've met with our committee and there are some very well trained, well qualified, highly motivated people from the profession. We only have one representative on that committee — it's a government committee but there's only one person from BCHIS on that committee. I think they're doing a yeoman's job in ascertaining where, how, why, what kind of units, and so on, to develop.
MR. CHAIRMAN: I recognize the Hon. Second Member for Vancouver-Burrard.
MS. R. BROWN (Vancouver-Burrard): Thank you very much, Mr. Chairman. I just have a couple of questions that I would appreciate the Minister making a statement on. The first one has to do with the cancer clinic — not with the kind of care that's given by the cancer clinic because I believe that we probably have the best care possible coming out of the cancer institute — but something about the staffing of the cancer institute and about the physical facilities of the cancer institute.
I've had to visit the cancer institute a couple of times because I've known people who were ill in there. Although we wouldn't like to see it furnished like some sort of luxury hotel, I think there is something that can be said for making what some people consider to be their last days on earth just a little bit more comfortable than is presently possible at the cancer institute.
One of the patients presently in the cancer institute made a list of things that she thought made life particularly unpleasant for her now that she was in there. First of all, it has to do with the bathroom facilities. There are no bathrooms attached to the wards as such. It really doesn't make too much difference how ill you are, you have to get up to go to the bathroom. In point of fact, if you are so ill that you have to wait for the nurse to come and bring you a bedpan or whatever, you're liable to wait for a very long time. Along with the lack of facilities goes a lack of staffing.
She tells of one instance when, after she had had chemotherapy, she had diarrhea and actually waited
[ Page 1229 ]
in bed for an hour before someone came along to give her a bedpan. That's the first thing I'd like to talk about, the bathroom facilities.
The other things are really quite simple and not even very expensive to do something about — something like telephone jacks in the bedrooms. To a mother who is in this kind of facility with small children at home, it makes a difference to be able to pick up your telephone and just phone home once in a while just to hear the children's voices and to see that everything is O.K.
This is not possible if you are sick in the cancer institute. You have to be well enough to get out of bed and go down the hall to make a telephone call. If you are well enough to do this, probably the urgency of making the call isn't as important as if you are not well enough to do this.
There are no radios. The television sets that they have there are just a sort of standard model. If there is one person in the room who wants to watch TV, it doesn't matter how ill the other people are; the TV is on and the noise is blaring.
One instance she described was: across the hall the TV was going at full blast because the person listening to it was hard of hearing, but down the hall someone was having a heart attack and she was lying in bed — it's really quite a horrifying story when you hear the whole thing.
It seems to be so simple. These kinds of really basic little things wouldn't cost a fortune to have done. I thought that maybe if I brought it to the Minister's attention he would take a second look at the cancer institute.
Probably the most pressing problem at the cancer institute now is staff. There just is not enough staff on. The staff that are there are working as hard as they possibly can, but it's not possible for them to give the kind of care — and I'm speaking about the nursing staff now, not the doctors — to give the kind of nursing care, especially on the evening shift, that these people seem to need.
The second thing I'd like to talk about is a letter which I receive about a private nursing home. This is how it described it. It said:
"The diet given to the patients is deplorable. An example of one day's menu is as follows:
"Breakfast: cereal with powdered skim milk and water with occasionally a cup of clear tea.
"Lunch: soup with maybe some bread; occasionally a vegetable. No dessert.
"Supper: small servings of ground meat and two vegetables. Fresh fruit is given once a week."
It goes on to say that there is no television, no radio, no bus, no transportation provided whatsoever.
"From observation I would describe the patients as being very depressed, sitting out their lives in a most depressing atmosphere. I have been told that patients who smoke receive a small allowance for this habit, but those who do not smoke are not given anything."
What this person wants to know is whether this hospital is receiving a government grant and whether we have anything at all to do with the hospital. If not, have we any plans to see that hospitals like this upgrade themselves or go out of business or whatever it is?
Interjection by an Hon. Member.
MS. BROWN: Yes. I think what she was asking is whether we put welfare patients in this hospital. I can give you the letter, because I don't want to use the hospital's name.
The third thing I'd like to talk about is the gap that occurs between the service to a baby from when it's born up until about six weeks of age, and when the child enters school. What happens is that so many of these children, when they start kindergarten, we discover to be suffering from malnutrition and to be also suffering from the lack of good dental care.
I am wondering whether the Minister can tell us if there's anything that's being done to cover this gap. It's about a four-year period. By the time the kids get into kindergarten the dental problem, for example, is really quite far gone at that point — also the presence of malnutrition.
I would like to bring to the Minister's attention the article on page 1 of the Vancouver Sun of March 8, where the statement was made by the National Council on Welfare that: "Thousands of Canadian children are being mentally and physically damaged for life because of malnutrition." This is usually when it occurs, and I really think we have to address ourselves to doing something about covering that gap.
In closing I'd like to ask for a statement on what the situation is at this time as it affects the dietary aides at Riverview. Thank you.
MR. CHAIRMAN: I recognize the Hon. Member for Langley.
MR. R.H. McCLELLAND (Langley): Thank you, Mr. Chairman. In January the Minister of Health Services and Hospital Insurance, in conjunction with the Minister of Rehabilitation and Social Improvement (Hon. Mr. Levi), announced a new programme to encourage people to report cases of battered children in the community. The question I have is simple. I'd just like to know if in that intervening three months that programme has been successful. Has it had any degree of success or has it had any results?
I understand at the same time that it was announced that a Dr. Segal of the University of British Columbia was also employed to develop some kind of programme for future reporting and care of
[ Page 1230 ]
battered children. I'd like to ask whether that programme is continuing and whether you've had any results from that programme.
I would also like to ask the Minister, through you, Mr. Chairman, whether he meant what the Member for Oak Bay (Mr. Wallace) indicated in the House this afternoon, that the Minister's real concern with regard to hospital boards is that he wants more elected boards in the community; whether that's a fact or whether it's a fact that the Minister is moving toward more appointed boards.
The other question I have, Mr. Chairman, has to do with hospitals and the problems they have with developing meaningful budgets. It's becoming more and more difficult as time goes by for hospitals to develop some kind of cost controls under their present budgeting techniques, simply because budget figures are not known until more than half of the budgeting period is past.
The present system, as I understand it from accountants who are working within the hospitals, is also extremely complicated. Having looked at some of the financial reports that are submitted to BCHIS, the reporting procedures are mind-boggling. It takes not only a Philadelphia lawyer but a Philadelphia accountant as well to figure out what's going on. As I understand it, once you know what's going on you're still not sure, because half the year has passed and you don't know what kind of money you're going to be getting from BCHIS.
I understand, Mr. Chairman, that most hospitals in our communities, at least those hospitals which belong to the British Columbia Hospitals Association, would like to see some form of global budgeting set up within all of the hospitals. I profess no great knowledge about global budgeting. Briefly, as I understand it, it's simply a method in which we set up at the beginning of a fiscal year a budget base and some kind of a programme for a budget which could be set for the year, with the exception of perhaps some of the programmes which change and need to be altered, such as educational costs and increased services and changes in patient workload and things like that.
I understand too, having talked to the Minister previously, that there is a problem with regard to Ottawa's contribution to the health costs with regard to global budgeting. I know that perhaps because of the bureaucracy set up in Ottawa it may be difficult for us to set up a global budgeting system in British Columbia.
I am told also that the BCHA would like, if nothing else, at least some kind of medical technical committee set up by the Department of Health which could look into the problem of global budgeting and come up with some kind of programme which would see, if not global budgeting, then some other kind of budgeting which would allow the hospital boards throughout the province to develop more meaningful cost controls. They're just as interested as anyone else in cutting costs, effecting management techniques which would allow us to come up with better cost programmes and better cost savings to the taxpayers.
If we can't go into global budgeting, can we at least come up with some kind of committee that would study the whole budgeting picture; or is that already in your planning?
Thank you, Mr. Chairman.
MR. CHAIRMAN: I recognize the Hon. Minister of Health.
HON. MR. COCKE: I'll start with the questions of the Member for Vancouver-Burrard (Ms. Brown) about the cancer clinic.
It's very difficult. As you know, the cancer clinic is naturally financed by the government, but it is run by the cancer foundation. It was an old boarding home. It doesn't lend itself to the kind of activities, I guess, that go on there.
There are plans in the wind for an extension, an extra 28-bed addition, and so on. I hope that the situation there can be improved.
Judging from the way we read this thing, and because of the fact that you don't have that tight a control, it appears to be relatively better staffed than what you indicate. At the same time, that is not to say that it is. Sometimes the staffing isn't done in a way that might complement the needs.
I certainly hope that the facility can be improved. I agree with you. It's not place to spend that kind of time under those circumstances.
The question of nutrition. We have increased our nutrition manpower in the department some 300 or 400 per cent by adding two or three people. I agree that's not good enough. But there was a time when it was pretty well overlooked.
We're getting more to the place today where we realize just how important this whole question of nutrition is. We have a very able and capable nutritionist who's producing a great deal of information. She has to be assisted, and I think we're adding three this year, so that will help in that direction.
MS. BROWN: A supplementary question. The gap between the six weeks baby and school.
HON. MR. COCKE: That's one of the important reasons. For instance, I think probably most of you know about this day care confrontation that's been going on. Some of the people who are involved in this day care centre thing would like to see the Health Department completely out of the picture when it comes to day care.
One of the reasons we feel it's so important to be involved, and have our public health nurses involved,
[ Page 1231 ]
and all our other auxiliary services is for that very reason. We do lose touch with children at that time, and we don't get them again until they're into kindergarten or school. By that time, as you say, the time for preventive work is gone and we've lost the fight.
Sure, we want to keep in touch with children. We're going to be doing it in a preventive dental programme soon and we would want to expand to a point where we can do it in this whole question of watching for bad nutrition and starvation.
Dietary aides at Riverview: they're still there I understand. The question is not an easy one to resolve. I've had my executive assistant out there. We discussed the whole question with Riverview people, and there are two points of view. My particular point of view is that this group of people have to be brought up to a level so that we can justify the payment of their wages. That has to be done through the Civil Service Commission and no doubt will be done through negotiation and that type of thing. Now, to what level I'm not sure. I'm Minister of Health and that's not really my department.
But I will say this, the Government is looking at this whole question of men and women working in similar activities not being paid the same amount of money. We're giving it every consideration, I'm sure, as far as government is concerned. I'm sure the Civil Service Commission will be giving it their attention.
Back to the Member for Langley (Mr. McClelland). You were talking about battered children. Dr. Segal is working. As a matter of fact, there was some information over the air this morning I noticed. Yesterday he was talking to a group in the Vancouver area. We're very close to the situation. You knew that we had sent one of our people down to Colorado to study their way. They seem to be probably the most avant garde in North America on the question of battered children.
There has not been that great an increase in reports, and I'm rather pleased about that. Had this question been introduced in a sort of a way to attract the attention of people who weren't really looking at the problem seriously, I think we could have had a great number of reports that weren't really valid. What we're looking for is the real thing. So we're watching it. Dr. Segal is providing that kind of input. The people in Colorado indicated that we have to have somebody head it up, and he spoke yesterday to the pediatricians and gave them some suggestions. If you want to read about it, it's in the Press, or at least it was last night.
Now the elected or the appointed boards. I indicated quite clearly that we don't want to perpetuate that kind of appointment that happened in the Coquitlam area where most of the members were appointees from government.
Now, you can say, "Well what about all elected from a society?" That's no good either because if you have all elected from a society then a hospital like the Royal Columbian — practically everybody on the board would be from New Westminster — and yet it serves the other areas, such as Coquitlam, Burnaby, and other areas. They demand, and rightfully so, an opportunity to appoint their numbers.
As I said, we're just studying this whole question of boards now. We want them more representative. We think that groups, not necessarily the hospital society, should elect their members. Right? But other groups should elect members to represent them on those boards. That's the way we plan, not to make it a bunch of hand-picked representatives from government. We want to get away from those dark ages.
Now, on this whole question of the budget. The information that you've been receiving Mr. Member, through you, Mr. Chairman, is about a year old. This year the budgets for the first time in history were provided them at the beginning of their year. As a matter of fact, that's one of the things that's been happening lately.
The hospitals are going out of their minds — they can't believe getting that budget in January, as opposed to having to wait until much later in the year when so much of their expenditures had been made, and they were sort of on a committed course to a deficit position. So we have made that distinction this year and BCHIS had to go to an awful lot of work to do it, but they did it, and we did it, and hope that we can continue. As a matter of fact, we will continue that activity.
We're about as close to global — it's one of the pet things now — and we're about as close to global budgeting as you can get in this kind of an activity. A global budget, of course in sort of the broad sense, is a budget where you're allowed dollars and you spend it as you will, but if you run short, don't cry. We can allow that kind of budgeting, but then at the same time we have to have a check on it, which is the per diem and so on.
I think that the hospitals are relatively happy with the activities and they're working very closely with the BCHIS. Now the kind of budgeting that we do was recommended by the Canadian Hospital Association. So on that basis, I think that we're getting pretty close to where we can communicate pretty well.
MR. CHAIRMAN: I recognize the Hon. Member for Langley on a supplementary.
MR. McCLELLAND: The supplemental then is that the new approach to selecting hospital boards will not be through election from societies, it will be a completely new approach. Is that correct?
HON. MR. COCKE: Yes, likely.
[ Page 1232 ]
MR. CHAIRMAN: I recognize the Hon. Second Member for Victoria.
MR. D.A. ANDERSON (Victoria): A quick question to the Minister, Mr. Speaker. Mr. Speaker, there's about $25 million, I believe, in the drugs, alcohol and tobacco fund. It would seem logical to me that if we are to examine the expenditures of the interest of his money, which is probably somewhere under $2 million, it would be under this department's estimates. I wonder if the Minister would like to comment on whether or not the approximately $2 million of expenditure will be available for scrutiny by Members of this House?
HON. MR. COCKE: Well, as you know, it never has been up until now, and you're suggesting that it might be in the future. It's not my department in any event. It was under the Minister of Education in the previous government and I'm not sure now if it's still there. If not, it will probably be going to the Provincial Secretary. I can't answer Government policy on that situation.
The only thing that you do know, and has been announced by my colleague, the Minister of Rehabilitation and Social Improvement (Hon. Mr. Levi), is that we're trying to put all of the alcohol and tobacco and dependency drug money into full view and into a coordinated effort to work in these areas. So that's about as far as I can go with it.
MR. D.A. ANDERSON: To follow up then, if I understand the Minister correctly, not only is he unaware of any policy decisions in this regard as far as disclosure of information goes, but these particular programmes under that fund will not then be under the health department. Is that the correct interpretation?
HON. MR. COCKE: You mean the $25 million?
MR. D.A. ANDERSON: Well, the interest.
HON. MR. COCKE: No, I wouldn't think that that would be directly under Health. I would think probably that it will be under the Provincial Secretary. For allocation, we have to have some sort of central allocating agency and it will most likely be under the Provincial Secretary in my view. But that's only my view. And it's very unlikely to come to Health. In fact Health will participate in the decision-making with respect to where that money's spent.
Hopefully, it could be spent in a coordinated way with all of the other areas. We've got a list here a mile long of grants to different foundations and different alcohol and drug groups. So that's where we're at. But we are studying this whole question from a unified standpoint.
MR. CHAIRMAN: I recognize the Hon. First Member for Vancouver South.
MR. J. RADFORD (Vancouver South): I wish to make a few remarks in the area of the drug abuse problem in B.C. Last Friday, the Hon. Second Member for Vancouver Centre (Mr. Lauk) gave us a very wide-ranging speech on the subject and it was quite evident he had done a lot of research in this area. He went on to talk about the addiction problem reaching epidemic proportions and that it is contagious and he also talked about the addict becoming younger and younger all the time. He told us about how the age level of the addict is dropping and that it is now prevalent in the ages of 12 to 14.
There was one thing that bothered me during his speech and I think it is a problem that we have today. We many times talk about the diagnosis and cure of a problem rather than in a preventative area. The emphasis today, unfortunately, on many of our problems such as the drug abuse phenomenon seems to be on diagnosis and cure only, instead of being in the preventative area. I realize it is most essential care and cure is needed for those that are afflicted but I do think more emphasis should be brought into the area of prevention.
In the area of the drug abuse problem we have in B.C. today, I think one of the preventative measures that would help curtail some of the abuse concerning the drug problem would be to introduce into our school system at the kindergarten and elementary level a long-range programme, but an effective programme, to combat drug abuse.
I have here, Mr. Minister, a book. It is put out by the U.S. Department of Justice, Bureau of Narcotics and Dangerous Drug Abuse. It is used in kindergartens and elementary schools in many states in the United States. All it is is a colouring book. It has pictures in it and the main theme of this book is that drugs are only for sick people. This is the theme that is used.
Also some of the comments: It says on the first page, "A drug is a medicine that makes sick people well but it can make well people sick." The teacher is asked to get the children to colour it and also hold discussions on each part. Another item which is very interesting shows a picture of a TV and it says: "People on television and radio who advertise drugs mean only for sick people to take them."
Also all the way through this book, as I mentioned, the main theme is that drugs are only for sick people. The purpose of this theme is to reach the children with this idea as early as possible so that their subsequent experience with drugs will bring the idea to the mind again and again, as I said, that only sick people should be using drugs.
Also, Mr. Minister, at the last B.C. Federation of Teachers' convention, I was there, and they have a
[ Page 1233 ]
special room of all their teaching aids and all their textbook material for the elementary school age. Nowhere at this convention did I find on display anything to deal with helping and assisting to rid the community today of the drug problem.
Nothing is being taught, I suppose, in the schools to combat this at an elementary school age. I realize that some effort is being taken at the high school level but I think we should all realize that once a child is past the age of eight or nine or even earlier, the patterns have been formed. This has been one of the problems in our educational system — we are not really dealing with the problems of bringing up children until the patterns have been formed.
I would urge, Mr. Chairman, the Minister of Health Services and the Minister of Education to consider a programme in the kindergarten and elementary school system to combat the ever-increasing abuse of drugs in our society.
MR. CHAIRMAN: I recognize the Hon. First Member for Vancouver–Point Grey.
MR. P.L. McGEER (Vancouver–Point Grey): Thank you, Mr. Chairman. I would just like to twist the Minister's arm for a few minutes this afternoon to see if he might not do something about the number one form of air pollution in our country — smoking. We have had a word or two this afternoon about smoking. It is known to be one of the major killers in our society both because of lung cancer and because of heart disease. Why I say I want to twist the Minister's arm is the hope that he might become a champion of the non-smokers. I think we need non-smokers' rights in this province and in this country.
The former government put out a very excellent brochure and they deserve to be complimented on it. I understand it has been widely in demand saying, "Smoke is for fish, ham, bacon but not for you." I can recall speaking to the former Premier about smoking advertisements that were on B.C. Hydro buses at one time. They were promptly removed which was an advance.
What I am wondering, Mr. Chairman, if we couldn't, in asserting the rights of non-smokers to have pure clean air, undertake restrictions of the areas where people who do smoke can't pollute the air.
For example, Mr. Chairman, why should we permit smoking on buses at all. Pacific Stage Lines say, "Smoking in the rear." If the Minister in defence of people who don't want to be forced to inhale this pollutant and who know their lungs will be damaged if they do — why shouldn't we be able to breath clean air on the buses and have it absolutely outlawed for smoking on public transportation? This is done in some jurisdictions so I don't think we are taking away any human right. We are, rather, conferring a right on people to inhale healthy air.
The second, Mr. Chairman: Could we have a non-smoking area in every public restaurant? Why should people who go out to dinner be forced to inhale the smoke of the restaurant? Again, that is a violation of non-smokers' rights. In a restaurant or any public place, there should be an area where we can inhale clean air.
Why should there be any smoking in food stores? I don't see why the person who wants to purchase lettuce or broccoli should have to worry about whether there are cigarette ashes on them. Why couldn't we have non-smokers' rights so they don't have to deal with cigarette ashes and dirty air in food stores?
Mr. Chairman, there is a non-smokers' area on the ferries. If you hunt hard enough you can find it. If you have a magnifying glass you can actually see the sign.
Interjections by some Hon. Members.
MR. McGEER: Mr. Chairman, I was told there was such an area and I found it. I had to go around the ferry three times until I spotted it. What I would have preferred, Mr. Chairman, is to have that area — that small area — for smokers. Let them pollute their own little corner and they can inhale each other's smoke and get all the nicotine they like. For those of us who don't like that kind of thing and want to be able to breathe clean, fresh air, why shouldn't we have the majority of the boat for clean air and have the smokers in that little small section where they can breathe each other's dirty air.
Mr. Chairman, I think every public building should have its smoking area. The smoking area should be off in the corner — the small part — and the big part should be where people can breathe clean air.
Those who like to smoke can smoke in their own bedrooms or their own living rooms or smoke in their own corners of public buildings where they can inhale each other's pollutant.
We non-smokers have our rights to clean air.
What we want is the Minister of Health to be the clean-air champion for British Columbia and defend our rights.
MR. PHILLIPS: That's clean air, not hot air.
MR. CHAIRMAN: I recognize the Hon. Member for North Vancouver-Capilano.
MR. D.M. BROUSSON (North Vancouver Capilano): Mr. Chairman, the subject I'd like to raise is one that the Minister will find in his files. He'll find it in terms of letters and briefs and old speeches from myself and others, assuming that he's still got these things in his files. They certainly were there. I want
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to talk a little bit about the metropolitan health unit, in particular the North Shore health unit.
The one on the North Shore has a history going back to 1930 when it was originally set up by the Rockefeller Foundation. In 1943, West Vancouver joined and it's covered the entire North Shore since then. Today it has a staff of over 60 people including many part-time advisors and consultants and some volunteers as well. It's very much a part of the community life of the North Shore, Mr. Chairman.
It offers a very wide-ranging service. It has an excellent dental health service. It has a rehabilitation programme. There's a communicable disease programme, a public nursing programme, prenatal and postnatal care, services for infants and preschoolers. There's a special Indian health programme in cooperation with the Squamish Indian band staff. It has a very unusual mental health programme including some special programmes for senior citizens, and, as I said, a very wide-ranging staff of specialists and consultants and so on. It even does pollution control monitoring for the regional district. The mental health programme is one that the North Shore health unit set up as a pilot project several years ago on persuasion from this department.
In short, Mr. Chairman, Dr. Steve Casey, who is the director of the North Shore health unit, runs a first-class and a very well respected show. It well serves some 130,000 people on the North Shore of Burrard Inlet.
The problem, of course, is the financing. Let me give you some figures, Mr. Chairman, that will explain the problem I want to bring to the Minister's attention and which he can find, as I say, back in his files at least to 1969.
If you consider the way in which this North Shore health unit is financed, including North Vancouver City, North Vancouver District, West Vancouver and the two school districts on the North Shore, they provide 86 per cent of the financing of that health unit. Senior governments including both the federal government and the provincial government provide only 14 per cent of the financing. The 86 per cent which is provided from the taxes of the three municipalities and the two school districts amounts to $4.50 per capita — $4.50 per capita directly from the local taxpayers.
The province, on the other hand, back to 1964 — in other words, for 11 years — has presented exactly the same contribution of $25,874 which is 20 cents per capita. That's the contribution from this department of the provincial government — unchanged for 11 years — $25,874. That's 20 cents per capita.
So, to repeat, the local government, three municipalities, two school districts contributing $4.50 per capita, 86 per cent. Senior government — 20 cents per capita, 14 per cent.
Now if I can compare that, Mr. Chairman, with a non-metropolitan health unit. There are a number of public health services, of course, throughout British Columbia serving the non-metro areas — non-metro to the extent that, for instance, the health services in Coquitlam which has become a pretty urban area these days, are classified as being part of the non-metropolitan health unit.
By the way, I've been using 1971 figures, Mr. Chairman, because they're complete. The budget in 1971 for non-metropolitan public health services was about $6.25 million in this vote, in this department. That was $5 per capita that came from the provincial government. Local input to those, which in most cases was through the local school board, was 30 cents per capita — almost exactly the reverse of the metropolitan health unit.
If you check the Victoria health unit, or the capital city regional health unit, the Vancouver health unit, the Okanagan metropolitan health unit — a number of them — the percentages I've given you are approximately the same. I've used the specific example of the North Shore because I have those figures precisely.
On the North Shore we had $4.50 per capita from the local taxpayer, 20 cents provincial per capita. If you go to the non-metro area, you get $5 per capita being paid by the taxpayers of the province and the provincial government, and only 30 cents by your local taxes. Quite obviously, there are some inequities here in the way the taxes are being raised. Of course, this $4.50 per capita paid by the municipalities and the school boards is very largely raised from what? From the local land taxes. That's really where it's coming from.
If we look in this year's estimates of this Minister, Mr. Chairman, we find the amount going to local health grants is exactly the same as last year — $813,000. That's where the $25,874 that the North Shore will get will come from. That's why it hasn't changed for all these years. It's the same every year and it's the same amount in the budget. They raise the other areas but they don't raise this grant to these well-run, well-organized metropolitan health units. It's very unfair and it's getting worse.
Mr. Chairman, in 1969 I told this story to the former Minister. He stood up in his place and said that I was absolutely right and that he would look into it. In 1970 he said, yes, he still agreed that I was right and he promised that he would do something about it. In 1971 he promised again. In 1972 he wouldn't even answer when I raised it in the House. Still nothing has been done since I first raised this in 1969.
Last year, through the Press and through public announcements, it was clear that the Minister had planned to make some changes in a kind of a pilot project in Victoria. As far as I can learn, nothing still has been done there — I stand to be corrected on
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that. Certainly nothing has been done as far as any of the other health units. I wonder, Mr. Chairman, what the Minister will say in 1973 on this subject — this new Minister in this new year.
May I make one more point about the North Shore Health Unit — perhaps a plea for maintaining the North Shore health unit as a viable entity unto itself. This Government, Mr. Chairman, has shown great signs of wanting to centralize everything into big units. It would be my hope that the Minister will understand this point: bigness for bigness' sake is not an objective. Because this is a viable community service operating from Deep Cove right around to Horseshoe Bay, across the entire North Shore and including Bowen Island now incidentally, it deserves to be left as a natural community health service with simply some more fair financing.
Now I have one further topic, Mr. Chairman, I'd like to add to the remarks by my colleague, the First Member for Vancouver–Point Grey (Mr. McGeer) a few minutes ago. I want to read a letter to you, Mr. Chairman. It is from a lady in North Vancouver which I thought was rather an interesting one. She said:
"Dear Mr. Brousson:
Some time ago I wrote to you a letter requesting that 'No smoking' signs be placed on all long-distance buses, et cetera…"
And I didn't make this lady very happy, Mr. Chairman, I want to tell you.
"….and your reply, Mr. Brousson, was a suggestion that I write to the companies concerned. Needless to say, I was disappointed in your reply but I'll try again.
"I would like you to know that prior to my writing to you, I had spoken to Mr. Ritchie, the regional manager of Greyhound Lines and also Mr. Steinthorn. They too sympathized with my problem but since they cannot do anything to change the law, they suggested I write to my MLA who has the power to make these changes.
"I, like many others, I'm sure, would like to see smoking prohibited altogether from all travelling vehicles and restricted to certain areas in all public places."
Then she says, Mr. Chairman — and she got to me with this paragraph. She said:
"If you cannot do anything about this, would you pass it along to someone who can? Thank you."
So, Mr. Chairman, I'm appealing. I'm passing it along to someone who can. I hope the Minister will take some action on the subject that she's raised. Thank you, Mr. Chairman.
MR. CHAIRMAN: I recognize the Hon. Minister of Health Services and Hospital Insurance.
HON. MR. COCKE: Mr. Chairman, the Hon. Member for Vancouver–Point Grey (Mr. McGeer) and the Hon. Member for North Vancouver–Capilano (Mr. Brousson) have raised a subject that is very dear to my heart — the whole question of smoking. I recognize that it's an infamous habit. Certainly, if we could regulate it out of existence and if it would help me get away from the pipe at the same time, I'd go for it right there on the spot.
Your criticism of the ferry: Unfortunately, the Minister of Highways (Hon. Mr. Strachan) isn't here at the moment, but I think it's valid myself. I think that's a very small area. I wouldn't suggest that that be given to the smokers and the rest of them.
Another area you suggested would be that there should be non-smoking areas in every public restaurant. That's a pretty big expense to load a public restaurant with. You should have heard them when we put in restrictive health provisions, such as "just clean up," and they said they couldn't afford it. Some of them.
To set up special areas for non-smoking might be difficult. But anyway, those are public places and people can avoid restaurants.
As far as the health services in North Vancouver, yes, we understand. Now it's not quite as black and white as the Member for North Vancouver–Capilano (Mr. Brousson) makes it, Mr. Chairman. He indicates that only a little bit is coming from the provincial government. The Hon. Minister of Education (Hon. Mrs. Dailly) complains endlessly about the fact that it's her department that is paying for the services to your people in North Vancouver.
Yes. There's a crazy system. It was a system built years ago…
Interjection by an Hon. Member.
HON. MR. COCKE: That's right. Then they tied it down to 30 cents and 70 cents and it was just absolutely goofy. So what's happened now is that you've got a whole series of health units across the province which are all different, all financed in a different way. We have to do something about getting this thing on the track so that everybody gets treated properly.
The one thing that the Minister of Education and I agree on about that area in North Vancouver isn't whether its land taxes or her taxes or mine. We agree that there's been no help from the federal government in this whole question of the union boards of health.
Remember, we are dealing with the Capital Union Board of Health. We've made them an offer that they can't refuse. We've made them an offer to go on a new formula basis, a fair formula. I hope that they're going to accept the offer.
[ Page 1236 ]
AN HON. MEMBER: How long ago?
HON. MR. COCKE: Two weeks. Something like that.
MR. BROUSSON: That was supposedly last year.
HON. MR. COCKE: Oh, yes. It's supposed to be a long, long time ago.
In those kind of negotiations, where you're dealing with numbers of people, departments and so on, it's very difficult sometimes to come up with right answers the very first time around. But we have made an offer.
I hope to see us go a lot further in this whole area.
The Minister of Education (Hon. Mrs. Dailly), more than anybody, hopes that we can get health out of the education budget.
MR. BROUSSON: The Minister does agree that it's unfair…
HON. MR. COCKE: Sure it's unfair. I've said that from the outset.
I wish people would stop standing up in this Legislature, Mr. Chairman, and accusing me of centralization. Every move I've made, every word I've said since I've been Minister of Health Services and Hospital Insurance has been decentralization. Period.
MR. CHAIRMAN: I recognize the Hon. Member for Comox.
MS. K. SANFORD (Comox): Thank you, Mr. Chairman. I would like to ask the Minister some questions as they deal specifically with problems of rural medicine. I am wondering what sort of special considerations the department may be giving some of the problems that surround the practice of medicine in rural areas.
I am thinking particularly of Hornby Island at the moment, which has a population of about 300 people. Never before have the people on Hornby Island had a doctor, but because a young woman who trained at Stanfield and also at Vancouver General wanted to get away from the hustle and bustle of city life, she decided to move to Hornby where she has since established a practice.
Now she is facing very difficult problems and I think that these are things to which the Minister might give serious consideration. For instance, she is attempting on her own to conduct classes in basic health care and nutrition because she found that there was a large number of people who were actually suffering from malnutrition on the island. It was as much a matter of lack of knowledge as anything else.
She has also been attempting to conduct pre-natal classes. She is also conducting exercise and weight control programmes. Because she is there on the island she makes house calls and for that reason has been able to keep some patients in their homes where she can call on them each and every day, rather than having them sent over to a hospital for hospitalization which they would otherwise need if she were not there.
The difficulties that she faces surround the fact that she has to purchase her own supply of drugs and supplies of various kinds. She is wondering if perhaps the hospitals in the province might make available, for people like herself in rural areas, a small supply of drugs, which is all she needs. She finds that it's often difficult to purchase the amount that she needs because the drug companies just don't sell drugs in such small amounts. She doesn't need to buy more, but she often has to.
She finds it difficult to purchase the kind of equipment that she needs and is wondering if the provincial government could perhaps consider supplying her with things like stretchers or even big bandages. These kinds of things are difficult for a young doctor just starting out to practise.
Then there's the whole matter of an office for her. On a place like Hornby there just is no office space available. She can't begin to afford to build an office for herself. As a result, she has rented a house on Hornby which she is using for her office. Unfortunately, the house lacks any sort of sanitary facilities. It's not kept very clean and she finds it difficult to find the time to keep it in an immaculate condition.
She also finds that the lighting in the building is poor and that the heating is poor.
I'm wondering if the Minister would perhaps consider for areas like hers the purchase of trailer kinds of units which might be put in places like Hornby for the use of a beginning doctor.
There are trailers available, as I understand it, that are now used as first aid trailers for the various logging companies. If the Government could consider purchasing such a trailer, then she would be quite willing to rent it or to consider a lease-purchase or something of that nature as far as facilities for herself are concerned.
She needs help. She is doing a lot of things on her own. She just does not have the finances to go ahead and do the things that she would like to do on that island. The people on the island find that to have her there is a great benefit.
I am wondering if the Minister has considered any of these specific things as far as practising medicine in rural areas is concerned.
HON. MR. COCKE: Mr. Chairman, we're considering a great number of ideas with respect to delivering health care in rural areas. We've met with Dr. Wertheim and we're viewing her situation seriously. As a matter of fact, I wouldn't be surprised if the negotiations
[ Page 1237 ]
lead to implementation of not only assisting with a facility but also assisting with respect to income.
We might meet with some criticism from other areas around, but that's what we've done in the Chilcotin region and we'll be doing it elsewhere, no doubt.
As far as the trailers are concerned, I think in that particular area, if we had some sort of facility, it could be very well shared with health education and welfare or a number of government services. We find that there are times when they all might need some facility.
I am not sure about a trailer, but we'll look into every aspect of it. We recognize that problem on Hornby Island. We're with it.
MR. CHAIRMAN: I recognize the Hon. Member for North Peace River.
MR. D.E. SMITH (North Peace River): Thank you, Mr. Chairman. Just a couple of points that I want to raise in the Minister's salary estimate.
The first matter that I'd like to deal with is the matter of health units and health clinics operated throughout the Province of British Columbia. I know that we do have health facilities in most of the major centres in the province and many of the smaller centres. The only real problem that comes to my attention more frequently than others with regard to the health clinics is that while we do have the facilities available, quite often the manpower is a problem. We do not at this time have sufficient staff in numbers of areas, so we have a psychiatric unit or a unit which has a provision for a psychiatric nurse and some assistants, and periodically we find the unit staffed, and then for month on end we find that it's not staffed because of the inability to find trained personnel.
We run into some of the same type of problems in just supplying public health nurses to certain areas of the province.
While I am speaking about the service provided by the public health nurses of the province, I'd like to say to the Minister that I think without a doubt we have some of the best trained, the most conscientious people serving the community and the public through the public health department of any department of government. These health nurses in my opinion are dedicated people and they do yeoman service throughout this whole province, particularly in the rural areas where I know that they go out and hold clinics in very adverse weather conditions. They go into areas that are certainly isolated, yet they never seem to complain about it. They go out and perform their duties and their services well.
In tackling this problem I wonder if the Minister would give some thought to the idea of mobile health units operating in the rural areas of the Province of British Columbia. It seems to me that the Red Cross have done a tremendous job with their blood donor clinics. They go throughout the province and collect blood which in turn is used in our hospitals. We seem to be able to set up TB clinics to travel on a mobile basis throughout the province.
I know, Mr. Chairman, that this is much simpler to do than to set up mobile health units or health clinics with the accompaniment of personnel — which should include, I would think, doctors as well as well trained and well qualified nurses and perhaps a psychiatric nurse to travel with that unit. But I do believe that this may be one means of alleviating a problem that we have in rural communities today.
It's not good enough, Mr. Minister, for us to have the facilities at our disposal if we have no one to staff the facilities. So perhaps, travelling throughout some of the rural areas of the province on a regular basis, a clinic such as this, on wheels, mobile, that could be moved from place to place and located for a few days at a time with advance notice, would be an assistance to the local health units and certainly provide a better type of services than the nurses themselves can do right now. Because they are handicapped in what they can do. They are handicapped in the tremendous mileage that they have to travel into some of the more remote sections of the Province of British Columbia.
I can give you an example. Because of the fact that we couldn't for quite a period of time find health nurses to go into Fort Nelson, we've had the girls leave Fort St. John in the middle of the winter and travel, not only to Fort Nelson, but all the way to Cassiar by car. Now that's a distance of 700 or 800 miles that they've travelled by car, much of it on lonely roads in adverse weather conditions, because they wanted to provide this service.
It might have been an idea that we could have cut down on their travelling somewhat with a mobile health unit. I'd like the Minister to comment on that idea.
I'd also like to ask the Minister what is happening with the medical manpower committee that was set up? Is it your intention to continue this committee?
It was my understanding that the committee was to be responsible for drafting recommendations regarding this matter of doctor shortages in some of the remoter areas of the province and coming up with ideas and recommendations to solve that problem. I would just like to hear the Minister's comment on that remark.
There's one other matter that I'd like to raise and that has to do with the programme for the treatment of alcoholics in the Province of British Columbia. A great deal of literature is available to us now on the problem. Many organizations, and particularly the Alcoholic Foundation of B.C., turn out reams of information and statistical data concerning the addic-
[ Page 1238 ]
tion to alcohol. They say something in the neighbourhood of 43,000 are addicted in British Columbia right now, out of which 23,000 actively work in jobs.
One of the amazing things is a chart they turn out showing that when a person first becomes a social drinker, and then this eventually leading into alcoholism, that the rate of his efficiency drops very rapidly. The graph shows that over a period of from 7 to 14 years the person who is addicted to alcohol will drop from 90 per cent efficiency down to zero in that number of years. Of course, this is a charge against all of us in society as a whole.
I know of a treatment facility in Edmonton. It's called "Henwood." You may be familiar with this organization and the facilities that they have. They provide, basically, counselling service and group therapy and combine it with recreational facilities for people who actually live in for a period of time. It seems to be that they live there for a period of from a few weeks to several months, as long as the therapy is working and these people abide by the rules.
Now I understand that they have had fair success in rehabilitating alcoholics and that their records show that, once rehabilitated, the largest percentage of these people stay free from the addiction.
I would like to ask the Minister if he has anything similar to that in mind for the Province of British Columbia. It would seem that we know a lot about alcoholism from the standpoint of how it affects people and the numbers of people who are addicted; but we really haven't come up with the type of programme yet that in my mind has proven to be positive with respect to the results that we obtain in this province.
If Alberta has something that is good then I think we should look at it, as well as other parts of Canada, and find out if we can't redirect our programme along the lines of something that will be more successful than the programmes that we've had in the past. Thank you, Mr. Chairman.
MR. CHAIRMAN: I recognize the Hon. Minister of Health.
HON. MR. COCKE: Mr. Chairman, the alcohol question first. As you know, we have had a conference. We had the Alberta people here, as a matter of fact. They indicated that they weren't quite as excited about the programme as you are, that there is no real ace programme for alcohol, other than the fantastic success that the Alcoholics Anonymous has had — which is roughly 50 per cent or something along that line. But it is fantastic compared to anything else that we've ever seen.
The department of the Minister of Rehabilitation and Social Improvement and our department are working with groups endeavouring to put the whole question into a proper perspective in order to develop a good service. We're thinking in terms of the detoxification; then the 30-day kind of situation; then for those who are properly motivated — and motivation works all the way through the system — you carry on with those that you can't keep forever in that 30-day situation, but you can move them into maybe the long-term rehabilitative process.
Others could come out of the 30-day maybe back into halfway houses or whatever and back into the mainstream of life.
We realize it's a debilitating illness. We recognize it as being an illness and certainly we're working in that direction. We've got some fine people working with us.
As far as the van is concerned, we do have a mobile van that we're going into for hearing deficiencies.
As far as the van for a local health department, I agree with your first concept. You see, Mr. Chairman, you indicated that we need more public health people out there. Well, we're introducing 82 more into the system this year — into local health services. That'll help. We also, of course, need to broaden the services.
But as far as a mobile unit for local delivery, that's a pretty big….
AN HON. MEMBER: In specialized areas.
HON. MR. COCKE: Well, in specialized areas we're getting into mobile hearing. Then we've given the optometrists some help with their van for sight. I think we'll do a lot of that in the future. I think a lot of services will be delivered in that way.
Hon. Mrs. Dailly moves the committee rise and report progress and ask leave to sit again.
Motion approved.
The House resumed; Mr. Speaker in the chair.
MR. CHAIRMAN: Mr. Speaker, the committee reports progress and asks leave to sit again.
Leave granted.
MR. SPEAKER: The Hon. Minister of Labour.
HON. W.S. KING (Minister of Labour): Mr. Speaker, I have the honour to present a message from His Honour the Lieutenant-Governor.
AN ACT TO AMEND
THE WORKMENS COMPENSATION ACT
MR. SPEAKER: His Honour the Lieutenant Governor herewith transmits a bill intituled An Act to Amend the Workmen's Compensation Act and
[ Page 1239 ]
recommends the same to the Legislative Assembly. Government House, March 12, 1973.
Bill No. 130 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.
Mr. Lauk from the Select Standing Committee on Standing Orders and Private Bills presented the committee's tenth report which was read as follows and received:
Your Select Standing Committee on Standing Orders and Private Bills begs leave to report as follows:
The preamble to Bill No. 50 intituled An Act to Amend the Vancouver Charter had been proved and the bill ordered to be proceeded with amendments. Your committee notes pursuant to standing order 113 that the petitioners' advertising relative to sections 23, 24, 25 and 26 of the bill was not completed within the time limited by standing order 100, but nevertheless your committee is of the opinion that all proposed sections of the said bill were sufficiently and adequately advertised.
Mr. Lauk from the Select Standing Committee on Standing Orders and Private Bills presented the committee's eleventh report which was read as follows and received:
Your Select Standing Committee on Standing Orders and Private Bills begs leave to report as follows:
The preamble to Bill No. 51 intituled An Act to Amend the Vancouver Stock Exchange Act has been proved and the bill ordered to be reported as amended.
MR. SPEAKER: The Hon. Member for Saanich and the Islands.
MR. H.A. CURTIS (Saanich and the Islands): Mr. Speaker, I would ask leave to withdraw a bill standing in my name, Bill No. 14.
Leave granted.
Hon. Mr. Hartley files answers to questions.
Interjection by an Hon. Member.
HON. E.E. DAILLY (Minister of Education): Yes, we will carry on with the Health Estimates and if they progress well we may move into bills.
Hon. Mrs. Dailly moves adjournment of the House.
Motion approved.
The House adjourned at 5:54 p.m.